Three Rules for Getting Honors

By: Dr. Michael Ho

When I was a third-year medical student at Washington University, the Department of Surgery just hired a new surgeon to become chief of the department, Samuel Wells. Dr. Wells was straight-laced, perfectionistic, and fastidious about attire. And he almost never gave out honors.

It was then that I learned about the three rules of how to get honors in surgery:

(1) You had to be smart

(2) You had to work hard

(3) You had to be lucky

You had to be lucky because:

(1) The only way to get honors was to present a Grand Rounds before Dr. Wells.

(2) The only way to present at Grand Rounds was to get an interesting case.

(3) The only way to get an interesting case was to be assigned one during your surgical rotation.

And that was a matter of pure luck.

During my rotation, I was assigned an elderly patient with diverticulitis, a relatively banal disease in the world of academic surgery. The best I could ever earn was a high pass. But my apartment mate, Matt, was given a patient with a more esoteric disease, systemic lupus erythematosus. Honors was within his grasp.

Matt became a man possessed. He stockpiled facts about lupus like a nation going to war. When I went to sleep at night, he was still awake, studying lupus. When I woke up, he was still perched at his desk, reading about lupus. As the day of Grand Rounds approached, he knew it all.

“Did you know that lupus patients with a butterfly rash may have a milder disease? Did you know that the most common cardiac manifestation of lupus is not coronary artery disease but pericarditis? Did you know lupus is one of the ‘great masqueraders’ in medicine, including syphilis and tuberculosis?”

It was annoying, but impressive. Matt was asked to give Grand Rounds. His performance was brilliant. He received the only honors in our group.

We all know stories like that of Matt. Some would say he just got lucky. But as a witness to his toil, I knew better: Matt worked like the devil.

It is surprising how frequently luck – and the opportunity to excel – enters our lives in the form of jobs, assignments, duties, or tasks. Yet we ignore its call, forsaking the sanctity of luck.

The reasons always seem to make sense: We don’t have the time. We don’t have the experience. These arguments may be legitimate. But often, they merely reflect our fears and penchant for inertia.

The other, more insidious reason we turn our backs on fortuitous opportunity is lack of imagination. We fail to see how taking on even the most mundane and menial of tasks can yield a cornucopia of personal growth, important relationships, and benefit to the community.

As a junior attending, I took on a job no one else wanted: conducting the biweekly morning report. The preparation involved was not trivial. But it helped me prepare for my boards, enhanced my teaching skills, and benefitted the residents, who appreciated the opportunity to learn. Because of that opportunity, I earned the award for teacher of the year.

One of my colleagues was asked to write the hospital’s moderate sedation guidelines. Begrudgingly, he accepted this seemingly odious task. But the guidelines led to the administration-supported end to numerous unsafe sedation practices throughout the hospital. Just in time for a Joint Commission inspection, which the hospital passed.

Another colleague was asked whether he wanted to run the schedule for the operating room. It was a thankless duty that offered no extra pay, required him to stay late, and only promised headache and compromise. But he accepted the job, conducted himself with distinction, while simultaneously honing his logistical and people skills. He was later elected to become head of his group.

The value of luck in success is well-recognized and cannot be overstated. But the unfortunate truth is we often don’t recognize the many veiled forms luck can take, nor take full advantage of luck when it comes knocking at our door.

So the next time you are given a project that no one else wants, especially when you have no choice, recognize it for what it is: luck in disguise. Be smart, work hard, and impress others with your intelligence and imagination. Make excellence your brand.

With any luck, people will notice. And even if they don’t, the experience will refine your abilities and build your self-confidence. This makes you better prepared to take advantage of the next time opportunity comes your way.

My favorite quote of all time is by the smart, hard-working, some would say fortunate American icon, Thomas Jefferson, who quipped, “I’m a firm believer in luck, and I find the harder I work, the more I have of it.”

My modern-day corollary: Luck has no chance if it’s left unnoticed or one fails to work hard.

Dr. Michael Ho is the Director of Anesthesiology Consultants, an educational organization that helps physician anesthesiologists understand the complexities of anesthesia and pass their written and oral board exams. With over 20,000 hours and 30 years of teaching experience, Dr. Ho has helped thousands of anesthesiologists pass their boards and become Perioperative Consultants – despite his earning only a high pass in surgery.

Wondering what it takes to become a board-certified Consultant Anesthesiologist? Learn more at Anconsultant.com.

Editor note: I became a board-certified anesthesiologist in the fall of 2018, thanks in no small part to the preparation offered by Dr. Ho. While my prior board scores would have suggested a decent likelihood of passing, the reputation of Dr. Ho for excellent preparation for the boards and real-life anesthesia drew me to his organization. I still use and share information from his course to this day and am very honored to be able to share this guest post by him. We have no financial relationship.

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