Medical Student Stress Management & Well-Being

A medical school student’s life is stressful for a number of reasons, from new sources of anxiety to juggling an unfamiliar academic workload to test-taking fears. Many U.S. and Caribbean medical students suffer from sleep deprivation and don’t eat properly. This is why some medical associations have entire sections of their websites specifically devoted to stress management and well-being for medical students.

(Photo, inset right) WIPE OUT STRESS: AMSA has many tips for managing stress for med students. Photo: David Castillo Dominici/FreeDigitalPhotos.net

The American Medical Student Association (AMSA) has a section of its website called “Medical Student Well-Being”. The goal is providing students “with various coping mechanisms for the prevention and management of stress-related problems.” The site offers ways to encourage medical student wellness.

“Changing unhealthy trends in medical education may not be easy, but we, as well as our patients, deserve it,” the website says. “While learning to help patients care for themselves, it may seem as though we neglect our own health and well-being in the name of success.”

AMSA says medical school students should not feel alone when suffering from stress and anxiety. There are the following stress-inducing ramifications for each year of medical school:

• First-year medical students grapple with the increased work demands and trying to meet goals.
  
  
• Second-year medical students “develop varying forms of hypochondriasis while studying many diseases for the first time, as well experience stress from the upcoming USMLE/COMLEX Step 1 examinations.”
  
  
• Third-year students in clinical rotations “may deal with real issues of life and death for the first time, as well as the stress that comes along with deciding on a specialty”
  
  
• Fourth-year students, busy with residency applications and interviews, are often coping with the transition from medical school to internship.

Medical students also encounter trouble with relationships, poor diet, and depression, AMSA’s website says.

Alarming facts about medical students, compiled by AMSA at the start of the New Millennium, include the following:

• 12% of all medical students become clinically depressed during their medical student years/ 30% of all interns.
  
  
• Medical students show higher rates of substance abuse when compared to matched pharmacy students with equal access to medications.
  
  
• Each year, physician suicide removes from the U.S. a number of physicians equal to the size of a med school graduating class. Physicians have twice the rate of suicides of the general public.
  
  
• In a med school class, 98% of the students reported some form of abuse (verbal, physical) during their time as a medical student.
• In one study of marital satisfaction, 50% of doctors said they had an unhappy marriage and attributed this to their career.

AMSA says medical students must realize that individual health practices can affect the way “we, as doctors, advise our patients about important lifestyle issues such as diet and exercise.”

Wellness in medical school is commonly compromised. “With this in mind, remember: although stress is a necessary part of life, it does not have to prohibit well-being,” AMSA’s website says.

AMSA provides ways to cope, including:

• Basics of relaxation
• Nutrition
• Reading for fun
• Yoga

AN APPLE A DAY: AMSA says good nutrition is key to surviving med school. Photo: Zirconicusso/FreeDigitialPhotos.net

AMSA’s Wellness Resource Guide for Medical Students contains great tips for beating stress, all given by students. Some of the highlights include:

• Keep in close contact with your friends. Study with compatible classmates if you've studied together before, but don't change your study habits. If you are someone who learns better studying alone, then study alone. However, talk to your friends daily and meet them for meals/study breaks. Don't isolate yourself.
  
  
• Find something you enjoy and find relaxing that takes no more than an hour a day and has nothing to do with medicine, and make time to do it everyday.
  
  
• Keep good study habits. Study in a steady manner and learn it the first time through.

Notes for Concerned Medical Students

AMSA also offers some pointers for making it through medical school without losing your mind. Some of the “notes” include:

• “Don't wait until you are on the wards to practice and develop your interviewing skills... start now! Interview everyone with as great a depth as you dare. Medicine's fundamental thrill is intimacy. Find that kind of demeanor in yourself that delights others so they tell you their tales. Be ecstatic for the gift that people give you in love, trust and intimacy."
  
  
• “As you explore the glorious mechanisms of your body and life, let it electrify you in wonder and curiosity. Never get complacent over the miracle of life. Live in awe. Let this be the focus of your education; not your grades, which tell you nothing about the kind of doctor you will be."
  
  
• “Do not let the cost of education paralyze you. It is a privilege that you are so fortunate to be in school. When you finish, you will pay your loans back as soon as you can. If you choose service-oriented medicine, its gift is payback enough until funds come in.”

Why Yoga is Popular with Med Students

Yoga is one form of exercise popular with U.S. and Caribbean medical school students to relieve stress. On the website In-Training, The Agora of the Medical Student Community, Jennie Barnes writes about numerous ways yoga can help future doctors. In a March 5, 2013 article, “Yoga and Medicine: What Med Students Should Know About This Ancient Health Practice,” Ms. Barnes says yoga is often used by mental health professionals in conjunction with psychotherapy. “This is a particularly useful tool for victims of early childhood or pre-verbal traumas, because it allows patients to feel and express things physically that are difficult to express verbally,” she writes.

Ms. Barnes says there are many reasons why medical school students should study yoga.

“Yoga is an ancient health science based on the experimental and experiential,” she says.” The physical postures and meditative practices of yoga developed through years of intent study of the body’s responses to particular postures and meditations. Many patients have already caught on to yoga as a form of mental and physical self-care and preventive health. If we adequately understand yoga, we can seize an opportunity to encourage the healthy thoughts and behaviors that our patients gain through yoga and to build upon them.”

Ms. Barnes says that, contrary to popular belief, yoga is not tied to any certain religion and has myriad medical benefits.

“Interestingly, some of the principles ancient yogis discovered by experience can be explained by modern medical science,” she writes. “For example, twisting poses aid in digestion by increasing return of blood flow following compression of the bowels. Twists also move the cerebrospinal fluid, nourishing the central nervous system. Inversions — putting one’s legs above the head in head stand, hand stand or shoulder stand — are likely experienced as ‘cleansing’ because they help return lymphatic and venous flow from the extremities back to the circulation, allowing toxins to be filtered by the liver and spleen.”

Yoga helps heal the body and mind as well. “Like many forms of exercise, yoga strengthens bones, promotes weight loss, improves cardiovascular conditioning and increases oxygenation of the tissues,” Ms. Barnes writes.

Healthy Eating for Med Students

U.S. and Caribbean medical school students, like undergraduates, often do not eat properly. Eating junk food during late-night study sessions and indulging in alcohol on weekends and school breaks are common, but med students need to be aware of how important nutrition is to fuel their bodies and learn how to set an example for future patients. In addition to nutritional advice given on the AMSA website and materials, WebMD offers the following tips for eating well while in school:

• If you are staying up late studying or partying, diet is an important part of keeping strong and healthy.
  
  

(Photo, inset right) SHOP SMART: Med students should shop for healthy food instead of relying on takeout junk. Photo: FreeDigitalPhotos.net

Try to get your five portions a day of fruit and vegetables. These can be in tins, frozen or dried, but seasonal fresh fruit and vegetables may be a better value.

• Establish an eating routine. Start your day the healthy way, by eating breakfast. Try to stick to whole-wheat toast or a wholegrain breakfast cereal.
  
  
• Making your own packed lunch every day is cheaper and healthier than grabbing fast food between lectures.
  
  
• Base your main meals around simple things like casseroles, soups and stews; plus basics, like pasta, lentils and rice.
  
  
• Watch out for cheese and the calories it contains.
  
  
• Try to plan your meals and make a list of what you need to buy. Shop once a week, rather than every day, and stock up on cupboard essentials to avoid the need for takeout food.
  
  
• Be aware of the calorie count in alcohol. One pint of beer or lager is around 250 calories, the equivalent of a burger. One glass of wine is 130 calories, the equivalent of a slice of cake. Men should not regularly drink more than three to four units of alcohol a day; and women should not regularly drink more than two to three units of alcohol a day.
  
  
• Drink plenty of fluids to keep you properly hydrated, around six to eight glasses a day of non-alcoholic fluid. Carry a bottle with you to lectures.
  
  
• During times of great stress, it’s easy to let your healthy eating habits slip. But, in fact, a healthy diet and regular exercise can give you the energy you need to focus on your studies, as well as giving you an important break from the books

(Top photo) STRESS BUSTER: Yoga is popular with medical students. Photo: Ambro/FreeDigitalPhotos.net

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