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.  

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.”

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.

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.

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.