MAINTAINING SANITY IN MEDICAL SCHOOL
OLADOSU, OLAJUMOKE AISHAT
DOKITA Editorial Board Member
Introduction
Over the years, the issue of mental health has drawn so much attention. The rate of suicide is rising worldwide and Nigeria is not left out. In 2016, Nigeria became the country with the highest suicide rate in Africa [1]. Studies have shown that suicide is the second most common cause of death among medical students [2]. These suicidal events are often preceded by phase of severe depression and substance abuse. Suicide rates among medical students is reported to be nearly three times the rate of the general population [3].
Sanity is an all-encompassing term for the ability to think and behave in a normal and rational manner [4]. It is also known as a sound mental health. More education is needed regarding the issue of sanity and mental health amongst Physicians especially at the earliest stage of their training. This paper attempts to provide a glimpse into this often neglected aspect of medical training.
THE MISTAKE EVERYONE MAKES
Majority of medical students come to medical school with a common misconception that Doctors are Greek gods who never make mistakes. They think medical school is for those with very high IQs, those who aced their biology tests in secondary school or those who only need to read a text once before memorising everything that is written in it. The truth is that all these will help your competitiveness and increase your chances of getting into a medical school but none of these will retain you in medical school.
The main factor that determines if one finishes from medical school is perseverance. In other words, the perfect candidate must be smart of course, but must also be able to persevere despite harsh conditions. Establishing this foundation is very important because many medical students who are unaware of this fact end up making statements like “if someone had told me in advance that this is how it is going to be, I would have said forget it, it’s not worth it.”
Another misconception is the belief that “there is money in medicine.” It is not a lie that a number of Physicians and Surgeons are financially confident but this only comes after several years of being subjected to rigorous conditions of training. Aspirants who come into the medical program with the intention of making “quick money” end up being disappointed after finding out that there is nothing “quick” and “easy” about the “money-making process”.
Every medical student at some point has had one of these misconceptions and this has greatly influenced their outcome in medical school.
CHALLENGES MEDICAL STUDENTS FACE
A common challenge medical students have is coping with their hectic schedules. A typical medical school schedule contains five to six hours of lectures a day and thirty hours a week. This is different from the time spent during clinical postings. A typical schedule for clinical posting involves an hour of early morning grand round or mortality and morbidity review with the remaining time spent at ward rounds, clinics or small group tutorials.
Many students find it difficult to cope with the stress of several hours of lectures. The several hours of lectures are due to the broadness of the academic syllabus. There is little or no time left for hobbies or to socialise. The pressure and stress from overloaded medical curricula are further worsened by competition with peers. It is important to remember that the people one compares oneself with represent the very top fraction of students in the country and as such it should not cause worry if some of them are better than one is. Apart from the lack of time for leisure activities, the situation is worsened by sleep deprivation, not to mention the emotional drain stemming from sick and dying patients.
A lot of students after failing at coping with the system turn to the use of drugs. Drug addiction is estimated to be thirty to hundred times more common among Physicians than the general population [5]. Within a group of Physicians with addictions, it is estimated that nearly 10% attempts or commits suicide [6].
Another challenge medical students face is coping with failure. The biggest fear for every medical student is failing in medical school. Their sense of identity is tied up in their accomplishment and failure is seen as a blemish that ruins all the years of hard work. No one sees it as “I failed because I did not have a better understanding of what I should have known, what might have saved someone’s live” but a lot of people see it as “I failed because I am not good enough, medicine is not for me”. Medical students end up beating themselves up after failing an exam, develop inferiority complex, and recline to themselves because they think everyone sees them as a failure. That is how the cycle of depression begins and if they are not reconnected to people that make them feel otherwise, suicidal thoughts ensue.
The mistake friends and classmates make during this period is avoiding the subject. I remember coming back to school at the beginning of a new session and noticing that some of our classmates did not join us. I felt bad talking about it with other people because it really felt like I was gossiping. I also did not know how to talk to them because I saw it as reminding them of their failure. Support from peers cannot be over-emphasized. Students that failed need to be reminded that the fact that they failed does not make them a dullard, if they were a dullard, they would not have gotten into the program in the first place. Besides, the good thing about this system is that there is always a second chance to prove oneself.
FINDING A BALANCE
In medical school, you are often pushed to your limit and to do well, one needs to dedicate plenty of time, focus and energy to studying. You should be prepared to have very little free time. If a fulfilled, carefree life is what you are interested in, then pursuing another career path is a better decision. How do you find a balance between the little free time and the workload ahead of you?
Developing and sticking to a routine
If you are the type that has other things going on aside medical school or even if you are not, you need to make a daily schedule that works for you. Distinction students need an average of six to eight hours of study a day outside lectures [7]. An average medical student needs less than that. It is important for you to incorporate the hours of study you want to achieve and judiciously manage your time around this. It should be noted that a minimum of three hours should be allocated to study every day and all lectures must be reviewed on the same day they are given, if you want to be a B or C student [7].
Attend lectures
There is a lot of misconception that attending lectures is a waste of time. Studies have shown that students who have A’s are regular class goers [7]. It is important to allocate some time for lectures in the daily schedule.
Here is a sample study routine aimed at getting up to five (5) hours of study in a day.
5:00am – Wake up
5:00am – 8:00am – Study (3 hours)
8:00am – 8:30am – Prep for school, breakfast
9:00am – 4:00pm – School hours (1:00pm – 2:00pm Lunch break)
5:00pm – 6:00pm – Relax, dinner
6:00pm – 8:00pm – Study (2 hours)
8:00pm – 10:00pm – Do things you enjoy outside studying
10:00pm – 5:00am – Sleep (7 hours of sleep, you can sleep less depending on your preference)
This sample routine gives enough time to study, rest, sleep and even do other things outside study.
HEALTHY TIPS TO MAKING IT ALL WORK
Doing things outside of studying alone
“If you compare the rewards of developing mature personal relationships with the attainment of excellence in the medical profession, certainly the rewards are greater from medical profession but I firmly believe in devoting significant time and energy to the development of mature interpersonal relationships; when things go wrong at the interpersonal level, the anguish and heartache are measurably greater than you will ever experience from disappointment in your profession” – Robert L. Brent [3].
It has been established that medicine can be too demanding. It drains you and sucks out any form of relationship you have with the outside world. It is important to try as much as possible to be connected to things that make you feel the most alive. To some people, this may be as simple as having dinners with their families, attending their children’s school concerts, hanging out with some friends and if you are the reserved type, just lying in bed with a glass of wine and a nice novel to read would suffice. These relationships we have built and the connections we have made will serve as anchors that keep us sane.
It is also important to note that all these activities that you do in your spare time are not just about having fun. Although the main reason you do them is to enjoy yourself and take your mind off work, they are actually important in your personal development. Most times, you go for interviews and they ask questions like “what do you do outside medical school?”, “what extracurricular activities are you involved in?” These are questions to assess your participation in skills that are outside the scope of academic study but are still vital to being an effective doctor. Let us take for example, you lead a sports team; it shows your ability to function with other people you may have a personality clash with and it also shows your leadership and organisational role, making you a functional person who is capable of interacting with others. This gives you a bonus that cannot be achieved by sitting in your room every evening and studying lectures notes [8].
Stick with learning techniques that work best for you
Different people have different study techniques that work for them and you must find out which one works best for you. This is where a lot of students struggle. I remember it took me about two months after resumption before finding the study technique that worked for me during my preclinical years. Here are some study methods that might work for you:
- Form a study group
- Use visuals like diagrams, videos and cartoons
- Use mnemonics – Although this never worked for me because all the different mnemonics end up getting jumbled in my head but research has shown that it works for a lot of people [9].
- Test yourself from time to time on topics you have read
Good self-care
It is important to keep a healthy body and a healthy mind, stay fit, eat enough fruits, vegetables and most importantly, get enough sleep. Eating healthy is very important for success. A lot of medical students snack on carbs, sugars and carbonated drinks which are not healthy. Sleeping is just as important as studying, without it you cannot study properly. An average adult needs up to seven hours of sleep per night [10].
CONCLUSION
Being a medical student puts you in a very privileged position, you get to be among the very top students across the country and of course, this does not come without its own demands. It is important for you to know that you cannot handle everything on your own and it is good to have someone to talk to and to help us stay connected to the things we love. Depression and suicide amongst medical students are still on the rise despite the increased attention paid to the issue of mental health. It shows we are not doing it right yet. There is a responsibility on the part of educators to identify the stressors that medical students are exposed to and address them to reduce its deleterious effect on their mental health.
REFERENCES
- Rebecca Akinremi. Nigeria has the highest suicide rate in Africa, sixth globally. International Centre for Investigative Reporting. Available from: https://www.icirnigeria.org/nigeria-has-highest-suicide-rate-in-africa-sixth-globally/ Accessed 11th of April, 2021.
- Louise B A, Barry E B. Why are medical students and residents at higher risk for physician suicide? Available from: https://www.medscape.com/answers/806779-104444/why-are-medical-students-and-residents-at-higher-risk-for-physician-suicide#qna Accessed 11th of April, 2021.
- Brent R L, Brent L H. Medicine: An excuse from living. Resident Staff Physician. 1978 24(12):p61-65. Available from: https://www.google.com/url?sa=t&source=web&rct=j&url=http://www.garfield.library.upenn.edu/essays/v13p075y1990.pdf&ved=2ahUKEwiFn_ySur7wAhVKThUIHY02D7wQFjAKegQIExAC&usg=AOvVaw3skrQnoaE5Z8cpM2-tv3Jg Accessed 9th of May, 2021.
- Collins Online English Dictionary. California: Collins; 2021. Sanity. Available from: https://www.collinsdictionary.com/amp/english/sanity Accessed 19th of May, 2021.
- Keeve J P. Physicians at risk. Some epidemiologic considerations of alcoholism, drug abuse and suicide. J Occup Med. 1984; 26(7):p503-508. Available from: https://pubmed.ncbi.nlm.nih.gov/6747737/ Accessed 9th of May, 2021.
- Mata D A, Ramos M A, Bansal N, Khan R, Guille C et all. Prevalence of depression and depressive symptoms among resident physicians: A systematic review and meta-analysis. JAMA. 2015; 314(22): p2373-83. Available from: https://pubmed.ncbi.nlm.nih.gov/26647259/ Accessed 9th of May, 2021.
- Jenny L, Jasna V, Sara T. Study habits of medical students: An analysis of which study habits most contribute to success in the preclinical years. MedEdPublish. 2018; Available from: https://www.mededpublish.org/manuscripts/1506 Accessed 9th of May, 2021.
- Oxford Royale Academy. Life as a medical student: 12 things you really have to know. Available from: https://www.oxford-royale.com/articles/life-as-a-medical-student/ Accessed 10th of May, 2021.
- Putnam A. Mnemonics in education: Current research and applications. Translational Issues in Psychological Science. 2015; 1(2) p130-139. Available from: https://doi.apa.org/doi/10.1037/tps0000023 Accessed 10th of May, 2021.
- Stephanie L. 6 ways to stay healthy in medical school. Available from: https://www.topuniversities.com/courses/medicine/6-ways-stay-healthy-medical-school Accessed 10th of May, 2021.