One of the biggest challenges in medical school—and how it gets a head start

If you haven’t tuned up your car in years, you likely wouldn’t hop in the driver’s seat to take it on an unplanned trip across the country.

And yet, premedical students across the country have consistent and potentially increasing levels of burnout in comparison to their undergraduate peers before they even enter medical school. While medical students have often been highlighted throughout numerous studies for levels of burnout throughout training, what data are we actually tracking when premedical students are facing elevated levels of anxiety, depression and burnout before even entering this intensive training?

In reviewing the above literature, data and research, burnout and mental health challenges (some due to financial pressures) present as two of the greatest challenges for both premedical and medical students. Workload and time management were listed as significant contributors to students’ struggles.

However, what the national data does not address is the underlying primary source of distress—and throughout my time working with hundreds of medical students, I can say that is: losing track of their “why.”

Remembering your purpose

Over the past 15 years, I have served as a psychiatrist/mental health clinician for medical students and physicians, a faculty member providing career advising and formal courses on wellness/peak performance for hundreds of medical trainees, a presenter of peak-performance wellness workshops at global forums across the country, a creator of international web-based and social media-based outreach platforms reaching hundreds of medical students and most recently, an administrator of wellness programming and career advising trainings that support thousands of medical trainees and clinicians.

As a psychiatrist by trade, I did “deep dive” investigations with medical students to help them get to the core challenges underlying their stressors. While looking closely over the years at each student’s individual, up-close challenges to help them find hope and clearly see their next steps, I began to see the tiny, core connected threads that have united almost every medical student I have encountered when they were in deep distress: They lost hope, and they lost their connection to their why. For medical students, time and again, they lost connection to the reason they entered medical school in the face of inherent stress and challenges in training. Without the big, strong why to overcome their challenges, they were lost, frustrated, burnt out and without hope.

The pivotal underlying factor I have seen overcome or take down a medical student throughout all of these circumstances has been this: When a student is deeply connected to a deep inspiration and sense of life purpose to become a physician, that belief infiltrates everything they do and serves like a mental health “shield” to help guide them through even the most challenging situations.

Those students almost seem to shine through stress—because the desire is deeply embedded in their every action. For other students, saying things like “I can’t even remember why I wanted to be a doctor,” suggests their current mindset makes them more susceptible to anxiety, depression and burnout.

The students I have seen excel under stress repeatedly would say, “This has been really hard, but I know why I am here. I just keep seeing myself as a doctor, and I know I will get there.” The students who struggled greatly with resilience often saw themselves as victims to their circumstances, felt trapped and helpless, and often could not report a sense of underlying meaning or purpose in their lives. I have personally witnessed this, time and again, as one of the few key underlying differentiators between medical students who thrive and those who have deeply struggled. The key differentiators have been having a sense of purpose, including if your purpose is in connection with a loved one. The inevitable side effect of purpose is hope.

If you are feeling lost, here are a few quick things you can do to reconnect:

• Take a walk in the woods, in any weather, and breathe deeply. Take it all in. Witnessing the deep connections in nature brings an inherent wisdom to the body that supersedes one’s mind.
• Lean into sadness or disappointment to embrace whatever feelings of frustration, anger or anxiety you may have been pushing down that create a sense of separation from one’s self.
• Exercise—this is a very nice serotonin burst. When done on a regular basis, it has similar neurochemical impacts on the brain as a low-dose SSRI.
• After completing any of the above exercises, sit in a quiet space, close your eyes and pull in an image of your most beloved to relax you. This can be a spouse, partner, child or even a pet.
• This may sound macabre, but often works—imagine you are observing your own funeral. Write your eulogy. Then read it out loud to someone you care about deeply.
• Pull out citrus aromatherapy oils like orange, grapefruit or bergamot.
• Create a digital vision board. Programs like Pinterest or Canva have images that may spark joy or remind you of that internal “why.”

Viktor Frankl, a physician, philosopher and author who himself survived atrocities of World War II in Germany, used his body of works to create a theory of human resilience which he called “logotherapy.” One of the primary tenants of logotherapy is the “meaning of life”—we are called moment-to-moment to answer the demands that life places on us. The focus is not on what we feel we deserve from life, but rather what our responsibility is to give to life. We have the ability and the ultimate necessity to self-transcend in order to improve humanity.

In his book, “Man’s Search for Meaning,” he emphasizes the importance of feeling that one’s life has a purpose, and the crucial role a sense of life purpose has on one’s grit and resilience. We all have a different why, maybe it is a career in medicine or it may even be a deep commitment to family or a loved one. Whatever it is that we hold as the most sacred “personal compass” in our lives—that is what we need to stick to and hold clearly to be able to move forward in the face of great challenges.

Seeking guidance

If you are a medical student or have a colleague in deep distress, please seek mental health support. This article is not a replacement for professional interventions or support.

• You can seek immediate help in an emergency room or dial the Suicide and Crisis Lifeline at 988
• The national crisis text line can be reached by texting HOME to 741741
• The Physician Support Line, a free, confidential support service run by volunteer psychiatrists, is available Monday through Friday, 8 a.m. to 11 p.m. ET, at (888) 409-0141

Finding your internal ‘GPS’

Having an internal “GPS” can be extraordinarily helpful in mitigating and navigating stressful and challenging situations. You won’t be able to make that metaphorical trip across the country until you put into your internal navigation system what you envision as the final destination. From there, everything else will follow—or at least flow with more ease.

Related reading:

Remembering your ‘why’ in medicine during the preclinical years of medical school

How our lives before medicine help us become the doctors we’re meant to be