You Belong Here

Why do so many medical students feel alone while surrounded by so many people living through the same experiences?

In this episode of The Only Life You Could Save, Dr. Cassie Ferguson explores belonging—the often-overlooked foundation of well-being, resilience, and human connection. She examines how comparison culture, competition, scarcity thinking, and the pressure to "fake it till you make it" can leave students feeling isolated, disconnected, and unsure of their place in medicine.

Drawing on research, personal stories, and lessons learned from years of mentoring medical students, Dr. Ferguson unpacks the hidden forces that undermine belonging, including stereotype threat, perfectionism, and the confusion between fitting in and truly belonging. She challenges the myth that belonging is something we earn through achievement and offers a different perspective: belonging is not a reward for success. It is an inherent part of being human.

Through practical reflections and the powerful "Just Like Me" practice, this episode invites listeners to move beyond comparison and reconnect with their shared humanity—both with colleagues and with patients.

In this episode:

• Why comparison culture is so damaging in medicine
• The difference between competition and collaboration
• The "superchicken" experiment and what it teaches us about success
• Scarcity mindset and its impact on community
• Stereotype threat and belonging in medical education
• The difference between fitting in and belonging
• Why authenticity can feel risky in medicine
• The role of shared humanity in compassionate care
• The "Just Like Me" practice for connection and compassion

Key Takeaway:
Belonging is not something we achieve through grades, accolades, or fitting a particular mold. It is something we remember. When we stop measuring ourselves against others and recognize our shared humanity, we create the conditions not only for our own well-being, but for deeper connection, stronger communities, and more compassionate patient care.

Transcript

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Today's episode is about something we don't talk nearly enough about in medicine: belonging. As you'll hear, the fear of not belonging, of not being enough, drives so much of the comparison, competition, and silence we see in medical school. It leaves us lonely even when we're surrounded by people who are going through the same thing. It pushes us to fake it, to isolate when we're struggling, and to hide the parts of ourselves that feel too risky to show. In this episode, we'll explore how a scarcity mindset and the myth of meritocracy can damage not only our well-being, but also the communities we're trying to build. We'll unpack the impact of stereotype threat, especially for those who are underrepresented or marginalized in medicine. And we'll ask, what does it actually take to belong in a culture that often rewards performance over authenticity? We'll draw on research, stories from medical students, and personal experience, and I'll share with you a practice called Just Like Me, a simple, powerful way to remember our shared humanity in the midst of all the pressure to measure up. Because at the heart of this conversation is a radical idea. You belong, not because of what you achieve or how you compare to others or whether you fit a mold, but because you are human, just like the rest of us. As we've talked about before, during the first few weeks of class as a first-year medical student, I sat in the very back row of our classroom. I studied by myself. I panicked when I didn't know something, whether it was which pen to buy, because we still use pens then, where to park, or how to use the Henderson-Hasselbach equation, because not knowing signaled to me that I was already behind my classmates, whom I assumed knew everything and to whom I compared myself regularly. Nearly every medical student I've spoken with about barriers to well-being in medical school points to the comparison culture and the sense that they are constantly in competition with their colleagues. A graduating fourth-year medical student when we talked, Sam spoke of how difficult it was to connect with people and make good friends in medical school. He said, you want to be ahead of others. You want to get into a better residency program, you want to go farther and do better things. I'm always wondering if I'm ahead of someone or behind them. And it leads to me not being able to divulge to them what's really going on in my life. Sam's experience points to a phenomenon I see frequently in medical school. Students often approach their peers for validation, validation that they're studying enough, doing enough research, participating in enough extracurricular activities, rather than for true connection. This kind of interaction leaves students feeling lonely, despite being surrounded by a whole bunch of other people with similar goals and aspirations. Even when they join the student organizations, go to all the social events, and put themselves out there, this undercurrent of competition keeps students from the vulnerability needed for true connection and a real sense of belonging. And in this way, comparison and competition become a real source of stress, anxiety, and suffering in medical school. Competition and comparison also can keep students from asking for and giving help. Sometimes when students struggle, instead of reaching out to their classmates and asking for help, they tend to fold in and push harder on their own to avoid confronting the feeling of not enough. And sometimes when they succeed, instead of looking around and pulling the person up just behind them, they keep that success for themselves, fearing that there's only so much to go around. These manifestations of competitiveness in medical school are frequently driven by a scarcity mentality. Students are told and come to deeply believe that there is not enough for everyone to get what they want or even what they need. Good grades, positive clerkship reviews, residency spots, and this fuels fear and unhealthy competition. Keeping a competitive edge feels necessary in medical school because students are made to believe that that's what got them this far. But the constant comparison that's inspired by competitiveness drives individual unwellness and unwellness in the whole community. Margaret Heffernan, who's a CEO and entrepreneur, gave a great TED talk called Forget the Pecking Order at Work. She starts by telling the story of an evolutionary biologist who studied productivity in chickens by counting the number of eggs they laid. Wondering if he could breed more productive chickens, he designed an experiment. First, he chose a group of average chickens. We might call them the B- chickens and left them alone for six generations. Then he chose a second group made up of the individually most productive chickens. Heffernan refers to them as superchickens. And with each generation, he selected only the most productive for breeding. After six generations, the B-chickens were all healthy, fully feathered, and as productive as they'd started. In the super flock, all but three of the chickens were dead. They'd peck the rest to death. The bad news here is that y'all are super chickens. It's not your fault. That's likely how you made it through the gauntlet of applying to and getting into medical school. The good news is that you can now make different decisions about how you interact with one another. As I've talked about before, when I failed my first biochem test three weeks into the first semester of medical school, I woke up to the reality that I needed help. When I moved to the front of the classroom, asked my peers for help, I discovered that I was not the only one who felt lost. In retrospect, taking these steps sounds simple, but at that moment on my career timeline, they were excruciating. It meant rumbling with the fear that my best might not be good enough, which it often isn't in medicine. It meant sharing the imperfect and truest parts of myself that I'd grown up worrying would result in my being rejected or left out. Still, reaching out to my peers, asking for help, and learning that my weaknesses and fears were not unique connected me to my classmates in a way that posturing and pretending would never have allowed. And when I was in a position to help my classmates, I did. Comparison and competition in medical school are fairly well-known obstacles to thriving. There are, however, less obvious barriers that more commonly affect students who are part of a socially stigmatized or marginalized group, and for those students who live in the intersection between one or more such groups. One such barrier is stereotype threat. You might have heard the term stereotype threat. It comes from the work of psychologists Claude Steele and Joshua Aronson back in the mid-90s. Basically, it describes what happens when we're reminded of a negative stereotype about a group we belong to, and then without even realizing it, we start to underperform. One well-known example, female college students tend to do worse on math tests if they're asked to mark their gender before the test starts. Just that teeny reminder can activate all the cultural noise about girls not being good at math, and it takes a toll on performance. Same thing happens with students from lower income backgrounds. If they're told a test is measuring language ability, they don't do as well as their wealthier peers. And even older adults who read a newspaper story about how aging affects memory ended up doing worse on a memory test afterward compared to those who didn't read it. What's wild is that it's not about actual ability. It's the added pressure of not wanting to confirm a stereotype. That pressure clutters your thinking and steals your brain power that you'd otherwise use to focus or problem solve. Stereotype threat is universal. Every single one of us is part of a group that's been stereotyped. The effect of stereotype threat is more harmful, however, when membership in a particular group puts us in the minority. This means that based on the current demographics of medical school, black students, Latino students, indigenous students, older students, students with a chronic illness or a mental health diagnosis, students with children, LGBTQ students, students who are the first in the family to attend college, or students for whom English is not their first language. All of these students may arrive in medical school feeling that they are constantly at risk of confirming a negative stereotype about their group. And the most harmful aspect of stereotype threat is that this feeling can become a self-fulfilling prophecy and negatively impact academic performance. Frustratingly, the effect of stereotype threat tends to be greater the harder a student works at a task and the more that they care about their performance. Even when stereotype threat doesn't lead to underperformance, vulnerable students carry an increased emotional and cognitive burden and may struggle with self-doubt and a decreased sense of belonging. The cumulative toll of contending with such a threat repeatedly and over long periods of time can threaten students' belief that they can meet the demands of the environment. Most empirically validated interventions that decrease stereotype threat in higher education are systemic, which means the responsibility to implement these interventions lies with medical educators and administrators. Up until five years ago, a hallway in our medical school was lined with all the paintings of the former deans of the medical school. It happens that all these former deans are older white men. While removing these paintings didn't change the fact that there has never been a dean of our institution who was not old, white, and male, keeping them up can reinforce the stereotype that physicians are old, white, and male. And just being reminded of the stereotype can increase anxiety and decrease performance in those of us who don't check all those boxes. There are things that you can do yourself to mitigate stereotype threat. Research has shown that even just becoming aware of it may help students attribute their performance anxiety to this phenomenon rather than to the risk of failure. Research also shows that the impact of stereotype threat dissipates if a student can reframe the nervousness that naturally appears before an exam as a potential facilitator of strong performance rather than a feeling that will put them off their game. Understanding that worries about belonging in school are normal and transient and are not unique to your group can increase your sense of belonging. The last obstacle to belonging in medical school that I want to talk about today can be summed up by a phrase that I heard frequently when I was in training. Just fake it till you make it. No idea what those five acronyms stand for that your professor just used? Just nod and smile. Unsure how to hold the retractor for a three-hour operation without losing feeling in your hands? Worry about that later. Wondering how you'll sleep tonight without constantly replaying the moment you saw a patient die for the first time? Just act like it doesn't bother you and cry alone in the stairwell like everybody else. We become masters of disguise in the service of faking it to fit in. We pretend we know when we don't. We act like we can handle it when we can't. We say we're fine when we're not. Fitting in feels like the path of least resistance to belonging in medical school because depending on the situation, standing out in the culture of medicine may be interpreted as incompetence or disruptive or arrogance. And yet true belonging and fitting in are substantively different experiences that have disparate effects on our well-being. As Brene Brown wrote, when we sacrifice who we are, we not only feel separate from others, but we even feel disconnected from ourselves. Or in other words, if I get to be me, I belong. If I have to be like you, I fit in. There's a big caveat here. In medical school, there are times when letting our classmates, teachers, and patients know who we really are and what we really feel, believe, and think feels risky because it is. As someone who's lived through medical school and training and who has spoken with, mentored, and supported hundreds of medical students, it can sometimes feel reckless for me to advise you to be yourself in all situations. Choosing to seek accommodations for dyslexia, sharing with your classmates that you've been treated for depression, wearing hijab on the wards, or speaking up when you witness a patient being ridiculed by the care team on rounds, these choices might make you vulnerable to pity or prejudice or even disdain. They can flag you as an outsider. The tension that students feel between being true to themselves in all spaces and abandoning parts of themselves to fit in is confusing. And there's no one size fits all solution to navigating that tension. First, I just want to acknowledge this tension and say this. When being your authentic self or speaking up feels unsafe, your decision to stay silent demonstrates the wisdom that arrives with experience and listening to your instinct. Second, deciding to fake it until you make it incorrectly assumes that there is a defined point in time that you will have made it. It assumes that there is a finish line in medical training and that once you cross, you will no longer be forced to choose between pretending and being your true self. As Maya Angelou told Bill Moyers in a landmark interview in 1973, you are only free when you realize you belong no place. You belong every place, no place at all. In other words, a sense of belonging cannot be externally derived. It does not arrive when we contort ourselves to fit into the mold offered to us in medical school, nor can it be felt when we refuse to show up in spaces where we fear we will not fit in. The key to belonging, it turns out, is within. The absolute truth of belonging is an internally felt understanding that everything, all living beings, and everything contained in the earth and in the universe, are interconnected, meaning that we all belong. This understanding of belonging has been useful to me because it's not conditional on where I am, the people I'm with, or how I'm feeling. I don't belong when someone deems me worthy of belonging. I belong, period. The transformational part of this as a physician in training is that this felt sense of belonging is not dependent on whether you pass the physiology exam or have the right answer on rounds, or are eventually chosen as one of U.S. News and World Report's best doctors in America. It's not dependent on being in a privileged racial or ethnic group or having been born in a certain set of economic circumstances. You don't access this sense of belonging by comparing yourself to your peers or some past or future better version of yourself. You access it simply by remembering that you belong and then forgetting and remembering again. On the flip side, when you insist on believing that you don't belong, you not only will struggle to feel that you belong among your peers, but you may also struggle to see how much you have in common with your patients. And this limits your capacity for compassion. Pemma Schoden wrote in her book, The Places That Scare You Compassion is not a relationship between the healer and the wounded. It's a relationship between equals. All of us will become better physicians when our care is rooted in an understanding of our shared humanity and our common frailties rather than in pity. In this way, remembering we belong not only impacts our own well-being, but the well-being of those for whom we are charged with caring. The team-based nature of our chosen career also means that we will become better physicians when we see how connected we are to our colleagues. Your medical school classmates are the people whom you will someday trust to manage the trauma patient's airway while you prepare to place a chest tube. These are the people who you will call when you're unsure whether you should operate. The people who will text you in the middle of the night when they can't stop thinking about that patient who wasn't supposed to die. The people who will say to you on your very worst day, we are here, lean on us. What I hope you walk away with today is the understanding that we belong when everything is going our way and we feel like we're on top of the world, and we belong when we've reached rock bottom. Hiding away when we're hurting denies us the compassion that comes with being seen and denies our community the sacred responsibility to bear witness to other people's suffering, which can be transformative. To end, I want to share one of the simple practices I've adopted called Just Like Me. This is a practice for increasing our sense of connection and compassion, and was adapted from Mirabi Bush, a teacher and co-founder of the Center for the Contemplative Mind. It helps us to remember what we share as human beings. You can do this practice by bringing to mind a friend or a mentor, a classmate or a patient. You might think of a family member, teacher, or the environmental service worker you see in the hallway when you're studying late at night. While keeping this person in mind, silently repeat or say aloud these phrases. Later, you can use these phrases or change them to other phrases that seem more appropriate to you. Okay, here we go. This person has a body and a mind, just like me. This person has feelings, thoughts, and emotions just like me. This person has during his or her life experienced physical and emotional pain and suffering, just like me. This person has at some point been sad, just like me. This person has been disappointed in life, just like me. This person has sometimes been angry, just like me. This person has been hurt by others, just like me. This person has felt unworthy or inadequate at times. Just like me. This person worries. Just like me. This person is frightened sometimes. They're just like me. This person will die. Just like me. This person has longed for friendship. Just like me. This person is learning about life, just like me. This person wants to be caring and kind to others, just like me. This person wants to be content with what life has given, just like me. This person wishes to be free from pain and suffering, just like me. This person wishes to be happy, just like me. This person wishes to be safe, strong, and healthy, just like me. This person wishes to be loved, just like me. To bring this practice into your daily life, you might notice when the urge to compare or compete with a classmate comes up. And remember that they worry just like you. When we feel too embarrassed to ask our preceptor a question, we could remind ourselves that our attending has felt unworthy or inadequate in their life too. I want to be clear that this is not a replacement for methods of coming to appreciate our differences. Certainly, while it's true that we are all interconnected, it is also true that we have and are very aware of our separate physical bodies, identities, and experiences. My hope is that you pay special attention this week and the next and the next to how comparison and competition, how our need to fit in, our tendency to isolate and stereotype threat, how these are keeping us from each other. And in doing so, how they're also keeping us from becoming our best selves from the kind of physicians that patients truly need. Thank you for listening, and as always, keep reaching out. I'm grateful that he reached out to ask whether I might record these lectures, and grateful for his talents that made it possible to do so. Thank you also to Dr. Ashley Pavlik, a friend and colleague, and the course director of the Good Doctor at MCW, who makes space for this content in our curriculum. To Dr. Dave Marculis, the chair of the Department of Pediatrics at MCW, who pays for my time to teach medical students about well-being. To my pediatric emergency medicine colleagues who take exceptional care of kids and of one another. To my family who reminds me that medicine comes second. And to my students, past, present, and future, for keeping me honest always. Finally, thank you to Alex Brown for creating our theme song, Cam Collins for his sound production skills, and to Madeline Sturm for her brilliant art and design work.