The topic of burnout is huge in today’s medical community. Multiple articles and studies have been published demonstrating that burnout is prevalent in all levels of medical training from the day-one medical student to the most senior practicing attending.
Whenever I hear the word “burnout,” I’m reminded of the ugly, oh-so-dark side of being a medical student, the side that hides in the shadows, away from the prestige and privilege that comes with the noble profession. Maybe it seems like I’m exaggerating; I mean, it’s just me jumping to conclusions when I associate the feelings of being overworked with the days where I can’t seem to find the bright side of anything, right?
A very important topic is that of mental health in medical practitioners, notably medical students. According to a study in the Student British Medical Journal, 30% of medical students report having a mental health condition — with a majority of 80% stating the level of available support was poor or only moderately adequate. This column was born from these alarming statistics and aims to stimulate conversation on mental health in medical students, from providing suggestions on how to maintain one’s mental health to discussing the taboo and stigma surrounding conversations on mental health in practitioners and students, and how to eliminate it.
Medical school is a notoriously challenging experience during which students undergo tremendous personal change and professional growth. Though the stressors that come along with this are varied and unique to each student’s context and experience, they may be categorized within a few common themes. Harvard psychiatrist Raymond Laurie has previously described the concept of “role strain” with respect to negotiating relationships with their families, friends, partners, peers, attending physicians and patients. Additionally, with regard to students’ concept of themselves, individuals who have high achievement may be challenged in new ways both intellectually and emotionally.
There’s a lot of talk about mindfulness these days — its importance, its effectiveness, the benefits of meditation and even the structural changes in the brain that result from it. (Do you want a less reactive amygdala and increased neuronal density in the hippocampus? Meditate!) It’s one thing to read about the benefits of doing something, but as many know, it’s another thing to actually apply it and understand it. So how can medical students use stress reduction strategies “in the context of the high-stakes, high-stress and time-limited environment of medical school.”
Before starting medical school, I had the opportunity to travel to Japan and visit an array of Buddhist cities peppered with ancient temples and samurai villages. As I explored these breath-taking communities, I discovered the samurai’s commitment to the pursuit of perfection in lifestyle and skill. Now, as I face the challenges of being a medical student, I find myself turning to the canon of the samurai.
As I settle into my second year of medical school, I’m confronted with the fact that I’m one-fourth of the way to an M.D. — that an entire year has passed, and unsurprisingly, all those predictions my deans made at the very beginning came to pass: time flew, we learned more than we thought we ever could, and upon close self-examination, we’re very different from how we were this time last year.
“Neuroanatomy lab exam. You’ve got this. You studied hard. You’re good at anatomy, you know that. Okay, found a tag you definitely know. Start at the one you know. You’ll be okay.” It’s the way I try to start every exam. I try to talk myself up to push away all of the negativity slowly flooding my brain. Anxiety is a tough card to be dealt, especially in medical school. There are only so many ways to cope with the mounting pressure.
In many ways, the students of Class of 2017 have become my second family. In the warm August of 2014, each of us arrived at orientation from different walks of life. We became one in the quiet moments as we donned our ceremonial white coats one after another and nervously found our designated places next to our coating second years. It was not unintentional that we swore the Hippocratic Oath as one — it marked the beginnings of a four-year relationship with each other and our transition from civilian life into medical. It represented an unspoken first moment of camaraderie. It represented the first knot tied in this large professional community.
The subject of mental health is especially close to my heart; my struggle with depression and anxiety has had an immense impact on my experience during medical school. Yet I never realized how utterly commonplace this is until reading a recent piece on Medscape, “Med Student Suicide, Depression: National Response Needed.” I had no idea, none at all, how many others there were struggling just like me. What I do know is, had there been a screening method in place and more than a half-ditch effort to de-stigmatize these problems, my medical school experience could have been vastly different.
The nightmare begins like any other. At first, everything seems familiar. But slowly, you realize something is not right — something is out of place. Outside the window, clouds black as night gather, lurching forward like a hurricane. The thunder is so intense you feel the electricity pulsate through your chest. An impending doom consumes your emotions. The room seems to press in on you like some scene from “Alice in Wonderland.” Then the words creep in.
For me, hepatitis B booster shots feel pretty much as pleasant as being sucker punched in the arm. You can imagine that it didn’t inspire much elation when I scrolled through my calendar to see, spelled out in big red letters, a reminder for “Hep B #3.” Now, as I reflect, this reminder feels like a victory of sorts.