By: Maria Sajan and Munazza Khan 

“In the back of my mind, there’s probably this idea that this is just temporary - getting rid of your hobbies, putting everything on hold. But I wonder if perhaps after this it’s only going to get worse.” - Year 5 medical student (Picton, 2021, pg. 8)

The pre-med years are infamous for their high stress and burnout rates: the striving for straight A’s and 528s on the MCAT, the anxiety of meeting a gazillion deadlines, accumulating shadowing hours, working on those extracurriculars, and much more! 

As you can probably already imagine, you will encounter many more stressful situations in your journey from medical school to residency and so forth. If not addressed promptly, these elevated stress levels can lead to burnout and empathy erosion over time. Thus, it can be helpful to home in on those stress-management strategies right NOW and give yourself a head start.

We’ve collected some statistics to give you a better view of the level of stress medical students endure throughout their journey, and the habits some of them have adopted to deal with the high-stress environment of medical school. 

Exactly How Burned Out is Today’s Pre-Med and Medical Community? 

A survey conducted by Kaplan in a sample size of 400 pre-meds indicated:

• Nearly 40% of survey respondents had considered dropping their pursuit of a career in medicine because of stress in the pre-med process. To put things into perspective, in a group of 400 pre-meds, 160 considered dropping out of the rat race, 180 stated they experienced stress frequently, and 104 reported being in a constant state of stress.

• More than half of respondents said “self-medicating” (using alcohol or other drugs) is a common problem among their pre-med peers.

• Another study in a group of graduating medical students showed that: 18% reported drinking alcohol more than three times a week, and 21% reported at least one episode of binge drinking in the last 30 days. 18% of female and 11% of male medical students reported that their drinking had increased in medical school, and impairment rates due to alcoholism for physicians are reported to be as high as 10%.

The pandemic has aggravated this problem with a decrease in opportunities to engage in humanistic activities, such as volunteering activities at medical clinics or hospitals (which may be something most pre-meds are highly passionate about). Now, pre-meds have more time to focus solely on academics and the MCAT, which may not necessarily be a good thing! You might already be experiencing burnout, but if you’re unsure, check out this quiz to see where you stand.

The transition from a pre-med to a medical student does not lighten the load in terms of stress and burnout. A widely accepted fact is the correlation between medical training and a high rate of burnout, anxiety, and depression. Understandably, this is the beginning of the domino effect which might follow physicians throughout their careers. 

There is no doubt that this pandemic has negatively affected student wellness and increased the need for implementation of effective stress-management routines for pre-med and medical students. This is where self-care comes into the picture!

What is Self-care, and Why Do Pre-Meds Need It?

Self-care can be defined as actively attending to your own health, be it physical, psychological, emotional, social, professional, environmental, spiritual, or financial. But a multitude of factors prevents medical students from practicing self-care, such as increased pressure, time constraints, and the stigma around seeking help.

An online questionnaire completed by 871 medical students exhibited a strong inverse relationship between perceived stress and their quality of life, indicating that an increase in stress strongly correlates with a decrease in the quality of life, both physical and psychological. There are a number of implications that arise from the psychological stress, which might harm your medical school application - the exact one that you've worked extremely hard for since high school - specifically in terms of lowered academic performance and increased professional misconduct. Evidence suggests that student self-care may help buffer this relationship! 

A study by Ball & Bax (2002) found a decreasing trend in positive coping strategies such as exercise and socialization, along with a significantly increasing trend in potentially problematic use of alcohol among first-year medical students.

Developing and maintaining effective self-care habits in your undergraduate years can help prevent you from developing more destructive instant gratification habits later on. Empathy erosion can also result if elevated stress is not handled well. It’s important for you and the people around you that you find self-care habits to help alleviate your stress levels.

Along with the importance of overall wellness, there is also a possibility that your lack of self-care at the undergraduate level may negatively impact your medical school application. During the short period of time leading up to the application cycle, the more extracurricular activities you try to add to your list (i.e. the more you broaden up your list of extracurriculars), the more highly likely it becomes that you are not entirely focused on all of them.

Therefore, your pre-med extracurriculars might end up lacking depth from the perspective of the admissions committee, leading to a negative impact on your application. Trying to cram all those activities into your schedule will also most definitely lead to your burnout. Instead, we recommend focusing on a few hobbies and extracurriculars and considering a capstone project to showcase your commitment to an area of your interest.

What Can Pre-Meds Do About Their Self-care Needs?

We looked into ways that medical students practice self-care to get a better idea of what works and what doesn’t, allowing you to implement better habits in your own life starting today.

A study by Ayala et. al (2017) focused on developing a visual taxonomy of student-identified self-care behaviors to discern what students were doing for self-care. They identified 10 domains of self-care which included:

1. Nourishment
2. Hygiene
3. Intellectual and Creative Health
4. Physical Activity
5. Spiritual Care
6. Balance and Relaxation
7. Time for Loved Ones
8. Big-picture Goals
9. Pleasure and Outside Activities
10. Hobbies 

These domains were organized along two continua of self-care that reflected social versus individual engagement and physical versus psychological health as seen in the concept map below:

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Have a look at the point map to see if there are any domains you can work on! Let us know what you choose by filling out this poll, and check out the results at the end to see what works for others!

There may be some areas that you have yet to consider that significantly affect your mental and physical health. Being thoughtful in how you engage in these areas and what activities you partake in can instill healthier habits for medical school.

You may think that you don’t have the time to fit self-care into your schedule, but it’s important to keep in mind that regularly engaging in self-care will rejuvenate you to bring your most focused, present self in your other activities. Medical schools don’t want future caretakers who can’t take care of themselves; engaging in self-care is what will make you a well-rounded and empathetic physician. 

Remember the world-famous saying, “You can’t pour from an empty cup!” A constant state of stress is likely to empty this cup.

Self-care is a gradual, adaptive process. Unfortunately, you won’t see all the fruits of your labor overnight, but starting early can have huge implications in other areas of your life right now and as a physician in the future. 

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About the Authors:

Maria Sajan is entering her third year at Wilfrid Laurier University majoring in Health Sciences. As co-president of her university’s Stem Cell Club, she is dedicated to increasing the number of registrants in the OneMatch Stem Cell & Bone Marrow registry. Her interests also include writing, gardening, and biking.

Munazza Khan recently graduated from Gulf Medical University with a BS in Biomedical Sciences. As someone who was drawn to Cancer Biology early on in her second year, she is currently researching the immune response to hypoxic stress in a tumor microenvironment and how immunotherapy could be used in the future. She is also an avid cat and plant lover, but sadly, her cat is on a mission to destroy any plants in sight. Her hobbies include playing soccer and board games.

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Works Cited

Ayala, E., Omorodion, A. M., Nmecha, D., Winseman, J. S., & Mason, H.R.C. (2017). What do medical students do for self-care? A student-centered approach to well-being, Teaching and Learning in Medicine, 29(3), 237-246. 

https://doi.org/10.1080/10401334.2016.1271334

Ayala, E.E., Winseman, J.S., Johnsen, R.D., & Mason, H.R.C. (2018) U.S. medical students who engage in self-care report less stress and higher quality of life. BMC Medical Education, 18, 189. https://doi.org/10.1186/s12909-018-1296-x

Ball, S., & Bax, A. (2002). Self-care in medical education: effectiveness of health-habits interventions for first-year medical students. Academic Medicine: Journal of the Association of American Medical Colleges, 77(9), 911–917. https://doi.org/10.1097/00001888-200209000-00023

Brendan Murphy News Writer. (2021, January 12). How the pandemic has spiked stress for many med school applicants. American Medical Association. https://www.ama-assn.org/residents-students/preparing-medical-school/how-pandemic-has-spiked-stress-many-med-school.

Picton A. (2021). Work-life balance in medical students: self-care in a culture of self-sacrifice. BMC Medical Education, 21(1), 8. https://doi.org/10.1186/s12909-020-02434-5

Have any questions about pre-med self-care? Let us know in the comments below, and we’ll respond to you personally!