A white coat should not stay white and a black belt should not stay black. For a physician and a martial artist, the ceremonial receipt of one’s white coat or black belt represents the crossing of a threshold. Within both traditions, the status symbol marks a beginning, not an end. Things will be forever different on the other side of that doorway, but rarely in the ways expected.
I received my white coat a few weeks ago. It represents the culmination of years of struggle: studying throughout my undergraduate education in premedical coursework, assisting in clinical studies at Dana-Farber Cancer Institute, months of sequestered preparation for the MCAT (standardized medical school entrance examination), the long battle of application essays and revisions, and the seemingly endless time spent on the waitlist.
The ceremony itself was the right mix of awe-inspiring and awkward– the speakers gave thoughtful and provoking talks and our families demanded countless posed photos of the occasion. A specific phrase by Dr. Dennis Ledford, the recipient of a Humanism in Medicine award, gave me great pause and opens this piece. “Your white coat should not stay white, it should be stained by the grime and darkness of the human condition. It is a necessary mark of a physician engaged in the true art of healing.”
Many martial arts utilize a belt color hierarchy to establish a progression of skill and achievement– almost universally, a white belt is the beginner’s belt and a black belt is the highest level attainable. However, the black belt isn’t necessarily the end of learning: within most schools, the black belt signifies that the martial artist has developed enough of the foundations so that the true lessons may begin.
With no further belts to chase, the artist can finally dive deep and explore the martial art through trial and error– learn what is effective and what is legacy. They are free to fail, to play, to innovate, and to become students of the process, rather than students of the exam. Mistakes and errors, which would have previously blocked promotion, no longer define failure; time can be devoted to a fruitless search of a novel submission technique or mastering a single punch through thousands of repetitions.
A truly black belt, in literal color, denotes recent promotion and the most faded black implies a depth of experience through use and wear. Thus, with sweat and time, the martial artist would have a black belt that has bleached to white, rounding back full-circle to the beginner.
Yet, being comfortable with failure is impossible for the premedical student. In order to endure and survive the selection process of graduate medical applications, we need to have every extracurricular under our belt, ace every course or lab, explain every academic misstep, score in the highest percentile for the MCAT, and interview well.
Not only does this lengthy process weed out many fine potential physicians and deter others from even attempting, but it creates within the accepted student an unintended culture that we carry with us to the first day of classes– we had to pretend to be perfect to get in here, and we have to continue to be perfect in order to graduate.
This delusion must end. Our white coats are our black belts, and we are stuck in the mindset of a burgeoning martial artist– chasing that next promotion rather than learning the subtle lessons of our profession. We have developed a necessary and strong disgust of failure because it brought us to this point, but now it only burdens us.
I must accept some basic truths of the student, despite my premedical conditioning:
Yes: I will fail. In the process of developing proficiency in any art or profession, failures are the fundamental building blocks of the learning process. Developing a fear of this or any failure is the death of the student.
Yes: I will stumble. I do not have the depth of knowledge in molecular biology like some of my peers. Others can rely on my strengths and I must be vulnerable enough to rely on others for their strengths.
And yes: I will make mistakes that end lives. This is the bitterest pill to swallow– I will fail patients and I will cause harm to them, either through action or inaction. When I get to that stage, the question then becomes, “Can I still learn from each failure? Can I remain a humble student or will I have the pride of a master?”
Whether in a white coat or a black belt, the only fear should be the end of learning. I hope to stay a student forever. I hope to accept my failures, to learn from each of them, and to never keep my white coat white.