During my medical student training, I was lucky enough to be a sports scholarship holder playing Australian rules football (AFL) at the University of Sydney. I played for the NSW representative team and we competed against reserve team professionals from:
Our pre-season commenced in October, with time trials starting day one. And the season itself ran for six months, potentially ending in late September. Training and the interstate travel schedule meant that much of my weekends were occupied. In addition, there were late-night training and early morning strength and skill sessions. As well as additional work such as video reviews, recovery, and attendance at club events. I am currently playing in the AFL Sydney first grade competition and have been involved in various positions of leadership and coaching throughout my time in football.
Sport and medicine can seem quite disparate to some with the end goal of team sport a seemingly superficial pursuit of winning and the other directed toward a more impactful and humanitarian purpose. However, sportswomen and men possess traits that are sought after in medical trainees. Medicine, too, is a high-performance environment. An effective doctor, like any high-level team sportsperson, is paid to perform at an exceptional level. In my more than ten years playing AFL at a semi-professional level, I identified key attributes transferrable to my role as a medical professional.
The best teams I have played in are often a reflection of their leaders. These leaders are individuals who balance the need to contribute their own talent with a selfless devotion to the pursuit of the team’s goals. The most influential leaders I have witnessed led by example and treated each member of the team as equal, regardless of their talent.
Little things, such as remembering new and junior team member’s names (not always a strength of mine!). And performing simple tasks not expected of an experienced player would create a collegial environment. These acts improved the ‘buy-in’ to the team ethos and make individuals feel valued and worthwhile. For example, after one of my teammates suffered a serious accident, our captain raised funds for the player’s medical costs by cycling for over 500 kilometres continuously. An inspiring and also a humbling experience for our team.
As an intern, senior colleagues in positions of leadership performed simple, considered acts to include other team members. Examples included my registrars sending me home on time when possible. Or consultants asking about my weekend or taking time out from the round to buy the team coffee. Another instance that particularly resonates with me was when a term supervisor brought me a Casio calculator watch after hearing I was a ‘Back to the Future’ fan. These leaders were inspiring and made you want to join them on their journey. The best leaders I have come across have their own unique style and leave a legacy, wherever they work or play.
AFL relies heavily on individuals contributions to a team. The most successful teams I played in had players willing to commit to team principles and values above their own aspirations. These teams would clearly outline communal goals, values and behaviours. Individuals then joining the program could identify these goals and would more easily find his place and role within the team. Teams that were unable to identify their collective goals often underperformed.
During my emergency term, I witnessed incredible examples of teamwork on a regular basis. One evening, a high-speed motor vehicle accident came in and the trauma code was activated. The team assembled prior to the patient’s arrival. Surgical doctors, emergency doctors and nurses, radiographers, clerks, anaesthetic and intensive care staff were all assigned specific roles.
The patient was critically ill. Yet, within minutes the bleeding was stemmed, intravenous access obtained, fluid resuscitation administered, pelvic and long bone injuries identified. And binders were placed to allow the patient to be stabilised for intubation and emergency laparotomy. It was incredible to observe the teamwork which allowed a methodical and timely response to such a critical situation.
The concept of team culture is complex, with many contributing variables. When I first started playing senior football, I entered a team that was relatively successful, but had a mediocre team culture. The senior coach did not talk to players outside the first team. And he had his favourite senior players who he selected week in, week out, despite consistently average performances. This left new and talented junior players out of selection potential. Additionally, the senior players saw newcomers as a threat and some would do their best to make them feel unwelcome.
As a player who experienced this culture first hand, and who was then involved in its successful rebuild with a resultant improvement in the on-field performance, I was able to better understand the elements required for a good team philosophy. As I became more senior, I found that consistently working on these components significantly improved our team performance more than any other aspect of our program. I also saw how many teams would unsuccessfully try to reproduce the blueprint for a profitable culture, without adapting this to match the uniqueness of different teams.
Part of our culture rebuild saw a movement away from winning as the sole marker of success. Instead, the process of training, individual improvement, culture, coaching and physical preparation became additional measured endpoints. Considerable time and resources were allocated to education, employment, chapel services, mentoring and psychology services for players. This investment made us feel valued and proud of our club. It was promoting motivation on and off the field. Many people in sport refer to the famed culture of the All Blacks, New Zealand’s national rugby union team.
In James Kerr’s book, Legacy1, the author talks with amazement about an All Blacks game where he witnessed a number of senior players sweeping the sheds and cleaning up the rooms after the game. One of these players was a former world player of the year. This scene exemplified the humility of these superstars and their willingness to take on and perform lesser roles that perhaps people in other teams would not feel worthy of their time.
Although culture in the workplace is a topical issue in medical training, my experiences as a JMO have been positive. I have felt comfortable approaching senior clinicians for advice. And I’ve felt well supported by registrars, medical administration staff and nurses. Issues such as understaffing, unpaid overtime hours and a lack of focus on education and wellness are being addressed, allowing for a much richer learning experience.
For example, the initiation of the junior medical officer (JMO) Evening Teams Service at my hospital has allowed for a dedicated evening shift JMO (who has not worked during the day) for each major service in the hospital. Allowing the day shift JMOs to leave work on time. In contrast to the blunt and hierarchical approach taken by some of my previous football coaches, the healthcare system has worked hard to remove hierarchical barriers that have previously impeded JMO development. The teaching, learning and experiences I have received from senior colleagues have fast-tracked my maturation as a junior clinician.
Setting and maintaining challenging but fair standards that allow an individual player to retain his or her autonomy can provide a foundation for success. In medical school and as a JMO I enjoyed tutors who challenged me and expected a certain level of performance. For example, I loved that my Neurology professor expected a complete neurological exam in the first week of our physical examination tutorial. I then learned that this was maybe a bit ambitious.
In football, our standards encompassed performance at training, game day and importantly, general behaviour outside of the playing arena. This behaviour encompassed how players treated support staff, supporters and fellow teammates. As well as their attitude towards university study, and the way they presented themselves at club events. Small details were examples of poorly learned behaviours which we would try to coach out of our players. Such as turning up late for your scheduled physiotherapy appointment. Or players who started running before the whistle during a set of sprints
To avoid player misunderstanding, it is important to clearly outline and communicate the set standards to foster improvement. When starting a new term as an intern, I found that my supervisor’s orientation and mid-term assessments were important milestones. They allowed me to understand the requirements of my job and where there was room for improvement. Some of my colleagues who received poor marks at the end of term were confused. They had received no orientation and good mid-term reports. When I first started on the wards, it was the interns or residents who had come before me that I turned to, to understand the expectations and standards of a junior doctor.
Throughout my time in sport, and more recently in medicine, I have been lucky to have great mentors. Mentorship can come about formally through structured programs or, more commonly, on an informal basis. At the two football clubs I have played at, formal mentorship groups have been established to allow everyone the opportunity to have a mentor. Outside this program, one of the senior players became a mentor through his willingness to teach and engage with my desire to listen.
Perhaps he recognised the timidness of a country kid. I was quite stunned by the bright city lights of Perth when I first moved to the city. He would always be looking over his shoulder for me and my mates. He was able to help me understand what was required to play senior football in the Western Australian Football League.
Through my current football club, I was put in contact with a former captain, who allowed me to shadow him in the emergency department as a junior medical student. Often, I would leave those shifts embarrassed at how little I knew. But the staff would always support my learning and invite me back the following week. These mentors have had a profound impact on me personally and on my career in sport and medicine. They would often take time out of their busy lives to simply listen and give a gentle suggestion or nudge in the right direction.
I found that support especially helpful when things were not going well. They would help me navigate through the same issues they faced when they were at a similar stage as me. I could ask them anything and they would always come up with a helpful answer if needed. Often, I found they had made me answer my own question without me realising at the time! I would recommend that every medical student or JMO put some time into seeking out a mentor. There are many people out there who are willing to help us.
Having hobbies or pursuits outside of medicine can provide a fledgling doctor with tools. Such as the importance of teamwork, meeting standards, and the value of a robust workplace culture to navigate training as a student and JMO. Team sport has certainly given me many non-clinical skills that I have taken into medicine and adapted to benefit me. Keeping busy with hobbies or activities can also give a junior doctor joy and motivation in times when he or she may not be getting that at work. Having the support of a team of people, or an involved mentor to lean on can also help during these times. As these people become part of your network and as your network becomes bigger and stronger, the less, hopefully, you will feel you are doing this on your own!