“What If I’m Not Good Enough?”

Adam-Borecky-header1I want to briefly touch on a topic that can be somewhat of an “elephant in the room” here in the medical school community where test scores are guarded tighter than nuclear launch codes. After some reflection, I believe that the reason for this secrecy is not so much the competitiveness of my class, but the temptation to associate ones identity with academic success. We tie ourselves so closely with our exam scores that when they are low, we tend to think of ourselves as inferior. This semester I fell into this trap. Big time. And it took a bit of a breakdown to make me realize just how much I had let this idea sneak into my life. This is the elephant and I say that it’s high time we acknowledged it.

I didn’t do great on my first set of exams. I resolved to try harder. Unfortunately, working harder is not the same thing as working smarter and I ended up actually failing half of the subjects on my second exam set. This triggered a personal crisis that left me feeling totally derailed. Then, instead of doing the rational thing and asking for help, I fell into despair and allowed negative thoughts to crush my already-weakened self-esteem. What if, after all I went through to get here, I can’t do this? What if the admissions committee made a mistake in accepting me? I’m letting down everyone who supported me. I don’t see anyone else struggling…I must be the only one. I felt even worse when professors began e-mailing me, asking to meet to discuss “opportunities for improvement.” Then the dean of student’s secretary called me, telling me that he wished to meet with me. What if they tell me I’m not smart enough to be here…?

But I couldn’t have been more wrong. I was greeted with a level of compassion and understanding by the dean and my professors that I didn’t expect; all they wanted to do was help me. We talked about time management and study techniques and ways I can better manage the crazy information load. Especially comforting was the knowledge that I wasn’t the only one struggling. Swallowing my pride enough to tell my friends seemed to make it safe for them to open up about their own struggles. It turned that out a lot of people were having a really hard time with classes; it’s just that nobody wanted to be the first person to admit it. I think that every one of us at some point felt like we were the only ones there who didn’t belong there… Thanks to the help and support I received, I was able to do much better on the next set of exams! It’s still a struggle, but are all slowly learning how to tame this beast.

What is it about pre-medical and medical education that is so ridiculously stressful? I think a major part of it is the pressure that gets put on kids to become doctors. For example, as I write this at home I can see on my parent’s refrigerator several Christmas cards from people, proudly announcing how their little Jimmy is in medical school. This is sign of a culture that places an arbitrarily high value on becoming a physician. The danger in this is allowing kids to believe that they only have value in their parents’ or in society’s eyes if they choose to enter medicine. It becomes a pot of gold at the end of a rainbow for kids seeking approval and affirmation. Come on, America. Some kids want to be doctors. That’s great. Other kids want to be artists or engineers or teachers. If that is their passion then how dare we allow ourselves to think less of their achievements just because those professions get less fanfare than others? Parents, please understand that the line between pushing your kids to do their best and pushing them into your idea of what’s best is a treacherously thin line.

For the students out there, I want to offer a few words of encouragement. Don’t believe for a minute (as I foolishly did) that a test score or an acceptance letter to some program is what gives you value as a human being. If you are looking for these external circumstances to give you a sense of self worth, then you will always, always be left lacking. Be content with your own God-given ambitions and talents, no matter where they lead you. Realize that we are all unique individuals with different strengths and weaknesses. Remember that cliché quote that says something about how if we judged an animal’s intelligence by the ability to climb trees, fish would sure look pretty dumb? Well, it is equally ridiculous to judge a human’s worth by their ability to get into medical school or the ability to ace tests.

As I continue my journey, I find that my old habits don’t disappear easily. I am often still too hard on myself when I don’t score well and perhaps a little to proud of myself when I do. Seeing myself as valuable despite external circumstances is a lesson I will likely have to learn many times as I venture through life. I am just so thankful that we’re not in this journey by ourselves!

Of Marathons and Water Faucets

Michelle, First Year Medical Student

Being in med school isn’t a sprint. It’s a marathon, and those who succeed are those who can endure.

This shouldn’t have been a surprise for me, but it was. I’d heard medical school compared to “drinking out of a fire hydrant.” The comparison assumes that the sheer volume of information, thrown at us all at once, was what made it so hard.

Spoiler alert: that’s not what makes medical school hard.

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Me at the Holiday Classic Loma Linda Loper’s 5K — their 25th anniversary!

Well, at least not directly. That factor alone isn’t what makes medical school hard (make sure to do your multivariate analysis! Thumbs up for EBM!*). I like the analogy I heard from a fellow medical student: medical school isn’t so much like a fire hydrant as it is a water faucet turned on full-flow. . . that never stops. What makes it hard isn’t just the amount of information, it’s the amount of time we have to sustain such a high level of performance.

But I didn’t realize that at the beginning of school. I still thought the hardest thing about medical school was the large amount of material we had to learn in a short amount of time. So I was pleasantly surprised when I found that the demands of med school were very doable. Yes, we had to learn a lot, and there wasn’t much time to do it, but learning it all was far from impossible. It would just require a not-insurmountable step up from my studying habits in undergrad.

And that’s what I did. It started out well enough. I scouted around campus to find quiet study spots, fine-tuned my study methods and chose what resources to focus on for each class, and soon my days fell into a rhythm. Go to class, study. Go to class, study. Go to class, study. . . It sounds heart-rendingly dreary, but it didn’t seem so at the time. It felt good to stretch and exercise my academic capabilities, the way the endless activity of putting one foot in front of the other can be invigorating to runners.

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How studious! Just like a good little medical student.

(And I admit, I exaggerate — I took plenty of time out to have fun — watercoloring, baking, playing music, going on walks with my eight-year-old cousin, taking weekends off to go on church camping trips, visiting Disneyland. . .)

At any rate, I felt prepared when the first week of exams** rolled around. And it was nice to change things up from the grind of morning lectures-afternoon labs-evening studying. During exam week, there were no lectures to go to, no labs to do, no new material to study.

But then the second test cycle began. After a week of relative relaxation, I felt like I couldn’t go back to the reality of med school. Go to class, study, go to class, study, go to class. . . let me do something with my day that’s not studying.

There’s a word in Tagalog, sawá, that describes the feeling you get when you’ve been doing the same thing for a while and you’re tired of it, like when you eat a lot of something and you get tired of the taste. If you’re not careful, that can happen in medical school. The material every day is new, but the monotony of

wake up

go to class

go to lab

study

go to sleep

. . . and doing it all over again can get, well, boring. It doesn’t help that I tend to fall into routines — studying in the same place, in the same way, at the same time.

Then before I knew it, our second set of exams was before me. And like magic, new motivation to study suddenly appeared! The week before exams I studied harder than I had since before our first test week. But there’s only so much you can stuff into your brain in even a week, before everything starts to merge together into a muddled mess.

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The Yerkes-Dodson law states that that level of performance — whether school-related, work-related, or whatever — increases with increasing stress up to a point, at which increasing stress will decrease performance. This is part of the basis for procrastination. There’s always a willpower-barrier to getting any task done, and sometimes it takes the stress of an approaching deadline to get over that barrier.

The Yerkes-Dodson law: increasing stress increases performance up to a point, after which performance falls

The Yerkes-Dodson law: increasing stress increases performance up to a point, after which performance falls

Liken it to a reaction’s activation energy: stress is the catalyst that shrinks the mountain in the middle, allowing the reaction to proceed to completion. Unfortunately, the longer I’m in school, the bigger that hump seems to be.

Activation energy is the energy barrier to completing a reaction. A catalyst reduces the activation energy and allows a reaction to proceed more easily.

Activation energy is the energy barrier to completing a reaction. A catalyst reduces the activation energy and allows a reaction to proceed more easily.

So, what’s the end of this story? The hump will get bigger and bigger, and the stress will have to be higher and higher for me to get over it, leading to greater and greater procrastination? (Insert hyperventilation here)

I don’t think so. I’m going to be optimistic and say this is just a temporary setback. I may have “hit the wall” now, but that’s nothing a little rest, some stretching, maybe a massage, and — most importantly — not giving up can conquer (marathoners will relate to this!). In the words of Dory from Finding Nemo, “Just keep swimming, just keep swimming, just keep swimming, swimming, swimming. What do we do? We swim, swim, swim.”

I’ll give you one more analogy, but the Bible says it better than I would. Galatians 6:9 says, “Let us not lose heart in doing good, for in due time we will reap if we do not grow weary.” We just have to keep doing it, and God will reward us. Even if we start to grow weary, never fear! Isaiah 40:29-31 tells us,

“He gives strength to the weary,

And to him who lacks might He increases power.

Though youths grow weary and tired,

And vigorous young men stumble badly,

Yet those who wait for the Lord

Will gain new strength;

They will mount up with wings like eagles,

They will run and not get tired,

They will walk and not become weary.”

 

*EBM stands for Evidence-Based Medicine, which is like a research class for continued medical education. Even after we’ve finished medical school, we won’t know everything (hard to believe, I know!), but we should have the skills we need to find the correct answers to questions we and our patients will have.

**For those of you who may not know how our schedule works, we take our classes in blocks of four to five weeks, after which follows a week of exams. Each day’s exam is an amalgamation of questions from all our subjects; this helps simulate the experience of the national boards exams.

This Brave New World and the Meaning of Life

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It took about a week of classes before I came to an inconvenient realization: I actually have no idea how to study. I feel like the big-shot college quarterback that finally makes it to the NFL, only to get completely pummeled and humiliated in his first game against a professional defense. We all might have had great grades in college, but med school is on a completely different level. I think the intensive time commitment required for these classes is the most difficult thing for me.

Back in college, I lived the eclectic life of a typical small-liberal-arts-college hipster. Sure I would study, but that happened sporadically between tutoring, jazz piano, RAing, teaching labs, listening to music that nobody’s heard of, and sipping fair-trade coffee while debating english majors over the lingering effects of Portuguese colonialism on the migratory patterns of the European Gold Finch. Med school is different. In med school, you don’t do anything except med school. When med students encounter free time, we don’t know what to do with our lives. My classmates and I collectively had an existential crisis after we finished our first set of exams because we forgot that there was life beyond the books.

Christian wishes he had gone to dent school instead.

Christian wishes he had gone to dent school instead.

This lifestyle has taken a toll on my emotions as well. A few weeks ago I accidentally deleted two days worth of electronic flash cards and found myself crying harder than when I read “The Fault in Our Stars” this summer.

Fortunately, the medical school administration understands this syndrome well and plans an annual weekend retreat for students and professors following the first set of exams. I think they started doing this when the city of Loma Linda began to receive complaints of half-conscious first-years wondering aimlessly around the streets because they didn’t have the brain function left to find their way home.

Jonathan utilizes the sacred art of the 10 minute power nap during Cell lab.

Jonathan utilizes the sacred art of the 10 minute power nap during cell lab.

The retreat was wonderful. We drove several hours to the east, up into the hills and away from the Inland Empire’s smog. No cell service. No wi-fi. Just human fellowship, and it was beautiful. The most meaningful experience I had happened on Saturday afternoon when I joined about 10 of my friends around a piano and we just starting singing. Soon we had a cello and a guitar and we just sang random hymns for close to an hour. I’ve honestly never even liked hymns that much, but in that window of time, all my concerns about worship style melted away, right along with the stress of the previous weeks. When everything else is pushed aside and relationships become the focus of our lives- I think that is happiness.

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Later that evening was the legendary medical school talent show. I discovered a thriving subculture of musical talent in the form of medical school-themed parodies of popular songs (the genre is a cult favorite on YouTube). Indeed, at least half of the performances that night were popular songs with their lyrics adapted to fit the struggles of med school life. I realized that one of the best parts about being in med school is being able to complain about being in med school. I had the privilege to beat-box with an acapela group that sang a med-school adapted version of Pentatonix’s “Daft Punk Medly.”

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2nd Year…A Pause to Remember a Sacred Oath

Paige, Second Year Medical StudentAs is evident by the fact that this is my first blog post since the summer before year 2 of medical school commenced, 2nd year is BUSY!  Last year, we heard the 2nd year students grumble about how much they missed 1st year and how busy and completely consuming the ominous 2nd year was.  However, as a 1st year student, it was hard to believe that things could really be that much more difficult.  Little did I know, all the grumblings about 2nd year being one of the most difficult years of my academic life would indeed be indeed prove to be true.  In addition to a heavy academic load that includes: Pathophysiology, Pathology, Microbiology, Pharmacology, Neurology, Psychopathology, Preventive Medicine, and Biochemistry there are the additional requirements of labs, self-study lectures, continuity clinics, medical simulation labs, clinical skills OSCEs, and the ever-looming Step 1 test that will basically determine which residency programs we will be eligible for upon completing medical school.  Throw in extracurricular service activities, time to eat (cooking optional), exercise, spending time with loved ones, and devoting time to building a relationship with God and needless to say, there are never enough hours in the day to accomplish everything with the type of perfectionistic approach that we medical students desire.

If you have read my blog posts prior to this, you must be thinking, “Wow, this girl has suddenly become quite the Debbie Downer!”  I hope that you will continue to read however, because it has been this process of fully realizing the difficulty and challenges of medicine that has shown me even more of the immense value of this profession that I have chosen to pursue.  Moreover, it has shown me that even when things get tough—which they do—if you have the right support system, priorities, and determination, it can be done!

As I sit here on my last weekend of Christmas break and reflect over the past few months since beginning this year, I can honestly say that there have been many times, in fact, the majority of times when I have not had my priorities straight.  Relationships with family, friends, and God have all been stretched to the limit as I have put school again and again at the top of my priority list.  I have always had to work hard in school, but I have always been up for the challenge and have always truly enjoyed the process of learning.  Yet, at the beginning of this Christmas break I was exhausted, burnt out, and dreading the thought of once again immersing myself in the firehose of information that never gets turned off.  As far as I was concerned, the challenge was starting to look like it was a bit more than I could handle.

However, God showed me once again in a most unsuspecting way that He was the one guiding and sustaining me down this career path.  On New Year’s Eve my family had the opportunity to visit the Reagan National Library near my sister’s house in Ventura, California.  There are thousands of quotes scattered throughout this exhibition of President Reagan’s life story and accomplishments, and it would take days to read all of the information provided about the life of this incredible man.  We only had a few hours to walk the museum so we casually perused the information, taking note of just the main highlights.  One quote, tucked away in the volumes of information, stood out to me immediately.  It was spoken by President Reagan on his inauguration day and read, “I consider the trust that you have placed in me sacred, and I give you my sacred oath that I will do my utmost to justify your faith.”

Upon reading this quote, I was immediately struck with awe at the relevance it had in my own life.  It reminded me of that day a year and half ago when I recited a sacred oath “To Make Man Whole” and received a white coat that would signify the sacred trust of many patients that I would soon encounter.  I have no doubt that God used this quote to remind me of the reasons why I am currently working so diligently to conquer this difficult 2nd year of medical school.  As I look to begin this last 6 months of year 2, I am reinvigorated by this reminder of the sacred trust that has been placed in us as healthcare providers, and our sacred oath to be the best physicians that we can be in order to justify the faith that our future patients will have in us.