My first year of medical school (M1) was challenging for all the “normal” and expected reasons: new city, new house, new school, and a new academic curriculum. However, only through reflection three years later, what truly became salient was my willingness to let my academics overshadow my personal relationships, mental and physical health.
While going through the online school curriculum I first tried to re-write my own notes as I watched the pre-recorded videos and read through the 60-100 pages of coursework. Usually we were given 1-2 days to study between classes so I would spend at least 12 hours each of those days writing notes and trying to absorb the content. When it came to the practice questions at the end of assignment, I rarely had the time or mental energy to read them before our 8am in-person class. During this class we were placed in small table groups of 5-6 classmates where we would work through cases and questions. At the end of these 4 hours we would have a challenging online quiz over the reading.
The amount of outside study resources available was overwhelming, and I didn’t know which ones to use. Anki note cards was the most talked about resource, so Jonah, my husband, and I purchased Switch remotes and downloaded the medical student created decks to use on our computers. There were over 30,000 cards in total, so it was near impossible to determine when to review which cards in connection to the clerkship material. I then tried creating my own virtual flash cards and downloading some from upperclassman and peers. I would spend hours going over old notecards ones and rarely ever learned new ones. They piled up very easily, and seeing the “numbers needed to review” rise gave me persistent anxiety. Even when I worked towards answering them within 6-7 seconds, there was not enough time in the 24 hour day to complete them in addition to our coursework.
It seemed like a miracle that I passed (above 70%) on every block that first year. But, I did it! Unfortunately, seeing that the average score in the class was 85%, when I barely scored a passing grade in the 70s, built a sense of inadequacy and unintelligence. We were told that we were all part of the top 1% of academic achievers, so of course we would feel inferior to our peers. However, learning that knowledge and actually getting over my imposter syndrome was difficult. Further realizations started to become salient over time in medical school of the disadvantages I possessed compared to my peers. First, only a handful of my 144 classmates were from a hispanic background, and those that were in racial minority category were commonly placed in the needing “extra academic support” groups. Second, many of may peers graduated from Ivy League or similar type undergraduate universities while I had only graduated from a state college. Third, there was a significant number of students who had parents and generations of family members who were physicians who provided academic tips, resources, and mentors whom I didn’t have access too.
Unfortunately, in order to successfully pass my M1 year my relationship, physical and mental health plummeted. The only thing I prioritized above school work was sleep. I knew from my high school and college years that sleep was the last string that held me together, and if ruptured. my entire being would collapse. Therefore, I was determined to fall asleep between 10-11pm each night whether or not I finished my course work. This provided me the mental stamina to stay present during classes and do my very best on quizzes and tests.
Honestly, I barely remember details from those months of September 2019 - February 2020. My husband reminded me that I was very distant and only focussed on my school work even though we were in the same medical school and class. He recalls that he barely saw me look up from studying on my iPad and computer. Our relationship was defiantly injured that first year as I struggled to stay afloat with all the course material and content. Even though we ate most of our meals together, a habit we learned was crucial during college, we didn’t emotionally connect during our “downtime.” If we were not eating we were talking about medical school. We thought it would be fun to start “Grey’s Anatomy” and watched many seasons during our M1 year. We thought it was a great way to “fun study” because we worked up a lot of the cases and they randomly correlated to content we were learning in class. We would sometimes get into arguments on who guessed it correctly first, but that is just our competitive nature.
Before, COVID-19, would also try to get out into the city, but our efforts to explore were solely focused on finding a new place to study. I distinctly remember going to a free day at the Chicago Aquarium and walking around all morning looking for a table instead of relaxing and enjoying the aquatic life. We only took a break to watch a 30 min water show, and then went right back to studying. We did the same thing during the free days at the Art Museum and the Natural History Museum. Even, on our family cruise during winter break...Study, study and more studying.
I constantly strove to perfect my knowledge so I would do well during the quizzes and exams. Every moment I had free I would study and try to absorb the material. However, I should have realized early on the impossibility of knowing everything in medicine.
“Perfectionism is a way to escape feeling unloved and not good enough” Dr. Tanner
M1 Academic Lessons Learned:
I should have focused on understanding the school work and the material that was provided over outside resources. Each medical school exam was very specific to what was provided, and if I learned things outside of the curriculum (including STEP prep) then there was a chance I had wasted my time. In turn, I would loose points for little facts that I could have easily memorized if I had just focused on the review material and questions provided. There is a benefit to go to outside resources when I didn’t understand something. However, I wish I would have gave myself a time limit so I wouldn’t get stuck in the weeds for over an hour. Later I learned to just set aside 5-10min to look up each concept I didn’t understand AFTER my school material was completed for the day. It also took me all year to learn which material was best to use for each category.
See this blog post for an example of all the resources needed for medical school.
There are SO MANY RESOURCES out there! Take a deep breath, you might use a couple during one block, and a completly other on a different block. You will get your groove eventually. Usually you have to pay for them unless your school is awesome and buys some for you. Expect to spend at least $3,000 to pay for resources for all 4 years.
Learning all Subjects: Boards & Beyond, Osmosis, AMBOSS, OnlineMedEd (Best for MS3)
Pathology: Pathoma (Videos and book)
Histology: Histology Guide (free)
Memorize with Pictures (Biochem, Micro, Pathology, Pharmacology): Sketchy Medical, Pixorize, Picmonic (20% off with link), Osmosis
Anatomy: University of Michigan Pictures (free)
Quizzing YourSelf: Anki (free), NBME
Dermatology: DermNet (free)
STEP Exam Prep: UWorld (#1 priority), Amboss, NBME
Psychiatry: NowYouKnow-Psyc (20% off with code: MedPsycMoss)
Neurology: NowYouKnow-Neuro (20% off with code: MedPsycMoss)
I learned that it was a waste of time to write out my own notes. There is just too much material to memorize and learn and not enough time. There was also the possibility that I could write down the information incorrectly, which I sometimes did and led me to learn it incorrectly. During my second half of M1 year, I learned about writing information on the “First Aid Step1” book. Following advice from upperclassman I used a pdf version to highlight and add notes from the curriculum. Once I started doing this I saw myself cut down my study time in half! Since “First Aid” had all the topics I needed to know for STEP1 it was easy enough to search the section and add my own pictures from outside resources (sketchy pictures, pathology and histology slides, etc). I would also highlight the topic in my book as we covered it in classwork and tab the page so I would know which material to go back and review for the exams. If the material wasn’t highlighted, then I ignored it and planned to study it during my second (M2) year. I had used the Notability app during college, so it was the best app I could find that fit my needs. One lesson I learned was that you need to turn the Notability document into another pdf, save it to your computer, and re-load it to the Notability app after every unit. If this is not done then all the added content and highlighting has the possibility to move around since it is such a large document with over 900 pages.
Coming from Colorado to Chicago made us miss nature and the mountains greatly. Our neighborhood was on a busy road and did not have a safe park nearby. Thankfully we found the Morton Arboretum, which saved our sanity. Every weekend we would drive an hour to to this beautiful (paid) park and study 6-8 hours in their welcome center which has a gorgeous view of their lake surrounded by trees. We gave ourselves a one hour lunch break to go on a mini hike to explore the gorgeous grounds. However, we would then go right back to our educational material. Even though we breathed the same medical education air, we didn’t really connect during our M1 year. This led us to be individually isolated in our own minds. For me, anxiety and depression drove me to a level which I had never seen before. Check out this blog post on "Call of the Void: Suicide Ideation"
I was very thankful that our school had a mental health center where they had free PHD psychologists who regularly worked with medical students, residents, and physicians. In college I had taken advantage of a similar mental health resource which provided 6 therapy appointments per school year. I was so happy to hear that the school provided unlimited therapy sessions. Therefore, I signed up early for sessions and have continued to work with my therapist to this day 4 years later! At the time I knew that I struggled but I couldn’t put my emotions into words. I remember the first time I asked my therapist if he thought I suffered from “a-n-x-i-e-t-y.” It was so hard to utter those words out loud. However, when he matter of factly said “yes” I felt a wave of relief fill my being. Finally, I found a reason for why I seemed to always struggle more with academics compared to my peers. Later on I would get the courage to ask if I could try anxiety medications as we had learned in my medical school psychiatry curriculum.
In December of M1 year I learned about Adverse Childhood Experiences for the first time. Through reading the “advocacy” material provided for our class workshop I learned I had suffered from trauma and abuse from my childhood home. It all suddenly made sense why I had such a strenuous relationship with my parent, my abuser, and never was a “good enough” nor considered a loving daughter. Getting into medical school was not a big deal and everything I tried to accomplish academically and personally would never meet their expectations. This started since I was a baby as I was always seen in a negative light by my parent. They frequently told others how I refused to reach toward them and instead would reach toward others even when I was in their arms. Then when I was a 9 year old I remember admitting to them that I no longer wanted to be forced to be a ballerina and instead preferred karate. Additionally, as a child I didn’t like to speak, read, or write their language (Spanish), and preferred speaking English like my classmates. Three emotionally abusive non-swear words that would constantly leave my parents' mouth to describe me were: “lazy,” “stupid,” and “ugly.” Even though I made them unhappy I always tried to be a good daughter, do what I was told, and be the best I could be. Unfortunately, physical abuse and emotional neglect frequently followed when I disappointed them.
This constant pressure to appease led me to become highly sensitive of other’s emotions and later led me to become anxious of my surroundings. As I grew older this social-type anxiety combined with my Type A personality into something commonly called the “pre-med” personality. This personality trait was difficult to remold during the highly stressful M1 year because it was a trauma response which catered to always comparing myself academically and socially to my peers.
In fact, "unprocessed trauma can look like a personality,” but it is a normal adaptive response to stress.
Check out this blog post to read more about how trauma and ACEs impacted my future mental health.