The most important piece of advice I can give to incoming medical students is to be vigilant about how you are feeling day-to-day and to be aware of your actions. As is often said, our personalities, the distinctive makeup that makes us who we are, are set in stone. If you are a mindful person, you’ll stay that way even as you get older. If you are someone who likes to strike up conversations with anyone that is around you, that part of yourself won’t change. However, your behavior, the way in which one conducts him/herself towards oneself and more importantly to other people, will change when you start medical school.
In the months leading up to my first day, my long-time mentor told me, “My medical school years were by far the toughest times of my life. But once you get over the hump, everything becomes better.” Having completed three years of medical school, I have to nod in agreement. But, not for the common reasons you often hear: “It’s like drinking from a fire hydrant.”
The sheer amount of information I learned in medical school is significant, but I found that specific topics were tougher to get a firm grasp over compared to others. (I’m looking at you histology.) Moreover, multiple pressures make themselves apparent at different moments, and all of these pressures are additive. A big one is that you take several courses every semester with only one exam per course deciding your entire grade. Did you pass and move on to the next semester, or did you fail and have to wait to remediate? Or did you get a C in biochemistry and are labeled as an at-risk student until you pull your grades up?
No one in medical school wants to talk about preclinical or clinical grades, but grades are influential because they determine your class rank and partially what goes into your MSPE (the infamous Medical Student Performance Evaluation or Dean’s Letter, an objective summary about a student that is submitted to residency programs). The same goes for Step 1 and Step 2 CK, by far the hardest exams a med student takes because of the plethora of topics each one covers and the hundreds of hours and thousands of practice problems required to prepare. If you are aiming for top residency programs, admissions committees look at your board exam scores and how your grades are in comparison to your classmates before anything else. If you lack in one or the other, or both, you have to compensate with strong letters of recommendation and a CV that shows that you are a candidate that programs would want to invite for interviews. That too is another pressure. Other forces at play include student loan debt (with the average being close to $200,000), and your life outside of school with family and friends.
With all of that comes a level of stress that can morph into unhealthy behaviors if you are not self-aware. A level of stress that can weigh down on a person to the point of self-combustion. For me, there was a never a day during medical school where I didn’t feel stressed about something. Am I putting enough time into preparing for this upcoming exam? How are my patients doing? What do my attendings think of me, and how will they evaluate me at the end of the rotation?
For many, this perpetual cycle of trying to be the best can lead to transforming into robots. You’ll do whatever you need to do to come out on top without regard for your well-being and sometimes at the cost of interpersonal relationships with your classmates and those you work within the hospital setting.
From my perspective, I dealt with anxiety and worry in two ways. One being an unhealthy avenue of eating whenever I felt I needed the rush of feel-good hormones when I wasn’t having a great day. Though I was a frequent gym-goer, I slowly put on more and more weight until I gained over 25 pounds. My physical and mental endurance was on a decline until I realized that if I didn’t do something right now, it would be too late for me to reverse course. Today, I’m much more aware of what I eat, I feel as healthy as I’ve ever felt before, and I have many more hobbies to engage in (reading books, writing, photography, even picked up ping pong recently).
The other way that I channeled my stress was in reflection, through journaling on my iPad Pro. If I was in the mood to type, I would turn on my iPad, connect my keyboard, and let my thoughts transcribe themselves. If it was a late night, I would use my iPhone, press the microphone button, and dictate my thoughts out loud. I’ve found this type of reflection to be the most beneficial for me because I’m able to pick apart how a day went and see what things went well (and what I can improve on). It’s also a great way of jotting down spur-of-the-moment encounters with people that I would otherwise forget over time if I didn’t record it somehow. It makes for great material for stories that I want to write, and experiences I can draw on when the time comes to write my personal statement.
Overall, it is essential for medical students to develop and increase self-awareness and to practice healthy changes in behavior when the occasion calls for it. With self-awareness comes a deeper appreciation of why you are doing what you are doing to become a doctor. With self-awareness comes a better feel and sense of how those around you react and respond to your unspoken and spoken actions.
Ton La, Jr. is a medical student and student editor, The New Physician.
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