Katia K.
Photo provided by Katia K.
If you’re reading this, your presence is valuable.
Medical students are frequently made to feel like we are not capable of contributing to the care team in a meaningful way. As first and second year students we are mostly shielded from the hierarchy of medicine, until clinical years where we become constantly reminded of our position as the least experienced person in the room. Countless hours are spent trying to stand out of the way and keep thoughts and comments to ourselves, not wanting to upset the order of things - this brings a sense of learned helplessness where we then fear the autonomy that comes later on. The reality is, human connection does not require medical expertise. Medical students are highly accomplished and diverse in the hurdles we overcome to stand in the position we do – we have lived our whole lives as human beings, which is often the most important qualification for patient care.
The times that I have stamped out my feelings of insecurity and drawn on the part of myself that, prior to med school, was confident and loved connecting with people, I have been greatly rewarded. Medical students have the unique position of having more time and less responsibility, more curiosity and more caring. Patients frequently feel vulnerable, overwhelmed and invalidated by the healthcare system, and no patient has complained about getting too much time with their doctor. Their criteria for excellence is quite different from your preceptors’ – they won’t ask about your USMLE score or pimp you on lysosomal storage diseases. I have been told by patients that I am “their favorite doctor” just for taking a few extra moments to clarify something or draw a diagram after my preceptor has left the room. I have been told I will change the lives of my patients just by listening a little longer. You are sometimes the only buffer standing between patients and a harsh, uncaring healthcare system and connection can be the most important part of a patient’s experience – no credentials required.
Katia K., Kansas City University
Class of 2024
Q: Is there an event or situation that completely changed your outlook on mental health/wellness? What happened, and how did it change you for the better?
A: In my first rotation as an M3, I was told that it was surprising how much I talked to patients and seemed to feel comfortable with them - this came from thousands of hours of clinical care experience before medical school. In the same conversation, I was told that, “some preceptors won’t like that.” While that advice seemed strange at the time, it proved to be true quickly when my very next preceptor told me that, while my enthusiasm was nice and all, I should just let him do all the talking and to merely observe the encounters. Another particularly discouraging moment happened to me as an M4, where I offered a crying patient a tissue and a couple words of comfort, and was afterwards reprimanded by the preceptor for interrupting “her” therapeutic moment with the patient. After many instances like this I learned to prioritize preceptor preferences over patient interaction, where medical students are sometimes seen as time consuming inconveniences and staying quiet means keeping the doctor in a good mood. This caused me at times to feel deeply irrelevant and discouraged about my role as a medical student.
What healed me from these negative interactions were many healthy and positive experiences with residents and attendings. I had countless mentors who were incredibly attentive, encouraging, kind and communicative. These individuals went out of their way to ask how I was feeling or make sure I had somewhere to sit, expressed their vulnerabilities or encouraged my autonomy. They taught for the sake of helping students learn, not to invoke shame. They not only made me feel safe and respected but they reminded me that it is possible to be a physician in any specialty or level of training and approach trainees with empathy. I learned that having difficult or unfair interactions with mentors did not always reflect that I was defective in some way, but that they had their own interpersonal challenges as fellow humans. The skill of recognizing criticism that is not constructive, and then not taking it personally, is not pleasant to develop but does get better with practice. I witnessed a thousand ways to be a nurturing mentor, and it motivates me that I will be able to take the best things with me to use in the future– not only that, but I value that I learned what not to do. Sometimes that is equally as important!
Q: How do you/did you manage the pressure of clinical training, such as frequently changing environments and balancing clinical performance with studying for shelf exams?
A: The frequent changing of environments is one of the most difficult aspects of clinical rotations. The primal part of us that feels deeply uncomfortable in a social situation where we don’t know a single person, where we have to venture into an unknown place and find our way (not to mention be on-time), or where we are asked to do something on our own that we aren’t entirely sure how to do, is a constant companion during clinical years. While this aspect of clinical years will likely never change, reminding yourself that each time you will learn and become used to the new environment within a few days, and even that the routine of unfamiliarity will become familiar, can help with the anxiety. By the end medical students truly become “experts” in these uncomfortable situations and handling them with grace. In an unpleasant rotation, remember that no matter what they put you through they can’t stop the clock and this time will pass - eventually you will look back on these times without many hard feelings. Know also that learning through real experience does inevitably happen on clinical rotations. Unlike in preclinical years, 10-20 practice questions throughout the day or spending 1 hour a day studying (plus a bit more time on the weekends) is often all that is required to prepare for shelf exams.
Q: What is your most used coping strategy or technique?
A: Normalization - whenever I am feeling deeply overwhelmed, hurt or disappointed, as is sometimes the case in medical school, I remember that in reality my experience is not unique and that often my friends and upperclassmen have experienced or are currently going through something similar. I am not the first person to get a lower grade than expected, fail something, get an unfair evaluation, have an awkward moment with a preceptor, struggle with loneliness on a sub-internship, feel I fumbled an interview, or feel let down by a program on Match day. These are universal hardships we go through, and I always feel deeply helped to reach out and vent together with my friends (or on reddit). There is always someone that has gone through the same thing or is currently going through it.
Several studies have revealed that medical students, physicians, and healthcare professionals experience mental health symptoms at rates significantly higher than the general population. Stethos[Cope] is a chapter of IfYoureReadingThis designed to help medical students and professionals cope with the unique stressors of medical training and change the narrative of mental health in medicine.
To read more letters and interviews from students, and to learn more about mental health in the medical community, visit the Stethos[Cope] home page.