Beyond Competence

December 16, 2018
by Mark David Siegel

Supererogation: the act of performing more than is required by duty, obligation, or need.

                -Merriam-Webster

Hi everyone,

The Clinical Competence Committee (CCC) held its biannual marathon last Thursday, beginning at Yale at 7:30A and ending at the VA nine hours later. Katie Gielissen chaired the group of APDs, Core Faculty, and Chiefs. Seonaid Hay entered scores on the computer, and Alfred Lee kept us on track- 2 minutes per trainee, max.* Clinic preceptors made cameo appearances throughout the day, and Brett Marks filled our bellies with sandwiches, coffee, salads, cookies, brownies, and hot chocolate. By 4:30P, with the sun fading outside, we finished the last of 138 files. We applauded Katie, cleaned up the conference room, and filed out into the West Haven mist to board the shuttle back to New Haven.

The CCC’s charge is to monitor trainee performance, and I’m happy to report that you’re all on track for promotion or graduation, though some of you will be hearing from advisors about areas to work on, like cleaning up inboxes, finishing notes on time, prioritizing clinic agendas, and creating more effective study plans- standard fare for otherwise high-performing residents. 

The lack of serious trouble gave us time to praise your special efforts- like when you scour the literature to make elusive diagnoses, when you double check orders to avoid mistakes, when you visit radiology to ensure nothing is missed, when you linger at the bedside to reassure a frightened patient, when you practice presentations with medical students, when you stay late to settle crises, and when you unload work from tired friends. These are all examples of going beyond the call of duty, which is what we mean by supererogation. 

Some have argued that the practice of medicine is supererogatory by its very nature. Others disagree, claiming that when we do our work, we’re just meeting the obligations we agreed to when we signed up for medical school. We won’t settle this dispute today, beyond acknowledging that we can see extraordinary efforts wherever we look, whenever we pay attention. You are beyond competent, because your work is exceptional. You inspire us, or, as the CCC would say, you are aspirational. In a word, you are supererogatory. 

It is a privilege to watch you grow. Enjoy your Sunday, everyone,

Mark

*It only takes two minutes per trainee because the advisors prepare the files beforehand...

PS If you want to wade more deeply into the topic of supererogation in medicine: 

https://jme.bmj.com/content/medethics/28/2/70.full.pdf

https://jme.bmj.com/content/medethics/28/2/68.full.pdf

https://jme.bmj.com/content/medethics/28/2/75.full.pdf

MDS

Submitted by Mark David Siegel on December 16, 2018