Advice for New Rheumatology Fellows: Construct Winner’s Triangles

June is always a bittersweet month, at least in academic medicine. We get to look forward to a new fresh set of faces coming into our training programs, but we also have to say goodbye to those once-fresh faces that have progressed through their medical education journeys. These transitions are never easy, neither for the trainees nor for programs. Yet they are an inevitable part of our lives, and they provide milestones that allow us to assess how far we’ve come.

To those fresh faces entering our specialty: I want to welcome you with some advice as you progress through fellowship.

And to those who are less fresh faced: I guess it’s never too late for some unsolicited advice.

Between memorizing the complement cascade and learning how to examine a swollen knee, remember to construct winner’s triangles in your professional life.

What is a winner’s triangle, and why is the concept so important? Let’s rheuminate!

Winner’s Triangles

The winner’s triangle is a concept developed by Acey Choy in 1990 and was based on mid-20th century theories about social relationships.¹ These theories are part of transactional analysis, a psychoanalytic framework in which social interactions are analyzed to determine the ego state and understand behavior.² Because this magazine is not The Psychologist, I’ll spare you the details, but will simply say transactional analysis has its origins in Sigmund Freud’s ideas.

One social model that came about from transactional analysis was the drama triangle, described by psychiatrist Stephen B. Karpman, MD, in 1968.3 Dr. Karpman envisioned triangles that mapped onto relationships. At the three vertices are three roles: the victim, the rescuer and the persecutor. According to Dr. Karpman, victims believe they are powerless at the hands of a perceived persecutor and seek help from a rescuer. Unfortunately, according to theorists, these relationships then reinforce each other and take on a life of their own, with people exchanging roles.

Personally, I find this social model overly negative, simplistic, fatalistic, manipulative and misanthropic. It certainly seems to be a product of its time, and although some aspects do resonate, I’m not sure it captures the gist of the human experience. This was the basis for Acey Choy’s innovation, first published in 1990 and further elaborated on in 2009.⁴ Rather than a drama triangle comprising victims, rescuers and persecutors, the winner’s triangle comprises creators, challengers and coaches. These are the relationships I would strongly encourage all trainees, if not all rheumatologists, to engage in.