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Dr. Ronald Lee, Psy.D, is a Clinical Psychologist in his own private practice, specializing in working with health care professionals and people of color.
What we know is that pre-med and medical school are thrown into a highly competitive environment that requires a person’s tremendous amount of time, energy, and finances to reach their final goal. The expectations to quickly memorize medical facts in morning rounds, demonstrate medical procedures on actual patients, and answer diagnostic questions in real time will place students in a pressure-cooker setting to perform with excellence on demand. This relentless amount of stress will cause most medical students to experience moments of mental health distress in the form of self-doubt, loneliness, anxiety, and depression. It is not unusual for a few medical students to struggle with even more severe conditions that may require professional mental health support. Some students can have mental health challenges that manifest symptoms of somatic disorders, bipolar symptoms, obsessive compulsion, and sometimes even thoughts or behaviors of suicide.
For medical students, compassion fatigue can be a real thing! Students who are burned out typically struggle to muster twice as much effort to meet their typical levels of productivity. They often feel exhausted and find themselves feeling increasingly numb and distant from their patients, even when they are in acute distress. Medical students who are burned out become more isolated from their colleagues during downtime and they generally engage in fewer social activities. Burned-out students may question the reasons why they are in medical school, and they can be plagued by a debilitating dose of impostor syndrome. Studies on burnout remind us that students of color and those who self-identify as LGBTQ are at higher risk for burnout than medical students who are White and cisgender. In addition, the pressures of medical school can at times trigger PTSD symptoms for students who have a history of being discriminated against or traumatized in the past.
Strategies like designing a good plan to manage time and keeping a healthy balance of work, play, and wellness will serve medical students in the long run. Every medical student has a “why” for entering medical school. It could be related to a desire to help people, to realize a family aspiration, and/or to give back to a specific community in need. Being mindful of these reasons by staying in touch with mentors, keeping a journal, and/or having a vision board on your wall will be good ways to sustain your drive towards getting that medical degree. By setting an intention to keep your “why” as the core reason for your actions, you will push through the rigors of medical school with additional drive, focus, and inspiration. Finally, it is also important that driven students in medical school allow other people to support them during those times when they have hit their limit for effective self-care.
Quite often programs lack the acknowledgment that medical school is inherently stressful, and they fail to provide student support when mental health concerns arise. The highly competitive and cutthroat culture of medical school has been the subject of much scrutiny in professional training circles, describing the environment as toxic and unhealthy. Medical schools should shift mental health care from reactionary measures (“you have counseling centers and drop-in mental health clinics at your disposal”) to more proactive initiatives (“we have access to yoga classes, walk-in support groups, and a wellness center whenever you need it”). Medical schools that provide extra support for first-year students, carve out time for student cohort meetings and social events, or assign mentors to students for timely support are just a few ways that schools can build a more positive and healthier program for their students’ medical training experience.
The idea of talking to an initial stranger about personal problems can be daunting to some people. I would acknowledge to a student that once you begin therapy, you tend to settle into the process over time, and most clients find it helpful. What we also know is that ethnic groups of color are commonly more hesitant to seek help outside of their families or home communities during times of need. Medical schools should be mindful of higher-risk groups for cultural stigma against mental health care within their student body. I would encourage all students who are struggling to seek help, as most counselors and therapists are obligated by law to keep mental health conversations confidential. And as far as professional consequences are concerned, mental health support is a common option for medical students, and their rights to privacy in mental health-related matters should be spelled out by medical schools in their written policies and procedures. The goal of mental health support is to ultimately increase a student’s control over their lives, not lessen it.
As you metaphorically drink through the open fire hydrant of medical school, you need to set personal limits and regulate your flow of work the best that you can. Time management is important. Designing a schedule and keeping to it will be essential. Give yourself some buffer time in between tasks, and schedule in leisure time. The basics of healthy eating, sleeping, and exercise are important ingredients for well-being. Keep an ongoing activity in your routine that gives you joy. Your constant challenge will be to maintain balance in an inherently imbalanced program of work demands. Be realistic about your social needs. For example, for social extroverts, it may be wise to set a personal limit on your weekly level of social activity. However, for introverts, it may be more about forcing yourself to stay engaged with a small network of friends (even if it means giving up that extra study session). And finally, take in personal indulgences like recreational drinking, thrill-seeking, eating in excess, and sleep deprivation in moderation.
It is normal for medical students to have periodic moments of self-doubt and occasional bouts with imposter syndrome. It is also common to occasionally fall behind in your tasks and studies. Remember that medical school is a marathon, not a sprint. This period of your professional training is a time to pace yourself and to be soft about your own progress. In many ways, struggling with mental health issues has become the new normal. Since the COVID-19 Pandemic, almost everyone in the world has experienced some level of traumatic experiences that result in temporary states of anxiety, depression, and loss. If you face your own challenges head-on and seek professional support as needed, you can find comfort in the fact that experiencing mental health struggles makes you a more empathetic and authentic doctor. To find the grace to share with patients that you too have walked in their shoes during times of struggle will pay immeasurable dividends to both you and your patients.
Inspira Advantage is proud to feature insights from leaders like Dr. Ronald Lee, Psy.D, to help pre-medical students better understand how to care for their mental health throughout the demanding journey to medical school.
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