At the start of medical school, students come to some tough realizations. Looking to your left and right on orientation day, you're surrounded by others who were tops in their undergraduate classes. These are students who participated in various extracurriculars, volunteered at the hospital, ran marathons, speak multiple languages and may have had previous careers.
Trying to get to know and work alongside these peers, it can be difficult to let your guard down. With so many different backgrounds and experiences, nobody wants to be the first to admit they don't know what a pulmonary embolism is or whether a sodium level of 143 is normal. In this way, medical school can be an environment where vulnerability of any kind is discouraged from the outset. We strive to be perfect and look happy doing it.
Despite having access to support services, I developed a strong sense of shame and struggled to seek help when I needed it during my first year. I was isolated and lonely studying at home most of the day. Struggling to squeeze in socializing with my new classmates, I was in a new community and still had to use GPS to find everything. As an only child with newly divorced parents, I didn't have a strong support system.
I was at home or in the anatomy lab for the first three months, and I quickly gave up on my former hobbies, like singing and yoga. And yet, it felt like nobody around me was as stressed, confused or behind as I was. I was no longer the smartest or the most put together and, at 25, trying to find a new identity outside of these adjectives felt like a crisis. Three months into my first year, I called my mom crying and said I didn't think I could hack it. Now, at the end of my medical school career, I know that my peers were also struggling, but we all felt too ashamed to admit it at the time.
There were a few things that helped me grow in my ability to ask for help and admit any lack of knowledge. First, I feel fortunate that I attend a medical school where the faculty and staff encouraged us to succeed together. There are no set numbers of passing grades or culling of students. My amazing peers shared resources and information freely. In the past few years, my school has shifted to a pass/fail grading system and does not report grade point averages early on. I feel these changes reflect a desire to foster community among students. If students aren't given environments where it's safe to be wrong and fail, vulnerability will ultimately be stifled.
Second, as a first-year student, I participated in a section of the Healer's Art course offered at my school. For one semester, a family physician facilitated small group discussions surrounding the humanistic aspects of medicine. During the session on grief, each student shared a great loss in their life with the group. Students talked about important people who had passed away, or the loss of a passion or joy they once had. Several students cried. Sitting in that group, even just once a month, I felt a sense of belonging that I had not known in medical school previously. Throughout the semester, I felt more and more comfortable sharing how lost and lonely I felt. It was a structured, safe environment where I could be honest, and it helped me more than I realized at the time.
Third, nothing helped me deal with my own impostor syndrome more than having a close group of medical school friends. These peers were my strongest support system and my greatest source of hope and strength. On rotations, we helped each other find patient rooms and lent each other our stethoscopes. We got together after work and laughed until we cried about the dumb things we'd done on rotations. We also shared when we were struggling. One morning, driving home from a 24-hour labor-and-delivery call, I called a friend in tears after leaving a delivery where I felt awkward, unskilled and in the way. I worried aloud whether I could really be a doctor. She listened and validated my feelings. It was the only thing that allowed me to calm down enough to sleep. Having the ability to be vulnerable around people who understood exactly how I felt was how I survived.
Lastly, I decided I had to take some risks. I became that girl who always asks the question everyone is thinking. I admitted in front of groups large and small that no, I did not know what a pulmonary embolism was and for too long I'd been afraid to ask. The person who had been suffering the most from my inability to ask for help or admit I didn't know was me, and I was the only one who had the power to change that for myself.
I was paying at a coffee shop here in Johnson City, Tenn., one day, and I saw a picture hanging on the cork board behind the register. It was a picture of two dogs standing in a puddle. One dog had short legs and his belly brushed the muddy water. The other was tall, and the puddle barely came up to his ankles. The bottom of the picture said, "We all experience the same puddle differently."
This picture struck me, not only because I, too, have short legs, but because for years I had wondered why I wasn't good enough or smart enough to achieve more. I'd been comparing myself to everyone else without accepting that we each experience everything differently.
When I look to my left and right at graduation in May, there will be people beside me who are mothers and fathers, primary caregivers to ailing parents, first-generation college students, children of immigrants and individuals who live with chronic illness or disabilities. So many of us have other struggles and responsibilities that take up our time outside clinic and lecture. To compare yourself to someone else without being able to see what they look like in the puddle is both impossible and fruitless. I've learned so much by being vulnerable with the people around me, and I've felt more like my authentic self doing it.
Margaret Miller is the student member of the AAFP Board of Directors.