Establish a Self-Care Routine Before Starting Medical School

This blog is the third in a series that we are publishing on the soft skills and self-care rituals that all premedical students should work on developing prior to starting medical school.

The toll that medical school takes on students is well-documented. A 2020 article published in Medical Education Online summarized research findings on the impact of starting medical school on student wellness. “Prior studies suggest that mental health is especially affected, with higher levels of anxiety, depression, and perceived stress among medical students compared to age-matched non-medical student peers,” the article noted.

If you’re thinking, “Sure, medical school is stressful, but it’s temporary…,” you may be underestimating the problem. The American Medical Association references physician burnout as an epidemic, noting that just under two-thirds of doctors report signs of burnout including “emotional exhaustion and depersonalization.” In 2017, as a response to the gravity and universality of physician burnout and its negative impact on patient care, the World Medical Association amended the Geneva Declaration’s Physician Pledge, a modernized companion to the Hippocratic Oath, to include (among other things) the line “I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard.”

You must take care of yourself, to take care of others.

This is why we recommend that aspiring medical students do not wait to consider integrating self-care practices into their schedules. Because, while school is temporary and residency is temporary and fellowships are temporary—practicing medicine is not and it will continue to bring stress throughout the many phases of your career.

Although self-care looks different for everyone, there are some basic practices we recommend you consider. The Harvard Health Blog offers “four ways to nourish your body and soul,” that overlap considerably with the AMA’s recommendations for medical students.

• Physical Activity. Finding a regular exercise routine is a powerful way to ensure that you stay physically healthy, but it can be difficult. Harvard’s blog recommends that, no matter how, you make it a practice to incorporate movement into your day as much as possible. Park further away, take the stairs, stand up and stretch routinely while studying, discuss your coursework while taking a walk or flip through flash cards while on an exercise bike. The minutes and benefits will add up.

• Good Nutrition. Eat as plant-based and colorfully as possible. Try to avoid high-carbohydrate and sugar snacks, and don’t try to compensate for a poor diet with supplements and vitamins. Practice what you will (eventually) preach to the fullest extent possible. The AMA also recommends that students try to avoid high-sugar energy drinks and vending machines in favor of proper, nutritious meals.

• Obtain calm. Take at least a few minutes every day to engage yourself in something that calms you. This could be meditation, yoga, painting, reading, knitting, baking, or playing an instrument. What works best to soothe your busy mind?

• Sleep. Yes, even in medical school. Routinely get the amount of sleep that you need. Usually that’s around eight hours. And be sure to stay away from electronic devices and/or alcohol directly before bedtime. Erin Ayala, PhD, and the lead author of the medical student self-care study, provided the AMA with the following tips to improve medical student sleep:

  • Track your sleep so that you understand the amount you’re actually getting and what improvements you need to make.

  • Create a routine based on consistent bedtime and wake-up times.

  • Relax prior to going to bed, and don’t use your bed as a study spot.

  • Consider your caffeine and alcohol intake and how those may impact your sleep.

Read the rest of the series:

• Learn How to Accept Critical Feedback Before Starting Medical School

• Before Starting Medical School: Create a Study Routine that Works for You

Before Starting Medical School: Create a Study Routine that Works for You

This blog is the second in a series on the soft skills that all premedical students should develop prior to starting medical school. 

Medical school admissions officers admit applicants who have demonstrated their ability to thrive in a challenging academic environment through competitive transcripts and test scores, meaningful experiences, and high-quality letters of recommendation.  Yet many first-year medical students find themselves shocked by the intensity of the curriculum. 

Dr. Aron Sousa, Senior Associate Dean of Academic Affairs at Michigan State University’s medical school, described this phenomenon in an email written to U.S. News and World Report.  "For the most part, the intellectual difficulty of the work is about the same as a meaningful upper-level college course, but there is so much studying and work that even very good students work long hours," he wrote. "Most medical schools expect their students to work 60-80 hours a week every week." 

David Delnegro, a fourth-year medical student at the University of South Florida, also via an email to U.S. News and World Report, echoed this sentiment. "The speed in which medical school material is delivered is breathtaking and will humble every incoming student, especially since little guidance is given on how to prioritize the mountain of material," he wrote.

We share this, not as a cause for alarm, but as a point for preparation. Incoming medical students often have a history of taking on academic challenges with relative ease, but many have not yet learned the study skills effective for an even more demanding environment.  

According to a Medscape article, Study Hacks for Medical School, written by Kolin Meehan, research shows that effective study habits can be distilled into three simple rules. “Accomplished students actively construct a study plan and configure the surroundings to maximize their chance of success. Whether using 3x5 flashcards or Quizlet, one highlighter or a rainbow of colors, effective study strategies share common features borne out in the literature: Fully remove all distractions, temporally disperse the material, and repeatedly test concepts. These three simple rules stand to beget untold benefits to students at every level,” Meehan wrote.

As the article’s title promises, Meehan also provides suggested “hacks” for meeting these three conditions: removing distractions, dispersing the material, and testing yourself. We’ve summarized them below. 

1. Mold your environment. Opt to go somewhere to study that is free of distractions. It should be away from others and quiet. Don’t just silence your phone, but keep it out of your sight. Meehan notes that research shows that even silenced and without notifications, keeping your phone within your field of vision creates a psychological distraction. You will waste energy trying to ignore it, so help yourself by keeping it put away.

2. Define your time. Meehan recommends that you use the “Pomodoro Technique.” This involves setting a timer for a set interval to work. For example, 25 minutes with no interruptions. Follow this with a five-minute break. Do this for about four iterations and then take a longer break, for about 30 minutes. Meehan explains why this strategy works. “Study sessions structured in this manner enable students to accomplish a day's work without perceiving the level of fatigue normally felt during long, uninterrupted study cycles. The short breaks punctuating the day are sufficient to initiate the consolidation process and enable longer study periods,” he wrote.

3. Slow and steady wins the race. While Meehan recommends the Pomodoro Technique for daily work, he emphasizes the need to study consistently throughout the full semester. Do. Not. Cram. Research shows that spaced repetition is necessary for long-term retention. “Study structures that incorporate spaced repetition vastly outperform single, large cramming sessions,” he wrote.

4. Test yourself. Use frequent self-assessments to ensure that you are recalling the information that you are attempting to learn. He notes that studies have shown the brain must be asked to recall the information to ensure retention. “Students face a very real ‘use it or lose it’ situation,” Meehan wrote.

5. Seriously, do not cram. Meehan again pointed to the superior results in studies of spaced learning combined with self-assessment and recall over passive review (or cramming). If you have been properly spacing your learning and testing yourself, the benefits of cramming are negligible. Save your time to enjoy a walk (or perhaps a quick rest!) before the exam. 

Try incorporating these three hacks into your day-to-day and let us know how they work for you. We think it will pay off.

Read the rest of the series: Learn How to Accept Critical Feedback Before Starting Medical School