Minali Nigam is an MD/MA candidate at UNC School of Medicine and UNC School of Media & Journalism:
During the third year of medical school, I had one goal: to be the best doctor-in-training I could. That meant sacrificing some things I enjoyed. Things like binge-watching Netflix, writing for fun and sleeping in.
I always thought doctors needed to be selfless. However, in trying to be a good doctor, I didn’t expect to become so selfish with my own time. Rarely did I check in on old friends or build new relationships. Instead, I spent much of my free time studying alone or chart-stalking patients. While I loved my work, I was becoming too immersed in it. I could see the trajectory of my social life, and it wasn’t pretty.
Every doctor-in-training has had this same conversation at some point or another. “It’s for one more year. Once it’s over, I can go back to having a normal life, and more balance.”
A certain degree of sacrifice is necessary in medical training. However, “it’s one more year” can become a slippery slope. One resident described his job as “soul-crushing.” Then an attending called herself the “worst mom” for missing another parent-teacher conference. I realized that every stage of medicine could trap you in work and rob you of other life experiences. After a year on the wards, I knew that I needed to make some changes to prevent burnout and enjoy every aspect of my life.
I started seeing my school’s wellness coach.
Med School Can Be Crushing; Wellness Can Help
When you think of wellness, you may picture yoga, meditation, or playing with therapy dogs. You may feel like time not spent studying/researching/shadowing is wasted.
Dr. Chantal Young, a clinical psychologist, understands. She is the Director of Medical Student Wellness at the Keck School of Medicine of the University of Southern California (USC). She developed a required 34-hour wellness curriculum for first-, second-, and third-years.
“Some students are like ‘this is fluffy’ or ‘this is not important,’” said Dr. Young.
However, medical students worldwide ignore these lessons at their peril. A 2016 meta-analysis looked at over 100,000 medical students across 47 countries. 27.2% of students screened positive for depression, and 11.1% reported suicidal ideation during medical school.
These rates of depression/suicidal thoughts are almost three times higher than the general population.
Med school can sometimes feel like drowning
Dr. Young’s curriculum addresses these issues. They cover stress management, imposter syndrome, and sleep hygiene, among many others.
“No matter how many improvements we make to the field of medicine, [being a physician is] still going to be a tough job. You’re still going to be dealing with human suffering, human death, making mistakes,” she said. “Med students need a special set of skills. To know how to take care of themselves, to know how to be resilient, to know how to be self-compassionate. It is the school’s burden to teach them.”
Medical students come with “pre-existing vulnerabilities.” These include high expectations and pressure to perform well, Young said. Academic stressors include the pace and volume of courses, USMLEs, and preceptor evaluations. Students can become so focused on their career, that their personal lives get put on the back burner.
Wellness Is Preventive Care
The goal of wellness is to address emotional distress before it escalates. Think of wellness as preventive care.
“Wellness is not treatment,” said Shahnaz Khawaja, a licensed counselor and wellness coach at the University of North Carolina-Chapel Hill (UNC-CH). “It’s easier to prevent a collapse than it is to treat collapse. It takes less energy, fewer resources, and outcomes are higher in terms of health and wellness.”
There are eight dimensions of wellness. They are: emotional, environmental, financial, intellectual, physical, occupational, social, and spiritual. The coaches work to understand the student’s goals in each wellness area. Then they develop an individualized plan together. It’s not about balancing all the dimensions. Instead, they set goals in each area and acknowledge which ones may require more conscious effort.
If wellness is prevention, Khawaja equates therapy with treatment. She believes some students experiencing high levels of stress may need therapy.
Practicing wellness is different, however. Wellness aims to prevent students from reaching that breaking point. It’s like counseling patients on diet and exercise to prevent future heart disease.
Molly Crenshaw is a third-year medical student at UNC-CH and sees a wellness coach for an hour a week. This time encourages her to reflect and prioritize things that are important to her.
“I am not one-dimensional despite how med school makes me feel. Tapping into what makes me different has helped tremendously to keep things in perspective during school,” Crenshaw said. “For example, I make time to coach volleyball for two hours every weekend. Volleyball is something I have excelled at in my past, and I love the energy.”
Opening Up Can Normalize Med Student Experiences
Don’t have a wellness curriculum or wellness coach at your school? No problem. Khawaja explains that everyone can and should make a wellness and crisis plan.
“So a wellness plan is these other things I need to do for me to be well and healthy,” she said. “A crisis plan [is for] when something starts to go wrong in my life, these are the things I do that help me stabilize myself.”
Getting eight hours of sleep and eating well are examples that could go in a wellness plan. Meditating, talking to a friend/family member, or counting to ten could go in a crisis plan. You might use your crisis plan to stabilize a high-stress situation. Students can also set goals in each of the eight dimensions of wellness.
You don’t have to practice wellness in isolation; it can be a shared experience.
At USC, Dr. Young encourages students to open up about their insecurities and goals.
“Everyone’s feeling nervous. Everyone’s worried about the future. Everyone is sitting in class comparing themselves to everyone else,” Dr. Young said. “Normalizing the experience goes a long way.”
UNC medical student Molly Crenshaw does just that.
“We feel like we have to act like we have it all figured out,” she said. “I have committed to telling everyone that I go to [a wellness coach] weekly… I’ve made it a commitment to make it more accessible to discuss with classmates.”
Concluding Thoughts
When I first went to my school’s wellness coach I was hoping to save my neglected social life. I set a few goals in the social dimension: Build relationships, visit an out-of-state friend every month, and go out for dinner every week.
So far, I’ve followed through with these goals. But even more exciting than my resuscitated social life is the fact that I’ve become more self-aware in the other dimensions too. I smile more (emotional). I go outside as often as I can (environmental), and run (physical). I’m pursuing another degree (occupational), and tutor medical students (intellectual). I meditate (spiritual). I’m even learning about the stock market (financial, currently the most neglected dimension).
My wellness dimensions are not perfect or balanced, but that’s not the point. For now, they seem to be in harmony. By self-reflecting, I’m confident that when I’m a resident and attending, my life will be well.
Minali Nigam is an MD/MA candidate at UNC School of Medicine and UNC School of Media & Journalism
