By Philip Carullo
By the end of my first week of medical school the excitement of becoming a doctor was overpowered by the volume and speed of material presented to me. I felt helpless and fearful for the impossibility of managing it all. The analogy I like to share with incoming classmates is that no matter how prepared you are for the first day of class, it may feel like someone body checks you onto the floor. As you try to get back up that person keeps pushing you down and backwards. You get stuck in this perpetual cycle. It took 3 or 4 months before I could finally catch my breath, stand up, and learn how to begin managing the stress of medical school. For me the key was building perspective, realizing that this was a different ball game than college, and being able to alter the expectations I had for myself with the course material. I am now just weeks away from finishing the preclinical years and I am much more in tune with what stress is and how to manage it! I hope my tidbits can help some of you aspiring to enter the field and who will undoubtedly be challenged in similar ways.
I began developing a perspective on stress by realizing that it was an inescapable reality and the only thing I had control over was how it manifested itself externally. During my first class, anatomy, the only stress reducing mechanism I had was studying as much as possible. This meant no fun except for the evening following an exam. Although this was not a balanced approach, I was comforted knowing that I was doing my best. I figured that if I worked hard and failed an exam, that it was unavoidable and nothing more could have been done. This was a safe and comforting rationale, and it worked for me during this early phase of adjustment.
I had two important realizations once anatomy ended and a new round of classes began. First, medical school becomes harder and harder, but we become adaptable and able to retain information easier. Interestingly, I have been told of studies that have proven the brain changes that occur during the course of a medical school education! Second and more importantly, I needed to pace myself and enjoy the process of becoming a doctor. This meant embracing the ethos that were often endorsed by our school’s faculty like, “if something is important you’ll hear it again and again”, or “you can’t learn it all even if you tried, so start living life now and don’t wait”. With hesitancy I took this advice and learned how to personalize it. I began enjoying the city life of Chicago on the weekends and watched several TV shows to pass my free time. Taking time for myself every so often helped me remember that I was a person first and medical student second.
If I fast-forward through a bunch of courses, exams, and a summer of research, I can now share with you how I managed stress across the entire spectrum of the preclinical curriculum and make some recommendations for those just starting out. One thing that I encourage every incoming student to do is find a mentor. I found classmates that were in the year ahead of me and sought advice from them during times of need. They were very helpful in explaining how they made it through each set of classes, both academically and mentally. It was also very comforting to have them identify with what I was feeling and to hear about what was to come in the curriculum. Similarly, shadowing a physician mentor in clinic every so often can be highly motivational. It’s promising to know that a rewarding career exists beyond the mountain of material that we are expected to digest as students!
I would also highly encourage exercising. As a physician told my class during a pulmonary physiology lecture, “Your life only gets busier so start building healthy habits now”. We heard a similar plug for exercise during one of our pharmacology lectures where we learned that it is one of the most potent antidepressants known. Cliché or not, exercising has totally changed my perspective. Although I worked out in college, I never felt the benefits of it to the extent that I do now. I think that moving around and getting your heart pumping alongside a rigorous academic schedule pushes the reset button with regards to accumulating stress. Lifting weights, running, or both combined can keep you sane when the workload gets intense and is a much needed break from book work.
This next piece of advice depends on an applicant’s circumstances. If at all possible, attend a pass-fail medical school. The cutthroat mentality that existed as a pre-medicine student dropped off after the first few weeks in my class. We are not ranked against each other and are rarely given averages to exams. Our school trusts that we were smart enough to become doctors, so believes that a pass-fail curriculum fosters a more collaborate and stress-free environment amongst students. Managing the volume of material is the real challenge of preclinical years and not having the burden of the extra competition has been super nice. I would highly recommend considering pass-fail schools when making your final decision.
Lastly, I believe that a slow and steady approach with studying wins the race. I still to this day spend a majority of my free time studying. However, I also exercise 5 days a week, cook at home many weekdays and enjoy city life most weekends. I find studying to be a therapeutic activity and that has helped me stay focused. Being disciplined can be tough and it is true that even in medical school some can still cram material a week or two before an exam. I would argue that cramming is detrimental in the long run because a slow and steady approach is safer, less stressful, and also makes relearning material for the USLME Step 1 much easier.
To end this discussion I would just like to remind any aspiring medical student that being a physician will prove to be rewarding. I am already realizing this as a second year as we get prepped for the transition into the wards. Our gift for working hard and training for more than a decade post-college is the intimate access into people’s lives, hearing their stories, hardships, and sometimes being able to help through medical interventions. With that said, stress will always coexist with such responsibilities. Learning how to cope with it is essential to enjoying your life. Take your time, experiment to find what works for you, and learn techniques from others to start building your own perspective on stress management!