Abstract: Test anxiety in medical school is a common challenge, driven by high-stakes assessment and amplified by generational mental health trends, social media influences, and lingering effects of COVID-related educational disruption. This article examines how performance pressure, imposter syndrome, and unfamiliar testing environments contribute to anxiety among medical students. It emphasizes that test anxiety is common and manageable through practical strategies, including attending to basic wellness needs, practicing with exam-style questions, simulating testing conditions, and using structured approaches during exams. Social connection and support are highlighted as key protective factors. The article reframes struggle as a normal and meaningful part of medical training, supporting resilience and sustained academic success.

It’s 8:00 a.m., and the final exam starts.

A student sits in a silent classroom staring at the first question on the screen. They studied for weeks. They know the material. But suddenly their mind goes blank. Their heart starts racing. Their thoughts spiral:

What if I fail? What if I don’t belong here? What if this one exam changes everything?

For many medical students, this moment feels all too familiar.

Test anxiety has always been part of rigorous academic environments. But in recent years, it has become one of the most common concerns students bring to my office. The anxiety itself isn’t new, but the intensity and frequency seem to be increasing.

Medical school is, by design, a high-pressure environment. But today’s students are navigating additional pressures that make test anxiety even more likely.

The encouraging news is that for most students, test anxiety is manageable. Understanding where it comes from, and learning how to prepare both academically and mentally, can make a significant difference.

Why Medical School Creates High-Stakes Pressure

Medical education is structured around a series of major performance checkpoints. A small number of high-stakes exams can significantly influence a student’s academic progression and career trajectory.

From admissions exams like the MCAT to licensing exams such as the USMLE Steps, success in medicine has long been tied to standardized test performance.

Within medical school, exams often determine whether a student progresses in a course, advances to the next semester, or, in some cases, faces probation.

That structure alone can generate significant pressure. But several other factors are amplifying test anxiety for today’s students.

The “Perfect Storm” Facing Today’s Medical Students

Most current medical students belong to Generation Z, a cohort that research suggests is experiencing higher levels of anxiety and depression than previous generations. According to a 2025 narrative review in the Journal of Child and Adolescent Psychiatric Nursing, anxiety is substantially more prevalent among Gen Z (generally defined as individuals born between 1997 and 2012) than in any of the three generations before them.

A 2023 Walton Family Foundation and Gallup survey reinforces this pattern. It found that Gen Z reports negative emotions, including anxiety, stress, sadness and loneliness, at rates at least 7 percentage points higher than millennials, Gen X, baby boomers and the Silent Generation. Only 15% of Gen Z ages 18 to 26 rated their mental health as excellent, compared with 52% of millennials at the same age a decade earlier.

For students entering demanding academic environments such as medical school, these broader mental health trends mean that many arrive already navigating significant stress and anxiety, conditions that can easily intensify in high-stakes testing environments.

There are many possible explanations for this, from economic uncertainty to the pace of modern life, but what we often see is a group of students entering an already demanding environment while also navigating broader mental health challenges.

Medical school can also be isolating. Students may be living away from home for the first time while managing an extremely rigorous academic workload.

At the same time, they’re constantly exposed to curated portrayals of medical school on social media.

Many students follow influencers who present highly polished glimpses of life as medical students or physicians. These snapshots can create unrealistic expectations about what medical training should feel like.

When students encounter the inevitable challenges of medical school, they may conclude that something is wrong with them rather than recognizing that difficulty is a normal part of the process.

The result can be what I often describe as a perfect storm for test anxiety.

The Rise of Imposter Syndrome

Test anxiety is often closely connected to imposter syndrome, the belief that one’s achievements are undeserved or that one will eventually be exposed as a fraud.

Students sometimes tell me:

“I studied so hard, and I got a C in the class. Maybe I’m not cut out for this.”

“Everyone else seems to be doing better than I am.”

“Maybe I don’t deserve to be here.”

What’s striking is that these feelings can persist even when students are progressing through the program successfully.

Part of the problem is the myth of the “perfect medical student.” Many students believe the ideal medical student earns all A’s and never struggles academically.

But that student doesn’t exist.

Medical school has always been difficult. Struggling in a course, or even struggling for a semester, does not mean you don’t belong in medicine.

Yet social media can make it feel otherwise. Students may sit in a challenging lecture where everyone seems confused, only to later see classmates posting online about how great the day was.

Your lived experience tells you the class was difficult, but the online narrative suggests everyone else is thriving. Over time, that disconnect can reinforce feelings of inadequacy.

The Lasting Effects of COVID on Test Anxiety

Another factor shaping this generation of students is the educational disruption caused by the COVID-19 pandemic.

Many students completed part of their high school or undergraduate education in remote environments. Exams were often taken at home rather than in traditional proctored settings.

Now they find themselves sitting in silent classrooms for hours at a time, taking high-stakes exams under strict conditions.

For some students, the testing environment itself becomes a source of anxiety.

I often hear students describe the exam room as “eerily quiet.” They’re not used to sitting in a rigid chair for several hours without looking around, checking their phone, or taking a break.

These environmental factors may seem minor, but they can contribute significantly to the stress of test day.

What Actually Helps Students Manage Test Anxiety

The encouraging reality is that most students can reduce test anxiety with a combination of preparation, self-care, and practical testing strategies.

1. Start With the Basics of Well-Being

One of the first things I look at with students is their basic wellness habits.

This might sound obvious, but many students neglect the fundamentals during exam periods. I often hear something like:

“I’ve slept two hours a night all week and I’m really anxious about this exam.”

At that point, anxiety is inevitable.

Students perform best when they prioritize:

• Adequate sleep
• Regular meals
• Hydration
• Movement and sunlight

These may seem like small things, but they form the foundation of cognitive performance. Pulling an all-nighter rarely leads to better exam outcomes.

2. Practice With Exam-Style Questions

Another important strategy is self-testing.

Students benefit greatly from practicing with multiple-choice questions throughout the learning process. This helps them move beyond memorizing information to understanding how concepts are applied clinically.

The goal is to avoid making connections for the first time during the exam itself.

Ideally, by test day students are simply showing up and performing what they’ve already practiced.

3. Mimic the Testing Environment

I also encourage students to practice under realistic testing conditions.

That means sitting in a quiet room, timing themselves, and completing a full practice exam when possible.

This serves two important purposes. First, it builds stamina. Medical exams can be long, and students need to practice maintaining focus for extended periods. Second, it removes surprises. If students have already practiced sitting in a silent room for several hours, the actual exam environment feels familiar rather than intimidating.

4. Have a Plan for When Anxiety Appears

Even well-prepared students may feel anxious during an exam.

The key is having a strategy.

Students who develop a systematic approach to answering questions are less likely to panic when anxiety arises. Instead of reacting emotionally, they can rely on the process they’ve practiced.

When anxiety appears, structure restores a sense of control.

5. Stay Connected

Finally, one of the most important protective factors against anxiety is social support.

Medical school can be isolating, particularly for students who are adjusting to new environments or living away from home for the first time.

Building relationships with classmates, mentors, family members, or counselors can provide essential grounding during stressful periods.

No one gets through medical school entirely alone.

A Different Way to Think About the Journey

One of the most important conversations I have with students is about expectations.

Many enter medical school believing they must excel at everything immediately. When that doesn’t happen, they assume they don’t belong.

But the reality is that medical school is meant to challenge you. Growth often happens precisely at the point where things feel difficult.

Struggling at times doesn’t mean you’re failing. It means you’re learning.

The Bottom Line

If you’re experiencing test anxiety in medical school, you’re not alone.

Many intelligent, capable students face the same challenge at some point in their training. The key is recognizing the anxiety early and developing strategies to manage it.

Medical school is demanding, but it’s also a process designed to shape resilient physicians.

You earned your place in this journey.

With the right preparation and the right perspective, you can learn to show up, perform, and succeed even in the moments that feel most intimidating.

Conflict of interest disclosure

The author reports no conflicts of interest.

AI use

The abstract summary was produced by the editors using Microsoft Copilot on April 25, 2026. No other part of this article was generated by AI.

I had been sitting with her idea of attention, especially her claim that the love of neighbor consists, in its fullness, in being able to ask another person, “What are you going through?”¹ It struck me that this is the most basic question in medicine. It is what every history tries to ask beneath the scaffolding of onset, location, duration, character, timing, severity, and the rest of the catechism. Yet the more I sat with Weil’s question near the end of my third year, the more I wondered whether I had become better or worse at asking it.

A study that warned me about myself

That thought brought me back to a study I had read in the summer before starting medical school, back when I still believed I could become a physician without becoming emotionally damaged or detached. A nationwide study by Hojat et al.² suggested that empathy among osteopathic medical students declines throughout our education. This unsettled me. Empathy, apparently, did not simply bloom once students reached patients, as one might hope in the inspirational montage version of medical education. It became more vulnerable precisely when patient care became more central.

At the time, I took the study as a warning about myself, then promptly dismissed it in the private, embarrassing way people dismiss warnings meant for them. I cared too much, I thought. I was too self-aware. I would simply not let that happen to me, as though sincerity were a lifelong prophylaxis against fatigue and the slow moral weathering of institutions. But moral failure rarely announces itself as evil. It usually arrives sounding reasonable, tired, behind schedule, and in need of finishing a note.

Now I am in my third year, spending much of my life in a short white coat that feels less like a symbol of professional identity than a visible reminder that I am still becoming. I am not sorry that I am learning. That is the whole point. But I am occasionally sorry that patients must put up with the awkwardness of my becoming: the repeated questions, the uncertain exam, the extra few minutes required for me to translate their life into something I can present. They agree to this. They can say no. That so many say yes still feels generous, and I am grateful.

Third year is the first time medicine becomes human for many of us. It is also the first time you understand how easily real humans can become an obstacle to medicine.

When patients stop being hypothetical

Before this year, patients were mostly hypothetical. They were 56-year-old men with substernal chest pain radiating to the left arm. They were women with malar rashes and renal disease. They were children with barking coughs, immigrants with eosinophilia, farmers with organophosphate poisoning, and unlucky people who existed mainly to test whether you remembered the side effects of amiodarone. They were suffering, technically, but in a clean and educational way. They wanted you to learn.

Real patients are not always like that. Real patients tell you about their chest pain and then, without warning, about the daughter who does not call, the medication they stopped because it was too expensive, the dog that may or may not have bit them, the gummies from the gas station, the mushroom that looked “a little slimy.” They bring their whole lives into the room, whole, even when the system has allotted them fifteen minutes.

During one clinic day, I wrote in my journal that patients seemed to talk to me for too long because I looked them in the eye and listened. My next thought was almost funny in its bluntness: maybe I should stare at the computer more. Reading that line back now, I see something more serious underneath it. I had recognized that attention invited disclosure, but instead of immediately seeing that as the heart of the work, part of me saw it as an obstacle to efficiency.

Attention, not niceness

This is why Weil has stayed with me. She did not write about empathy in the usual medical-school language of “patient-centered communication,” “reflective listening,” or “validating concerns,” phrases that sound as though they were assembled by a committee trying to make kindness billable. Her word was attention. For Weil, attention was not niceness or emotional performance. It was a disciplined openness to reality, a way of emptying the self enough to receive another person as they actually are.

When a label replaces a person

The medical history can be an instrument of attention. It can also become a net we drag through another person’s life, keeping only what is diagnostically edible. In clinic, I met a patient whose blood sugar was catastrophically high because she had not taken her diabetes medications for months. The easy word would have been noncompliance, that ugly little word medicine uses when a patient’s life has failed to arrange itself conveniently around our recommendations. But the reason was not mysterious or rebellious. The medications were expensive. Once cost became clear, the problem changed shape. It was no longer a matter of explaining diabetes harder, as if the missing ingredient in American healthcare were a stern PowerPoint about hemoglobin A1c. It became a question of access, prescription assistance, follow-up, and whether the plan we made was one she could actually live with. Attention did not make the medicine less medical. It made it more accurate.

This is one of the dangers of the compartmentalization medicine demands. We have to categorize and compress; there is no way to practice medicine without turning the chaos of a person’s life into diagnoses, problem lists, billing codes, and plans. The danger is that, under the pressure of efficiency and exhaustion, our categories can harden into names for people. Those lacking access become “noncompliant.” The frightened become “difficult.” The overwhelmed become “poor historians.” Sometimes these labels contain useful clinical information. Often they contain the system’s impatience, and our own.

The conditions that make empathy hard

And exhaustion is not nothing. Medical students are asked to cultivate compassion in conditions often hostile to it. We are told to be humane while being trained in a system that rewards speed, recall, polish, and performance. We are asked to understand the complexity of patients’ lives while our own lives narrow to flashcards, question blocks, shelf exams, evaluations, unread emails, half-packed lunches, and the ambient terror that every ordinary human interaction may someday need to become a bullet point on an application. Patients live in the world. Medical students live in medicine. This is not always the same place.

There is a particular panic to being a student in the room with a patient who is telling you something important in a way that is not immediately useful. You are trying to listen while remembering the questions, the exam, the differential, the plan, and whether your attending will think you are thorough or merely slow. Somewhere in all this, the patient is still talking. It is tempting to become efficient in the worst sense: to make the encounter smaller, guide the story back onto the rails, and stare at the computer just long enough for the patient to understand that the open portion of the visit has ended.

Patients notice when you look at them, when you listen, when you are trying. One older woman told me that when I become a doctor I should keep doing what I was doing and talk to my patients. It was encouraging, yet damning, because talking was apparently unusual enough to mention.

Of course, not every patient rewards attention. Some are generous and grateful; others are suspicious, hostile, uninterested, or unpleasant. One preceptor put it plainly: some patients will be easy to love, and others will be difficult to care for. You still have to treat both with the same respect and patience. This sounds like a Hallmark card until you have to live it at 4:15 p.m. with a headache.

Weil’s attention is not sentimental. It does not require pretending that every person is delightful. It may actually begin where liking ends: the refusal to let irritation become blindness, or to make another person smaller because they are inconvenient, unpleasant, or hard to understand. This is why empathy, understood as attention, is more demanding than empathy understood as feeling. Feelings come and go. They are affected by hunger, sleep, caffeine, and your stack of prior authorizations. If empathy is only a feeling, then its absence means we have failed. But if empathy is attention, then it is something we can practice even when the feeling is weak: by pausing before entering the room, asking one more question, noticing the label forming in our mind and not letting it be the final word.

Empathy fades like cataracts, not like loss

The Hojat study frightened me because it suggested that empathy was more fragile than I wanted to believe. I still imagined it as a moral possession I could guard if I was vigilant enough. Now I think empathy declines less like an object being lost and more like growing cataracts. No one flips a switch. The light just gradually changes. You get tired. You get faster. You get praised for being concise. You learn the shortcuts. You start to think of patients as work, and then, if careless, as obstacles to work.

Medical education and the healthcare system deserve some blame for this. It is not enough to tell students to be compassionate while placing them into environments that make compassion feel inefficient. Empathy requires time, rest, continuity, mentorship, moral reflection, and some remaining life outside medicine from which to remember what people are like when they are not wearing gowns. But systems are never the whole story. They do not absolve me. I still choose what kind of attention I give: whether to look at the patient or the screen, whether to let the story breathe or strangle it into bullet points, whether to treat my fatigue as an explanation or as permission.

Before medical school, I thought the danger was that I might become less empathetic in some dramatic, unmistakable way. But the real danger is quieter. It is not that I will stop caring. It is that I will become too busy, too tired, too evaluated, too fluent in medicine’s abbreviations to notice when I have stopped seeing. That is more frightening because it does not feel like cruelty. It feels like getting through the day.

And yet there is hope in that, too. If empathy can narrow, perhaps it can widen. If attention can be captured, perhaps it can be reclaimed. If I can catch myself wishing the patient would talk less, I can also catch myself and ask why their talking felt like a problem. I can remember that the story is not an interruption of the work. The story is the work, or at least the part that keeps the rest of it from becoming mechanical.

Weil’s question remains embarrassingly simple. “What are you going through?” It is the question beneath every history, physical exam, differential, and plan. It is also the question medical students have to ask ourselves. What are we going through that makes attention difficult? What is training doing to the way we see?

The work of becoming a physician is not only learning how to diagnose disease. It is learning how to preserve the kind of attention that allows another person to remain fully visible before us. Not because we are naturally compassionate or immune to fatigue, irritation, or vanity. But because attention, like medicine, is a practice. And because the patient in front of us is almost always telling us more than we have time to hear.

References

1. Weil S. Waiting for God (Craufurd E, Trans.; Fiedler LA, Intro.). G. P. Putnam’s Sons; 1951. (Original work published 1950)
2. Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Does empathy decline in the clinical phase of medical education? A nationwide, multi-institutional, cross-sectional study of students at DO-granting medical schools. Acad Med. 2020;95(6):911-918. https://doi.org/10.1097/ACM.0000000000003175 (opens in new tab)

Abstract: Medicine is often portrayed as a profession defined by dedication to patient care and scientific knowledge. Yet many trainees gradually discover another dimension of medical culture: competition within the profession itself. From the first years of training, students enter a system characterized by limited residency positions, constant evaluations, and increasing expectations for research productivity. These pressures can create an environment where colleagues quietly compete for opportunities, recognition, and career advancement. While competition in medical training can motivate excellence, excessive comparison may contribute to anxiety, self-doubt, and burnout among young physicians. Despite its impact, this aspect of medical culture is rarely discussed openly. This article reflects on the structural and cultural factors that fuel competition in medicine.

When people imagine the life of a doctor, they usually picture long hours, difficult exams, and the emotional weight of caring for patients. What they rarely imagine is something else that quietly shapes the lives of many physicians.

It is “Competition.”

Not the healthy kind that pushes people to improve. Not the friendly rivalry that helps colleagues grow together. But the silent, uncomfortable competition that exists between people who are supposed to be on the same team.

Many students enter medicine believing the main battles will be fought against disease. They learn physiology, master procedures, and eventually help patients recover from illness. Despite the repetitive nature of medicine regarding the clinical picture, diagnosis, and treatment of diseases, medicine has another side that is beyond expectations when physicians face challenging cases with atypical presentations, outbreaks of new diseases, new treatment agents, or new diagnostic modalities. Therefore, medical students should know the first lesson when entering the medical culture: not every piece of information is written in the curriculum.

But there is another lesson that appears slowly, often without explanation. Medicine is a hierarchy. The latter is responsible for the protection of patients’ lives, since life is precious.

Scarcity (“May the odds ever be in your favor.”)

Scarcity is not inherently negative. In many respects, it serves an important purpose within medical education. Medicine is a profession where decisions can directly affect human lives, and society expects physicians to meet exceptionally high standards of knowledge and professionalism. Competitive selection processes help training programs identify candidates who have demonstrated commitment, resilience, and the ability to perform under pressure. In this sense, competition can motivate students to study harder, refine their clinical skills, engage in research, and pursue continuous self-improvement. Ultimately, the goal is not merely to reward achievement, but to ensure that patients are cared for by highly competent physicians.

From the first day of training, every student learns that future opportunities are limited.

Residency spots.

Fellowship opportunities.

Leadership roles.

Academic positions.

Authorships and grants.

Competition often begins long before residency applications are submitted. Students interested in competitive specialties frequently seek information about expectations through faculty advisors, residents, mentors, specialty interest groups, institutional career offices, and increasingly through online communities and social media. While some requirements are clearly documented, such as examination performance, research productivity, and clinical evaluations,¹ other expectations are often communicated informally through the hidden curriculum.

A systematic review and meta-analysis of 75 studies involving more than 880,000 medical students found that specialty decisions are influenced by multiple factors, including academic interests, perceived competencies, lifestyle considerations, patient-service orientation, mentorship, career opportunities, workload, prestige, and advice from others. Notably, mentors were among the most influential factors identified, highlighting the important role of formal advising and informal guidance in shaping students’ career aspirations and perceptions of competitiveness within different specialties.² Students may receive advice regarding networking, identifying mentors early, pursuing specialty-specific research, or demonstrating commitment to a field years before applying for residency.

Professional organizations have also attempted to reduce uncertainty surrounding specialty selection and residency applications. For example, the Association of American Medical Colleges (AAMC) developed the Careers in Medicine (CiM) program, which provides structured career advising, specialty profiles, self-assessment tools, and resources that help students make informed decisions about specialty choice.¹ The AAMC also publishes the Report on Residents and other workforce data resources that allow students and advisors to better understand residency pathways, applicant characteristics, and specialty-specific expectations.

In some specialties, hundreds of highly qualified candidates compete for only a few positions. The National Residency Matching Program (NRMP) indicated that the 2025 match program was the largest in its history; 47,208 active applicants applied for 40,041 PGY-1 positions.³ Competition varied substantially across specialties. Highly competitive fields included thoracic surgery (~2.4 per position), orthopedic surgery (~1.7 per position), plastic surgery (~1.8 per position), neurological surgery (~1.8 per position), and otolaryngology (~1.4 per position). These numbers highlight how, despite overall expansion in residency positions, certain specialties remain intensely competitive due to limited training capacity and high applicant demand.

While every profession has competition, medicine is unique: career progression in medicine is built within a rigid ladder of training, and progress depends on competence as described by evaluations, recommendations, and physicians’ reputations.

Many students enter medical school believing that hard work and academic achievement are the primary determinants of success, having already been rewarded for these efforts through admission to a highly competitive profession. Over time, they may discover that career progression is influenced by additional factors beyond individual effort alone, including mentorship, networking opportunities, institutional culture, and access to resources.²

Evaluators (“Make sure they remember you.”)

Another factor is evaluation systems. Students and residents are constantly assessed through grades, class rankings, recommendation letters, clinical evaluations, and performance reviews. Because these assessments can influence future opportunities, they have long been recognized as important drivers of competition among trainees.

In response to concerns about student well-being, many medical schools have adopted pass/fail grading systems, particularly during the pre-clinical years. Studies have shown that pass/fail curricula are associated with lower levels of stress, anxiety, and burnout, while enhancing greater collaboration among students.^4,5

However, these approaches are not without hazards. Critics argue that reducing objective measures may make it more difficult for residency programs to distinguish among applicants, particularly in highly competitive specialties. Similar concerns emerged when the United States Medical Licensing Examination (USMLE) Step 1 transitioned from numerical scoring to pass/fail reporting in 2022. While the change was widely welcomed as a strategy to reduce stress and discourage an overemphasis on examination performance, some educators and residency directors expressed concern that competition might simply shift toward other metrics, including research productivity, clinical evaluations, institutional prestige, and Step 2 Clinical Knowledge scores.⁶ As a result, efforts to reduce harmful competitiveness may improve student well-being while simultaneously creating new challenges for residency selection.

Surviving Institutional Culture (“Nobody ever wins the Games, period. There are survivors… there’s no winners.”)

Finally, there is the issue that few people openly discuss: institutional culture.

In some environments, collaboration is encouraged and mentorship thrives. In others, hierarchical structures and elements of the hidden curriculum may discourage trainees from openly expressing uncertainty, asking questions, or discussing mistakes for fear of negative evaluation or reputational consequences.^7,8

Indeed, many medical schools have introduced transition-to-clerkship or “bootcamp” programs designed to prepare students for the clinical environment before they begin their core rotations. These programs often focus on communication skills, professionalism, teamwork, clinical reasoning, and expectations within the clinical workplace. Beyond improving clinical preparedness, such initiatives may also help students navigate elements of the hidden curriculum by clarifying professional norms and reducing uncertainty about expectations. Studies have suggested that transition programs can improve learner confidence, preparedness, and adaptation to clinical training.^9,10 Although these interventions do not eliminate competition, they may reduce some of the anxiety and uncertainty that contribute to unhealthy comparison and stress among trainees.

Many report bullying as a major component in the teaching experience. A recently published systematic review in the Journal of Occupational Health revealed the prevalence of bullying was reportedly 51%. Moreover, females and residents that belong to racial/ethnic minorities experienced bullying more frequently.¹¹

When these factors combine, competition becomes an unspoken part of medical culture.

While competition can motivate improvement and encourage excellence, young physicians can be adversely affected when the pressure becomes too intense.

Over time, these comparisons create anxiety and self-doubt. This culture makes it harder to ask for help. When everyone feels they must appear strong, admitting uncertainty is an admission of incompetency. Ironically, the pressure to appear competent can sometimes prevent the openness that true learning requires. While striving for excellence can motivate learning and professional growth, maladaptive perfectionism has been associated with depression, burnout, and impostor phenomenon among medical students and physicians.^12,13,14

The Exhaustion of Burnout (“I hate being so alone.”)

Most conversations on physician burnout focus on workload: long shifts, night calls, and administrative burden.¹⁵

Young physicians describe another kind of exhaustion – the emotional fatigue from feeling constantly evaluated or compared.^16,17 A resident may work tirelessly to care for patients but still feel that their value is determined by metrics: exam scores, research productivity, or seniors’ and consultants’ opinions.¹⁸ When professional identity becomes tied primarily to performance, even minor setbacks can feel disproportionately distressing. Some trainees may begin to question their competence, their place within the profession, or whether they truly belong in medicine, a phenomenon that has been linked to impostor experiences and psychological distress among medical learners.^19,20

Why No One Talks About Competition in Medical Training (“Stupid people are dangerous.”)

If competition affects so many people in medicine, why is it rarely discussed?

Part of the reason is tradition. Medicine has long been a profession built on resilience and discipline. Admitting vulnerability has not always been encouraged.

Another reason is fear. Young physicians may worry that speaking openly about professional culture could harm their careers. And sometimes, competition itself discourages honesty.

If everyone feels they must appear successful, one’s struggles remain invisible.

Finally, health professionals are expected to sacrifice their own needs for the sole benefit of the patients they serve. Patients deserve skilled, knowledgeable physicians. The margin of error in medicine is not acceptable; you must give the patient 100% of your attention since a lapse can cause errors, complications, or death.

The most effective medical teams are rarely the ones where individuals compete against each other. Rather, interprofessional teams share knowledge freely, support each other during difficult cases, and learn together.

Many experienced doctors eventually realize that collaboration, not rivalry, is what improves patient care.

For students entering medicine, understanding this reality can be empowering.

Students are frequently taught how to succeed academically, yet many receive little formal preparation for navigating the social and cultural dimensions of medical training. Learning how to manage competition, evaluations, professional expectations, and uncertainty often occurs through experience rather than explicit instruction, which can make the transition into medical culture particularly challenging.

In recent years, medical schools are introducing wellness programs and mentorship initiatives. Hospitals are beginning to recognize the importance of supportive training environments.

But addressing burnout requires honest conversations about professional culture while developing employment policies that reduce work hours or encouraging participation in wellness workshops as professional development. Competition will always exist in demanding professions, but it should not overshadow the values that drew people to medicine in the first place.

Many physicians eventually discover that the greatest satisfaction in medicine comes from simpler moments:

Helping a patient recover.
Teaching a student who is seeing their first case.
Working with colleagues who trust and respect each other.

And they remind us that the profession is defined by community.

How Medical Culture Can Reduce Harmful Competition? (“A necklace of hope”)

Recognizing competition in medicine should not place the responsibility solely on students and young physicians. Competition is shaped by educational structures, institutional culture, and professional expectations, meaning that meaningful change requires action from multiple stakeholders.

Medical schools and curriculum leaders can play an important role by creating transparent evaluation systems, clearly communicating expectations, and enhancing learning environments that reward collaboration alongside academic achievement. Student affairs offices can further support trainees through wellness initiatives, career advising, and programs that help students navigate the culture of medical training.

Mentorship is another important intervention. Faculty mentors and advisors can help students interpret setbacks realistically, identify opportunities for growth, and understand that career success is not defined by a single examination score, publication, or residency application outcome. Effective mentorship may also reduce uncertainty and help trainees develop a healthier professional identity.

Peer support represents another evidence-based strategy. Research suggests that peer-mentoring programs can provide psychosocial, professional and academic benefits.²¹ Creating opportunities for students and residents to learn from and support one another may help counteract the isolation and comparison that sometimes accompany highly competitive environments.²¹

Collaborative learning practices may also contribute to healthier training cultures. Sharing study materials, helping colleagues understand difficult concepts, supporting junior learners, and recognizing the contributions of others during research or clinical work reinforce the idea that professional growth is not a zero-sum process. Educational research has increasingly emphasized the value of cooperative learning environments in promoting both academic development and psychological well-being.²²

Competition will likely remain a feature of medicine because opportunities, resources, and training positions are limited. However, institutions can help ensure that competition does not overshadow the values that sustain the profession. Excellence in medicine is best achieved when high standards are balanced with mentorship, collaboration, and a shared commitment to supporting the next generation of physicians.

Conflict of Interest Disclosure

None.

AI Use

No AI was used in writing this article. The competition in medical training image was generated using ChatGPT.

References

1. Association of American Medical Colleges. (n.d.). Careers in medicine. https://careersinmedicine.aamc.org/ (opens in new tab)
2. Yang, Y., et al. (2019). Factors influencing subspecialty choice among medical students: A systematic review and meta-analysis. BMJ Open, 9(3), e022097. https://bmjopen.bmj.com/content/9/3/e022097.abstract (opens in new tab)
3. National Resident Matching Program. (2025, May). Results and data: 2025 main residency match. https://www.nrmp.org/match-data/2025/05/results-and-data-2025-main-residency-match/ (opens in new tab)
4. Bloodgood, R. A., Short, J. G., Jackson, J. M., & Martindale, J. R. (2009). A change to pass/fail grading in the first two years at one medical school results in improved psychological well-being. Academic Medicine, 84(5), 655–659. https://academic.oup.com/academicmedicine/article-abstract/84/5/655/8353384 (opens in new tab)
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