By Casey Paton
Medical school is characterized, and often caricatured, by the immense levels of stress that plague students throughout their four-year education. While you may not be able to decrease the frequency of tests and assignments in your courses, you can learn to cultivate effective self-care regimens that enable you to feel your best. The Yerkes-Dodson Model of Human Performance suggests that you perform at your peak level with an intermediate level of stress. The model posits that you are bored and your performance lackluster when your stress levels are low. It furthers suggests that high stress levels lead to distress and subsequent fatigue, exhaustion, ill health, breakdown, and burnout. Yikes! Clearly the sweet spot lies between these extremes. At an optimal stress level, you will feel energized and focused. You will experience stress but it will compel you to perform at your maximum to reach your goals.
So how can we establish effective preventive, management, and coping strategies to maintain optimal performance under medical school stress while still caring for our mental health? Let’s consider a Primary, Secondary, and Tertiary Prevention framework for stress management, just as we would classify Public Health measures overall. By working to manage our stress levels, we can work to maintain positive mental health.
Mental Stress Primary Prevention:
In Epidemiology, Primary Prevention is aimed at decreasing the incidence of disease by preventing the onset, before symptoms are present. The strategy is to reduce risk factors by promoting overall health in the population. For personal mental health, let’s consider it the establishment of a sustainable, robust study routine and the cultivation of a healthy environment in which to learn. This strategy will help to temper the development of stress, which should enable you to better care for your mental health.
1. Invest in a calendar or planner and use it!
You will likely be more organized and thus more effective in achieving your goals if you establish a record-keeping system which you can refer to frequently. You can carry a large planner with a month view and subsequent pages for each day. You can utilize an online calendar such as the one provided through Gmail or the Apple calendar. This tool will help you track your assignments and obligations. You may even be able to import your Academic Calendar from Blackboard to your iOS calendar, if your school enables this.
2. Learn your schedule for the academic year
Review which courses you will be taking at each point in the year. Does your school structure courses into semesters, blocks, trimesters, or something else? Becoming familiar with the timing of your classes and your break periods will allow you to more quickly master your environment and decrease stress. Learn how frequently you will have exams, when you will need to bring your white coat or other items, when your school has academic breaks, and simply which days you will need to bring lunch from home. Try to anticipate the inevitable crunch periods. You will probably be occupied with studying for a few days before each exam. Inform your family and outside friends about these dates and encourage them to visit at other times. A post-exam reunion would be a great way to celebrate your success!
3. Learn to cook and prepare meals in bulk
Identifying sources of healthy, tasty meals can be a source of stress. If you learn to cook food in batches and pack lunches and snacks for the week, you can avoid the stressful morning scramble to assemble your meals. Additionally, if you prepare staple foods in bulk, you can create tasty dinners from them as well, saving you lots of time and money. Consider preparing five or six servings of your favorite carbohydrate and protein sources each Sunday. Then slice fruits and vegetables that would pair well with each and either combine in a single-meal container or leave sliced in a larger container for easy access. This is a good opportunity to try out some new food combinations. If you customarily eat a lot of rice and chicken, for example, consider swapping the rice for a grain such as quinoa, couscous, or farro. Each of these can be prepared in about twenty minutes by boiling on the stove. Beans and lentils are excellent sources of protein and fiber, and tend to cost much less than a comparable number of servings of chicken, beef, or pork. Do you know about how many calories you should be consuming each day? Do you know how many grams of each macronutrient you should consume? If you are not sure, check out the NIH’s Body Weight Planner for an empirically-constructed caloric needs estimate.
4. Find an enjoyable fitness outlet
Being physically active is associated with many positive health benefits. Some of the most important to medical students are the positive associations between aerobic exercise and increased memory and better sleep. Additionally, aerobic exercise is correlated with a decreased incidence of heart disease, stroke, and diabetes. Strength training has been shown to prevent muscular atrophy. Yoga and meditation classes encourage a mindful, wellness approach to fitness that can complement any existing fitness routines. Whichever method of exercise you select, simply engaging in this break from studying for some physical movement can clear your mind and allow you to return to work later with more focus.
5. Establish good sleep hygiene
Many Americans do not get enough sleep. This is unfortunate because sleep has been shown to increase your ability to remember facts. Additionally, sleep deprivation is correlated with increased incidence of obesity and other chronic conditions, possibly due to the carbohydrate cravings that a lack of sleep can incite. By managing your schedule to allow for adequate sleep each night, you can minimize your risk of mental stress due to fatigue and its concomitant conditions. Practically, you can promote healthy sleep habits in many ways. Establish a nightly bedtime that will allow you to sleep 7-9 hours a night and try to maintain this schedule even on the weekends. Do not drink caffeinated beverages in the evening. Eat your last meal earlier in the evening and try not to exercise late in the evening. Also, unplugging from electronics for a half hour before bed can help you transition to a restful state.
Mental Stress Secondary Prevention:
In Epidemiology, Secondary Prevention is concerned with detecting the earliest symptoms of disease before its clinical diagnosis. This may include screening tests for a disease. Secondary Prevention stresses that early detection and intervention for a disease will be more effective and cost-efficient than later treatment. In a personal mental health model, consider Secondary Prevention as the recognition of early symptomatology such as irregular school performance or self care habits and the intervention to correct these problems before they manifest in serious academic or personal problems.
1. Prioritize your schedule and obligations
Inevitably, there will be periods of time during medical school in which you feel overwhelmed by the amount of studying and assignments you need to complete. To mediate some of this stress, make a list of the most important obligations in you life, and cut back on all non-required work for a few days or weeks. If you need to decrease extracurricular or volunteer activities, be sure to inform others about your busy schedule and allow them time to rearrange either obligations or personnel. Do not burn bridges by repeated absences or lack of communication. Remember that your class requirements take priority and decrease external obligations as necessary.
2. Maintain healthy eating, fitness, and sleeping habits
It can be difficult to justify time spent cooking healthy meals and exercising when you are in a stressful block but maintaining a regiment that allows you to stay healthy will allow you to keep a steady rhythm to your studying. Minimize the time required for these healthy endeavors by preparing food in bulk and limiting the number of shopping trips required each month. Plan a fitness schedule with emphasis on efficiency. Consider fitness programs such as High Intensity Interval Training (HIIT) which allow you to achieve a maximal heart rate repeatedly in a shorter time interval, usually twenty to thirty minutes. Also, heavy weight lifting is very effective in maintaining muscle mass with a limited time requirement.
3. Try to keep up with lecture material each week
If you are able to preview lecture slides before class each day and then review your lecture notes immediately after class, you can maximize the absorption and retention of course material upon the first pass. Reviewing all cumulative lecture material each weekend and creating relevant flashcards as you go will allow you to pace yourself so you will feel less stressed as the exam approaches. Look into streamline options such as exporting your lecture notes from Notability to digital flashcards directly.
4. Study in groups
Working with others is not only an effective way to synthesize and review material but also a good stress mediator. You can seek advice from older peers and your classmates about the best ways to study for each course, including the best resources from which to study as well as the most important takeaways from each block. Additionally, it is easy to feel overwhelmed with all the required readings for a course. Speaking with other students can reassure you that the amount of time you spend studying each night is sufficient!
Mental Stress Tertiary Prevention:
Tertiary Prevention in Epidemiology is the intervention taken to stop the progression of an established medical condition. Once symptoms have manifest, a clinical diagnosis can be reached. From this diagnosis, physicians and other health care providers can develop a plan to treat the condition. In a personal mental health model, Tertiary Prevention can encompass all the actions that you should take when you start to struggle with coursework and recognize that you are not achieving the level of success that you desire.
1. Seek help with coursework
At some point in your medical training, you are likely to receive a grade on an assignment that you feel is below your true abilities. These situations are likely to incite feelings of anguish and self-doubt, so you should monitor your emotions. If you are feeling excessively stressed, take a moment to recall your reasons for pursuing a career in medicine, and remember that your mental health is critical to achieving these goals. Still, you should take this opportunity to reflect on the factors that may have led to your suboptimal performance. Did you struggle with this type of material? Were your usual learning strategies insufficient for this course? Did you encounter a time-consuming obstacle in your personal life that impacted your performance? If you feel that your performance on this test or assignment is an anomaly, then perhaps you should simply adjust your schedule to allow yourself more study time in the future.
But if you are not certain why your performance was below your goals, perhaps you should seek help. If you feel your lackluster performance was course specific, maybe speak with the course director about concepts that you did not understand and ask for advice about the best ways to study for their course. Consider requesting a student or professional tutor. If you feel that your study habits overall are not up to par, perhaps speak to your advisory dean for advice about the best campus resources to help you improve. If you feel that your performance is entirely due to a personal factor, take the time to ensure that this personal business is appropriately attended to so you can perform better in the future.
2. Meet with a counselor
If you are feeling overwhelmed with feelings of despair, inadequacy, frustration, or hopelessness, talk to someone who can help you sort out these feelings. Maybe start by sharing your feelings with a family member for some strong emotional support. Consider also sharing your feelings with a close friend, maybe another medical student or a friend outside of medical school. Often other medical students are feeling similarly during difficult courses and these connections can reaffirm your confidence in your abilities.
Often universities and medical schools have trained counselors who are available to speak with students who are feeling stressed, depressed, anxious, or just wish to talk. These services are generally free, confidential, and directly on campus. If you feel the need for more regular appointments, reach out to a university or medical school psychiatrist. You may wish to ask your advisory dean or other student advocate for advice on how best to obtain these service. Importantly, if you feel you would benefit from any of these services, do not hesitate to reach out. Speaking with an appropriate resource as early as possible will likely provide the greatest opportunity to help you succeed in your remaining coursework.
If you are contemplating harming yourself, seek professional counseling immediately. Even if you are not planning to harm yourself, you should take advantage of the resources available to you to help you cope with the stressors are facing. Remember, your safety is far more important than your grades or future career.
One free resource available in the US is the National Suicide Prevention Hotline at 1-800-273-8255. Their website also lists local crisis centers.
3. Lean on personal support systems
Medical school is a difficult endeavor. Students often move long distances to attend their chosen medical schools and can feel separated from friends and family due to the strenuous burden of coursework and school obligations. Do not feel that you can not reach out to these people for support if you are struggling. They may provide the inspiration, motivation, or just the distraction needed to get you ready to start working again!
About the Author
Casey Paton, BS MA, is a first year medical student at the University of Rochester School of Medicine. She graduated from Cornell University in 2015 with a degree in Human Biology, Health and Society and four years of biomedical research experience. She earned a Master of Arts degree from Fisk University, analyzing the effects of oxidative stress on dopamine neuron degeneration. She has worked as a Research Assistant at Vanderbilt University Medical Center, studying the epigenetics of learning and memory. Casey has been the recipient of two national research fellowships including the National Science Foundation’s Graduate Research Fellowship. She is an enthusiastic power lifter, distance runner, and a Certified Personal Trainer with the American College of Sports Medicine. Casey is passionate about basic science research and hopes to lead her own research lab in the future.