Playing the Infinite Game: Relationships in Residency

In Finite and Infinite Games, James P. Carse describes two types of games: the finite, which are played to win, and the infinite, which are played to continue the play.

Medical training often feels like a series of finite games—pass the exam, get through the rotation, master the procedure. But in reality, residency is part of a much bigger, ongoing, infinite game: becoming and remaining a good physician, colleague, and contributor to the profession over a lifetime.

Seen this way, relationships with peers, staff, nurses, and mentors are not transactional—they’re foundational. And like any long game, these relationships will face strain: miscommunications, moments of tension, even conflict. In the intensity of training, it’s easy to see these moments through a finite lens—right versus wrong, winning an argument, defending your position.

But that mindset is short-sighted.

I didn’t always see it this way. It took me years—and more than a few broken relationships—to realize that professionalism isn’t about being perfect, or always being “right.” It’s about being able to repair and restore. I learned the hard way that unresolved conflicts don’t disappear; they linger, and can quietly shape how we work and who we become. Only by taking responsibility for my part in those situations did I start to understand the deeper work of being a physician.

In the infinite game of medicine, preserving and restoring relationships is essential. The ability to reflect, apologize when needed, seek understanding, and move forward in good faith is not a soft skill—it’s a survival skill. It’s how you stay in the game.

Why does this matter? Because medicine is deeply relational. No one practices alone. The colleagues you support today may be the ones who support you tomorrow. The culture you help build now is the one you’ll inherit as staff. And the trust you invest in can carry forward for decades.

Residency is not just about becoming competent—it’s about becoming sustainable. Restoring relationships when they rupture isn’t a detour from your growth as a physician; it’s a defining part of it.

Play the infinite game. You’re not just training to win. You’re training to continue. Together.