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Emil Chuck, Ph.D., is the Director of Advising of the Health Professional Student Association/Student Doctor Network.
Current traditional students have likely been traumatized by many incredible challenges during their young lives. Random gun violence, COVID-19, and political whiplash have made it easy to seek alternate or online worlds to find community, validation, and perhaps some relief or entertainment.
“Premed syndrome” has always been rife with comparisons to others. Social media and influencer/marketing pressure have intensified feelings of inadequacy. Broader awareness of mental health over the last decade or so has helped youth to seek help in general ways, but personal support remains challenging.
Premeds are also surrounded by the pressure to succeed or curry favor as a success. The Asian American Foundation recently published a report on youth mental health that summarizes factors that contribute to mental health challenges, and I’m sure they are similar in other races and ethnicities.
It’s very easy for students to explore their boundaries at the cost of losing their sense of balance or control; arguably, that’s what being a teenager is about. But at some point, one realizes that “working harder” does not mean “working smarter.” Less sleep or chugging down caffeinated energy boosters to spend more time studying will not get you a better grade.
Science has told us how our brains effectively remember information, and many of us have not appreciated the discipline involved in studying uninterrupted (turn off distractions and notifications whenever possible) for brief periods and letting the information settle (Pomodoro Technique) over a consistent, long time. The old rule about setting aside 3 hours of personal study every week for each 3-hour college course is still a good rule of thumb. A medical school curriculum typically has 24 hours of preclinical classes each week, so many schools have adopted a 4-day lecture schedule.
If one finds themselves skipping out on too many activities that help them feel balanced (exercise, movie nights/concerts, day-cations, 15-minute breathing meditations, calls to loved ones), they need to pay more attention to themselves (or a trusted friend should point this out). These balancing events should be regularly scheduled whenever possible without sacrificing rest.
I think the best way to build healthy coping mechanisms is to set aside time to slow down. Schedule things that allow one to fully relax and enjoy where they are or the community they are in. It should be easy to find things one can do briefly (15-minute breathing break without checking their devices), daily (exercise and diet habits), weekly (activities with friends or community), or monthly (concerts or nights out).
It doesn’t hurt to pick up a book (audio is fine) that has nothing to do with the serious matters of the day. Many people will challenge themselves by picking up a different language (outside of “medical Spanish”) or a different art form (musical instrument, sculpture, photography). Community service is also a way to remind students that healthcare only addresses one aspect of a person’s overall needs. While SDN is part of the “social media” world, we encourage students to interact with us and all online social media/groups in moderation.
Medical schools are also directly asking applicants about what habits they have undertaken that promote their well-being. (Describe specific steps you take to manage your stress and maintain wellness while balancing personal, educational, and professional responsibilities: Feinberg/Northwestern University.) This shows how critical these habits and practices are for aspiring health professionals’ success.
I take an optimistic point of view because most health professions programs want students to succeed and have taken steps to promote student wellness resources and build student-centered wellness systems. AAMC has collected resources to help administrators encourage discussions of mental health as a core practice, and most programs list resources on their websites. Professionalizing self-reflection as an essential practice and promoting narrative medicine through stories, poems, and other literary/art forms underscore the value of these lifelong habits to build endurance as their lives and work environments shift.
Of course, I acknowledge that gaps still exist despite how embedded these systems are in the curriculum. As I apply the “water from a firehose” metaphor, schools are sophisticated in identifying and monitoring students who may be drowning based on the high frequency of formative assessments to set up individualized tutoring and resources. A few schools I know give students a personalized study plan for board or licensure exams and appropriate time off to prepare. Yet students still react to the information deluge and the intensity of managing different expectations with a sense of panic about not keeping up with their peers. The question remains how programs can further encourage students to stay focused on excellence with a life-balanced approach, given the emphasis on competition and meeting perceived benchmarks.
Climate surveys from AAMC and ADEA suggest that while a sense of a welcoming community is strong, an inclusive culture that respects different life journeys remains elusive for those from marginalized groups. Staff also generally report lower satisfaction, similar to student satisfaction in climate surveys. I argue that students sense how faculty and administration treat staff as an accurate indicator of the program’s commitment to wellness, and prospective applicants should listen more to how staff are valued when it comes to wellness.
Sometimes I wonder how interprofessional education includes psychological or wellness professionals (it is part of the vision for the new Illinois College of Osteopathic Medicine). Most interprofessional discussions involve clinical, patient-based discussions for care, but I’m unsure how they learn to care for each other, especially in stressful situations. Moreover, the Core Competencies for Integrated Behavioral Health and Primary Care overlap with general interprofessional competencies.
Medical educators realize that shaming trainees before their peers must stop as a pedagogical practice. Onboarding seminars or mini-courses for clerkships and residencies ensure students know how to document their experiences, write proper SOAP notes, and behave appropriately. What is not often covered is the emotional and moral distress students may experience, which includes being disoriented as one changes from place to place and being shamed for incompetence in front of their peers. Most mini-courses emphasize the importance of being prepared and knowing the rules of engagement with other professionals.
More prehealth applicants have said they were involved in Crisis Text/Hotlines or as Behavioral Health Technicians, and they have been trained to hold conversations with those struggling with their mental health during stressful situations. If today’s medical students have hundreds of hours of experience (as they claim on their applications), then any student should be able to recognize and sit down with their peers who are experiencing feelings of inadequacy or incompetence. I’m certain many know what to say to their peers that would connect.
To that end, current students should ask their peers, especially older students with whom they may have been connected early on as first-year students. Even if the older students are on rotations, our society is so used to texting or Facetiming one another. No one is that far removed unless they don’t want to be contacted. Lean on each other without shame or guilt. The admissions committee felt confident you could do it with the school’s resources, so use what is available to you.
Inspira Advantage is proud to feature insights from leaders like Emil Chuck, Ph.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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