When John Allen, MD, started on his path to medical school, he utilized his experience training for triathlons to guide how he studied. Taking a “no pain, no gain” type of approach may have worked during his postbaccalaureate premed program, but once in med school, it was less than ideal.
The reason: Outworking his peers proved to be more challenging. “You have a lot of people who are trying really hard to make themselves competitive for various career paths that may require a lot of extra effort,” Allen said.
Allen studied until the wee hours, barely slept, and then had trouble retaining information. He didn’t examine why. Instead, he just pushed harder.
“I think I took an extremely sort of maladaptive mindset and then went into a very competitive environment, and it sort of compounded on itself,” he told Medscape Medical News.
Once Allen started medical residency, he spiraled even further. Working all the time and exhausted, he began to withdraw. Eventually, he came to realize that he was depressed and anxious. He had badly needed help for a long time but never knew who to ask for help or how.
Mounting Pressure
Medical students may feel an intense pressure to differentiate themselves from their peers, said Allen, who is now assistant dean in the Office of Student Affairs at University of Maryland School of Medicine in Baltimore.
The toll of medical school is “quite great,” echoed Riley Behan-Bush, a fourth-year joint MD/PhD student at the University of Iowa Carver College of Medicine in Iowa City, Iowa. “So it can leave you feeling this sense of ‘I don’t have enough time to take care of myself…,’” she said.
Medical students may feel pressure to do well on standardized tests and do research in pursuit of competitive careers, Allen said. Some students even get advice from the internet, or their peers, that if they don’t know exactly what field of medicine they want to go into, then they should prepare for the most competitive pathway. All of that can take a toll on one’s mental and physical health, according to Allen.
The extent of that toll is variable, Allen acknowledged For some students, the impact on their health is high, and they may even need to take time off to address medical conditions or quit altogether. For others, however, being in medical school means doing what they love, and they enjoy it, he said.
Set Boundaries
Medical school can feel long and hard, as if you are “drinking from a firehose,” Behan-Bush said. Students often never feel like they’ve learned enough, so she made a conscious decision early on not to sideline the activities that she valued most in pursuit of a career in medicine.
“For me, that was ‘I’m not going to pull an all-nighter’ because sleep is more valuable to me than the extra one or two points I might get on an exam,” Behan-Bush said.
She also set boundaries on her studying time. “Just like anyone who has a job, I have to have a cutoff time, and I have to allow myself to enjoy time with friends, enjoy time with my partner.”
Don’t wait to get into medical school, pass the step 1 exam, or match to a residency to be happy, she advises other students, “because you forget to live and experience your life as you go through it.”
Pick Three Nonnegotiables
To stay balanced during medical school, write down the three things that are most important for your well-being each week, Behan-Bush suggests. For her, it’s maintaining exercise, doing something social with her friends or husband, and reading before bed.
Make these things nonnegotiables. “And then over time, as long as you can achieve those three, you will find more time in your life for other aspects that you want to do,” said Behan-Bush, who is also a contributing co-host on The Short Coat Podcast, which is about getting in and surviving medical school.
There are also many student-run activities at most medical schools, such as gyms and intramural sports, Behan-Bush said. “Take advantage of your resources. Medical schools are here to help you out because they recognize you are low on time and money.”
To promote wellness, the University of Maryland Medical School offers workshops on maintaining healthy expectations, making time for self-care, and identifying and reframing stress, Allen said.
“I think that there’s a theme of medical students feeling like ‘Oh, I gotta work as hard as possible and sacrifice all of my life for this one pursuit,’” Behan-Bush said, adding another point: “The journey is not going to get any easier, so you might as well focus on taking care of yourself now while you’ve got the chance.”
Ask for Help
There is a persistent idea that asking for help in medical school makes you look weak, Allen said.
Maybe you avoid asking for help to avoid a potential stigma. “I think University of Maryland made a really strong push to be more open about those types of struggles, and to try to normalize those types of struggles, and make people understand that asking for help is really a sign of strength,” he said.
It’s also about learning how to learn, Behan-Bush added. At the beginning of each phase in medical training, it can feel overwhelming. For example, in the clinical years, you are learning how to see patients. “So you have to give yourself grace that in the first three weeks…you’re going to be in learning mode,” she said.
Mistakes Will Happen
Allen recalled one busy morning during residency that proved to be pivotal to his medical career.
While balancing multiple hospital patients, Allen admitted a patient who he had seen before. While in the middle of rounds, he hastily ordered this patient Lovenox for deep vein thrombosis prophylaxis, even though she had a past documented adverse reaction to the blood thinner.
During the admission process, an allergy alert had popped up on his screen, but he had inadvertently ignored it.
By the time Allen realized his mistake, canceled the order, and alerted the nurse — all within just a few minutes — the nurse had already administered the medication to the patient. Although the patient survived (and spent a few extra days in the hospital for monitoring), “that really broke my heart because I felt that I had really, genuinely caused harm to this patient,” Allen said.
To compensate for his pain, Allen did what he had always done before — used his triathlete mindset. He worked even harder, came into the hospital before everyone else, and stayed later, he said.
Two caring staff members approached Allen to ask if he was ok; he ultimately sought out professional help, got diagnosed and treated for depression, and improved well enough to continue in his training. He also got involved in patient safety and quality improvement efforts.
Allen shares his journey with his trainees to help fight stigma. A 2016 radio piece also documented his experience.
A lot of medical students and young professionals want to do everything without assistance. “They want to fly and show everyone what they can do,” Allen said. “It’s also ok to be open about feelings and needs.”