Most morbid views of life are also practical. If you consider your mortality, all games are finite. But here, infinite games are the ones that outlive you. Most of what I discuss here is much more eloquently written in many other books. Finite and Infinite Games by James P. Carse and Intern’s guidebook by Dr. Dustin, OME are the two books that mention it very well. Here is my take on infinite games of residency:
What are finite games?
These games have rules, a start and stop time and clear guidelines on how to win. Examples of finite games include getting into medical school, passing medical boards in your home countries, passing the USMLE Steps, matching your residency program, etc. In finite games, you see yourself and others as simply playing a role in achieving your goal. We can collaborate like studying together, but the end goal is still YOU passing the exam.
Remember how exhausted you felt right after you grind through these finite games. They are necessary evils. You want to get into med school and there are limited seats. You will have to compete with someone else to get that seat.
Finite games often leave people crushed, and while we may have achieved a "win," it often comes at the expense of someone else's loss. Half of us who apply for the match, unfortunately fail. Perhaps we've developed some survival skills along the way, but now it's time to stop playing finite games and start playing infinite ones. One because they are called finite for a reason—you can only bare the toxicity for so long. And two because life is more than a competition.
What are infinite games?
Like the games we've played, residency has a start and end point (three years for IM), rules (You will be handed a guidebook!), and a test to wrap it up (The ABIM). You can play a finite game and "check the box." However, if you do so, you will soon realize that you missed the point.
In infinite games, there are no endpoints, winners, or losers. The game is about developing your work ethic. It is also about learning to deal with people and building relationships. There is no winning or losing in residency—only effectiveness in patient care. What you do in residency, in some form, you keep doing that for your entire career.
How do you play the infinite game?
Making this transition from finite to infinite games will be challenging, like any change is. You have never had this much support, supervision, and feedback as you will in residency. Residency is the time to learn, grow, and become effective—see what works for you and practice that. You'll have the chance to develop your skills and take on more autonomy. The day you graduate, supervision ceases to exist, feedback becomes rare and awkward and support changes form.
See people as people, including patients and your colleagues. They have emotions, souls, egos, and fears. This will make you effective in all aspects of your work. The more effective you become during training, the more effective you will be in life. Learn to be a problem solver. No matter what problem you think you have identified, I can assure you, you aren’t the first one to discover it. Sometimes the problem is too big to have simple solutions. Other times, it is more effective to work around them. Having a problem-solving mindset is a cognitive skill and a hidden milestone of every residency.
Remember that this game lasts the rest of your life. This is not a time to "get through to see the other side." Embrace the challenges and the learning opportunities. The more you learn and grow, the more effective you'll be for the rest of your career. The goal is to learn to be someone you would love to work with. Think of it as three protected years to let you live a simulation of your future professional life.