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

Some Students Don’t Match on Residency Match Day. Do they Need More Support?

Match rates improved across all applicant types in the 2023 National Match. U.S. MD seniors garnered a 93.7 percent match rate (+0.8 percentage points from 2022) and U.S. DOs achieved an all-time high with a match rate of 91.6 percent (+0.3 percentage points from 2022). Among international medical graduates, who historically match at lower rates, U.S. citizens achieved a record high match rate of 67.6 percent (+6.2 percentage points from 2022) and non-U.S. citizens matched at a rate of 59.4 percent (+1.3 from 2022).

The Match generally brought positive feedback for the improving rates, but what about those who don’t match? “After the match, of course, there's an uptick [in calls] every year," said Pamela Wible, MD and Founder/Operator of a mental health helpline for doctors and medical students. "Matchless medical students reach out to me who don't know what to do with their lives, sitting on $300,000 of student loans, sobbing on their couch" continued Dr. Wible, in a MedPage article published after the 2021 Match.

A recent MedScape op-ed considers the challenges for matchless medical students and urges the medical community to provide more proactive and structured advice and guidance on how to navigate not matching to a position. The authors suggest the following ways that medical schools or national medical organizations can offer more meaningful support: 

• Prior to Match Day, organizations can facilitate webinars/meetings that both normalize not matching to a position and also provide guidance on useful actions. The meeting might include topics such as how to adjust career plans, approach loan repayment, enter the SOAP process, explore alternative positions in research or other fields, and reapply to a future Match process. 

• Medical schools should focus on providing mental health support services and ensuring that students know how to access these resources both prior to, on, and after Match Day. In addition to providing access to emergency counseling services, the authors suggest that schools offer stress reduction workshops/tips and opt-out mental health services prior to the Match.

• Finally, schools and the medical community must work together to destigmatize not matching. Students should feel comfortable and safe pursuing next steps knowing that their school and the wider medical community will support them as they determine how they will continue to pursue their dream of practicing medicine. 

“Stay in touch with your dean and others at your medical school and ask them for help…Also, get involved in a research project. Look for mentors at your medical school who are working in the field of medicine you want to work in and volunteer to help,” said Margarita Loeza, MD, MPH and Assistant Dean of Student Affairs and Admissions at the Charles R. Drew University of Medicine and Science in AMA article published last month. 

Post-MCAT Survey Shows Prospective Medical Students are Increasingly Interested in Schools that Provide Academic and Social Support

Earlier this year the AAMC released its 2020 Post-MCAT Survey results. This survey, administered annually, provides insight into the individuals who take the MCAT—their backgrounds, preparation strategies, career plans, and interests. In 2020, 39.2 percent of test-takers responded to the online survey, which equates to over 30,000 people. The survey is provided after the MCAT is submitted, but prior to the test-taker receiving results. This year’s findings show slight, but persistent shifts in the socioeconomic background of MCAT test-takers, an increased interest in the academic and social support provided by medical schools, and growing concern about the cost of applying to and attending medical school. 

Below, we provide selected findings from the latest survey:

Premedical Life and Experiences

To gauge socioeconomic status, the AAMC uses the Education Occupation (EO) indicator, which classifies test-takers as EO-1 through EO-5 based on a parent’s highest educational level and occupation. Every year since 2016, the largest proportions of MCAT test-takers have come from those categorized as EO-5 (a parent obtained a doctoral degree and/or is employed in an executive, managerial, or professional occupation) and EO-1 (a parent obtained less than a college degree and/or is employed in any occupation) at 25.4 percent and 24.1 percent, respectively. It is important to note, however, that the percentage of MCAT test-takers classified EO-1 has declined slightly each year since 2016, with a 2.6 percentage point decline over the last five years.

Most respondents, 61.9 percent, decided that they wanted to study medicine prior to entering college. And a large number reported having spent time volunteering in a healthcare setting (84.9 percent), shadowing a physician or other healthcare professional (80.9 percent), and just over half (50.7 percent) participated in a laboratory research internship program for college students. 

More respondents graduated from college prior to taking the exam (53 percent) than not (47 percent). But this percentage has shifted annually, with the exact opposite occurring in 2016 (53 percent taking the test pre-graduation and 47 percent taking it post). Most of those who had graduated did so recently: 42 percent within the last year and 31.9 percent within the last one to two years. Just 12 percent had taken five or more years between graduation and the MCAT. About 60 percent reported taking courses at a college or university in the three months prior to the MCAT, while just over a quarter (27.6 percent) said that they had not attended school in the past three months. 

MCAT Preparation Strategies

Most respondents reported that they started their preparation by reviewing the scope of topics that the MCAT covers (81.4 percent) and assessed their progress throughout their study period using practice exams (82.4). Over three-quarters of respondents created a study plan to fit their schedule (75.2 percent), identified their strengths and weaknesses using practice exams (78.3 percent), and assessed their readiness by taking a final practice exam (78.4 percent).

In terms of the concepts, most prepared by answering practice questions while studying each topic (87.8 percent), consistently reviewing content they had previously studied throughout their preparation (82.6 percent), and testing their understanding of concepts studied (80.7 percent). Slightly fewer made sure to review each answer choice in the practice questions to determine why they were correct or incorrect (74.7 percent) and mixed in their review of different topics throughout their studying (74.9 percent).

The most used resources were the Official MCAT Practice Exams (85.4 percent) and commercially published MCAT prep books (72.6 percent). In terms of utility, 73.1 percent of those who used the Official MCAT practice exams described them as “very useful,” and 61.7 percent of those who used the Official MCAT Section Bank found it “very useful”. While just 45 percent of those who used commercially published MCAT prep books called them “very useful,” another 38.4 percent labeled them “useful.”

Almost all (89.7 percent) respondents said that they prepped for the day of the test by taking a timed, online practice test with scheduled breaks to “mimic the exam day.” A large number also practiced pacing so that they could get through all the questions in each section in a timely manner (85 percent), and most (79 percent) made sure to get plenty of sleep the night before the exam. 

When asked to name their biggest challenges in preparing for the MCAT, over two-thirds said that they struggled with maintaining confidence in their ability to succeed on the MCAT (67.6 percent) and 60 percent noted their difficulty with getting through the large amount of material they needed to learn for the test. 

Career Plans and Interests

Most respondents noted that they are “very likely” to apply to an MD-granting medical program (86.8 percent), while just under one-third said that they are “very likely” to apply to a DO-granting program (32.4 percent). Both percentages have been relatively stable since 2016. 

When asked what would encourage their application to medical school, students were most likely to select: finding a school where I will feel comfortable (88.9) and a fit between my interests and a school’s mission (83.4). However, the number of students who selected availability of academic support in medical school (71 percent) and availability of social support in medical school (63.9 percent) both increased significantly from 2016 (+7.8 percentage points, +11.5 percentage points respectively).

When test-takers were asked to describe what would discourage them from applying, most students selected grades, MCAT Scores, and other academic qualifications (72.5 percent). The number of those who selected the cost of applying to medical school (53.1 percent) and the cost of medical school (68.9 percent) as deterrents has increased by 6.5 and 6.1 percentage points respectively since 2016.

For full survey results visit https://www.aamc.org/media/51241/download