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Why Is Med School So Hard? How to Stay Sane While Studying

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by Alec Palmerton, MD in Uncategorized
Why is med school so hard?

It’s the end of another grueling day. You know that you SHOULD be studying. But every time you sit down, it seems like nothing goes your way. The only thing faster than your text-skimming eyes is your racing mind. All you can think about is how much you have to do and how little time you have to do it in. You keep asking yourself, “why is med school so hard?”

Feeling unproductive makes everything more overwhelming. It’s easy to blame yourself – and there are plenty of reasons to do so. “Why didn’t I take better notes before?” “I KNOW I should know this.” “How do other people seem to get this, and I still can’t?”

You know all these negative thoughts aren’t helping anyone – least of all you – but you can’t stop. So you become even less productive, the ruminations worsen, and the cycle perpetuates.

Welcome to Med School Insanity. It’s a (seemingly) never-ending ride of feeling:

  • Never on top of things,
  • Guilty about not being more productive, and then finally
  • Anxious about how much time you’ve wasted

Rinse and repeat.

If this feels like your day-to-day, you are not alone. Med school is, in many ways, a perfect setup for making you feel like you’re losing your mind. In this article, we will discuss:

  1. Why it’s so hard to stay sane in medical school, and
  2. Tips for overcoming those challenges and thriving

Why is Med School So Hard?

The first step to dealing with staying sane in med school is recognizing that you are not alone in your struggles. Far from it. In a US study, roughly 50% of medical students reported burnout within 12 months. More than 11% had contemplated suicide. Burnout, depression, anxiety, and feeling overwhelmed are woven into the med student experience. Don’t look now, but the situation is the same (if not worse) in residency.

And it’s not even limited to the US. A 2016 meta-analysis looked at over 100,000 medical students across 47 countries. 27.2% of students screened positive for depression during medical school. Like the US study, 11.1% reported suicidal ideation during the same period.

These rates of depression/suicidal thoughts are almost three times higher than the general population.

The reasons why med school is so hard are well-known and numerous. Some of them include:

  • Residency applications are stressful and high-stakes. Stress is the product of how important something is and how little control we feel over it. The outcome of residency applications hinges on so few things. (e.g., USMLE scores, research publications, school reputation, clerkship grades/letters, etc.). Few if any of these are under our direct control. As such, stress multiplies.
  • Busy professors have little incentive to teach well. Thus, most do the logical thing and deliver rushed lectures filled with minutiae.
  • Furthermore, adding activities or assignments may seem like a way to make up for inadequate lectures. But this risks overwhelming students further; it’s easier to add projects/activities than remove them. Thus, like an over-eaten apple, students’ precious time is taken bite by bite.
  • No one likes to admit weaknesses, especially in medicine. Unfortunately, this culture of invincibility creates lonely students pretending to be ok on the inside, but racked with self-doubt on the inside.
Why is med school so hard?

Med school often feels like this. But does it have to?

Solutions to Make Med School Less Overwhelming

Assess and Address Burnout/Mental Health Head-On

Med school burnout, depression, anxiety, and even suicidal ideation are stratospheric. Given the high prevalence – and straightforward solutions – the first step is to see how burned out you are. I’ve found this free burnout self-assessment instructive.

If your score is 40+, you’re reasonably burned out. This is the stage to recognize prevention is the best cure.

If you’re 50+, you likely are having a hard time concentrating. Your eyes may be moving across the text, but without you understanding what you’re reading. Lectures may be a bunch of noise with little comprehension. Your productivity is suffering.

The solution? There isn’t a ton of high-quality research on effective burnout interventions. That said, students I work with have found flow helpful in overcoming their exhaustion.

Flow is the experience of losing yourself in an activity. It came from research on people who “were so enthralled in what they were doing that they seemed to be in a trance.” It’s behind when musicians “feel the music” or athletes are “in the zone.”

Flow encompasses things like being so:

  • Engrossed in playing a game that you lost track of time
  • Engaged in what you were learning that you forgot to eat lunch
  • Into writing a paper that you missed an important appointment

You can read more about flow here and how it can help you with overcoming burnout.

At the least, try and build flow activities into your day. If your burnout is severe, you may need to take several days of minimal work/maximum flow to get back on your feet. For extreme burnout, this trade-off of wellness now for more productivity later is net-positive.

Recognize that Wellness is Peak Productivity

You may be wondering, “wellness is great in theory. But if I can never get through my to-do’s, how does adding flow help?” Sadly, it’s not surprising that so few students feel willing or even capable of dealing with them. To a busy, stressed-out med student, taking more time for sleep and self-care is the last thing on your mind.

The most natural thing to do when you feel stressed and overwhelmed is to do what feels familiar. And for most high-achieving med students, what is the norm? To work harder, sacrifice more, and cut anything not directly related to your studies.

However, those responses miss the point. Burnout, depression, and anxiety tank your productivity. If you struggle to fall asleep or are waking up several times every night, that’s not a recipe for success. Likewise, if you’ll nod off without coffee or never feel well-rested in the morning, your learning will be subpar. Having intrusive negative thoughts is not the way to learn – let alone master – anything. Neither is mindlessly re-reading something because you couldn’t focus the first two times.

If you’re burned out, suffering from depression/anxiety/other mental illness, face it head-on. I could tell you wellness is essential. However, for the bitter taskmaster in all of us, the most compelling reason is efficiency. The less burned out/depressed/anxious you are, the more you will get done. The more energized and focused, the higher your scores will be.

Yes, wellness is essential as a goal in itself. However, being more rested and less anxious/burned out is BEST for learning/mastery.

Choose to Work When Your Mind is Sharpest (Usually the Morning)

Did you skim the last section and think, “ok, ok, burnout bad. Whatever”? If so, please ask yourself when was the last time you had a day of peak productivity. Was it recently? Then move on. If not, please reassess your attitude towards the power of wellness.

Once you are in the right headspace, the next step is to figure out how to improve your efficiency. I could write articles and articles on this topic, but for now, I’ll focus on one observation:

Everyone benefits by doing their most important work when their mind is sharpest.

In most of medical training, you won’t have much choice. In preclinical classes, you don’t get to choose what you learn or the pace of the material. It’s worse in clerkships; your “where, when, and what” are usually out of your hands.

Instead, the one choice you can ALWAYS make is when you do your work. Specifically, do you do it before a long grueling day of classes/rotations or after?

For most people – even ardent night-owls – this will be the morning. Medicine is an exhausting grind, and I’ve yet to meet someone fresher after a long day than before. As such, make sure that you wake – and sleep – early enough to get your work done before the crush of responsibilities.

Yes, I am suggesting that if you need to be in the hospital by 5AM, you should sleep by 7PM and wake up at 3AM. No, I’m not suggesting this will be easy. However, studying for 2 hours before a 5AM shift is a lot easier than trying to do so afterward.

The choice is yours. To read more about how you can transform your mornings to get more done in less time, read this.

Less is More

If you’re feeling overwhelmed, another reason is that you’re trying to do too much. It seems natural that to accomplish more, we should set our goals even higher. Shoot for the moon, and at least you’ll land among the stars, right? But, in fact, research on scarcity suggests that the opposite is true.

If people have too little of something (e.g., time to complete their many tasks), they get dumber. Seriously.

The technical term for the stupid-making effects of scarcity is loss of “bandwidth.” Bandwidth involves things like fluid intelligence, like your performance on IQ tests. In one study on scarcity, they studied people who were poorer/richer at different times of the year. Money scarcity dropped an IQ measure by the equivalent of 8-9 points. In another, the “scarcity” group had nearly an entire standard deviation IQ lower. If you think scarcity is a great way to sabotage medical students, it gets even better.

Bandwidth also involves impulse control and planning for the future. At Princeton, researchers divided students into two teams while playing a version of “Family Feud.” In the game, which involves guessing under timed conditions, they gave one team much more time than the other. In one version of the experiments, they provided both groups the ability to “borrow” time from future rounds. But, of course, there was a catch. For every second they borrowed, they would lose two seconds in a later round.

The results of the experiment? The students with less time borrowed much more, sabotaging their future selves.

The upshot of scarcity research for busy, overworked medical students? The less time we have, the worse our decision-making and intelligence. Overworking ourselves creates short-sighted decisions that snowball into being even more overwhelmed later.

I realize that the natural response to this will be, “but I have too much to do. It’s not my choice!” However, scarcity research suggests you’re overwhelmed in part BECAUSE you are trying to do too much. Paradoxically, trying to do less can improve the quality of our work and let us get more done in less time.

For more on how slowing down can lead to greater productivity, see this.

Be Clear On Your Goals – and STAY IN YOUR LANE

If less is more, the next question is, “what do I choose to focus on?” As my late Stanford advisor Dr. Salvatierra reminded us, “if you chase one rabbit, you’ll catch it. Chase two? Catch neither.”

But which rabbit to catch?

To answer this, I turn to the concept of the ONE Thing. It’s a fantastic read but can be roughly summed up by the question:

What’s the ONE Thing you can do such that by doing it, everything else will be easier or unnecessary?

For most of us, that would be mastery of content. Want to impress your attendings? Having a firm grasp of medical concepts can help you shine in any setting. Need to score higher on your Shelf Exams/USMLEs? Mastery and application of concepts it the foundation of success.

The power behind the ONE Thing is that we can do even more with less time and effort by choosing our focus well.

For more ideas on how to achieve focus so you can take back more of your day, read this.

Focusing on fewering things can help make med school less overwhelming

Concluding Thoughts: Play the Long Game

When you’re stressed and overwhelmed, it feels unavoidable. You wake up to the same drudge every day with no end in sight. What’s worse is that you struggle to imagine how life could be any different.

As the research on scarcity shows, having too little time fosters short-sighted decisions. It’s hard to invest in things that will make your future better when your present is miserable.

However, every present was a future moment at some point in the past. In other words, a lot of our current misery is due to choices we made in the past. Of course, that is a depressing thought. Yet, the powerful corollary is that the choices we make now can brighten our future.

I’ll leave you with the story of Robinson Crusoe. The story goes that he was stranded on an island. At first, he is going to starve until he figures out how to make a spear. Then, with his spear, he can catch five fish per day – enough to subsist. The problem is that to catch those five fish, he needs to spend every single last bit of his time.

Now, he has a dilemma. Does he keep fishing with a spear until the end of his days? Or, does he willingly catch FEWER fish, but with the spare time, make a boat and a net?

In the first case, he’ll never be hungry. In the second, he’ll sacrifice short-term hunger for long-term plenty. Because once he makes his boat/net, he’ll be able to catch more fish in less time. And with that surplus in time, he can do other productive things – make a hut, plant crops, or even start a fish farm.

From the outside, the choice seems obvious. However, remember that many decisions in your training (and life) have similar trade-offs.

Will you invest the time in wellness to improve your productivity tomorrow? Will you sacrifice a few days to drowsiness to make yourself into a morning person? And will you reflect on your ONE Thing and pursue it doggedly?

These are the questions that shape our future, which becomes our present. For the sake of your sanity, I hope you choose well.

Why do you think med school is so hard? What solutions have you found to make things better? Let us know in the comments!

Photo by Tony Tran on Unsplash

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.

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