car comes with an owner’s manual.
Take care of it, change the oil regularly, have a mechanic
look at it when you hear noise in the engine, and the car should
serve you well for years. Medical
students need an owner’s manual as well.
The four years of medical school are exciting but
stressful. Medical students need to take care of themselves so
that they can make the trip and enjoy it as well. This guide to surviving medical school is designed to help do
just that. It is
written by the Committee on Medical Education of the Group for the
Advancement of Psychiatry (GAP).
All of the members of the Committee have been medical
school faculty and have interacted closely with medical students
for many years. Our
experiences suggest that students who do the best job surviving
Understand something about what they were like before they get
to medical school;
the stressors they might face during medical school;
steps to care for themselves during medical school, in order
minimize stress; and
when they might need extra help to deal with stressful
volume of material to be learned in the next four years is several
times greater that most of you have experienced before.
Feeling helpless and pressured to learn more are normal.
The expected and unexpected challenges and experiences you will
face, sometimes in a state of near exhaustion, can at times be
you are not alone.
the fears, anxieties and distress you will confront, the privilege
of becoming a physician is worth your efforts.
Learn what you need to learn in medical school and you will
be prepared for a lifetime of learning. You will read scores of
books during your medical school years – read this one first for
a smoother ride!
2 – First, Take Your Own Pulse
way we cope with medical school depends to a great extent on what
we’re like before we ever
get to medical school. We
enter medical school with different temperaments, coping styles,
attitudes, prejudices and life experiences.
They can help or hinder us as we try to make our way down
the road to becoming physicians.
Understanding the individual ways in which you tend to cope
with stress, and what types of situations might be particularly
difficult for you, can help you best negotiate the trials and
tribulations of medical training.
Sometimes, we’re not aware of our coping styles and
it is hard to admit to ourselves that we have a particular
characteristic or that we harbor a particular attitude.
But, even if we’re aware of those characteristics and
attitudes they can still affect the way we deal with situations.
Here are some things to think about to begin a process of
– How do we tend to react?
individual has his or her unique temperament.
Some people tend to become anxious, while others have a low
threshold for irritability. Withdrawal
is a coping style for some people, while still others may become
sad periodically. Whatever
tends to happen to us when we are in stressful situation is likely
to happen during medical training.
To begin to understand something about your own
temperament, think about how you tend to behave during exam times,
what happens to you after a break-up with a significant other, or
how you react after a disappointment or criticism.
You can even ask loved ones for some insights into what you
tend to do when things get rough.
This type of self-discovery process can help uncover
strengths as well as problem areas. Traits such as being able to
ask for help, not being embarrassed to admit that you don’t know
something, working well with others, being able to use humor, and
being able to enjoy friendship and leisure activities are
invaluable tools for coping with difficult situations.
Knowing how you tend to react can help you:
what your responses might be
situations you might find difficult
when to look to a strength to help with a weakness
how to look for appropriate resources to support you when you
and Expectations – What do we ask of ourselves?
us worked hard to get into medical school.
Once accepted, we continue to have high expectations for
ourselves. While these may help us constantly strive for excellence,
they can sometimes cause undue stress, especially as overwhelmed
medical students. Acknowledging
these expectations and feelings can be the first step towards not
letting them get the better of us.
Here are some attitudes some of us have, but may not be
Best or Bust.
Those of us who get to
medical school have often spent much of our lives being at the top
academically, or we would not have been accepted.
But always being at the top, or always needing to be at the
top, can be very stressful. The
constant push to be the best may become overwhelming, given the
sheer volume of material to learn during medical training.
We experience information overload!
But, since everyone around us has also been the best, we
have all had to face the fact that we cannot be the best in every
endeavor in medical school.
For many of us, this comes as a shock since medical school
may be the first place we have had to grapple with this
important to remember that just because we’re not at the top
doesn’t mean we’re at the bottom.
we work hard enough, we should be able to understand it all.
times, this is a useful attitude; it helps give us an extra push
from within when we need it.
However, when taken to an extreme, it can also lead to
workaholism, frustration, unrealistic expectations, and
self-defeating behaviors. Although
we may be accustomed to understanding all the material that is
presented, there is no way we can completely master the volume of
material that we encounter during four years of medical school.
Understanding your wish to do so can help you to set more
realistic goals and save yourself unnecessary self-criticism.
doctor has to love everything about medicine
Many of us have known for a long time that we wanted to be
physicians. Most of
us worked extremely hard to be accepted into medical school.
Unfortunately, even if you have relatives who are
physicians you can’t actually know what it’s like until you
begin yourself. Along
the way, some of you will find that it’s not what you imagined
it would be. This can
be difficult. You might even discover that there are aspects of
medicine that you don’t enjoy, or that you dislike or fear.
Some of these reactions are transient and related to being
overtired and stressed. But
some reflect likes and dislikes that will persist.
Feeling that you can’t possibly read another chapter in a
textbook, review another handful of class notes, look at another
pathology slide, or see another patient doesn’t mean that you
don’t belong in medical school.
It may mean that you had bad day, that you need a vacation,
or that you’d rather go into urology than pathology.
Rather than being frightened by these attitudes and
feelings, acknowledging and making peace with them can help guide
you towards the field or specialty that will be most satisfying
and enjoyable in the years to come.
doctor has to always love taking care of patients
close to people can be a great joy, but it can also be a burden.
complain, nag, wheedle, demand, threaten, and arouse our
sympathies and our desires to rescue them from the deterioration
of their health or from death.
There will be times when you’re angry at a patient
or a patient’s family
and there will be times when you just want all the people who are making
demands to go away. Some
people find it too frightening to acknowledge these feelings,
because they think that having such thoughts and feelings means
that they won’t become a caring doctor.
Actually, the opposite is true.
Harboring those feelings without acknowledging them can
lead too much greater resentment than allowing yourself to
experience them and to realize that most professionals who take
care of sick people have similar feelings from time to time.
expectations – What do others expect of us?
cope in medical school is also the product of your past and
present life and family experiences.
Sometimes family members can be extremely helpful by
providing support, being good role models, and giving us love.
But sometimes even the most supportive families have
expectations that put pressure on an already burdened medical
student. It may be
hard to acknowledge that your family is adding to your stress,
particularly if your family is sacrificing emotionally and/or
financially to help you. But
acknowledging this does not mean you love or appreciate them less.
Here are a few ways that family expectations may affect
families think that their status in society or their financial
well-being will magically change if one of their children becomes
a physician. Many
families put themselves into debt in order to finance “their”
medical student. If
your family harbors this type of wish, you may feel that your
family’s financial security depends on your success.
Obviously, this can add tremendous pressure to an already
stress-filled situation. You
may also feel guilty if you need to take a break for fun, or if
your choice of specialty doesn’t match your family’s wishes.
you can answer all of our medical questions!
families think that just because you are in medical school you
should be able to answer all their medical questions – or worse,
function as everyone’s doctor.
Requests for everything from cures for the common cold, to
prescriptions, referrals and second opinions are frequent burdens
for the newly minted medical student.
Your wish to succeed for your family and come up with the
right answers may lead you to put yourself in a position you’re
not ready to assume. Realizing that your family may not understand that you still
have vast amounts to learn may save you from many compromising
situations. It takes
strength to help your family understand that you are not yet a
physician, and certainly not their physician.
Because of the emotional ties you have with your family, it
is best that you not serve as their physician, but rather use your
knowledge of the medical system to refer your family members for
care. As medical
students, there is no reason not to ask faculty members to help
identify such physicians.
us who have other family members who are doctors may feel pressure
to enter the “family business.”
Some may feel pressure to follow in their parents’
footsteps. Some may
worry that they only got into medical school because they had a
physician parent. Parents
or siblings may be more understanding, but they may also feel that
you shouldn’t complain because, “It was tougher when I did
students with relatives in medicine may find it more difficult to
complain about the profession, or to admit that they don’t like
or feel aptitude for some aspect of medicine.
with significant others
significant others who are very loving and supportive may have
times when they are fed up with the demands of your medical
spent studying, nights in the hospital, erratic hours and no
ability to control your schedule could drive even the most
flexible partner to distraction.
A significant other with a demanding job or academic
pursuit in another field may feel that you should be able to have
more flexibility than you are realistically able to have. When both partners are medical students, other difficulties
may emerge, related to differences in study habits, expectations,
needs, fears, capacities, and interests.
There may even be times when you feel competitive.
Realizing that these issues are likely to occur at some
point during medical training can help you to help those you care
about, understand and support you.
have a better idea of how your temperament, attitudes and
expectations affect you, you will be more prepared to move on with
the business at hand, learning to take care of others.
know that medical school can be stressful.
In this section, we will cover some of the stressful events
or “stressors” that affect most medical students, sooner or
should be thought of as challenges which, when weathered
successfully, help us to grow into competent physicians.
Whether they help us grow, or grind us down, depends on how
well we make use of good first-aid and preventive maintenance.
flunking; I can’t do this!
may be the most common and worrisome thought experienced by
medical students. It is ever present and always intimidating.
There are may different times when you will feel that you
will fail: the first day of medical school, before a major exam or
boards, on rounds during clinical rotations, just to name a few.
of failure is a universal “stressor.”
We all experience it at some point, despite objective ways
that suggest it may not be as bad as we fear.
“Good” and “bad” performance is often a subjective judgment…and the faculty makes the call.
That means we don’t have much control.
For better or worse, medical schools are authoritarian
if we perform poorly, we feel “dumb.”
Since medical school is challenging, it is not uncommon for
most of us to feel, from time to time, that we are doing poorly,
even if we are doing well.
is smarter that I am!
school is very competitive. The
level of competition is often more intense than it was in college,
because everyone wants to be “the best” and the stakes are
high. Not only are
our careers at stake, but our actions directly affect the lives of
experience of medical school can be like trying to take a drink of
water from a fire hydrant. The reason we think
there is too much work is that there really is.
Four years is not long enough to learn everything we need
to know when people’s lives are in our hands.
However, everything does not have to be in your head all
the time; you have books, computers, colleagues and faculty to
learn from and use as resources.
overload will vary during medical school.
There will be facts to memorize, labs to complete, lecture
material to wade through, and exams.
During clinical rotations there are too many patients to
work up, too may menial tasks to perform, too much reading to do,
and not enough hours in the day.
Best or Bust” and “If I work hard enough, I should be able to
understand it all” philosophies are part of your attitudes, this
stress can throw you off base.
Get help fast if it starts.
different than everyone else
challenging enough to be in medical school.
Imagine the additional stress you feel as a woman, an
ethnic minority, a physically challenged or homosexual student.
Feeling different from classmates, as well as from the rest
of society, can be one of the greatest “stressors” encountered
in medical school. This
stress is accentuated if “differences” interfere with the way
people react to you. While
medical schools attempt to include cultural content and
experiences in the curriculum, this knowledge does not always
change misconceptions and related behaviors.
pass out during Gross Anatomy Lab!
time you read this guide, you will probably already have met your
cadaver, even given him or her a name and learned, to your dismay,
that he or she was not constructed strictly according to your Netter’s
dissection is a powerful experience initially, before long you
work on “the body” with little thought of what you are really
doing. Regardless of
what anyone thinks, though, it is a “rite of passage.” We are
virtually the only group empowered by our culture to have this
special experience, to learn directly from the dead the secrets of
I have All these Diseases?
study disease processes in pathology, complemented by your
physical diagnosis course, you suddenly find that you are
experiencing the symptoms of illnesses that you have just studied.
It is not unusual to think the worst when a symptom occurs.
So when you are studying brain tumors you are convinced
that the onset of a headache is sure to be an astrocytoma.
When studying about tuberculosis, the first time you cough
you look for blood in your sputum to rule out T.B.
When learning about acute appendicitis, every ache in your
abdomen means you must check your lower right quadrant for rebound
sweating, even on a hot and humid day has you checking for sighs
of thyroid hyperactivity. A
birthmark that has not changed in color or size raises concerns
about a melanoma. You
may question whether you are becoming a hypochondriac.
Rest assured that you are not alone reaching the conclusion
with each new illness that you study that you may be facing the
fatal form. Sharing
this experience with classmates usually lends itself to a good
laugh by you and your classmates as they often have gone through
the same experience. You have caught “medical student disease.”
classes are ridiculous!
medical school, basic scientists teach many of the beginning
classes. Some of them have interests that seem far from the practice
of medicine. For
example, some enthusiastically describe microanatomy and
biochemical subtleties that do not seem to have much to do with
why we’re here. They
invite us to join them in their enthusiasm by asking us to carry
out esoteric experiments in their labs and by memorizing whole
sequences of physiologic processes that are hard to understand and
still harder to pronounce. It
helps if we remind ourselves that these are the building blocks of
sciences introduce us to the inevitable tension within medicine
between the knowledge of science and the art of healing.
We need both!
is too much sickness
frequently focus on illness, and the grisly medical scenes
depicted are often unreal.
Most people are unaware of the extraordinary variety of
ways our bodies can be mis-assembled, broken, infected, worn out,
or riddled with tumors. As
medical students, textbooks and clinical experiences introduce new
material to this “scene” every day.
Most of us handle this stress with denial, by saying to
looks awful.” Good
thing I’ll never get it.”
Or, “Fortunately, I’m the wrong age, sex, race,
occupation, or religion to get hit with that one.”
So we are usually not consciously aware of this stress.
Occasionally, we become overwhelmed, and may experience it
in a number of ways – from feeling depressed to getting
“medical student’s disease,” we may even believe “we have
clinical years, medical students are at the bottom of the pack –
attending physicians, fellows, residents, pharmacists, social
workers, nurses and ward clerks all seem to outrank us.
We feel powerless in this hierarchy.
Rounds, the hallmark of medical training, consists of group
visits to patients’ bedsides.
While rounds are instructive, the experience can strike
terror into the heart of the “lowly” medical student who is
asked to play “What
am I thinking” by those who are senior who press forth with
increasingly complex questions until you reach the limits of your
knowledge. You may be
embarrassed, feel unsure or even dumb, but try not to let it get
to you. All of
use have experienced it and may continue to in the current system.
It doesn’t mean you are really dumb if you fail this
look behind you when the first nurse or patient addresses you in
this way. You may feel like the ultimate imposter but, at the same
time, hope that someone does believe you have something to
contribute. Take heart, most patients in teaching hospitals are
familiar with the student role.
Often short white coats and nametags serve to identify
in the minds of many patients, there is no important difference
between a medical student and a “real” doctor.
A student may be the person who spends the most time with
the patient, listening and offering support, and patients may view
their students as the most important member of the team.
This can be enormously rewarding, but also very stressful.
please drop your pants
values most of us learned before we entered medical school are:
thorough physical exam, which might include a rectal or pelvic
exam, violates all
three of these values. Take
heart. All of your
classmates will be experiencing anxiety in these situations.
Before you get to your first patient, you will have
practiced every part of the physical exam on your classmates or
Gentleness, practice, respect and reassurance all have a
powerful impact on minimizing your discomfort and the discomfort
patient is driving me up the wall
people going into medicine really do want to take care of people.
That’s why most of us are surprised when we first find
ourselves disliking and/or dangerously close to exploding at a
“patient” is a role that everyone experiences, usually
transiently at some point in their lives.
Both nice and difficult people can become difficult
patients when they are stressed or in pain. Many patients do not recover rapidly or they experience
chronic debilitating conditions.
To be in the hospital, patients have to be quite ill or in
need of a procedure, both of which are stressful and
and anxiety have an impact on disposition and interaction.
patient’s a crock
patients who don’t get better despite our most impressive
diagnostic and therapeutic efforts, or who have physical
complaints but no observable or measurable signs of pathology.
careful when a patient is labeled a “crock,” because it may be
a problem that medicine cannot yet document.
Also, whether or not the crock’s problem is medical,
emotional or both, it is still a real problem.
Pain is painful, itches itch and depression is depressing.
way, I’d ever do that!
patient in the clinic or hospital is in a vulnerable position.
Just like a two year olds, patients may push boundaries and
test limits. They may
ask questions you cannot answer or want you to make decisions for
them, or to tell them an uncertain prognosis.
Remember, you are not the physician responsible for their
care. That physician
must help address these concerns or questions.
Sometimes, patients are seductive and suggest that you are
attractive or desirable to them, you may also be attracted to a
patient. It may be
difficult to resist, but it is essential to do just that.
As a patient’s physician, you cannot be their lover.
Patients’ are in a dependent role and may not be able to
make informed judgments about personal relationships with their
A Balancing Act
noted, balancing personal and professional lives is a challenge.
Although support from significant others can be invaluable,
late nights and the seemingly endless journey through medical
training can take its toll. Many
things are in short supply: limited money, limited energy, and
limited time. Families and friends may even believe that we don’t want to
be with them or don’t care about them.
Relationships require ongoing verbal understanding,
patience, respect, caring, negotiation, and compromise.
our best efforts, some of our patients will die.
We all know this, but coming to grips with the reality of
death, particularly with the loss of someone we are caring for day
in and day out, is always painful.
The first time “we lose” a patient (notice the verb and
the subtle and usually erroneous implication that we have been
careless or forgetful) is usually the hardest time.
difficult for many reasons. We
have come to know and value the patient, it can be doubly hard if
the patient is our age, or reminds us of a friend or family member
we love. The death of
a patient also underscores our feelings of helplessness and
inadequacy. We may
even feel guilty if we feel some secret relief at seeing our
patient’s suffering finally ended.
Before medical school, many of us had never seen anyone
die, and we are reminded of our mortality.
Our first patient’s death shatters a favorite myth: If we
just study long enough and work hard enough, we physicians can
rescue everybody from death.
Accepting limitations and understanding that caring is
vital, especially when cure is not available can be painful, but
it is at the heart of medicine.
medical school, life intrudes.
Family members become ill or die, partners break up, and
financial issues can cause hardship.
At such times, remember, seeking help is not a sign of
weakness, and can be vital in resolving a problem.
All of us
can rise to an occasional challenge – cram for an exam, pull an all-nighter studying, work throughout the night with a
very sick patient, or endure long and arduous work during a
catastrophic event. But
none of us can remain well balanced or practice good medicine
without periods of recovery. Because the study and, later the practice of medicine,
consists of a series of strenuous challenges, it is vital to have
a plan for preventive maintenance.
But alas, our educational institutions, as well as the
mystique of medical practice, all seem to value the extraordinary
physician who works long hours without a break, who puts his or
her personal and physical welfare second, ignoring bodily or
emotional needs and functions.
Our system encourages behaviors in students and physicians
that would be of concern if we saw them in our patients.
We exhort our patients to eat healthy food, maintain ideal
weight, get sufficient sleep, exercise regularly, engage in
recreation, avoid smoking, alcohol and other substances of abuse;
at the same time, many of us do not come close to practicing what
as we need to bring our automobiles in for five thousand mile
check-ups, we need to follow our own advice regarding health
promotion. We must care for ourselves in order to care for our patients!
most important tasks in medical school is to build and maintain
should not end just because you are in medical school.
Don’t precipitously abandon your spouse, partner, lover,
friends, or family. Their
love, interest and support for you is potentially the most
important support in your life. Paradoxically, for medical students as well as physicians,
there are more external obstacles to being good spouses, partners,
lovers, or friends than for many other groups in our society.
The nature of our work can take us away from them and leave
us isolated and exhausted. Maintaining
relationships (never mind beginning and developing relationships)
takes time and energy. Early
in our careers we are not only short of money, but also short of
emotional availability because of the time and energy demands of
our work. We have to
be particularly careful that our careers do not seduce us away
from the people we love. Consciously
carving out time, and
energy, for these important people pays dividends, and saves
simple, but it can be very difficult.
Medical education covertly, if not overtly, promotes
delayed gratification, and the sacrifice of convenience and
comfort. We all have
been conditioned into making medicine our first priority, an
almost universal hazard in medical education and patient care.
We often feel that we have no control of our time.
The experience of lack of control is more negatively
stressful than is fatigue. For
practicing physicians, monitoring office hours and patient
workload, arranging for coverage with time off for some weekends
and holidays, as well as scheduled vacations, and ensuring time
for healthy recreation are key.
But, students, too, can plan their days and weeks to
include social interactions.
It will help you cope now and throughout your careers.
Nonetheless, advance planning is necessary so that personal
life is not the first thing to go in a pressured period.
Friends in Class
probably the most important thing you can do to ensure your
survival and enjoyment of medical school.
Many schools support social activities and trust building
(everything from picnics to Outward Bound) as part of an initial
orientation. Many of
these can expand into formal or informal on-going activities.
More formal support groups can also be helpful.
Retreats, get-togethers for students and partners can build
rapport and help alleviate stress and isolation.
Classes, small labs and other study groups naturally
promote partnerships. Talking about one’s life and stresses is itself a major
adds to the stress of a massive workload, and many demands. Colleagues and friends provide consensual feedback,
validation and promote balance.
Study groups are a highly effective adjunct to the learning
process as well as encouraging the teamwork that will be necessary
throughout your career.
Care of Your Body
food, vending machines, too little sleep, and too much sitting may
all wreak havoc on your pursuit of health.
Too much caffeine can cause anxiety, interfere with sleep
and cause fatigue. Cooking takes time, but shared meal preparation and finding
more healthy snacks (an apple a day) can set the stage for
continued health and energy.
Take advantage of the preventive services offered by the
student health service or the dean’s office: ranging from
immunizations to classes in yoga and meditation.
school requires longer class time than most of us have ever before
experienced. We may sit or work in labs for 8-10 hours a day, and
then spend another four to eight hours of evening and night time
study at home or in the library.
Finding time for exercise may seem like an insurmountable
obstacle, but exercise can help in many ways.
The release of endorphins minimizes the impact of stress.
Physical activity improves bodily function and helps clear
the mind. Exercise can be both social and fun. Find enjoyable activities, particularly those that include
companions. Even if
you are not gifted athletically, you can walk, jog or run in a
group; play soccer or basketball; swim, ski or skate together.
Your Mind (in new ways)
to prevailing mythology, medical school is a good time for finding
new interests or enhancing old skills.
Whether it is the evening game of scrabble, practice on a
musical instrument, reading the newspaper or detective stories, or
creating fiction, poetry or art your mind will benefit from new
activity. About the
last thing on your mind as you enter medical school is playing or
having fun. Although
some faculty subscribe to the dictum, ‘the harder you work, the
better you will do in medical school,’ this statement is not
totally inaccurate, but it is also not entirely correct.
We know that medical school is demanding and difficult, but
all work and no play will merely exhaust you and subject you to
the law of diminishing returns.
A break allows you to return to work refreshed.
Developing the ability to play or disengage from your work
should be cultivated in medical school.
Hobbies or activities learned or continued in medical
school will contribute to balance now and throughout your
professional life. Consider
participating in the many student-generated activities that happen
in medical school: follies or talent shows, movies, dances, and
get-togethers. But, plan to get away as well.
Take advantage of the community in which your school is
theater and concerts; visit museums and historical sites; attend
sporting events. Discounted
fees for students are often available and many events are at low
or no cost.
activities are more satisfying than assisting others in need.
Tutoring elementary school children, teaching painting,
music, health education, or swimming, being an athletic coach for
young people, assisting in a nursing home, volunteering in a
clinic or soup kitchen – all bring the dual satisfaction of
doing good and meeting a community need.
Many medical schools have formalized service-learning
programs, or can help connect you to facilities or groups in need.
Additionally, joining with classmates in these activities
not only does good, but encourages friendships and other support.
what you like and do best. The
life of a physician can be lived in dozens of ways.
In addition to the broad range of specialties from family
medicine to emergency medicine to psychiatry and neurosurgery,
clinicians, teachers, researchers, and administrators in medicine
all have life styles that are quite different from each other.
Even clinicians in the same specialties can have varying
professional and personal life styles.
good look at what various physicians do on a typical day as well
as over time. Try to
assess the attributes and life styles of the people who inhabit
each professional niche. Utilize school-based, community and national resources to
evaluate your interests, skills and personal needs to choose a
specialty area and career pattern that fits your expectations and
don’t bend to pressure for premature closure.
Give yourself time during medical school to explore who you
are and what you want. While
you will need to consider family input (your mother was a surgeon
and her father and grandfather were also), television and media
models and other pressures, take them with a grain of salt.
The choice must be yours.
Remember, you, not they, will be the one to live your
professional life. If
the fit is not a good one, you can spend your professional life
disappointed and fighting your work, rather than enjoying and
looking forward to each day.
The values subtly and sometimes unintentionally, underlying
your education will fight constantly against balance.
“Keep working” goes the saying, don’t squander your
time, energy or money on anything frivolous. Yet, life is not
either-or but a balance that will promote your professional and
personal growth and lead to your comfort and success as a
do when prevention doesn’t work.
means what to do till the doctor comes, or it can be translated as
getting help! In
spite of your best efforts at prevention: maintaining a healthy
life style, managing time, and keeping a balance, life events may
produce stresses and strains.
the most enlightened environment, the medical school experience is
still stressful. The
combination of intense workload, long hours, and the
responsibilities that come with clinical care can affect even the
most centered and mature students.
There are a number of strategies that provide resolution
while promoting growth, strength and competence.
They can be divided into approaches that involve others and
those that can be done alone, and include:
Talk About It
Sleep On It
Figure It Out
opening strategy is talking
about it. Whether
it is a loss of a significant other, or poor performance on an
exam, talking about it is helpful.
It usually feels best to talk with friends or classmates
with whom you feel particularly comfortable, classmates who have
gone through the same or similar stress and survived. They will understand your experiences, as well as welcome a
discussion, which opens the door for them to talk it out with you
as well. You will
need to watch out for those classmates who want you to use their
solution (what worked for them) whether it fits you or not.
Yet, comparing experiences can lead to a variety of
viewpoints and approaches. Other
good choices for discussion are with those you love – spouse,
partner, family member or friend from your pre-medical school
days. Not only do
they care, but letting them share more fully in your life can
strengthen these meaningful relationships.
can also be helpful. They
can provide support in understanding content, but their long term
experiences also give them an understanding of what approaches
others have successfully utilized.
Reputation counts, and other students can often identify
those faculty who are particularly available and effective.
The Dean of Students office in many institutions can also
serve as a support. Some
students avoid the administration for fear of stigma (‘will this
be in my dean’s letter and negatively impact my chances of
getting into a good residency?’), while others are suspicious of
authority. For many
students, going to the dean’s office resembles being sent to the
principal in elementary school, but deans and their staff can be
resources. They are
familiar with the issues that arise in medical education, and the
variety of student reactions.
They can address problems and they also know what has
worked historically for students in similar situations.
They can be student advocates with sufficient clout within
the system to address inappropriately stressful or demanding
situations in a way that will improve the students’ experience.
For example, they can address facilities problems, i.e.,
opening hours for the library, or harassment issues.
symptoms such as mood changes, anxiety, unexplained fears, sleep
disturbances, appetite changes, headaches, irritability and panic
feelings, don’t go away with the first aid we’ve recommended,
help is available. Premenstrual
symptoms, eating disorders, and substance abuse also occur in
medical students as they do in the general population.
Sometimes, a medical illness such as thyroid disease can
present first with psychiatric symptoms. If you experience unexplained highs or depressive symptoms
such as inability to concentrate, persistent irritability or
sadness, crying, even thoughts or plans of suicide, help is
essential. This can even include a medical leave. Many medical students
use mental health services with very positive outcomes. Use of these services during medical school should not
compromise career plans.
schools have a student health service or counseling center with
trained and experienced professionals who can provide assistance
not only in resolving acute problems, but also in developing
preventive strategies. Additionally,
they can prescribe appropriate medication if needed.
Such programs are confidential, with student information
protected and not included in academic records.
some individual approaches as well.
Since medical students tend to be individualists and
problem solvers, it is no surprise that individual solutions may
be the first if not only approach.
These really provide “first aid” in that they are
immediately effective and can defuse a problem before it develops
a life of its own. On
the other hand, being able to involve others in resolving a
problem can promote more long-term solutions.
Away and Sleep On It
are helpful responses for initial and rapid relief.
Gaining perspective and distance can lessen the impact of a
stressful event. We
all know that fatigue does not lead to performing at our best.
Sleep buys time and perspective as well as physical
recovery. It often
makes the difference between mild annoyance and full-blown crisis.
approach consists of brief conversations with yourself and
includes such questions as:
stress event(s) caused this reaction?
of reaction did I have and why?
my pre-set cause me to react to this particular stress?
anything seem helpful?
anything make it worse?
strategy while often done alone, can also be part of your
conversations with others in talking it out. It may be most useful
to combine several approaches – especially walking away
and sleeping on it, then utilizing opportunities to talk
about it and figure it
as these strategies are, you should recognize that there are other
less successful, if not downright destructive approaches, that may
seem to be easier and effective.
seems to promise a quick fix, but in the long run only worsens the
this approach initially seems effective, ignored problems tend to
hibernate, not disappear or resolve on their own.
This approach prevents you from learning enough about your
own vulnerabilities and strengths to give yourself warnings when
you are about to suffer a similar experience.
It may lead, to your being increasingly sensitized to the
stress-related encounter, rather than being broadened or
instructed by the process. Not
sharing your experience with loved ones may keep them from
learning about or understanding your experiences, minimizing their
ability to be supportive to you.
In the long run, this approach can cause avoidance of
growth and may lead you, unwittingly, to seek professional roles
that are more secure but less rewarding than others you might have
enjoyed. It can also
have the opposite effect, leading you to push yourself unknowingly
into dangerously stressful situations or roles, because you need
to maintain a sense of mastery of stress.
approach also may seem to be an immediate solution, and it is
frequently used by medical students as well as practicing
overwhelming emotional energy into work is a great way to get work
done, whether it is studying medicine or caring for patients.
Unfortunately, this approach doesn’t promote learning or
future prevention, and it may distance you from friends, family
and other loved ones. As
in walking away, it can be useful first aid, if you also take time
to figure out the cause of your reaction.
Working it off can lead to some bad professional choices
later in your career, if it is the only aid you allow yourself.
approach is, alas, all too frequent and it is generally combined
with overwork or ignoring the problem.
There are many medicating agents available in our society.
Alcohol is the agent of choice for many, but marijuana and
prescription drugs are not far behind.
Although self-medication may seem useful for numbing the
pain that come with all kinds of stresses, as well as for
momentarily relieving loneliness or boredom, it is particularly
hazardous for physicians and medical students.
We tend to lead the kind of high demand, high stress lives
that make self-medicating look attractive, especially the secret
kind that helps us maintain the façade of being strong competent
physicians while covering over inner shakiness.
More important, this approach does not address the cause of
the problem, nor enable us to prevent it in the future, and with
frequent use, we become increasingly dependent on the substance
for day-to-day productivity, often requiring greater amounts to
achieve the desired result. We
become addicted. Since
we have easier access to drugs than most people, it is simpler to
choose this route, and it is certainly more dangerous.
It can lead to accidental death.
proficient at effective first-aid strategies allows and builds the
cultivation of back-up support and good preventive maintenance
into your life-style. The
more you understand the causes of your responses to stress, the
easier it is to develop more effective prevention and resolution.
care of yourself is not a selfish act but rather one that will
serve you well as you continue your personal and professional
proficient at knowing yourself, building good preventive
maintenance into your life style, and using the first-aid
strategies outlined in this guide will help you run smoothly for
your exciting trip through medical training!
Medical Student Association
of the Association of
American Medical Colleges