Not winning is good for you

ABSTRACT

While we will all have personal experience of losing, the increasing use of awards has raised concerns that the beneficial effects both of winning and of losing may be diluted. I will explore background concepts of both winning and losing, considering the potential advantages of awards when delivered via a competitive and just structure. Great advantages can come from losing, which are often more significant than those obtained merely through winning. I illustrate this point with my own background and that of the distance learning clinical neurology course that I help run at Queen Square. Finally, I use the example of our course as a way that some challenges currently facing medicine in the matter of neurology numbers can be tackled.

Introduction

We all know what it’s like to lose. Whether it’s losing a race at school or losing in the battle to save a patient’s life, losing is an inevitable part of living. I am writing this piece fresh from one such scenario. Our distance learning clinical neurology course team was at the Royal College of Physicians (RCP) in London in May 2019. We had been delighted that our course had been shortlisted for the Excellence in Patient Care Awards. Even so, when the winner was announced, there was a tinge of sadness that it was not us. Often the biggest problem is the messy package that comes associated with losing. It is not so much the word itself, but the full stop which follows it, suggesting an irredeemable failure. The fear of failure can prevent us from even taking part, worrying about the shame of not succeeding. This fear in turn really can lead to us failing to reach our true potential.

Tackling the fear of failure by expanding awards

Rather than tackling concerns of failure head on, there has been a tendency in society to increasingly reward mediocrity to try to avoid losing altogether. Commonly these days, participation alone in events at schools is sufficient to justify an automatic award. Such has been the proliferation of prizes in recent decades that it has been estimated that there are currently more film prizes awarded each year than there are full length films produced.¹ Just a few years ago the overall estimated value of the trophy and awards industry was estimated at US$3 billion in the USA and Canada alone.² As there is evidence that awards are more likely to be valued when the conditions and the procedural utility of award allocation is deemed to be just, being too free with awards may lessen their value.³

Even if one agreed with the approach of increasing awards in contained environments like schools and colleges, real life, of course, is built around times of losing. Setting students up with easy wins may ultimately put them at risk of not achieving their goals. On the other hand, there can be real benefits to awards when judiciously bestowed. The term phaleristics (with both Greek and Roman roots) embraces the study of awards. Work in this field has shown that awards can certainly be beneficial, interestingly, for both the giver and receiver, and that this does not require additional monetary incentives.⁴ Sir Winston Churchill stated that ‘a medal glitters, but it also casts a shadow’ referring to the negative effects not winning an award can have.^4,5 This concern of ‘crowding out’ non-recipients, however, seems more relevant to monetary rewards than symbolic prizes such as ceremony awards.⁶

Learning to lose

So if awards can be justified and losing is inevitable, how should we proceed? To answer that I ask you to think about someone you admire – not just someone you want to be, but who you hold in high esteem. The chances are that you will know of some major loss that they had to overcome in becoming that figure of respect. I might name Louis Braille, who lost his eyesight as a child after an accident with the awl his father used to make holes in leather. Braille overcame the loss of his vision in a remarkable way, developing the tactile system of writing that bears his name by embossing paper with an awl. Losing will not automatically make us stronger, learning how to lose however can be seen as an essential ‘acquired skill’.⁷ Each of us will have moments in our life where we fought back against failure or loss. For myself, I think back to my disastrous first attempt at medicine; failing in my second year and having to work for years for a chance to start again. When a student dropped out of medicine at another medical school too far in for an A-level student to replace them, I was given the precious gift of a second chance. I kept working hard and ended up top in my class with prizes and distinctions. None of that would have happened but for my earlier failure. Nor indeed do I think I would have been able to pursue a career in neurology, often seen as a complex or even intimidating subject.

My own perspective and our course

My own striking failings of the past have given me a real passion to help teach and support learners. As well as clinical work as a consultant neurologist, I am co-director for our distance learning clinical neurology course at University College London Queen Square Institute of Neurology. This was the first distance learning clinical neurology MSc in the world. All our students (over 100 were registered in 2018) are practising doctors based both in the UK and worldwide. Some are aspiring neurologists, others general practitioners, medics, neurosurgeons or psychiatrists. While traditional face-to-face neurology courses exist, they may not fit a doctor’s schedule and often require significant travel, while online learning in medicine can be beneficial for the learning process.⁸ An advantage of a distance learning course is the flexibility that this provides and it mirrors the increasing use of online technology by trainees in medicine.^9,10 Our recently updated course utilises over 400 e-lectures with multimedia which have been developed by experts across Europe. In addition, strong engagement is provided by the tutors with monthly activities, forum pages by time zones, journal clubs and videos. We offer link-ups by Skype and are developing potential additional online resources, such as podcasts and instructional videos too.

Not winning can be good for you

After our course team learnt that we had not won an Excellence in Patient Care Award at the RCP, Emma Vaux, vice president of education and training, did a good job of consoling those who had not won with a speech. She used the phrase ‘not winning can be good for you’ and I determined to put that to the test by emailing her to ask for chance here to demonstrate the service we can provide. We had come to the award ceremony not seeking glory but rather trying to promote our course. We are a small group of neurology consultants and administrators who are passionate about our course. Neurology is very common in medicine, indeed you cannot really escape it in any specialty. It does not help that there are not enough neurologists in the UK. Indeed neurology is still a ‘shortage specialty’ in the UK with just one neurologist per 115,000 members of the population in 2006.¹¹ This is still a major problem in the UK and other high income countries.¹² The situation in developing nations is far worse. We strive to do what we can to aid the teaching of clinical neurology, in keeping with suggestions regarding the use of distance learning and improving neurology teaching access to non-neurologists. The distance learning approach on our course has been tried and tested now over the best part of a decade. We want to do our bit to help tackle the ‘crisis’ facing neurology numbers through the powerful tool of online learning.¹¹ We are happy to hear from any doctors who are interested in joining our course.

Conclusion

Whether we feel a loser now or will be a winner in the future can depend simply on where we put the finish line. I would encourage you to try and maximise your development when you do not win, while fixing your eyes on the prize that still may lie ahead. As for us, we are very much putting this into practice. Even though we did not ultimately win at the Excellence in Patient Care Awards, we appreciate being shortlisted and still aim to keep further improving our course with enthusiasm and determination. If you would like to find out more about joining us on our online clinical neurology course, please do email me at t.young@ucl.ac.uk – I look forward to hearing from you!