Scenario: Samantha S is feeling stressed because of the heavy workload as a 2nd-year medical student and its impact on her life. Her main concerns are:
- She is having an identity crisis because she is performing below average academically when she is used to being among the best.
- She struggles to have a personal life while studying long hours.
- She is anxious about how to explore different specialties, find the right one for her, and do what it takes to be accepted in a residency in that specialty.
Your role: Throughout this activity, you will play the role of a 3rd-year medical student and will provide anticipatory guidance on academics and work-life balance to Samantha S, a distressed 2nd-year medical student.
You struggled with some of the same issues as Samantha S when you were a 2nd year student. It was hard for you to discover that you were no longer the best in class academically as you always had been at the top of the calls as an undergraduate student. To cope, you gradually shifted your focus from being the best in every academic challenge to doing what you need to do to be a good doctor. You are now feeling pretty content.
You are happy to share insights you developed during your own academic struggles. You find that using skills you have learned on how to provide patient-centered care come in handy when offering support to peers.
Challenge 1: 2nd Year Medical School Academics
A. Testing Pressures
Scenario: You are a third-year medical student and notice 2nd-year student, Samantha, looking sad as she sits by herself in a common area between classes (Expand your choice to view feedback).
You: Hello Samantha. You look a little down. What’s going on?
Samantha: I’m bummed out! I just got my results on the Step 1 SMLE practice test, and they weren’t good.
What do you say next?
If you want to express empathy at this point, which is the best choice?
You: “I’m sorry to hear it. “
This is a good expression of empathy. It shows that you understand and care that Samantha is unhappy.
You: “You probably weren’t the only one. “
This isn’t the best choice, although it has some merit in trying to make her feel better by letting her know she’s not alone in not doing well. This is not really empathy.
You: No wonder you feel down! [Validation] It sounds like you were surprised by it, too.
Samantha: Yes! I was used to scoring at the top on standardized tests. But there’s major competition in medical school.
You: [laughing] That’s probably an understatement! At least you found out what subject areas you need to work on ahead of time, while you have time to focus your studying.
Samantha: True. It did help me discover where I need to focus my studies.
B. Study Skills and Starting to Investigate Specialties
Scenario: 2nd-year medical student, Samantha S, feels supported after having the above conversation with you. So, she feels comfortable asking you for help with other topics that have been bothering her: study skills and starting to investigate specialties. You help her by providing anticipatory guidance, sharing your personal experience, including helpful resources, so she can be prepared for what is to come.
Samantha: Now, if I can just stay motivated to study every day. In undergrad, I used to do all my studying on Sunday nights and right before exams. I found out you can’t do that in medical school. You have to keep at it every day, but that’s hard to do. How do you do it?
You: I just keep in mind that I want to get into a surgical specialty and that keeps me going. But you are right. Procrastination has to go or you will soon be overwhelmed with trying to catch up.
Samantha: I don’t even know what specialty I want yet or what I’m supposed to do to get into a residency once I do figure it out.
You: Look, you don’t have to go it alone. You will find supports are available, like our school has regular seminars offered by the Careers in Medicine department.
Samantha: I’m afraid I skipped some of the seminars they offered already because I was busy studying.
You: I recommend going if you can. That’s how I learned about special interest groups. Since I want to be a surgeon, I signed up with a surgery adviser. They recommended I join the local surgery specialty interest group and the student section of [national surgery society]. These groups are a good way to explore what specialty you want.
Samantha: Thanks, I’ll look for those.
You: People will tell you that you have to do things to stand out so you get into the residency you want, like doing research, volunteering, shadowing someone in the specialty, etc. But if you try to do too much, you burn out. A resident I met in the special interest group gave me tips on which activities are the best to join for surgery.
Samantha: Good to know.
You: Also, the American Association of Medical Colleges (AAMC) has a great resource that can help, called Careers in Medicine (aamc.org/cim). It includes a timeline that tells you when you should be doing what, in order to improve your chances of getting in the residency you want.
Samantha: That’s really helpful. Thanks! [She pulls out her phone and sends a reminder to herself to look up the AAMC resource.]
You: [Thinking to yourself] It’s funny, I had been feeling a little down about my clinic performance, but helping helping Samantha put me in a really good mood.
Challenge 2: Work-Life Balance in Medical School
2nd Year Medical School Challenges: A Preview of 3rd Year Academics. Providing Anticipatory Guidance
Scenario: You run into Samantha several weeks later and check in on how she is doing.
Samantha: What they say about the amount of information you have to learn in medical school being like trying to drink from a fire hose is true. I’m exhausted. I’m looking forward to having fewer classes and less studying in third and fourth year.
What do you say next?
You: “I hate to tell you, but it doesn’t get much easier in third year, because you have less time to study when you are in clinic all day.”
This response gives Samantha anticipatory guidance, which helps Samantha prepare for the future realistically.
You: “There is still some studying.” [Playing it down so as not to discourage Samantha]
It does not help Samantha to keep what she faces in her 3rd year a secret. You helped prepare her a little.
Samantha: Oh, great.
You: If you can find a way to deal with your study habits now, you’ll be better off next year. At first I just sacrificed sleep, but you can only do that so long.
Samantha: I’m already burned out from not enough sleep. What did you do?
You: Prioritizing helped me get through the “fire hose of information” problem. You can’t learn it all, so focus on what is important. For me, that is whatever will help me be a better doctor, will be on an exam, or will prepare me for my personal career goals. Being number 1 or even top 20% is no longer a priority for me, but sleep, now that is important!
Samantha: Thanks, I like the simple way you describe it. What do you have to study in the clinic? Is there a syllabus I could look at ahead of time?
You: Sure you get some assignments. And you have to learn how they do things in each clinic you visit. And you also read about what you see in clinic. You have to start directing some of your own learning. They might recommend a good source, but you often have to take the initiative and look things up.
Samantha: I see what you are saying. That must be hard when you still have classes. [Empathy]
You: I realized I had to change my priorities and balance my efforts or I wouldn’t be able to keep up in the long run, and I might hurt some important relationships. So, I stay focused on what’s most important and make sure that includes time for my relationship and a little down time.
Samantha: I don’t even have time for a relationship. Thanks. That gives me something to think about.
You: You’re welcome. Hang in there. Once you get in the clinic more often, what is most important starts to get clearer.
Samantha: Thanks. I look forward to that!
Provide Resources and Tips for Self-Care
Sharing Resources Example 1: Work-Life Balance
Scenario: A day later, you think of some ideas that might help Samantha better cope with the stresses of medical school, so you send her an email.
I’ve got some tips on work-life balance I’m going to send to you. Let me know what you think.
Tips for Better Work Life Balance
Which of the following changes for better work-life balance recommended by the Mayo Clinic (2020) would you like to try?
Not overscheduling yourself.
Think of one specific way you will make this change in the near future.
Detaching from work when you are at home.
What ideas do you have for detaching from work tonight, for example?
Caring for yourself by relaxing, developing a support system, and helping others.
What one thing could you plan to do this week to achieve this goal?
Seek professional help if needed.
What do you need to get the help you need? Keep in mind the resources available through the school counseling office or similar supports offered by your institution.
Sharing Resources Example 2: The Importance of Sleep
Scenario: A few weeks later you think of another tip to share with Samantha: The importance of regular sleep, and write her because this was something you wish you had realized sooner.
I was thinking some more about the importance of sleep when you said you weren’t sleeping enough. It took a while, but I learned to use good study habits rather than all night study sessions to cope with the large amount we have to learn. It just goes into your short-term memory if you study last minute. Remember, you are not just getting through a class; you are preparing for a career as a professional. Here are a few things I learned in a seminar I went to last year that helped me prioritize sleep. They helped me so I thought I’d pass them on.
Samantha S. <SamanthaS@email.com>
Thanks! The stuff you sent on Work-Life Balance was good, too. I appreciate your help!
The AMA provides these recommendations for medical students regarding sleep (Murphy, 2018):
- Track your sleep.
- Create a routine.
- Wind down before bed.
- Don’t use your bed for studying.
- Watch your caffeine and alcohol intake, especially in the 2nd half of your day.
Sleep Guidelines: Recommendations for adults from the American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) are (Watson, 2015):
- 7 or more hours per night on a regular basis to promote optimal health.
- 9 or more hours may be needed by young adults, people with illness, and those recovering from sleep debt.
Sleep Knowledge Check
Which of the following do you think are negatively impacted by sleep deprivation?
Sleep deprivation has a negative effect on working memory (Krause et al., 2017) .
Positive and negative emotion
Sleep deprivation has harmful effect on positive and negative emotion (Krause et al., 2017) .
Sleep deprivation has a negative effect on hippocampal learning (Krause et al., 2017) .
A third-year medical student used several relational skills to help Samantha cope with scoring below average on a Step 1 practice exam:
Relational skills used in this dialogue to connect with and support Samantha:
- Empathy, or “the ability to sense, feel, and understand another’s emotions” (Patel, 2019).
- “I’m sorry to hear it.”
- Reflective listening involves conveying your understanding of what the other person said by briefly paraphrasing it in your own words. This helps the other person feel heard.
- Example: “It sounds like it surprised you, too.”
- Reframing involves pointing out the positive aspects of the situation and giving her more hope.
- Example: “At least you found out what areas you need to work on ahead of time, while you have time to focus your studying”
- Validation involves letting the other person know that what they experience is normal or the action they took seems appropriate.
- Example: “No wonder you feel down!”]
The third-year student also shares advice and resources on:
- What to start focusing on during 2nd year to develop her medical career and prepare to select a specialty
- The importance of maintaining a balance between academic or clinical work and personal life and getting enough sleep
- Anticipatory guidance to help her understand what 3rd year studies are like so that she will be prepared
Learning Points Summary
The same skills that medical students use to support a friend are the ones they will need with their patients. They include:
- Reflective listening: Convey your understanding of what the other person said by briefly paraphrasing it in your own words to help the other person feel heard.
- Expressing empathy: Empathy is “the ability to sense, feel, and understand another’s emotions.” (Patel, 2019) Be prepared with phrases, such as “I’m sorry you are going through this,” if you have trouble finding words to express empathy.
- Validation: Confirm that the feelings the other person has seem fitting or the action they took seems appropriate to enhance the other person’s self-confidence.
- Reframing: Changing from a negative way of looking at things to a more positive one by focusing on the positive aspects of a situation or what can be changed for the better.
Tips for Medical Students on Self-care:
- Maintain a healthy work-Life balance
- Prioritize: Focus on what is most important for your future career and wellbeing rather than being number one in your class.
- Make at least some time for what is most important to you outside of school, no matter what study demands you have.
- Set a regular study schedule from the start rather than procrastinating and cramming. With the heavy workload of medical school, it is unlikely you will be able to keep up otherwise. Also, crammed lessons will not be remembered as well.
- Sleep is an important part of self care. Sleep is important for well-being and optimal brain functioning.
Ayala EE, Berry R, Winseman JS, Mason HR. A Cross-Sectional Snapshot of Sleep Quality and Quantity Among US Medical Students. Acad Psychiatry. October 2017;41(5):664-668. doi:10.1007/s40596-016-0653-5. PMID: 28091977.
Krause E, Simon E, Mander B. The sleep-deprived human brain. 18(7); 2017. Nat Rev Neurosci.
Mayo Clinic. Work-Life Balance – Tips to Regain Control”. Healthy Lifestyle, Adult Health, Mayo Clinic. August 25, 2020.
Murphy B. 2018. Advice for a med student’s must-have—a sound night’s sleep. AMA Med School Life.
Patel S, Pelletier-Bui A, Smith S, et al. Curricula for empathy and compassion training in medical education: A systematic review. PLoS One. August 22, 2019;14(8). doi:10.1371/journal.pone.0221412. PMCID: PMC6705835. PMID: 31437225.
Stanford Coping with Your Crazy Busy Life BeWell, Stanford University Human Resources. 2021.
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