“Joy Kwon, a third-year medical student trainee with a photographic memory and a scathing eye roll, clocks out at the end of her 12-hour shift,” Gupta’s story says. “Before she steps away, one of her supervisors, Dr. Frank Langdon, tries to pressure her to stay. But she doubles down, reminding him that she has finished her shift and that she isn’t being paid.”

Before she leaves, Kwon tells Langdon, “Maybe all you lunatics need to learn how to set some boundaries.”

As the father of two doctors and given my former roles as President and CEO of a medical school whose graduates have been matched to residencies at America’s premier hospitals, I understand the overwhelming physical and mental pressures that students and new doctors face. While frequently invigorating, medical training and residencies can also be exhausting, soul-crushing, and relentless. The decision that Joy Kwon made to put a discrete end to her shift at Pittsburgh Trauma Medical Center made sense.

However, while Joy prioritized her physical and mental wellness by adhering to the end time of her schedule, she potentially impacted her career trajectory, both short-term and long-term.

Short-Term Cost: Diminished Team Trust

Midway through the latest season of “The Pitt”, the hospital’s computer infrastructure went down due to a massive ransomware cyberattack. This caused the entire hospital to immediately switch to paper charts and work without access to digital patient histories or records.

Prior to the attack, Kwon, thanks to her innate gift, memorized the hundreds of specific details on the ER’s digital patient screen and then reproduced them on a whiteboard with a Sharpie after everything went offline.

Once the hack was resolved, the fatigued staff realized they needed to devote extra off-the-clock hours to updating their previously offline digital patient records, which were now back online. None of the doctors or residents were happy about this, and the drain on everyone’s brains and bodies was immense.

Kwon had the same grueling grunt work to finish as her fellow doctors, but when the hours of her shift came to a close, she was out the door, likely leaving the extra tasks of transferring her patient records to someone on the remaining day shift or incoming night shift to handle.

If this is how the action played out, it isn’t hard to imagine the annoyance and sense of betrayal that the residents and physicians felt toward her for exiting when everyone else was putting in extra (and unpaid) hours to repair the damage of the cyberattack, in addition to migrating the handwritten information of her patients’ paper records to the hospital’s computer system. I imagine that the ill will would have been massive. 

Kwon’s actions, while understandable given her desire for a healthy work-life balance, prevented a memorable and enduring bonding experience with her suffering co-workers. It also potentially created simmering mistrust among them at being left to complete her tasks. Such resentment, especially among a tight team in a period of crisis, is not easily forgotten or forgiven.

The Long-Term Cost: Setting Boundaries in Residency Narrows Your Specialty Options

If you are interested in being an ER doctor or pursuing another high-acuity specialty, boundary-setting of this kind is not realistic or achievable. As shown in “The Pitt”, ER docs must function and focus in situations of extreme chaos. In fact, some – like Dr. Jack Abbot, a character on the show who’s also a U.S. Army veteran and volunteers as a TEMS provider for the Pittsburgh SWAT team in his off-duty hours – seem to crave the mayhem.

Kwon is intent on maintaining professional-personal equilibrium in her life, and explicitly said on the show that she is not interested in an ER residency. She has chosen accordingly, deciding to pursue pathology by the end of the season. Other non-urgent, lifestyle-friendly areas include dermatology and psychiatry, though both of those commonly require ER rotations during internship year. 

For students who aspire to work in internal medicine, family medicine, pediatrics, or general surgery, ER rotations are non-negotiable. You’ll either need to adjust your work-life balance ambitions to fit the needs of your patients and fellow doctors or accept that upward mobility is limited: any aspirations to become a Chief Attending Physician (Dr. Robby’s title) or a similarly higher-ranking supervisory position within the ER department would be unattainable.

Professionals in all industries dream of finding improved steadiness between the demands of their day jobs and the pleasures of their personal lives. Finding that symmetry keeps us sane, well-rounded, and fulfilled. But doing so at the expense of your patients and co-workers (fellow ER staff) will impede your success in your work journey.

Conflict of interest disclosure

The author is a medical school executive and has held senior leadership roles at institutions that train students entering residency. He reports no financial interest in the subject matter of this article.

AI use

No AI use was disclosed by the author.

Image: Photograph by Warrick Page/HBO Max

Abstract: Health professions education is a growing specialty in many different fields of health care. Educators create unique careers from different mixtures of clinical care, direct teaching (bedside teaching, classroom lectures, small group facilitation), curriculum development, program administration, and educational research and scholarship. As part of a qualitative study of physician medical educators, participants were asked about their advice to others interested in this specialty. They suggested focusing inward, to examine one’s own interests and goals, and looking outward, to build support, community, and opportunities to share knowledge.

Many health care providers teach to some extent, but more and more people are recognizing the importance of this growing specialty, which focuses on the process of education and offers opportunities to impact the way we teach and learn. Beyond providing clinical care, health professions educators can improve the knowledge and practice of generations of students and providers. What advice do today’s educators give to others interested in this rapidly evolving field?

As part of my thesis work for a master’s in medical education, I did a qualitative study of medical educators. I interviewed 22 physician educators across the United States to learn more about their work and how they got started as educators.^1,2 Some started as educators very early in their careers, while others began to focus on education after many years of working. I asked them what advice they would give to others interested in health care education. They suggested focusing inward, to understand one’s own interests and goals, and looking outward, for support, community, and opportunities to share knowledge. Their advice fell into four main categories.

Explore what it means to be an educator

Several participants recommended trying out different areas of health care education, through work, volunteer positions, or educational programs, to learn about the many aspects of health care education and figure out what fascinates you most. They described different elements and entry points into the world of health professions education, and many different ways to integrate clinical and educational work. What do they say to people interested in health care education?

“You could do education administration, you could do education research, or you could just be an amazing teacher. I say it just depends on what you want to do, and you don’t have to know now…”

“…just dive in and do things and get involved […] encourage people not to get intimidated with lack of formal training…”

“…reading a couple of those books to just get their minds thinking about things in a different way. Then probably taking something like the [educator course] early would be helpful.”

“…early on, volunteer for everything that you find interesting, being on a committee, reviewing somebody’s paper for them before they submit it, whatever. And don’t just look for things that are going to protect time because there just aren’t enough of those. And then there will be payback, hopefully, after you get a foot in the door and you make yourself indispensable initially on a volunteer basis.”

Focus on your goals

Educators described the importance of figuring out what is most important to you and communicating those goals to others. Being able to communicate your interests and passions can give you a competitive edge, and staying focused on what you want helps you advocate for what you need as your career progresses. It’s also important to recognize that you may need to look in a variety of places to find exactly what you are looking for.

“…get a sense of what you’re good at, what you like, and probably make some of the decisions based on those two things. […] trying to get a sense of what to do with your career and understand that that changes.”

“I go into any meeting with someone who’s responsible for my career saying, ‘Hey, this is what I want to do. This is what I expect over the next couple of years,’ […] to allow for those things to happen and to communicate my vision to them.”

“I do advise people to value their own time and to advocate for getting protected time to do things. It’s just really hard to find the revenue stream to do it.”

“Take the promotion criteria of whatever pathway you’re in, read it, create your to-do list and let’s start moving forward.”

“If you are really looking to be in something very specific and you know that, then you might have to be willing to go to another place to actually achieve that.”

Find support and build community

The importance of support in a variety of forms came up in multiple interviews. Educators talked about encouragement, emotional support, and opportunities offered by coworkers, supervisors, individual mentors and sponsors, hospital and professional groups, as well as educator networks and programs.

“My first piece of advice is to find a mentor who can help you understand medical education and academics because it’s not self-explanatory by any means.”

“Find good mentors. Figure out what you like and don’t…I always like to remind people that they don’t have to know. They don’t have to know what they’re going to end up doing. So just do what feels good in the beginning and learn, learn from the people around you.”

“I also really encourage people to find an academic home […] And for me finding a mentor actually means finding a network of mentors, you’re not going to put all your eggs in one basket.”

Share your knowledge

The importance of educational research and scholarship in different forms was stressed by several participants as a way to share one’s experience, teach others, develop a strong reputation, and advance the field. Also consider structured formal educational programs to push you to the next level and help you progress.

“I think scholarship becomes super important, and that’s not just necessarily papers, but I think it’s being able to present it at national meetings. Especially within medicine, there’s so many different specialties, and each specialty has at least one, if not two, national organizations. I think each of those organizations are now creating better avenues for folks to learn about teaching.”

“…my biggest piece of advice is that even though it’s medical education research, it can and should be done in a scientific manner. And that just makes it all the stronger and all the more meaningful.”

“…if you want to do education research, you’re going to need a master’s degree. It’s just very difficult otherwise to get the level of training and rigor going without it.”

Building from inside and out

Through their own experiences and advice, the educators in this study described important ways that people at any stage of their career can learn more and develop their skills as educators: through exploration, goal setting, community development and support, and shared knowledge and experience. Especially for people with an interest in education, considering health care education as a specialty is one way to expand your skills, develop an area of expertise, and build a challenging and meaningful career.

Conflict of interest disclosure

This article summarizes findings from a qualitative study of medical educators, conducted as thesis work for a master’s degree in medical education. First-person references throughout refer to Cynthia Stein, who conducted the interviews. Both references cited are the authors’ own prior publications in Cureus and BMC Medical Education. No funding supported the underlying study, and the research protocol was reviewed by the Harvard University Institutional Review Board and determined to be exempt. Cynthia Stein is affiliated with Boston Children’s Hospital and Harvard Medical School; Jennifer Kesselheim is affiliated with the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School. Both authors are practicing physicians and medical educators, and both report no financial conflicts of interest.

AI use

No AI use was disclosed by the authors.

References

1. Stein CJ, Luff D, Gold JM, Schwartzstein RM, Kesselheim JC. A volunteer passion: a qualitative look at how we measure and reward the work of medical educators. Cureus. 2024;16(7):e65849. https://doi.org/10.7759/cureus.65849 (opens in new tab)
2. Stein CJ, Luff DF, Gold J, Schwartzstein RM, Kesselheim JC. Serendipity, support and equity: a qualitative study examining career initiation in medical education. BMC Med Educ. 2025;25(1):1764. https://doi.org/10.1186/s12909-025-08014-9 (opens in new tab)

Abstract: Med and dental school admissions committees and references have been asked to assess an applicant’s “self-awareness” as an entering competency for medical and dental school, shifting away from explicitly evaluating cultural humility. However, as self-awareness remains a focus for leadership development for senior educators and leaders, it is not realistic that students should strive to be “masters” at this competency as applicants. This article argues that self-accountability is a more desirable and observable competency, and provides several assessment tools to explore cultural humility and self-awareness/accountability.

Background

In 2026, the AAMC Mission-Aligned Recruitment and Retention team identified Self-Awareness as a professional competency desired for entering medical students. It replaced “cultural humility”¹ to include a greater awareness of one’s own background and journey when developing a professional identity as a future physician. In this article, I argue that “self-accountability and integrity” is a more measurable competency that can be demonstrated through activities and actions. Independently, beginning in 2026-2027, AADSAS evaluations include a rubric to characterize an applicant’s self-awareness along with nine other desired competencies.²

How do admissions professionals evaluate self-awareness? I will discuss how the self-awareness standard differs from “cultural humility and awareness,” the previous competency, and why self-accountability and integrity are likely more desirable attributes that evaluators can better observe.

What is Self-Awareness?

The change in terminology signals a change to a more intrinsic focus. Self-awareness gauges how one thinks about and thrives in their native environment. As you consider life choices (hobbies, career goals, academic performance), you should become more aware of your emotions, relationships, and finances that shape your growth and life philosophy.

Self-awareness focuses on the skills that identify your values, strengths, needs, behaviors, and biases as you navigate your environment. While I have previously discussed the OCEAN personality traits³ that can be measured in memoirs or personal social media posts, we see many students relying on personality assessments to begin outlining their preparation for a health professional career (for example, via the VIA Character Strengths Inventory⁴).

Self-care focuses on behaviors that result from self-awareness. Exercise routines, dietary discipline, meditation, or artistic expression are commonly cited as ways to achieve some balance or manage stress.⁵ One can build greater self-awareness through discussions of philosophical texts,⁶ emotional intelligence assessments,⁷ situational judgment tests,⁸ and introspective practices such as journaling.⁹

Finally, “self-awareness” embraces the humanity of healthcare professionals that AI models cannot fully emulate. Self-awareness is debated as a distinguishing attribute lacking in artificial intelligence models. While AI programs may communicate emotively to adjust to a user’s preferences, they mimic emotions based on their training data rather than as an organic feeling or reaction. Programmers remain challenged to see if an AI program can develop feelings or a sense of morality on its own. While one can train an AI bot on the fundamentals of medical ethics, health professionals’ self-awareness should make human providers indispensable.

In contrast, cultural humility acknowledges external systems and structures that shape communities. A goldfish living in a bowl may have self-awareness of its own environment of light, food, and clean water, but may not have the “cultural humility” to know that different goldfish may live differently, with infrequent feeding or bowl cleaning.

How Health Professions Programs Emphasize Self-Awareness

Most applicants notice that self-awareness is not identified as a core value or desired attribute. “Self-care” is mentioned in three program mission statements (Alice Walton, Alix Mayo Clinic, and and Robert Wood Johnson Rutgers), but “self-directed” is mentioned in four (Pritzker University of Chicago, University of Illinois, Washington University St. Louis, and Ohio State University). It is less clear how self-awareness is reinforced or further taught in medical schools. Most efforts in self-awareness may be presented as a mindfulness/flourishing, or resilience-building module within a professional identity formation program.

Interestingly, the Floyd Washington State University School of Medicine discusses Medical School Professionalism and Self-Awareness in its Student Handbook,¹⁰ making self-awareness a necessary component for emulating integrity, respect for others, and humility in a privileged role. They specifically call out a practice of “self-awareness, self-monitoring, and self-governance.”

Self-Accountability as an Observable Competency

Demonstrating self-awareness requires setting expectations and goals that reinforce one’s self-image, values, and vision. To achieve these goals, you must establish patterns or systems to monitor progress and remain accountable until you meet or change your final objectives. As suggested in the 2025 HPSA Profile of the Accepted Applicant,¹¹ successful prehealth students find themselves in supportive communities that help one another achieve their goals.

When applicants are asked to explain personal weaknesses, bad grades, or institutional action citations, interviewers seek evidence of the candidate’s self-accountability by accepting the outcomes of previous choices and creating new systems to actively monitor their improvement. Candidates may also embrace a role as an accountability partner to help others avoid similar mistakes or support others’ recovery from them. Consequently, accountability overlaps with a “commitment to learning and growth” and embracing an “ethical responsibility for self and others.”

Pharmacy educators list three progressive stages that can frame self-assessment evaluations: valuing and internalizing, defining and modeling, and opportunities and practicing.¹² Students can observe their progress in self-assessment by documenting entrustable activities in self-reflections, portfolios, and mentoring conversations.

Systems that Support Self-Accountability

One can measure self-accountability by identifying intentional practices through self-assessments and 360-degree feedback from other observers. The 20-question Personal Accountability Self-assessment¹³ may serve as a conversation starter for identifying self-accountability strengths and weaknesses to include in your letters of recommendation. Ask what assessment inventories are used at your desired programs to frequently monitor and discuss ways to become more self-aware and accountable; how do these self-reporting tools contribute to subsequent comprehensive evaluations for residency or graduate training?

Because of the revised focus on “Self-Awareness” and “Understanding Others,” I now presume that Cultural Awareness and Cultural Humility are desirable additional competencies.¹⁴ While “self-awareness” rewards efforts focused on self-discovery by “looking in a mirror,” the ability to see one’s journey in a broader context may be valued only to determine program fit and mission alignment. Programs must articulate how their curricula and student support systems nurture self-awareness and understanding of others for professional development among learners, staff, and faculty (for example, AAMC Aspiring Docs, ScribeMD¹⁵). Measurable outcomes of how self-awareness workshops improve the learning environment and leadership effectiveness in health professions programs are unclear, and prospective applicants should ask how their program leadership is accountable for their own self-awareness as a model for their learners and faculty peers.

Conflict of Interest Disclosure

The author serves as Director of Advising Services for the Health Professional Student Association, which publishes SDN Review and produces the HPSA Profile of the Accepted Applicant referenced in this article.

AI Use

Many resources were found through searches mediated through Claude, Gemini, and Perplexity. The author wrote the abstract, initial drafts, and resource descriptions, with editing facilitated by Grammarly.

References

1. Association of American Medical Colleges. Premed competencies for entering medical students. AAMC; 2026. Accessed April 20, 2026. https://students-residents.aamc.org/real-stories-demonstrating-premed-competencies/premed-competencies-entering-medical-students (opens in new tab)
2. American Dental Education Association. ADEA AADSAS resources and FAQs, 2026-2027. ADEA GoDental. Accessed April 21, 2026. https://www.adea.org/godental/Apply/resources-and-faqs (opens in new tab)
3. Chuck E. Getting to know you with the Big Five personality traits. Student Doctor Network Review; 2025. https://www.studentdoctor.net/2025/07/10/getting-to-know-you-with-the-big-five-personality-traits/
4. VIA Institute on Character. VIA Character Strengths Inventory. Accessed April 20, 2026. https://www.viacharacter.org/ (opens in new tab)
5. Student Doctor Network. Thriving in school: integrating stress intervention practices; 2015. https://www.studentdoctor.net/2015/03/24/thriving-in-school-integrating-stress-intervention-practices/
6. Student Doctor Network. The meaning of life: finding insights in the humanities; 2024. https://www.studentdoctor.net/2024/11/21/the-meaning-of-life-finding-insights-in-the-humanities/
7. American Medical Association. Should medical school applicants be tested for emotional intelligence? AMA Journal of Ethics; 2006. https://journalofethics.ama-assn.org/article/should-medical-school-applicants-be-tested-emotional-intelligence/2006-07 (opens in new tab)
8. Student Doctor Network. Show me about yourself: virtual interviewing platforms for health professions programs; 2021. https://www.studentdoctor.net/2021/12/11/show-me-about-yourself-virtual-interviewing-platforms-for-health-professions-programs/
9. Student Doctor Network. Practicing the art of reflection with a prehealth journal, podcast, or online blog; 2024. https://www.studentdoctor.net/2024/10/31/practicing-the-art-of-reflection-with-a-prehealth-journal-or-podcast-or-online-blog/
10. Washington State University Elson S. Floyd College of Medicine. Professionalism and self-awareness. Student handbook. Accessed April 21, 2026. https://medicine.wsu.edu/md/student-affairs/student-handbook/professionalism/ (opens in new tab)
11. Health Professional Student Association. 2025 HPSA profile of the accepted applicant. HPSA; 2025. https://www.hpsa.org/wp-content/uploads/2025/10/Profile_of_the_Accepted_Applicant_2025.pdf (opens in new tab)
12. Odem S, Kellett K, Maxwell W, Whalen K. Best practices for self-awareness and professionalism to meet the curriculum outcomes and entrustable professional activities. American Journal of Pharmaceutical Education. 2025;89(5). https://www.ajpe.org/article/S0002-9459(25)00049-X/abstract (opens in new tab)
13. Pharmacological Sciences Training Program, University of Michigan. Personal accountability self-assessment; 2014. https://medschool.umich.edu/sites/default/files/2023-08/Personal%20Accountability.pdf (opens in new tab)
14. Student Doctor Network. How to assess your pre-professional competencies; 2024. https://www.studentdoctor.net/2024/03/15/how-to-assess-your-pre-professional-competencies/
15. Association of American Medical Colleges. ScribeMD self-reflection program for medical students. AAMC Aspiring Docs. https://students-residents.aamc.org/medical-student-well-being/scribemd-self-reflection-program-medical-students (opens in new tab)