The Balance of Medical School: The Wellness of Both Patient and Physician

By: Michael Howard, MD Candidate, Class of 2016, Saint Louis University School of Medicine

I often catch myself thinking that medical school is supposed to feel like an old monastery with monks tirelessly copying books by hand. If I am not relentlessly suffering in monklike self-flagellation, I feel guilty, as though I am failing as a student. It is difficult to maintain my confidence as I am reminded daily that I am no longer a top dog. My classmates seem brilliant, and it is daunting to try to become a competitive applicant for residency programs. Often it feels like my identity and motivation get mangled with the stress of academic frustration and self-doubt. However, I am thankful that Saint Louis University (SLU) has challenged me to proactively confront stress and prioritize self-preservation, as Slavin and colleagues describe in their article in the April issue of Academic Medicine.

Classes started at SLU with the compulsory talks on depression, anxiety, and student wellness. At first, most students brushed these topics off, but looking back, those lectures helped create a student culture where it is normal to discuss stress and disappointment. A few times now, a classmate has walked up to me after spotting the deep frustration and exhaustion in my eyes to remind me of the tools we have learned to achieve better balance and self-sustainability. For instance, we learned to put things in perspective with the following rule of 5’s: what will be important in 5 minutes, 5 days, 5 months, and 5 years? These reminders often help me to deal with acute disappointments.

And yet, I would spend endless hours in the library and never feel satisfied with median range test scores. In fact, I would start to feel inept and lazy until I became anxious about my ability to study and learn. Thankfully, a mindfulness elective at SLU challenged me to be more intentional with my expectations and armed me with tools to counter self-deprecating thoughts. I began to redefine success as becoming a well-rounded physician rather than just getting top grades.

With the start of the second year, the building pressures began to smother my curiosity and enthusiasm for learning. Even worse, sometimes I find that I have little mental or emotional energy left to connect with or relate to others. This is especially disheartening since the very connection and care between a physician and a patient is what first drew me to medicine. Fortunately, SLU faculty often center course content around clinical care. For example, we have a longitudinal applied clinical skills course that highlights the patient stories within patient cases, bringing to life the litany of pathologies we struggle to assimilate.

The deans at SLU foster a community where it is safe and commonplace to talk about wellness. I have learned ways to differentiate between good stress and distress and to be prepared for the inevitable self-criticisms. Most importantly, I feel that SLU helps me preserve some sense of my personal vitality and enjoyment of working with others. I can only suppose that patients will crave this exact enthusiasm as part of their medical care and that this fire will inspire me to achieve greater excellence in their medical treatments.

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