Some challenges will always be a part of medicine and medical training and are difficult to change. Being aware of them and having skills to deal with them can make a big difference. Mindful awareness of challenges and their impact is a good place to start.
The following list of medical school stressors is in order of how often items were selected by 985 students at six medical schools (Hill et al., 2018). Factors contributing the most to their stress (a moderate amount or a lot), using a checklist of potential stressors were (n=985):
- Academic workload 88.1%
- Conflicts in work-life balance 47.8%
- Romantic relationship management 39.2%
- Inadequate study habits 37.7%
- Poor time management skills 30.9%
- Financial difficulties 26.8%
- Competition with peers 25.6%
In response to an open-ended question, the following stressors with a slightly different emphasis from the original checklist were also often identified:
- Performance pressure (35.4%)
- Time constraints/lack of balance (33%).
Consider which stressors have impacted you. Notice any effect that just thinking about these challenges has on you physically or emotionally (check breathing rate, pulse, muscle tension, and physical signs of your mood). It is normal to feel the effects of stress in your body. Fortunately, there are learnable, simple, evidence-based skills that help mitigate the stress effects and enhance well-being.
Hill MR, Goicochea S, Merlo LJ. In their own words: stressors facing medical students in the millennial generation. Med Educ Online. October 5, 2018;23(1). doi:10.1080/10872981.2018.1530558. PMCID: PMC6179084. PMID: 30286698.
This page covers the following common medical school stressors in more detail:
- General Tips for Starting Medical School and General Resources on Realistic Expectations in Medical School
- Performance Pressure and Competition
- Family Pressures
- Develop an Inner Guide, Quiet Your Inner Critic
- Personal Goals
General Tips for Those Starting Medical School:
- Start with strong study habits from the beginning. Just pushing harder may not be enough; learn some study skills.
- Maintain health self-care including both actions taken and avoiding overextending
- Maintain and make friends
- Get your affairs (financial, health checkups) in order before school starts.
General Resources for Realistic Expectations in Medical School
- The Princeton Review – What to Expect in Medical School
- AAMC – Navigate Your Journey from Pre-Med Through Residency and What Medical School Is Really Like
- American University of Antigua, College of Medicine – 10 things you didn’t know about medical school.
- Peterson’s – A Brief Synopsis of Medical School – From First Year to Residency
Performance Pressure and Competition with Peers
Medical school has a competitive atmosphere, more so than undergraduate education. Even medical students who had never been competitive in the past may find themselves getting caught up in the competitive spirit of medical school while at the same time finding it a harmful stress. A certain amount of competition can stimulate greater effort and use of self-discipline in studies.
Consider how much of the pressure is coming from yourself and review the following ideas for changing that.
Tips for Handling a Competitive Atmosphere
Reminding yourself of your mission and goal for being in medical school. Is it to be number 1 in the class or to be a good doctor?- Excuse yourself next time a group’s conversation turns competitive and take a walk outside to get some fresh air.
Tips for Working with Goals Realistically and Effectively
You may find that setting and achieving your goals in medical school differs from undergraduate education, because medical education is more challenging. Competitive goals that involve being the best may be difficult to achieve because many other medical students may perform as well as or better than you do academically.
- Think about the difference between goals and expectations. Which are more likely to feel upsetting if not reached or experienced?
- What are your expectations for your medical training or career? How would it change things to treat them as goals instead? Do some research to help you develop realistic expectations. Consult with medical students or residents who are a step or two ahead of you. Let go of unrealistic expectations, but keep worthwhile goals.
- Next, set realistic goals. Since many medical students underestimate the difficulty of reaching goals they set during medical training, try automatically adding a degree of difficulty and some extra time to your plan for achieving your goal (Bird et al., 2020).
- Now structure your goals so that they are more achievable. Break goals down into stages and small steps within those stages. Make the steps realistic, measurable, and achievable steps.
Reference. Adapted from:
Bird Amber, Tomescu Oana, Oyola Sonia, Houpy Jennifer, Anderson Irsk, Pincavage Amber. A Curriculum to Teach Resilience Skills to Medical Students During Clinical Training. MedEdPORTAL. 2020;16:10975. doi:10.15766/mep_2374-8265.10975. PMID: 33015355 PMCID: PM
Pressures from Family to Perform
Pressure from Parents: Most students in our focus group described pressure from parents and others to perform well adding to the stresses of medical school. Research into medical students who had parents with strong expectations regarding their going to medical school vs. those who did not found that students who had parents with high expectations had more negative attitudes toward medicine as a career after one year of school and suffered more from burnout in year 5 (Griggin and Hu, 2018). What use can you make of this data? Be clear as early as possible about what you want as a career. Counseling is one potential way of getting clearer about whether this is actually the career choice you want.
Pressure to Provide Medical Advice: Furthermore, medical students are often asked by their families to provide medical opinions and have to explain they cannot do that.
Griffin B, Hu W. Parental Career Expectations: Effect on Medical Students’ Career Attitudes over Time. Med Educ. June 2019;53(6):584-592. doi:10.1111/medu.13812. PMID: 3073432
Do You Tear Yourself Down? Develop an Inner Guide Instead of an Inner Critic
Many medical students are highly perfectionistic, which is compatible with achieving high goals. However, it can be draining in situations where being perfect is difficult to achieve. Some students are highly critical and harsh on themselves when this happens, as if they have an inner critic inside who is not aware of how destructive this can be to self-esteem.
Challenge: If you have a harsh Inner Critic, listen for the next time it is active and see if you can be kinder to yourself. Think in terms of talking to yourself as a more benevolent mentor might talk. Try to follow the tips above for providing optimal feedback – to yourself!
Exercise: Use a journal to write down self-criticism and then rewrite it from the perspective of what a more benevolent mentor might say.
Thanking Your Mind: Taking the Power Out of Difficult Thoughts. Illustrates a brief technique from Acceptance and Commitment Therapy. By Dr. Russ Harris. Time: 1 minute 46 seconds.
Bird Amber, Tomescu Oana, Oyola Sonia, Houpy Jennifer, Anderson Irsk, Pincavage Amber. A Curriculum to Teach Resilience Skills to Medical Students During Clinical Training. MedEdPORTAL. 2020;16:10975. doi:10.15766/mep_2374-8265.10975. PMID: 33015355 PMCID: PMC7526502.
Personal Mission and Purpose
Having a personal sense of purpose is important for having strength, perseverance, and resilience. Clarify your current understanding of your mission and purpose regularly. Writing it down in a journal can help you refine it. Remember to update it periodically. You can then refer to your written purpose and mission when feeling confused or overwhelmed. It may be helpful to carry it in writing or a symbol of it with you to remind yourself of it.
Personal Challenge Idea: Write your Mission and Purpose for your life and career in a journal for yourself and review it periodically.
Adapted from: Bird Amber, Tomescu Oana, Oyola Sonia, Houpy Jennifer, Anderson Irsk, Pincavage Amber. A Curriculum to Teach Resilience Skills to Medical Students During Clinical Training. MedEdPORTAL. 2020;16:10975. doi:10.15766/mep_2374-8265.10975. PMID: 33015355 PMCID: PMC7526502.
Students whose patients die may feel grief with components of guilt, sadness, and anger. Although schools typically cover this topic and make recommendations for how to process your reaction to patient deaths, it is still often a difficult experience. Reactions can vary based on how expected the death was, the age of the patient, similarities between the patient and yourself or a loved one, physically disturbing aspects of the patients’ condition, and interactions with the patient and family (Batley et al., 2017). Patient deaths may sometimes be experienced as a trauma, which may lead to anxiety from dread of future failure (Belling, 2020). In time, you will be more used to the fact that clinical practice involves emotion and uncertainty (Belling, 2020).
How to Cope: Be sure to avail yourself of debriefing and counseling sessions that are available to you. Other advice to future doctors (U.S. News) may seem self-evident, but it is important:
- Allow yourself to grieve.
- Follow the recommendations in classes you have on how to cope with patient deaths. The recommendations are made because of accumulated experience on what helps.
- You may be advised to write your feelings of sadness and other feelings or discuss them with a colleague in order to process them. Some schools may suggest writing a letter of condolence to the family.
Resources and References on Grief
- How to Cope with Death as a Future Doctor. U.S. News and World Reports
- Haunted Doctors. Belling C. Perspect Biol Med. 2020;63(3):466-479. doi:10.1353/pbm.2020.0034. PMID: 33416620. – Discusses “unresolved sorrow or regret about past clinical events, in particular the deaths of patients”
- Batley NJ, Bakhti R, Chami A, et al. The effect of patient death on medical students in the emergency department. BMC Med Educ. July 10, 2017;17(1):110. doi:10.1186/s12909-017-0945-9. PMCID: PMC5504556. PMID: 28693475.