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By Sehra Rahmany

For most students, earning admission to medical school is a dream come true. The excitement is hardly containable, and, as classes start, it is easy to feel invincible. You are ready to fill your calendar with new opportunities, interest group meetings, research projects, and anything else that comes your way, only to top it off with studying well into the night.

As a first-year medical student, I was bombarded with generalizations and platitudes pushed on me and my class. We were told, “Sleep deprivation is normal,” or, “You should have anticipated the pressure of med school.” Indeed, there are lots of nights when medical students get only a few hours of sleep, and, yes, there is a lot of pressure on all of us related to the fact that one day we will be caring for others. However, this does not justify the regular practice of depriving yourself of sleep. You also must not belittle yourself if you are having trouble with the pressures and rigors of medical school. Furthermore, these exaggerated stressors placed on individuals may eventually manifest as anxiety and potentially lead to depression, for which medical students are at particular risk. A meta-analysis done in 2016 indicated that the overall prevalence of depression or depressive symptoms in U.S. medical students was 27.2%, and 11.1% reported suicidal thoughts (1).

Research done by Ishak and colleagues concluded that burnout if not controlled may lead to potentially disabling psychiatric disorders and suicidal ideation (2). Moreover, a meta-analysis by Frajerman and associates that included thousands of European medical students found that 46% were suffering from burnout and subsequent emotional exhaustion (3). It seems clear that those findings suggest that trouble lies ahead if no intervention takes place.

How can medical students and their mentors help prevent burnout? Prevention begins with implementation of curricular and extracurricular programs that promote and teach psychological health strategies. These programs can be an incentive for students to focus on the importance of self-care during medical school and for the many years after graduation. If we cannot care for ourselves, we cannot be expected to care properly for our patients.

I can attest to being a medical student who experienced burnout without realizing it. My excitement for learning never faded, but I came to a point in my first year when endless hours of studying were no longer effective. My entire life revolved around studying and practicing skills. I became anxious, which led to impaired performance in my courses. I had unintentionally built a system so strongly favoring schoolwork that it led to deterioration of my psychological and even physical health. Since that realization, I have been actively focused on restoring the balance in my life. I have set aside time for self-care, which I believe has allowed me to meet the demands of my rigorous curriculum much more effectively than when I solely concentrated on my studies.

Along the way, I have learned strategies that have helped me cope with the demands of school. These strategies include meditation, positive self-talk, exercise, and breathing techniques. All of these have significantly reduced my anxiety. Practicing deep breathing before exams and focused meditation have been instrumental in my ability to cope and develop a stronger sense of self. In addition, I have a more acute mental awareness and practice healthier daily routines.

The transition into medical school was not easy, and many students will of course continue to find it difficult. That is why we have to change the dialogue from, “You should have known what you were getting into,” to one that proclaims, “You are not alone.” Currently, my mentor and I are planning for 20-minute guided meditation sessions before exams or quizzes to be offered to all interested students. As I move toward my second year of medical school, I will both advocate for and strive to maintain healthy routines that will promote physical and mental well-being. My hope is that all medical students will find a formula for mental, physical, and academic success.

References

1. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316:2214-36. [PMID: 27923088] doi:10.1001/jama.2016.17324
2. Ishak W, Nikravesh R, Lederer S, et al. Burnout in medical students: a systematic review. Clin Teach. 2013;10:242-5. [PMID: 23834570] doi:10.1111/tct.12014
3. Burnout in medical students before residency: systematic review and meta-analysis [Abstract]. Frajerman Ariel, Morvan Yannick, Krebs Marie-Odile, et al. Presented at 26th European Congress of Psychiatry, Nice, France, 5 March 2018. Abstract no. 0R0050.

Sehra Rahmany
California Northstate University College of Medicine
Graduating Class of 2021

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