5 Intention

I have drafted cover letters, personal statements, and other essays where I had the challenge of putting on paper the aspirations for my career, explaining why my personal values and attributes made me a qualified applicant for a position. I knew I needed to explain how my experiences and role models had informed my decision to pursue college or medical school admission, a specific residency or fellowship training program, or a faculty position at an institution.

All these submissions were opportunities for self-reflection as I tried to align my career goals with my evolving professional identity. I wish I had maintained a “living document” that continued to evolve and that I could revisit as I matured as a physician. I have approached my cover letters as simply another version of my personal statement reflecting my discovery of a career path in medicine. In each version, I tried to explain how my life experiences had broadened my perspective and guided my decision to apply for the position. I now appreciate how life experiences and the perspectives gained are cumulative in their impact on career decision-making.

My most important and challenging personal statement was probably the one I drafted for my medical school applications. At this early stage of my education, I tried to organize my thoughts and align my values with my career aspirations to document my growing self-awareness with each iteration. I remember reflecting on my childhood illness and how I learned to trust the doctors and nurses that cared for me. My respect for physicians had been forged very early in my life, which is quite remarkable in retrospect, given my childhood was memorable for my many hospitalizations and the painful procedures performed by these same physicians. As I sat down to write, it seemed appropriate that I start my “mini” autobiography describing my trust of physicians as a child that over the years grew into admiration as they were my earliest professional role models.

One of my earliest and most vivid memories is waking up in a hospital room with a nurse caring for me. My parents had not arrived at the hospital that morning. While I could have felt fearful not knowing the stranger in my room, I immediately knew I could trust the nurse. She spoke softly and was gentle as she went about her duties. A few minutes later, I remember a physician coming into my room wearing a white coat. He had a similar gentle manner and a reassuring smile on his face. This was my first time to experience the care and compassion of a physician and a nurse. Though I was a young child, I will never forget their kindness, or their comforting facial expressions that I came to know very well. Despite many hospitalizations and procedures, I only retain fond memories of the physicians and nurses who cared for me. I believe my parents’ faith in my physicians fostered my own trust in the physicians, nurses, and staff at the hospital. They were my early role models of commitment and compassion, which are attributes I have embraced. I still consider my time as a patient to be my source of inspiration and motivation.

I then described how my professional identity was later nurtured by my experience as a counselor and director at a medical camp. I came to understand how my innate empathy for others can become compassion with added motivation to care for others. Patrick was the focus of this part of the narrative.

I had the opportunity to return the kindness of my childhood physicians years later while serving as a camp counselor at a medical camp in Arkansas. I quickly bonded with a camper who had cerebral palsy and was experiencing separation anxiety as this was his first time away from home. I took on the responsibility of serving as Patrick’s guardian for his first week of camp after meeting him and his parents at check-in. His parents had put their trust in me after our meeting. Patrick had a wonderful week at camp, and I will always remember that big smile on his face whenever our eyes met. Patrick provided me an early insight on becoming vested in the safety and well-being of another person. Whenever I lost sight of Patrick, I felt the anxiety of being a guardian of someone else. I learned the positive impact of caring for another with understanding and compassion. As a result, I gained a better insight into the responsibilities and rewards of becoming a physician.

After describing my motivation to pursue a career in medicine, I closed my personal statement by sharing my desire to emulate the professional attributes of my early role models.

I aspire to gain the trust of my patients and their families just as I trusted my physicians as a child. I will try to understand my patients and their challenges just as I did for the campers I cared for as a counselor at a medical camp.

I could have better highlighted my interests and aptitudes and how I would be a good fit for a career in medicine. I was happy that most of my medical school interviewers shared that they liked my personal statement. Many focused exclusively on elements of the essay during my interview. They were especially intrigued by the relationship I had developed with Patrick and how he had provided me a personal perspective about the challenges and rewards of being a physician. I now appreciate how personal narratives can be a foundational component of your evolving professional identity and how they can inspire others if you choose to share your personal reflections with colleagues. I often begin my lectures with a personal narrative to introduce the topic to be discussed.

If a mission statement is the introduction to your idealized autobiography, your personal statement serves as its abstract, remaining aspirational and hopeful. Your evolving professional identity is likewise aspirational and idealized at an early stage of your career.

A personal statement is a dynamic document to be revised as your professional identity evolves. The creation of your statement is the perfect time to reflect on your life experiences and deeply held values. It is also a time to reflect forward and contemplate the goals for your life and career. While there are guides for creating lengthy personal statements, it is probably best to keep your initial version simple and concise. As your career progresses with formative experiences that help you to better define your interests and aptitudes, it is appropriate to incorporate these added elements.

Figure 1. Topics for your personal statement

The topics you choose for your personal statement should appropriately reflect your personality and evolution as a physician (Figure 1). Start by discussing your beliefs and core values. This discussion is more poignant if personal experiences that were seminal in the genesis of these values are also presented. Describing one or more formative experiences that align well with your core values and desired career path is impactful to readers and serves as a source for personal self-reflection.

As your career progresses, novel experiences become more impactful for your professional identity formation. The perspectives you gain from them inform your decision to pursue a chosen career path and enhance your personal statement. Self-awareness of your strengths and weaknesses is considered a desirable core attribute for a physician. A discussion of your aptitudes is ideally supported with examples of utilizing your skills to resolve challenges in your life and career, especially as they relate to a future career in medicine. When you describe your aspirations for a perfect career in medicine, you conclude your personal statement. Being able to close with a vision for an ideal career that embraces achievable and laudable goals communicates to readers your self-awareness and professional commitment.

If you initially choose to be vague when addressing one or more of your themes, try reflecting forward to envision a time when you have better clarity. Seek counsel to identify additional formative experiences to fill in the blanks in the future. For example, one of your aspirations may be to find a training program that aligns well with your core values and a desire to find a specialty focused on having meaningful relationships with patients. Imagine you have determined that you would like your practice and connection with patients to take place in an acute care setting such as emergency or critical care medicine, and it is while you are training in such a setting that you discover you find the interactions with patients and the care you can give them there is more fulfilling. You are now positioned to describe how recent formative experiences in acute care settings have provided added perspective and informed this component of your career decision.

A career eulogy serves as a capstone project for solidifying your professional identity and career aspirations. Drafting a career eulogy has become a common professionalism and career development activity during orientation in postgraduate medical training as well as other postdoctoral programs. The common prompt is for the author to imagine they are at their retirement party. They are asked to consider what they would like their colleagues to say about them at the end of their career. The exercise is designed to promote self-reflection for the purpose of identifying core values and aligning these values with a future career in medicine.

Consider a personal statement and a career eulogy to be bookends of a professional career. Each document remains distinct yet complementary with a slightly different purpose for your professional identity formation. While a personal statement is created at a moment in time and evolves as your career develops, a career eulogy is your long-term vision for an ideal career with more permanence. If you expound on the aspirations addressed in your mission and personal statements, you have imparted a vision and commitment to your perfect career.

When preparing for interviews for medical school, residency and fellowship programs, or faculty positions, it is wise to revisit your personal statement to prepare for questions about your motivation to become a physician and your aspirations for your future medical career. A compelling personal narrative provides confirmation to interviewers and selection committees that you are committed to a rigorous education and training continuum.

Figure 2. Career eulogy themes from “Beginning with the End in Mind”. [Yu, 2015]

In 2015, Drs. Yu and Wright published the results of having internal medicine interns draft their “career eulogy” by asking them to reflect forward to compose remarks for a hypothetical introduction at their retirement ceremony. This professionalism exercise revealed several common themes starting with “aligning behaviors with core values” or integrity (Figure 2). I will continue to highlight that integrity, honesty, and adherence to ethical principles of medical practice are core elements of a professional identity. Another theme was “achieving excellence in medicine” or becoming an expert. The goal of medical training is to become highly competent, eventually achieving expertise, and to have an impact in your chosen field. The internal medicine interns also felt “changing the world and giving back” was important and consistent with the altruistic nature of physicians.

The interns shared that “focusing on teamwork and relationships” fulfills their need to have a connection with colleagues and to work in a supportive environment. Socialization is an important component of your evolving professional identity where you learn and collaborate with others in a mutually beneficial manner. An important element of wellness and resiliency is “realizing a work-life balance.” This balance lets you focus on self-care and mental well-being, maintain a healthy lifestyle, and enjoy family and friends. And finally, the participating interns felt “appreciating a career in medicine” with the fulfillment that comes from selfless service to others was important.

When considering potential career paths, reflecting forward to draft your career eulogy is a useful activity to determine if your proposed career path aligns well with your core values and desired career objectives. As you approach the end of your career, your career eulogy will serve as a source of inspiration for lectures or testimonials to colleagues.