Medical students are no strangers to burnout. Anna Askari, a fourth-year medical student at Ohio State University College of Medicine in Columbus, says she's often felt burnt out. Now, fresh from completing the demanding United States Medical Licensing Exam Step 2 Clinical Skills Exam, Askari talked with AAFP News about how she copes with stress and burnout and how she plans to manage it as a resident and beyond.
Anna Askari is a fourth-year medical student at Ohio State University College of Medicine in Columbus who has already experienced symptoms of burnout.
Q: Can you share with me when you've experienced burnout during medical school?
A: I think I really noticed it toward the end of the school year during my first year of medical school and then again during my second year when I was studying for my first board exam. That was a particularly stressful time. In my third year, too -- with our rotation schedules, you're not only kind of working a full-time job, but you also have to come home and study. I felt burnout at the end of third year, as well, when I was studying for my Step 2 Clinical Knowledge Exam, which I took about a month ago. When I realized I was experiencing burnout again, I took some steps to better help myself, and I feel like my Step 2 experience was better than my Step 1 experience.
Q: What do you do to manage burnout?
A: Yoga has been really helpful. We had an older classmate, Dr. Liz Maxwell, who is now a family medicine resident. She was a yoga instructor before medical school. When she came into the medical school environment, she realized how stressful it was, and she decided to create a yoga class for medical students once a week that she taught for free. It was fantastic. She would be on her third-year rotations and tell us little stories about her patient experiences. As a first- and second-year, I thought that was really fun.
I definitely use yoga not only as a way to exercise, but also just to be mindful, to take deep breaths. As medical students, most of us are Type A personalities, and we have this guilt when we're not doing something school-related. That takes away from any rest period that you need to give yourself. Yoga forced me to think about myself and take that time.
I'm also really involved in advocacy with both AAFP and the Ohio Academy of Family Physicians. I think it's important for medical students to take themselves out of the stress of medical school and reflect on why they went to medical school. It was fun, going to these meetings from time to time and seeing my future colleagues and mentors. It puts into perspective why I want to go into family medicine, how important our work is, and how much work we need to do to advocate for our patients.
AAFP President John Meigs, M.D., poses with AAFP Student Delegates to the AMA Anna Askari and Tyson Schwab. Askari says her advocacy activities are one of a number of tactics she uses to fend off stress and restore perspective.
Another thing for me is my free clinic work. It was something I did before medical school and it was a big reason why I went into medicine. During my second year, I was the volunteer coordinator at one of the free clinics, Noor Community Clinic. That was a good leadership position to have and it was something that helped me keep perspective on why I went to medical school.
Now, as a fourth-year medical student, I have the opportunity to complete one of my rotations longitudinally at the Helping Hands Free Clinic. It's a really good way for me to realize, "OK, I'm doing this, I'm learning all of this so I can see patients." As much as it might seem like it's more work, for me it was a great relief. It was an extracurricular activity that gave me perspective on why I am doing this.
I also feel that spending time with family and friends is really good, too. I hang out with my medical (school) friends, but nonmedical school friends are fun to hang out with because they're not going to be talking about anything medical school-related. It's really nice to not have to think about the part of your life that's really taking over your life.
Q: How has your medical school promoted student wellness and mental health?
A: We are really lucky at Ohio State to have Dr. Linda Stone. She is also a family physician, and she's in charge of the Humanism in Medicine Program. We have everything from groups like Dance in Medicine to an orchestra that (includes) medical as well as dentistry and pharmacy students. We have a lot of arts organizations.
I was involved in a book club during my first and second years of medical school. We'd read a book (or) an article, and then come together, have some dinner and discuss it. Usually these articles or books were things like The House of God(www.amazon.com). It was first- through fourth-year medical students, and sometimes residents and attending physicians would join us. It's just another example of taking care of yourself.
At Ohio State, every student -- graduate, professional, undergrad -- is given 10 free counseling sessions per academic year. I've utilized that all four years of my undergrad as well as my four years of medical school. Especially in medical school, I felt it was helpful to meet with someone outside of school. I would meet pretty regularly with her. When I felt burnout was occurring, especially at the end of school years, I would meet with her a little bit more.
If you need help more immediately, we have a psychiatrist specifically for our medical students. If you feel like you need medication or counseling referrals, he would be available. I had a lot of classmates adjust their depression medication dosages for medical school just because it got more stressful. It's something that comes with the territory. It's going to be a stressful tough time, a lot of competition and material to get through. It's important to have support from mental health professionals. It's also a really good practice as a future family physician to be able to talk about how we've utilized mental health services and normalize it for our patients.
Q: Are burnout and mental health something you talk about with your peers?
A: Yes, we definitely do, especially during a tough course or something like the Step 1 Exam. We also have had a lecture from one of our professors. He did a specific talk about burnout with statistics to inform us that it's an issue nationally and across specialties. He talked about how it starts in medical school and how building good habits and doing the things that keep you sane and level are important. As you're going into residency and your career, it's not necessarily going to get any easier.
Q: How do you plan to manage your own wellness as you launch your family medicine career?
A: I am really interested in direct primary care (DPC). DPC has all the elements that I think are important for me to prevent burnout -- from not working with insurance companies to having more time with your patients per appointment and being more available to your patients. I feel the kind of robotic work that some physicians unfortunately are forced to do -- having 15-minute appointments to get a certain volume to get paid enough to continue practicing -- is really stressful.
Also, I'll be continuing advocacy work. I think it's so important to come together with other physicians with different practice styles, all dedicated to family medicine, patients. Advocacy becomes more meaningful when other parts of our job, like filling out (electronic health record) notes, become tedious and stressful.
Q: Will you continue your free clinic work?
A: Yes, for sure. That's actually a really big career goal of mine, too.
Q: What advice do you have for other medical students?
A: Take advantage of mental health care professionals. There were high-stress times when I thought, "OK, this is going be a really tough time, I need to talk about this," and she would be someone who would check in with me. Hopefully, other medical students have that as an option.
I think it's just important to enjoy medical school as much as you can. It goes by fast, (even though) it may feel like, especially during burnout time, it's going so slowly, almost torturously slow. It's something that all of us dreamed of at one point or another, so keep that perspective in mind that it's going to be worth it in the end.
Do those extracurricular activities that work for you. Whatever it is that you're particularly passionate about in medicine will help you stay sane during a time when it's probably OK not to feel so sane.
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