Category: Pre-Med Blog

Avoiding Medical Fatigue

Avoiding Medical Fatigue

This was a tough week at med school. As a class, we had several sessions to learn about trauma-informed care: screening patients for traumatic events, and learning how to ask about these experiences to better provide a safe healing environment for them.

We were told in advance that this might bring up painful memories or difficult emotions. Although we had known to be prepared for this, I sensed that my class, including myself, seemed tired and drained after a long day of discussing important but hard topics.

As I understand it, this is an experience that is virtually universal in the medical field. Those in health professions, including medical students at almost every point in the training, are exposed to many difficult experiences that challenge us in unprecedented ways. Being a witness to suffering and illness can lead to fatigue—even losing the sense of compassion and empathy that caused us to choose this profession in the first place.

I know that I’ve often found some of the aspects of medical work to be emotionally difficult, especially feeling affected by patient stories. Outside of medicine, a lot of what I see on the news can get to me as well. I have my own ways of taking care of myself to make sure I stay well and avoid fatigue—one of which sometimes is just eating a big bowl of ice cream. But I decided to reach out to someone who has advised me about wellness, Dr. Potter, to see what insights she could offer beyond ice cream.

Dr. Jennifer Potter is an internist at Beth Israel Deaconess Medical Center, and in addition is an expert on wellness and a mentor for medical students. I asked for her advice about maintaining a “toolbox” of wellness—strategies to keep yourself well and avoid fatigue despite working in potentially stressful environments.

Be Well, Stay Well, Get Help

Dr. Potter acknowledged how difficult it can be stay well while working and learning in a medical setting. She said, “In medical school, there are constantly challenges in terms of the volume of information that you are being asked to take in, and finding yourself in new experiences all the time—that can be hard and can trigger deep sadness from the past. That is something that happens over and over in medical training.”

I completely agreed when Dr. Potter described the role of being a med student (or a pre-med) as “performing”—trying to be “on” all the time, showing that you have what it takes to become a physician. Feeling like you constantly have to function at your best becomes draining over time. It can be especially hard when you witness something that makes you uncomfortable, but feel like you don’t have the ability or time to process the emotional impact.

Dr. Potter’s advice is to “be well, stay well, and get help,” and to develop a toolbox to maintain all different aspects of wellness. She described elements of wellness including nutrition, physical activity, sleeping and getting rest, connecting and sharing with others, relaxing, and staying in touch with your spirituality. When you’re able to find what works for you, you continue practices to attend to those various aspects.

If you’re not able to find right away what works for you, seeking advice or help can be the way to go. “Know where to go when you need help, so that you don’t experience any barriers, or worries that it may be perceived in a stigmatized way,” said Dr. Potter.

What to Put in the Toolbox

Developing a “toolbox” is essentially developing skills for resiliency—the ability to deal with different kinds of situations that might come up in the future. Two of the tools that Dr. Potter shared with me were mindfulness and gratitude.

Mindfulness means attending to the moment: taking a breath to pause and assess how you feel, physically and emotionally. It’s easy to work for a long stretch of time, or spend the whole day in clinic, and suddenly stop and realize that you haven’t eaten or you’re not feeling well. Mindfulness counters that tendency to go through the motions without pausing to check in with ourselves.

At times, I’ve felt worried about what my clinical year next year might be like, when I’m taking part more actively in the care of a number of patients. What if I’m not prepared for some of these experiences?

Dr. Potter offered a piece of advice for dealing with those difficult experiences in the clinic, when something comes up that doesn’t feel quite right. She said, “Take that little U-turn that says: ‘Something just hurt me, and I’m going to come back to it later’…Never try to push aside the reaction that you’re having.” Even if you can’t address the feeling in the moment, revisit it later when you have the time and capacity to think about it. Don’t invalidate your feelings, but instead know that your reactions are normal and completely fine to have.

To practice mindfulness during the day, Dr. Potter has a technique that she uses: “mindfulness minis.” She ties mindfulness to simple moments such as washing her hands or entering a patient room. She takes a deep breath and tries to relax and achieve a moment of mindfulness.

In addition to mindfulness, another tool is gratitude. “Keep an outlook of optimism, and an easy way to do that is to try and think about, what are the good things that happened during the day?” said Dr. Potter. She described how in the winter during the snow, most of us are walking to work bundled up and grumpy. But a little child in a parka might be laughing and playing in the snow, delighting in the joy of something simple. Dr. Potter believes that we can learn from that.

Practicing Self-Care

Self-care might seem like something silly or extraneous, but to me it is essential to long-term success in a demanding profession. It’s about being “smart” in a different way from just succeeding in the classroom. Later on, I will write about self-care, what that means, and when and how to care for yourself.

When it seems like a billion things are going on and demanding your attention and emotional capacity, it’s okay to pause and center yourself. As Dr. Potter said, “Know how to stay steady when the boat is rocking.”

7 Best Apps for Pre-Med Students

7 Best Apps for Pre-Med Students

I get it: between taking Organic Chemistry, juggling all your extracurriculars, and still trying to have a social life, it can get hard for premeds to keep everything together. I have some suggestions for apps to help you stay organized and well. Even better, there’s an app that recently launched that has everything a premed could possibly need (#7). These apps will help you do everything from being productive to meditating to drinking water—who knew your phone could actually be so helpful? 

 

1. For being powerfully productive…

Focus Keeper. Do you ever feel like you’re drowning in work, but can’t focus for long enough to get anything done because you’re thinking about how much work you have? A productivity app might help you to improve efficiency and work-life balance while preventing exhaustion. This app is based on the Pomodoro Technique, a time management strategy that involves working for 25 minutes and taking a break for 5 minutes, with occasional longer breaks. I really like using this technique myself to study—it helps to keep me focused and stay aware of how much time I’m spending, and best of all, prevents my work from affecting my relaxation time when I’m done. Now Motivate MD’s Pre-Med App has this tool, but combines it with a powerful task editing list.

 

2. For when you’re bored on the bus/subway/shuttle…

Anki. This flashcard app can train you to be an expert in any topic. While I haven’t gotten to trying it myself yet, many of my med school friends say that Anki is one of the best studying tools they have. You can use it to learn a language, review your Biochem notes, or study for the MCAT. Anki is an intelligent flashcard platform that will present flashcards to you based on optimized learning strategies. It might just lead you to ace that MCAT…or just have a convenient excuse to get out of an awkward conversation on the bus. 

 

3. For becoming a meditation expert…

 

Insight Timer. Meditation can be a powerful way to ground yourself and improve your mental health during periods of stress. I understand, though, that traditional meditation isn’t for everyone. Personally, meditation doesn’t always work for me, but I like using the Insight Timer when I want to be mindful or listen to a guided meditation, because I always can find something that suits my needs. Insight Timer has a timer that you can set up to your own liking, if you want to meditate by yourself. Plus, it has thousands of guided meditations and courses that you can search for, covering a wide variety of subjects such as sleep, stress, regaining energy, etc.

 

4. For those with a green thumb…

 

Forest. Do you find yourself constantly checking your phone for messages when you’re supposed to be working? The Forest app can help you stop reaching for your phone and refreshing Instagram. The main gist of the app is that you keep it open to grow a forest, and your plants will wilt if you close the app to look at something else. You can even collaboratively grow forests with your friends and compete with each other. If you live somewhere where you can’t see a lot of real green plants, at least this app will help you care for a digital forest while being productive.

 

5. For those with a soft spot for cuteness…

 

Plant Nanny. I saw so many of friends using this app in class, and I was immediately hooked because it seemed really fun and cute. I have jumped onto the bandwagon and also use the Plant Nanny app, which helps you to improve your water-drinking habits. You grow an adorable plant, and get to water the plant every time you drink water during the day. I’ve always had trouble with staying hydrated, but this app has helped so much with my habits and is simultaneously very entertaining.

 

6. For those who are addicted to Starbucks…

 

Coffitivity. I’ll be the first to admit that I have a bit of a coffee and tea addiction. I also love studying in coffee shops; I feel like there’s just enough background noise and activity that I don’t zone out and fall asleep, as is prone to happen when I’m in a room by myself. Try Coffitivity, which will provide the soothing background ambience of a coffee shop while you work. Maybe like me, you want to stay calm and focused with that pleasant ambiance, while avoiding spending yet more money on coffee.

 

7. Last but not least, for those who want to excel and gain an advantage as a premed… 

 

The Premed App by Motivate MD. Within the last month Motivate MD has launched the first ever all encompassing app specifically for premeds. The app includes everything from Focus which is a one of a kind study tool that utilizes the pomodoro technique (the technique I mentioned in the first app of this post), creating and tracking every goal that you’ll need to set as a premed student, ample amounts of objective information, and much more cool stuff. The app does have a free trial so I’d strongly recommend taking the time to check it out… you have nothing to lose!

Marathons and Medical School

Marathons and Medical School

I ran my first marathon last summer. While I had participated in shorter races before, this was my first time attempting the 26.2 miles. I remember what it was like at the end of the race, running the last few miles to the finish line—actually, it hardly felt like running at that point, mostly just moving my legs unwillingly, as they no longer seemed to want to respond to the commands of my brain. I was sweaty and covered with dust that I had kicked up along the trail, 20-something miles or so along the California coast, on a summer day that was cool in the shade of the trees and hot when exposed on the dusty roads.

“It’s a marathon, not a sprint,” the saying goes. Grad students and med students are often told this, meaning: it’s a long road. Medicine certainly is, so the idea is to develop the skills to run a demanding race over a long period of time, to do so while avoiding burnout.

I wrote previously about burnout, and in thinking about the “marathon” quote, it struck me that long-distance running is actually quite similar to studying medicine (or pursuing any other profession, or just life in general). I have enjoyed long-distance running for a while now, starting with half marathons and completing my first marathon recently. I’m not by any means a very fast or accomplished runner, but this is a fun hobby for me. (To which some people say: “Running? Fun?”).

I’ll share some of the lessons that I learned from running, which consciously or not, I’ve also applied to some extent to life and medicine. Here’s one of the first lessons: honestly, I think pretty much anyone can do it. I never thought that I was particularly athletic, but I did like running, so I decided one day that I wanted to run long distances. While I might not have had any special running talent, I was able to do it after the time put into training.

Maybe you’re interested in long-distance running—I personally think it’s a great way to get exercise and stay fit, challenge yourself, and also make time to de-stress and listen to music or podcasts. Or maybe you don’t care so much about running, but you’re interested in how to run a marathon—both the 26.2 miles and the marathon of medicine.

It’s Only a Competition with Yourself

One of the strongest connections I’ve seen between running and medicine is the element of competition. I don’t think it’s a coincidence that many people in my class are runners; I think both medicine and running attract lots of tenacious, competitive individuals.

But at the same time, I believe that one of the reasons I’ve always been drawn to running is that I’d rather compete with myself than other people, and long-distance running is a sport where your progress is often measured against your own standards rather than others’.

In general, I don’t really like to compare myself to other people, especially because I think that comparisons are usually biased or flawed and can alienate ourselves from each other. But I do tend to set high standards for myself. I enjoy challenging myself and trying to reach new goals. As a runner, I’m running to beat my own time.

Sometimes during a race, I’ll find myself running next to someone and trying to surpass them. Maybe we’ll keep passing each other several times during the race. We might start a conversation. And after the race, we talk and congratulate each other. I’ve always felt that runners share a special sort of camaraderie during races.

Getting into med school and doing well in med school and getting matched into a good residency, and so on, that process does seem kind of like a competition with other people. It might feel that way whenever you’re sitting in the waiting room for an interview with the other candidates. I’ve still held fast in my belief, though, that better outcomes result when you draw motivation and inspiration from others, but challenge yourself by your own standards. That is the mindset that has encouraged me to continue running races.

Training Takes Time

I trained for my first half marathon around the time that I took the MCAT. Actually, preparing for both involved quite similar processes. (See my post on the MCAT, which discusses this.) For both, I had to log a certain number of hours to prepare adequately. I made a schedule over several months, and tried my best to stick to the schedule while making adjustments if I was getting tired.  

Like studying for the MCAT—or learning anything in medicine—training is not something that can be crammed. You can’t sit on the couch for several months, then suddenly run 100 miles the day before your race and say that you’re prepared. It’s imperative to make a plan for your training. I referred to a website that my friend showed me, called the Hal Higdon training plan. This training plan, which is fairly typical of most that you can find, involves gradually increasing the distance you run over weeks. You run most days, but also get rest days and cross-training days where you do other activities.

The takeaway: the preparation that you do, the work that you put into anything, is not effective when applied in bursts. It’s more a matter of endurance, putting in consistent work over a long period of time, seeing the rewards of the strength that you gain as you stick with your plan.

Don’t Lose Strength

During both the training and the actual marathon, it’s important to keep your strength. As I trained, I had to be careful not to injure myself or become exhausted. I increased my mileage by small amounts over time to help my muscles adapt; then around a week or two before the marathon, I ran 20 miles but no more than that.

The day of the race arrived, and I was pumped and ready to go. The first few miles of the race felt effortless; I had run many half-marathons before, and this was familiar territory. But as it happens, the difficulty of running began to increase exponentially after I passed around 15 miles or so. With each additional mile after that, it felt like my legs were becoming more and more unresponsive. By the last 6 miles—the hardest part of the race—I was barely aware of what was going on anymore; all I could think about was continuing to lift my legs against gravity.

I’ve been told that the training that goes into medicine is not easy, and in fact becomes harder and harder as more responsibilities are added on at each stage of training. I know that the demands placed on residents are often great, and often lead to physical exhaustion and little time to take care of oneself.

I wouldn’t say that studying medicine has to always be as intensely grueling as the last leg of a marathon. But what I’m aware of is that there are difficult moments, when many demands are placed on us and many responsibilities seem to lie in our hands, which we face with limited time and abilities. What do we do in those moments?

I think what helped me during the race was knowing where my finish line was, and knowing that I had trained and prepared for this so that my muscles were ready, and I was going to do this. At the end, it simultaneously felt like I had been running forever, could run forever, and really wanted to just flop onto the ground. But anyway, I can definitely tell you that it felt awesome to cross the finish line and gulp down some water, and then lie down in the cool grass and celebrate.  

More than Medicine

More than Medicine

More than Medicine

Medicine is NOT the most important thing.

There, I said it. You see, I struggled a bit with finding the right way to begin this entry, and I came to the realization that sugarcoating things is not going to make things easier. If you’ve pursued medicine for any length of time, you, like I have believed a terrible lie: that medicine is the most important thing. And in some ways, that lie has been useful- it offers motivation in troubled times, it calls us to higher ethical standards, and it provides justification for the many sacrifices we’ve made in pursuing careers (I refuse to use the word lives) as physicians.

I firmly believe that while our curricula venerate the noble calling of medicine- to which there is assuredly some truth, I’m not denying that what we do is noble and good-we as a medical community have bought into this lie wholesale, causing more damage than we may notice at first approximation.

Don’t mistake me, medicine requires nothing less than our best. I’m not saying don’t be driven, don’t work hard. I’m saying that there is more to life than that MD or DO behind your name.

You see, we’ve become so enchanted with the idea that medicine is some illustrious calling that we’ve wrapped our entire identities around this one- important, but singular- aspect of our lives.

It’s no wonder why this happens really; pursuing medicine is time-consuming, draining, and absolutely worth it. What’s more, medicine’s all-encompassing nature has made at least me (and probably you), feel like all you are is a pre-med/medical student/physician. This, my friends, is a dangerous act, you are more than medicine, regardless of how you feel about it.

Here’s a litmus test…

When people ask you “What do you do?”, is your first response to mention your life as a pre-med/med student/physician? I am most assuredly guilty of this: I readily share my status as a medical student when asked that question, and it seems to be the only thing people want to discuss when they find out. But you, me, we are more than just a career choice, even as we spend most of our waking hours studying. We are sons, daughters, spouses, siblings, parents, coaches, bakers, runners, board-game players, lovers, friends. And yet, somewhere along the way, we’ve forgotten that our identities are so much more than what we do from Monday-Friday (and sometimes on weekends). 

Somehow, the consuming fire that is medicine has caused us to rearrange our priorities so that items 1-10 are all medicine in one form or another. And then when we go home and try to relate to our friends who aren’t in medicine, things are jumbled, stilted, tangled. We’re disinterested oftentimes, and that’s not the fault of our friends-it’s ours for somewhere losing our humanity. Indeed, empirical data suggests that medical students rapidly decline in their ability to experience and express empathy the farther they go along in school-I firmly believe this is because we’ve forgotten that we are in- fact humans first, and physicians second. For the sake of both you and your patients-reclaim your humanity. Realize that medicine is not most important- instead, it’s merely a component of the wonderful, complex, intricate you.

But how we go about doing that is easier said than done- especially when medicine does take up so much of our lives. I’m sorry to say there aren’t any easy roadmaps to regaining your humanity. What I can share are the steps I’ve taken to continue to remind myself that medicine is a priority, not the priority, of my life. For now, I want to leave you with three actionable items that I believe can help us reclaim some of our humanity from the beast known as medicine.

1. Make a list of Priorities

I started this reclamation process by writing out a list of what I think my priorities should be- the 5-10 things that make me, me. For my part, the list looked something like this: Faith, Relationships with Family, Medicine, Relationships with Friends, and self-improvement. Your list probably doesn’t look like mine, nor should it- be specific, be general. The point of the exercise is to carefully ponder where medicine falls, and to allocate your energies (not necessarily your time) accordingly. Carefully consider why each of those things matter, and then put the list you wrote (and yes, write it out) somewhere you will see it regularly as a daily reminder to pursue what matters.

2. Re-frame the “What do you do?” Question

I challenge you, when asked this question, to re-frame it as a question of “What are you passionate about?” Now when people ask me this question, I say, I’m passionate about improving children’s lives. Even that simple shift of focus drastically changed me from thinking of medicine as my sole identity to one where medicine is part of one large passion project. It’ll challenge you to live a life more fully engaged with the world outside of medicine.

3. (Re)Connect with people outside of Medicine

Look, 99.99% of the people on the planet are not physicians, and yet 99.99% of the world will interact with physicians in some way (Source: I made up those stats). As a result of the insular nature of medical school, there will be a strong temptation to ignore the perspectives of non-medical people, or to measure their values as less in some way (more on pride in medicine later). It is to our detriment to ignore those voices. Instead, get involved in your community- even if it’s studying at the local coffee shop or public library instead of school. Listen to people, interact with them. By experiencing the lives of those not intimately involved in medicine, you’ll begin to see how others live out a multi-faceted existence- that they are more than their jobs, more than their relationships, more than their hobbies: they, like you, are the sum of all those parts.

With any luck, such a mentality will rub off on you, and help you to remember that you are more than medicine.

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Medical School Mentorship Series: Having Faith

Medical School Mentorship Series: Having Faith

A confession: I didn’t feel ready to start medical school. In fact, I found myself staring at the calendar and dreading orientation as the date quickly approached during the summer. There were a number of reasons for this. I was apprehensive of what seemed like the daunting demands of med school and residency after that, especially in light of what I kept hearing about burnout and career dissatisfaction. I had wanted more time to continue writing and playing music, two things I was passionate about and yet was afraid would have to give up. And my significant other was away in New York, making this transition especially tough for me to face.

I am not afraid to say that I struggled a lot at first, but I can think of many people who provided support through it. One of these people was Dr. Anthony D’Amico. After listening to his talk to our class, in which he spoke in a serene but impassioned manner about the wisdom he had gained over the years, I found myself tearing up. I went over to talk to him afterwards, and we had a very genuine conversation about my goals and fears, and how I felt about med school and being away from my partner.

Last week, I met with Dr. D’Amico to discuss wellness in med school. Dr. D’Amico is a radiation oncologist at Brigham and Women’s Hospital and Dana Farber, and advises and mentors medical students at Harvard. In his spare time, he also enjoys martial arts and teaching tae kwon do. Whenever I speak to him, I find that he has an especially calm manner; he always seems unrushed, and has a thoughtful word to offer.

“How do you advise students to be well in med school?” I asked him.

His response was: “Love, forgiveness, and faith.”

Love

Love, said Dr. D’Amico, is a powerful human force, amplifying our actions beyond what solely exists within ourselves. And yet, he said: “Love should be shared first with oneself—in a way, it is hypocritical to say you love another when you don’t show that towards yourself.”

But often, we don’t love ourselves. As I wrote about before on the subject of Imposter Syndrome, we tend to blame ourselves for our faults and refuse to take responsibility for our achievements. We tell ourselves that we don’t belong, that we only got to where we did because we got lucky. That we don’t deserve our successes.

Dr. D’Amico felt his share of this, coming from an immigrant family and making his way to MIT and then med school, yet often feeling that he didn’t belong in these highly intellectually challenging environments. It was something that he had to grapple with and eventually come to terms with on his own.

“I had to learn to respect myself for the good things I was given and the good things I choose to do myself,” he said.

As a mentor, he realized how important it was to respect himself first. Teaching students, he found that there was a huge difference where the desire to teach came from—trying to prove oneself and quell one’s insecurities, or genuinely trying to help the mentee. Once he was able to respect himself and his abilities first, he found himself in a better place to truly offer his full guidance to students, taking the extra step to help them through their own insecurities.

Forgiveness

Putting yourself in “jail”—it’s something we all do. We punish ourselves for our failures, whether that’s failing a test, letting down a friend, or falling short on some goal we set. We put ourselves in jail for a different length of time depending on how badly we messed up. But Dr. D’Amico argued, it’s better to seek forgiveness and let ourselves out.

According to him, there is a logistical side and an emotional side to forgiving oneself. Logistically, it comes down to making a plan: if you failed a test, seek help and make a plan to study better next time; if you said something you didn’t mean to your friend, find a way to sincerely apologize.

The next part is to be able to achieve forgiveness on an emotional level. Dr. D’Amico said that it’s important to remember: “You’re human and you’re not perfect—no one is, but you deserve another chance, freely, unconditionally, and without punishment. Recognize that you will fail and make mistakes. But that’s okay, we all do—teachers do, the people who created the situation in which you feel like you failed, they fail too.”

Dr. D’Amico had an experience where he struggled with failure, when he first started at MIT as an undergraduate. Coming from high school, where he was accustomed to acing tests without studying, he didn’t know how to study when the material wasn’t immediately accessible. He failed his first calculus test. Discouraged, he questioned whether he belonged.

With time, he began to see that his college experience was more than just passing or failing tests. He dedicated time to learning how to study, learning how to learn. Over the years, he found himself beginning to feel more comfortable at MIT not because he had grasped all the material, but because he had accepted the limits of his knowledge and yet was willing to learn.

This was an important lesson for him—that forgiveness comes hand in hand with humility. As a medical resident in oncology many years later, he founded himself in the high-pressure scenario of trying to insert an IV into a patient whose veins were hard to find. Despite his anxiousness in the moment, he took a deep breath and said to the patient, “I’m going to do my best, but we know we have a backup plan if this doesn’t work.”

Suddenly, he felt better. Admitting out loud that he might not succeed had put both himself and the patient more at ease. This was a moment that made him realize how important humility is—knowing that we won’t always succeed, because we are human, but being willing to try our best anyway.

Faith

If we can’t always trust in our abilities to get everything right, then what can we trust in? This comes to the matter of faith.

“Faith,” said Dr. D’Amico, “is a belief that one holds, but can’t necessarily prove, that things happen for a reason, that the dictator of what happens in your life is a loving force.”

For some, faith is based in a religious identity, but it doesn’t have to be. To Dr. D’Amico, faith is trusting that everything that happens in life, both the good and the bad, bring you to the successes that you are able to accomplish. Achieving this success might not happen in a straight line, a predictable arrow of a path—success, however you define it, is a winding path, and faith is believing that you’re taking that path for a reason.

Dr. D’Amico employs an exercise that he calls, “What happened next?” When something goes wrong or differently from what he hoped, he tries to recall similar situations from the past, and writes down what resulted from those situations. What he finds often is that for instance, the job placement that he was unhappy about resulted in meeting several important mentors, or the time he spent apart from his wife only ended up in them becoming even closer. To him, this exercise illustrates the concept of faith—believing that our paths will lead us to where we need to be.

Put to the Test 

As medical students, my peers and I are often going to be challenged; we will find ourselves in situations where we don’t know what to do, and even situations where we fail under high pressure. This is where the faith that Dr. D’Amico described will come into play.

I asked him what advice he would want to give to his mentees and medical students elsewhere. Addressing the issue of burnout, he said, “You have to maintain your identity. Make time for the people you love and the things you love. If you want it, you make that happen.” He advised us to “express ourselves and be real,” both to ourselves and to others who care about us.

“Love yourself,” said Dr. D’Amico. “Respect yourself, forgive yourself, be kind to yourself. You’re not going to be any good to anyone if you’re not kind to you.”

What is Medical Burnout?

What is Medical Burnout?

Several years ago, when I was still in college, I remember being on the plane back home when I picked up a magazine and flipped to a random article. It was about doctors, and I was pre-med after all, so I read it. That was how I learned for the first time about high rates of career dissatisfaction, mental illness, and cynicism among physicians, extending to the level of residents and med students. I remember thinking, “Is this real? Would this happen to me too?” I pushed the thought to the back of my mind, because it was easy to dismiss—I had MCAT classes, summer vacation and a busy upcoming semester. Bottom line,  it wasn’t relevant to me at the time.

However, it is relevant now. I became a med student and am starting to see elements of the future more clearly. “Burnout” is a word I hear all of the time—everyone seems to be saying it. Physicians are burned out. Med students are burning out. Levels of burnout in health careers are rising, leading to a decrease in quality of care.

I looked up burnout in the dictionary, and the first definition is: “the reduction of a fuel or substance to nothing through use or combustion.” The second is: “physical or mental collapse caused by overwork or stress.” The similarity these definitions share is interesting—they both have to do with overuse, exhausting a resource.

To be more precise, “burnout” in medicine is characterized by chronic stress, emotional and physical detachment, and exhaustion. There are many factors that can contribute to this feeling—being overworked, losing faith in the field of medicine, financial burdens, lacking time to maintain close relationships, losing motivation to take care of oneself, ect.

I recently read an article on NBC about physician burnout and its consequences, including medical errors. One dire quote from the article that struck me, stated by an emergency room physician: “I went into emergency medicine because I wanted to help people…And we’ve created a system that’s taking people who care a lot, and who really feel passionately about this, and making them angry, and apathetic, and depressed.”

I can’t speak as much to resident and physician burnout, but I am certain that these issues exist among med students. These are feelings that I’ve grappled with myself, and at my own school, last year faculty were shocked when a survey revealed that a significant percentage of the student body was struggling with mental illness.

I’ve had a lot of questions. First of all, why do these kinds of feelings arise? My best guess is that there are a number of great pressures and challenges associated with a medical career—which, no matter what you say in your med school admissions essay, you cannot be completely prepared for—and these pressures can frequently lead us to believe that taking care of ourselves is not the priority, that we’ve chosen a field where we must subjugate our needs to those of others.

Second, what could we do about this?

I don’t know. But I strongly believe that you must take care of yourself as someone who has chosen a career in medicine. You cannot take care of others, you cannot be empathetic and engaged with the world around you, if you push yourself to the point of hurting yourself. As my colleagues stated in our class oath: “To heal others the healer must be well.”

The predominant culture in medicine right now does not always seem to be one where the well-being of the individual is valued. Talking about your struggles, admitting that things aren’t going well—this isn’t the norm. If anything, we need to encourage a different kind of culture, where we’re comfortable discussing harder topics.

It’s not easy for me either, but I’ve spent a lot of time thinking about this, and I’ve come up with some important areas that I think are important to focus on, regarding being well as a person in medicine. I’d like to end by sharing some of those areas:

Balancing your schedule

There are only 24 hours in a day. As silly as it may sound, my life changed at one point when I came to a realization: when I didn’t get enough sleep. I ended up wasting more time overall because of constantly feeling tired and not being able to concentrate. When I did sleep enough, I was actually more productive in the long run, even if it meant not finishing an assignment on a given night. So after that, I started to make sleep one of my priorities.

The point that I’m trying to make is: we have a limited number of hours, and while it doesn’t always seem like we have a choice, we do choose at the end of the day what we do with those hours. Make choices that are right for you. Know your fuel and energy levels. Know that you cannot spend your days draining your fuel, constantly working, and not spending any time recharging.  

Prioritizing your priorities

Something I like to ask myself is: “Is the ladder up the right wall?” We spend a lot of time working on climbing up our personal ladders—without checking if the ladder is placed against the right wall. Once we get up there, we realize that we spent all that time climbing to just end up in the wrong place.

Make sure you know what your priorities are, and that the choices you make are in line with those priorities and values—that you’re climbing up the right ladder every day. For me, mine are not necessarily grades, evaluations, or salary. Mine are the people in my life, my well-being, and retaining the curiosity and empathy I need to contribute meaningfully to the causes I care about.

Seeking help when needed

Take care of your mental and physical health. Be aware of what your mind and body are telling you. When you need it, do not hesitate to seek professional help. Anyone—and I mean anyone—can benefit from professional guidance. This can be something as simple as speaking to an anonymous counselor through your school. There is no harm or stigma to asking for help when you need it.

And in the realm of academics and education, ask your professors. Talk to your classmates. You are not here because you’re expected to know everything already. You are here to learn.

Intro to Med School Mentorship Series

Intro to Med School Mentorship Series

Mentors are incredibly important to us at any stage in our lives. Personally, I would not have been able to learn what I did and overcome challenges without the help of my mentors.

During college at one point, I worked in a stem cell research lab with a mentor who taught me some of the most important lessons I ever learned. Through his mentorship, I learned about many life skills such as leadership, healthy skepticism and critical thinking, and thoughtfulness and consideration towards others. I still continue to keep in mind the positive traits that he taught me, and often keep in contact with my mentor and other lab-mates.

Since starting med school, I have met some new mentors and advisors—the reason that I have felt comfortable opening up and reaching out to them when I need advice so far, is because I can sense that they are genuine, non-judgmental, and invested in working with me and helping me.

Starting soon, I will be writing about my conversations with people who have served as mentors—such as physicians and faculty members at medical schools—about their experiences in their respective fields, and the advice that they would give to medical students about career, healthy living, and choosing your path.

For now, I would like to share some traits that I think are important in a strong mentor-mentee relationship.

Openness to Sharing

Both parties should first of all be open to honest communicating and sharing. The mentee should feel like they can share their thoughts, plans, and worries. On the other side, the mentor should be open to sharing their own experiences, and the real struggles and challenges involved in getting to where they have. The pair should feel comfortable discussing many different topics and talking about their opinions and ideas.

Genuine Desire to Teach and Learn

The mentor should be truly excited to teach the student—not to mold the student in their own image and set them on the exact same path, but to encourage the student and teach them in whatever path the student has chosen to pursue. The mentor should value the relationship, and not see mentorship as a requirement or obligation.

The mentee should be open to learning, and approach the relationship with an enthusiasm to learn from the insight of the mentor. The mentee should come to meetings at least somewhat prepared with an idea of what they want to discuss.

Ability to Give and Receive Constructive Feedback

Neither giving nor receiving criticism is easy, but both are important. While celebrating the students’ accomplishments, the mentor should also not be afraid to give constructive feedback. The feedback should not be discouraging and should instead be positive, specific, and actionable.

On the flip side, the mentee should be open to receiving feedback. The mentee should accept their deficits in knowledge and experience, and know that only through receiving and working with critical feedback can they continue to improve and learn.

The Black Hole of Reddit Premed

The Black Hole of Reddit Premed

The Internet can be a useful resource—but it is also filled with forums and various websites dominated by stressed pre-meds and med students, who sometimes dispense questionable advice. Reddit premed is a perfect example of this.

During college and when I was applying to med school, I tried to restrict how often I referenced these online forums, but I would sometimes end up looking at them anyway. Many people can probably relate to how anxiety-inducing I found the content of these sites to be. From users posting about their stats and activities, to others despairing about stressful school-related situations.

At one point, when I was anxiously waiting for a phone call from a school, I kept going online to one of the forums and refreshing repeatedly to see what the latest updates were. It made me feel awful, and I couldn’t focus on anything that day. It caused me a lot of unnecessary stress; everything would have turned out the same anyway.

This isn’t to say that the Internet is not a useful resource—it does have a lot of valuable information to offer—but I think that online resources should be used in moderation, especially when it comes to medical-related forums. My advice is:

Don’t:

Don’t feel the need to engage with websites that make you anxious or unhappy

I know I would feel like I had to keep up with everyone else, and read about what people were doing so I didn’t miss out on something important. But there are plenty of more reliable resources that can give you advice about med school or how to apply, like counselors, professors, or friends who are in med school. They tend to be kinder and more realistic in their advice.

You’re allowed to use the resources that work for you, and avoid the environments that are stressful or detrimental to your well-being.

Do:

Utilize the Internet for helpful resources, and know the difference between what is helpful and what is not

There are definitely some useful resources out there; for instance, I sometimes referenced the forums to get some information about specific schools and their applications. As long as you know the difference between what truly helps you and what just stresses you out, it’s possible to benefit from these online resources.  

Be mindful of the time you spend online in general

This is just something that I’ve been trying to work on personally. The amount of time that I spend looking at screens usually just makes me distracted or puts me in a low mood. Setting limits on screen time helps me to stay engaged with what’s actually going on around me, and puts things into perspective. Perspective can be especially important when it comes to getting through some of the stressful experiences that pre-meds and med students face.

Academic Envy

Academic Envy

Many pre-meds might be able to identify with this feeling: Your friend comes up to you and says, “I just won a scholarship!” or “My paper is going to be published!” You congratulate your friend, and you feel excited for them—on some level. But on another level, you can’t hold back this other awful feeling of academic envy. You wonder: What about me? Why can’t I do something like that too?

Envy as a pre-med—or a med student, or really at any point in your life—is a normal feeling to have. In competitive or high-achieving environments, it often feels like you have to do better or at least keep up with everyone around you. When someone else achieves something, you might feel jealous, maybe even resentful, maybe even fearful that you won’t be able to achieve the same level of accomplishment or success, however you define that.

Here are some ways to counter the feeling of envy:

Remind yourself that no one’s life is perfect

It can be easy to think that someone else has what you want, and to jump to feeling envious of that person. But the truth is, everyone has their own struggles. Those struggles may not be as visible as the accomplishments and successes, but they exist too—no one has everything completely figured out.

Keep your eyes in your own lane

What other people are doing does not truly affect you: your life is your own. You face unique challenges, and you have your own talents and resources, making it impossible to compare with others how “successful” you are or how well you’ve used your resources. Do the best with what you have, instead of measuring yourself against others. Like a swimmer in a race who’s constantly glancing to see who’s around her, you’ll only bring yourself down by using others as markers for what to do.

Recognize that success is not an expendable resource

Just because one person succeeds doesn’t mean that others have to fail (although the stresses of grades can sometimes make it seem otherwise). Still, there are many different types of success, and rather than bringing each other down, our successes can in fact encourage and build upon one another.

Remind yourself that no one is evaluating your life

Sometimes it may feel like the spotlight is on you, and everyone is watching what you’re doing and judging you. To put it bluntly: no one really cares. Other people are living their own lives, dealing with their own issues and challenges. They’re spending the vast majority of their time thinking about themselves rather than about you. So do what it takes to make yourself proud and happy, not what you think other people expect out of you.

Prioritize real connections

In these kinds of competitive scenarios and environments, it’s easy to reduce other people to just seeing their outside traits and accomplishments. This kind of envious mindset only contributes to an unhealthy environment. To counter that, try to see people for who they really are—unique individuals who have accomplished certain things, but also have their own struggles. Prioritize making real connections and getting to know the people around you, on an honest and more personal level.

Flipped Classroom Pros and Cons

Flipped Classroom Pros and Cons

Medical schools are increasingly adopting a “flipped classroom” model. My school uses a flipped classroom model, although I didn’t know much about it when I started. Now that I’ve been studying and learning as a part of this model for a while, it’s worked so well for me that I wouldn’t want to learn any differently. Still, the flipped classroom comes with pros and cons.

What I like about it:

It’s easier to be prepared for class

The way our classes are set up, we have prep work for all of our classes that we have to complete before we show up for class. The prep work includes videos, readings, and other resources to help us understand the material. Then during class, we work through cases and problems based on the material. I personally really appreciate that rather than trying to learn in a lecture, which might not always fit my preferences and learning style, now I can learn on my own pace before class and come to class feeling prepared.

 The discussions are engaging and helpful

I really enjoy the in-class discussions, based on certain cases and problems. In general, I feel that everyone in my classes contributes enthusiastically and with consideration of others’ opinions. We work through a case together, and the faculty leading the session helps point us in the right direction. Being able to apply the knowledge to solve a problem really helps me to remember key concepts.

This kind of learning model reduces stress

I highly prefer the flipped classroom model to the traditional lectures I had in undergrad. Back then, I found it much more difficult to learn—I wasn’t always prepared for lecture, so sometimes I didn’t get much out of class and found myself cramming material before the test. While med school still isn’t exactly “stress-free,” the flipped classroom level certainly allows for better learning and consolidation, so that I’m not cramming and stressing out before tests.

What can be challenging:

You have to keep up with the work

In order to be prepared for class, you always have to stay on top of work, since there is prep work for every in-class session. This can be challenging because everyone has off days or extremely busy days. One thing that helps me is that sometimes I’ll try to get ahead and do a lot of prep work in advance, so that I can have a few days where I know I don’t have to think about it.

 It’s not always easy working with all of your classmates

During class, we’re always collaborating and discussing with our classmates. For us, we work in small groups and rotate throughout the year. The fact of the matter is that not everyone always gets along perfectly with their group-mates. Sometimes, based on disagreements or different learning styles, group-mates can have conflicts, and this can be a factor that makes it more difficult to learn. Still, this is completely normal. In fact, these kinds of situations are an equally valuable learning opportunity to work with others who might not see everything the same way.

These are some of my thoughts about the flipped classroom—personally, I think that more schools should be adopting this kind of model. I’m also definitely interested in learning about how other schools might use the flipped classroom or similar models.

Have you had similar experiences? I’d love to hear your opinions, feel free to leave a comment below.