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,” as in-Training‘s founder Ajay Major so eloquently put it?
First, let’s recognize that the demands of medical school vary from year to year. The hours of studying and staring at your laptop screen create a different wear and tear on the mind and body than the hours standing in the OR or the delivery room. At the same time, there are many stress reduction techniques that can be used by first-years in the lecture hall, as well as by fourth-years on Match Day. One such strategy is mindfulness, especially because it’s not just a one-and-done activity, and is just like any new skill in that it takes regular practice.
The foundation of mindfulness includes the need to slow down, to pay attention and to simply be aware of the (sometimes chaotic) world around you. To be mindful of yourself means becoming self-aware, recognizing your highs and lows and understanding how you react to life’s daily struggles and demands. It means knowing what (and who!) gives you butterflies, what keeps you up at night and what leads to irritability or agitation. Rather than pushing your thoughts away or trying to fight them, it’s a matter of observing them. (Headspace.com has a great video describing this process, for those interested. Watch it here.)
If you want to make an effort to be more mindful, start by cutting out many of the distractions that are often faced during the day so you can turn more attention to yourself. Try to notice one new thing about your peers, your environment or yourself each day. Check your email three times a day instead of keeping your web browser open at all times. Turn off your Facebook, Twitter and social media notifications on your phone. When eating, prioritize time to sit down and focus only on your meal. Put your phones away and pay genuine attention to what your friends, peers, residents, attendings and patients are telling you. Having friends over? Ask them to put all of their phones in a basket at the door when they arrive. Going out to eat? Put all phones in the center of the table — the first person who gives in gets to foot the bill. Notice how your time together improves! It’s these simple acts and strategies that ultimately lead to stress reduction, because the quality of your time improves and you become more focused and less scattered overall. This is something that Daniel Olson, a fourth-year medical student at Albany Medical College, can speak to, as he himself has experienced the benefits of integrating mindfulness into life as a medical student. Daniel’s own journal through self-care as a medical student is a prime example of using self-reflection and mindfulness to improve his own quality of life:
“I was a mess. It was 2013, my second year of medical school, and my legs were progressively weakening. Fatigued, overworked, and trying to learn every detail of microbiology was taking its toll on me. At the time, I was unaware that this was stress manifesting as physical symptoms. As I finished my microbiology course, my symptoms began to subside and I was “ready” to tackle the next subject. This type of pattern occurred multiple times throughout medical school. If one had to lay out the diagram on a chalkboard, it would be: take on difficult challenge –> become highly stressed –> relax and de-stress only when challenge is completed. This is how I survived.
Over time, I realized that this strategy was unsustainable for my wellbeing. I began seeing a therapist and we discussed implementing features of mindfulness into my life. I started to meditate. When I showered I tried to focus on showering rather than studying. I bought a mountain bike and learned how to tackle trails on Saturday mornings. Surprisingly, the single most helpful change that I made to combat stress was possibly the simplest. Ever since my undergraduate years I chose to make “to-do” lists in my daily planner. Once a task was complete, I would strikethrough [sic] the assignment. If I did not finish the said task, the lack of strikethroughs [sic] haunted me. I would fixate on my unfinished work which would only add to my stress. After six years of successful usage, I reluctantly decided to ditch the planner. Immediately I felt relief.
I realized that the majority of my stress was self-generated. I put an inordinate amount of pressure on myself to succeed and get work done. Luckily, through mindfulness techniques, I gained some serious insight as to what makes me tick. I paid attention to my inner self and tried to implement changes in my life that could alleviate stress. To my surprise, I would perform far better in school because of these changes. During third year, I tried to maintain my progress in mindfulness and I did so while keeping my stress levels to a minimum. In addition, I scored higher on my second board exam through implementing a study strategy without a written “to-do” list, which is relatively rare for such a large and important test. There is still more ground to cover as I will be starting residency in a few months and stress will certainly be a part of the experience; however, I will not allow it to take control of the journey.”
Of course, there isn’t necessarily a right or a wrong way to go about taking care of yourself or improving your well-being as a medical student. Many medical students do what the literature says by eating well, exercising regularly and following all of the textbook examples of health and wellness — but it’s difficult to reduce stress without first accepting yourself and embracing the tenuous environment around you. That’s where self-compassion comes in. It’s a wonderful thing, and one that’s all too often missed when discussing stress reduction and mindfulness. So what is it, and how do you do it? Other medical students have said the following:
- “Take a few minutes to just sit quietly with my thoughts”
- “Give thanks at the end of each day, thinking about what went especially well that day.”
- “Take time for myself, by myself, to get away from school and stress for at least a few minutes.”
- “I do a lot of self-reflection. I remind myself of personal life experiences that were filled with uncertainty and I tell myself that I made it through those things, and have much more support and resources now, as I make my way through this.”
- “I try to get up early so I can have morning ‘me’ time. I try to spend at least one hour enjoying my cup of coffee, listening to NPR, and do a 10 minute yoga video.”
- “Tell myself nice things.”
- “Don’t take myself too seriously.”
In addition to slowing down and taking time for yourself to unplug, it’s also worth taking advantage of all of the tools and resources that are available. Headspace and Calm are great meditation resources. SuperBetter and Happify help with resilience. Gratitude journals provide you with a tangible boost of optimism, whether in an app or notebook. Ultimately, try several options and take advantage of the opportunities and resources that are out there. Once you find what’s most beneficial, do what works best for you and continue to prioritize your health and well-being!
Are you willing to share your experiences as a medical student regarding your own stress, health and well-being? All U.S. medical students are invited to contribute to Dr. Ayala’s newly launched national study. Research on these issues is important, and is typically done in a piecemeal manner by looking at only one component of stress, health or wellness. Help her fill in the pieces and build a representative sample of medical students by filling out the survey.