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Stress in Medical Education

Created February 13, 2013 by Andrew Crisologo
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It is 2 a.m. and you’re thinking to yourself, “How did I get into this situation again?” You know, where you promised yourself you wouldn’t get behind in that subject again. As you come to a full understanding of your circumstances, your heart begins to race because you realize you still have to nail down cardiac embryology for the anatomy exam in the morning. (Those of you who have taken anatomy know that is no easy feat.) You think to yourself, “I had plenty of time to study for this exam, where did all the time go?” At this point, stress and the foramen ovale are the only things on your mind. With stress taking up a significant portion of your brainpower, you are not just studying late, but ineffectively.

So what am I getting at? We tell ourselves that this level of stress is normal. We signed up for this long trek of academic punishment, so we just have to deal with the associated stress, right? True, elevated stress is to be expected while earning any professional degree, but does it have to be as high as we think? For the majority of students, it does not.

When I interviewed for podiatry programs, two of the questions the interviewers asked me were what I do for fun and how I handle stress. In retrospect, I now see how these were not two separate questions, but two parts of a single question. The faculty on the other side of the table know exactly what you are getting into. You on the other hand are completely ignorant. They know you need a healthy way to handle stress.

One of the things a student can do to soften the blow of this torrential onslaught is to take a look at their study methodology. If there were things I could go back and change about my experience so far, it would be to come with an open mind about how I study. Your study strategy may have worked well in undergrad; it still works per se, but is it the most effective way to study now?

Be aware of how you learn. According to the VAK learning model by Neil Fleming, three types of learning exist: visual, auditory, and kinesthetic. Visual students learn best when given material that can be taken in through their eyes. They prefer to see the material out in front of them, and charts, graphs, and pictures make monotonous lectures bearable. Auditory students learn best when focusing primarily on listening. They may benefit from listening to lecture recordings or talking out the material. Kinesthetic students learn best when they are able to get a hands-on experience. They may initially come across as visual learners because of all the charts and graphs they have but the difference here is that they made their own charts and graphs and learned through the process of making and writing out these aids.

Let us put this into perspective with an example: the Krebs Cycle. It is a massive venture to memorize all the substrates and enzymes and it can tease out your principal learning style. When you are studying, are you the visual student who flips through the slides over and over until you get it? Do you pop headphones in and listen to the instructor walk you through it? Do you find yourself standing in front of a large white board drawing it out repeatedly? Most people are a mix, so pick the one you most associate with and try focusing on that style.

I was surprised at how much my style changed from kinesthetic in undergrad to visual now. I learned this lesson the hard way by trial and error but if you want to get a jump-start on this process, check out this online quiz to see what style you most resemble. (http://people.usd.edu/~bwjames/tut/learning-style/) Use this evaluation once you enter graduate school or even once a semester to see how your style may change over time and help you study more efficiently.

But how do you schedule study time strategically? Isn’t setting aside a large chunk of your day for studying enough? I would beg to differ. Take, for example, a six-hour study block and turn it into several small blocks with a break in between each block as a type of reward. In my personal experience, setting out a stretch of time to study “subject A” creates short-term goals and creates a rewarding feeling of accomplishment throughout the day. If I were to try and study straight for a six-hour block, I would probably spend about half of it not studying. When I give myself a short break every hour, it makes it easier to focus when it is “study time” because I know a planned break is coming up. When the day is over, you will have actually had a lot more focused study time than before, because you spent less of the study block goofing around.

Now, what is one to do with these breaks? Aside from sleep, I enjoy reading a book (and not the electronic kind!) or getting up to move around. You have just spent the last block of time staring at the Krebs Cycle on your computer screen; it is time for you and your computer to have a break. It can be amazing how spending some time reading relaxes and charges me up for another go-around. I challenge you to pick up a book this week and give it a shot. Try and get out to take a walk 3-4 times a week as well. Get the blood pumping and clear your mind. Even 15-20 minutes of brisk walking per day can help reverse some of the ill effects of sitting around studying all day.3 These are some of the strategies that I have used to help manage stress during my medical education and I hope that they will prove to be positive outlets for your stress during the rigors of training.

References
James, Brad. What’s Your Style. University of South Dakota, 2009. Web. 28 Dec. 2012. <http://people.usd.edu/~bwjames/tut/learning-style/>.

Leite, Walter L., Marilla Svinicki, and Yuying Shi. “Attempted Validation of the Scores of the VARK: Learning Styles Inventory With Multitrait–Multimethod Confirmatory Factor Analysis Models.” Educational and Psychological Measurement 70.2 (2010): 323-39.

“The Nutrition Source: The Benefits of Physical Activity.” Harvard School of Public Health. Harvard University, n.d. Web. 28 Dec. 2012. <http://www.hsph.harvard.edu/nutritionsource/staying-active/staying-active-full-story/index.html>.

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