triathlon

I have often heard it said that the MD/PhD program is like a marathon: one should pace oneself accordingly.  However, having done both marathons and triathlons, I can confidently assert that the MD/PhD is much more like a triathlon, and most like the long (or iron-distance = "Ironman") triathlon.

The typical triathlon has three stages: swimming (2.4 miles), biking (112 mi), and running (26.2 miles).  There is usually a transition area in which one can change clothing if necessary, leave and pick up a bike or change into running gear.  Transitions can be jarring and difficult.  Being good at one discipline does not mean being good at all three.  Most triathletes are experienced in one or maybe two areas and weaker in the other(s).

Starting medical school is like the swim stage: getting in the water can be panic-inducing for the new triathlete, and similarly medical school can be overwhelming.  But after one gets over the initial shock, it can be quite relaxing and enjoyable because this stage is very straightfoward.

The longest stage of a triathlon is the cycling portion.  In the Ironman triathlon, it is 112 miles.  The time to complete this stage is most predictive of overall finish times.  We are advised to take in as much nutrition as possible on this stage, pace oneself on the hills, and stay calm and keep one's heart rate down.  There has to be some gas left in the tank for the marathon to follow.  Nutrition is critical because failure to eat and hydrate properly will result in a crash during the run.  We are supposed to hold back and finish a little slower than the best possible time we can have, because "there's no such thing as a good bike and bad run."

The graduate school portion is similar.  It takes a lot of time, can be a little less intense than medical school, and is an opportunity to refresh oneself relationally, physically, and emotionally.  I have seen many of my classmates push themselves early on only to burn out near the end.  You cannot race the bike portion at the same speed as one would do a century because you still have to run after you get off the bike.

... and believe me, by the end of the bike ride I was looking forward to running.

The last section of the race is the marathon.  I am most experienced as a runner so I was not particularly worried about the marathon - I knew I just had to get myself through the swim and bike ride by the cutoff times.  However, for the MD/PhD, I think I am strongest as a graduate student and scientist and weaker at medical school.

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I think I have flagged a bit towards the end of graduate school.  This is consistent with my race performance, in which I tend to flag a bit in the third quarter and then refocus and finish strongly.

I think my academic performance will be similar.  I have been pacing myself, holding back throughout the past seven years.  I think it is time now to focus, pick up the pace, and go for a strong finish.