Prioritize Your Self Care. You’ll Thank Us

When Ahmed Mukhtar Ahmed, MD, internal medicine resident at Brigham and Women’s Hospital, Boston, thinks back to medical school, he’ll tell you he was at peak wellness during his 2 preclinical years. During that time, his schedule — while busy — was predictable. Classes every morning Monday to Friday, studying on the back end, and unstructured weekends. “That left me time for going to the gym, getting adequate sleep, seeing friends, and getting through my studies,” he said.

Once he entered his third and fourth year, however, Ahmed found life much less predictable. “The rotations are so different for each specialty,” he said. “With surgery, for instance, the expectation was that you beat the intern to the bedside, so I was often getting up around 3 am to wake patients and ask them questions.”

He followed this up by presenting the case to the intern, doing rounds, then spending the entire afternoon in the operating room. Once home in the evenings, Ahmed still had to study. “I tried to have some semblance of work/life balance,” he said, “but my schedule was a stark contrast to the preclinical years.”

Ahmed’s experience is not unique: Time in medical school can be some of the most challenging when it comes to tending to your health and wellness. “Medical school isn’t always a super humane place to be, especially for young people,” said Scott Laker, president of American Academy of Physical Medicine and Rehabilitation. “The hours are tough, it’s a competitive environment, and some students are under financial duress thanks to student loans.”

Laker observes that medical students are highly functioning individuals but points out that everyone has a ceiling, and medical school tests that limit. Health as a med student, then, should include a holistic focus, one that considers both the emotional and the physical.

Now is the time to build the self-care habits that can foster you into a long career ahead, said Bess Levin, MD, a psychiatrist with Relief Mental Health, a psychiatric practice in Chicago. “In the short term, there are obvious impacts on physical and mental health,” she said. “But it’s important to consider that a demanding schedule may continue into residency and beyond.”

Managing Your Physical Health

When it comes to your physical well-being during medical school, you’ll want to focus on a few important buckets: Exercise, sleep, and nutrition. Try to establish something of a routine during your first 2 years, when you have the luxury of a somewhat fixed schedule. Ahmed blocked off his free time to ensure it included time at the gym, as well as adequate sleep. While that became difficult in his third and fourth years, Ahmed had at least ingrained the prioritization of these healthy habits. “In my clinical years, I kind of went with the weekend warrior existence,” he said. “On typical clinical days, there’s not much time for a life outside the hospital, but I could at least pin down my weekend time in advance.”

Keeping an attitude of “some exercise is better than none,” can be useful, too. Achieving the ideal 150 minutes per week is out of reach, but carving out some time on the weekends or sneaking in “movement snacks” throughout the day is worth your time and effort.

Getting adequate sleep can be nearly impossible once you move away from your didactic education, said Laker. “It’s very challenging to have healthy sleep patterns when you’re working in shifts,” he said. “While it can be trendy to push the envelope and de-emphasize sleep, it’s important to resist that and make it a priority to the extent that you can.”

Levin says taking some time to wind down each day prior to whatever bedtime you’ve set can be helpful to the quality of your sleep. “Rather than using 20 minutes to study before bedtime, use it to relax instead,” she recommended.

Taking Care of The Mental and Emotional

While med school can take a toll on your physical well-being, it may be the mental toll that hits hardest. Limited time for your personal relationships and hobbies, the stress of med school’s competitive nature, caring for patients, and lack of sleep can all add up. Finding ways to prioritize your mental health is essential, even under all that weight.

It can be tempting to cram in studying whenever you get a free moment. Levin recommends against this, however. “Try to use small breaks for a short walk, or to call a friend or family member to catch up,” she recommended. “And keep in mind that while relationships with peers and mentors who understand the rigors of medical training are important, it’s also essential to stay connected to your life outside of medicine.”

This is something that Ahmed prioritized during his UME years. “I looked for time on the weekends where I could schedule in my friends and girlfriend (now wife),” he said. 

Levin supports the concept of scheduling as an avenue toward self-care. “Rather than waiting for the opportunity to present itself, schedule time for things like exercise or cooking,” she said. “There will always be another lecture to review or more flashcards to go over, so, treat self-care as something that isn’t optional.” 

One positive change to the medical school culture is increased awareness of the mental health toll it can take, and more freedom to discuss it. “There’s now an understanding that we need an infrastructure around med school wellness,” said Laker. “Today we have ‘burnout czars’ and wellness programs, and an effort to de-emphasize testing to take some of the pressure off the students. In some cases, there are even work-hour restrictions, which have had a positive effect.”

If you’re feeling tapped out mentally and emotionally, check in with your school to see if wellness and mental health resources are available. If not, seek outside resources to assist you, and know that there’s no shame in doing so — your ability to care for others rests on your ability to care for yourself, said Laker. 

Ahmed found that tapping into mentors who had gone before him very useful. “Knowing that I wasn’t alone in navigating this journey and that there were so many people who had made it through ahead of me was incredibly useful,” he said. “I didn’t have to reinvent the wheel. Tens of thousands of med students have been through this, and getting their input helped me navigate each block.”

In that vein, when you can set realistic expectations about what’s to come throughout your education, you can alleviate some levels of stress. When you have a mismatch of expectations and reality, your stress levels can skyrocket. 

As a high achiever, trying to check every box — even at the determinant of your health — might be all too easy. But remember, said Laker, “Perfect is the enemy of good. Do what you can, when you can. There’s no silver bullet but knowing what you need to prioritize can set you up for better health down the road.”