Physician Heal Thyself: How will you deal with stress in medical school?

There is no doubt that stress features in the life of a medical student. You will be overloaded with information, from the anatomy of the ankle to the pharmacology of medications for dementia, which you are expected to understand in a limited time frame, using it to pass extensive exams that can define your early career. Coupled to this, professionalism at what is often a young age is a necessity as you are required to practice clinical skills on patients who view you as a working component of the NHS. On top of that, you may be a star player on the Med school hockey team that has training and a match every week. Indeed, there will be times at medical school where you will feel pressure to not fall behind in any of your responsibilities and commitments. 

So, how will you handle this? How do you deal with pressure currently in your life, and how can you apply that to deal with stress that you’ll have at medical school? It’s understandable that this is a not an uncommon question in a medical school interview. Students that don’t manage stress can often underperform academically as well as go on to have problems performing their role as a doctor later in their careers.

Too much stress and not managing it correctly is also damaging to the individual’s health. To name a few, excessive amounts of stress predisposes you to sleeping disorders, reduced concentration, depression, suicidal thoughts, gastrointestinal disorders, coronary heart disease and an increased likelihood to self-medicate inappropriately using drugs and alcohol (1).  

TYPES OF STRESS

Before moving on to management strategies, it’s first necessary to identify different types of stress. Broadly speaking there are types of stress: short term (acute) and long term (chronic). Acute stress results from ‘on the spot’ scenarios where there is a demand in the very recent past and an anticipated pressure in the very near future (2). Examples of acute stress include presenting a poster of your research in front of your year group, finishing work for an imminent dead line and even being a member of the crash team responding to a cardiac arrest.

Chronic stress is the stress of unrelenting demands for seemingly unceasing lengths of time. It results from incessant, repeated exposure of many acute episodes, leading to the individual losing hope of ever searching for a solution to the situation (3). Examples of chronic stress include the demand to stay on top of your growing list of work every week for the whole academic year or even financial stresses to save and conserve money such that you don’t go into the overdraft of your student loan. 

MANAGING ACUTE STRESS

When an episode of acute stress arises, it is necessary to manage not just the situation but your emotional response to the situation. Imagine this scenario: you have your first OSCE (clinical skills exam) in less than two hours and if you fail, you may have to resit the entire year. Firstly, take a breath and accept this situation as you can’t change the fact that you will have this exam. Next, be aware that you are stressed. The sensation of stress arises from the firing of neurons in a nucleus of the hypothalamus that causes a cascade leading to cortisol secretion from the adrenal glands (4). As a result, acknowledge the situation isn’t what makes you stressful but it’s how your brain responds to a situation. After this, look at the situation critically: what can you do to make yourself feel more prepared and less stressed? In other words, what’s the best way to spend your time between now and your OSCE? It may be to see your tutor, review your notes or maybe meet with friends to discuss components of the exam you don’t feel comfortable with. Use your answer to develop a plan on what you need to do in that current moment. 

MANAGING CHRONIC STRESS

Chronic stress requires more complex, life-altering approaches. If you do feel overwhelmed for a prolonged period and burnt out as a result of it, it’s important to communicate to senior members of staff. This is also the response you should use when stressed as a doctor. Concerning managing stress and preventing burn out at med school, some strategies are listed below:

1.) Stay healthy. Although this is easier said than done, eating a healthy, nutritious diet, exercising regularly and getting enough sleep prevents burnout and helps you manage stress. A good diet gives you more energy and alertness, helping you combat your tasks. Exercise releases endorphins, giving you a feeling of well-being. Sufficient amounts of regular sleep throughout the week will sharpen your attention, improve your memory as well as lowering cholesterol levels (which can influence high blood pressure, a component of stress) (5).

2.) Don’t neglect your hobbies. The extracurricular activities you enjoyed at school, whether they be sport, music or even art, are a great source of pleasure, gratification and a sense of accomplishment. In turn, new challenges outside of your course can give your mind time to relax (the old saying ‘a change is a as good as a rest’).

3.) Journal your feelings. Writing down why you are stressed allows you to have a narrative on things you are struggling with. Even if you just make a mind map on why you are stressed, it’s a great way to reflect on how you respond to circumstances, how you can improve your decision making and ultimately have more control on the way you think.

4.) Be proactive. If you are struggling to understand a topic of medicine, take responsibility for your learning by organising a study group with your peers or arrange a meeting with a lecturer to explain that topic to you. In doing so, you can solve issues you find difficult before they escalate into bigger problems. 

ANSWERING THE QUESTION: HOW DO YOU DEAL WITH STRESS?

• Identify the different types of stress, giving examples of both in your life 
• When talking about acute stress, mention how you will be systematic, thinking critically about what you can do to improve the situation and working out how to do it.
• When talking about chronic stress, mention strategies that you currently use. For example, you swim twice a week, you eat healthily, you keep a diary to reflect on what you are feeling at a point in time. It’s important to emphasise that these are strategies that work for you and that you can continue to use these whilst at medical school
• Finish by explaining that if you do feel very overwhelmed, you will communicate to members of staff, using the student welfare systems in place, in a similar way to a junior doctor seeking advice from a consultant when struggling in their career. 

CONCLUSION

Whilst stress can be a great motivator, too much can overwhelm you leading to problems in your career and health. Determining strategies to deal with stress before you start medical school gives you the potential to manage the inevitable struggles you could face.

Bibliography

1. https://www.researchgate.net/publication/298419251_Quality_of_Life_and_Depression_in_German_Medical_Students_at_Foreign_Universities
2. http://www.apa.org/helpcenter/stress-kinds.aspx
3. https://www.ncbi.nlm.nih.gov/pubmed/17615391
4. http://www.apa.org/news/press/releases/stress/2013/sleep.aspx