Thursday, April 10, 2014

Strategies for Wellness in Medical School

by Sophia K. McKinley 

Medical school presents multiple threats to wellness:  USMLE exams, demanding rotation schedules, and weeks of residency interview travel all pose challenges to healthy habits.  We go to medical school to learn how to take care of others and yet we often fail to take care of ourselves.  Of course medical students know they are supposed to eat vegetables, they know that sleep and exercise are important, and they know that it is hazardous to let stress get out of control.  Knowing all of this information, I once caught myself at a hospital desk late at night consuming pretzel M&Ms in lieu of dinner... for the third day in a row. 

I’ve struggled as much as anyone with practicing wellness during medical school, but now that graduation is in sight, I can look back across the past several years and identify the strategies that were (sometimes) effective.  Perhaps the main point is that there is no silver bullet—it took a variety of tactics to approximate the kind of healthy life that we in medicine encourage others to follow.  Here are some strategies that worked for me. 

1.    Look for free exercise:  I lived 4 miles from medical school and most of the university-affiliated hospitals.  Every morning I rode my bike to the medical area, and I invested in whatever boots/coats/facemask it would take to permit bicycle-commuting through the winter months.  Even though it was only a 20 minute ride, I accumulated over 1000 miles a semester!  On the wards, I tried taking the stairs whenever possible as another source of free exercise. 

2.    Overschedule workouts:  I instituted a “pencils-down” rule during Step 1 studying.  Every night at 8:30 I attempted to force myself to go to the gym for 45 minutes no matter what.  It was difficult and I sometimes didn’t make it, but having that daily commitment made it much more likely that I ended up on the treadmill than if I had just decided I would exercise when I was finished (is anyone ever finished studying?).  I would even pencil yoga classes into my schedule while on the wards.  Even if I went straight home most days, I’d make it to the class more often than if I didn’t think about how it would fit into my life at all.
3.    Cook in advance: I spent an entire weekend every several weeks freezing individual GladWare containers full of homemade stews and vegetable-based meals.  Somehow all the chopping, measuring, and simmering were more tolerable in bolus form.  I ordered the plastic containers in bulk online, and I convinced my mother to give me a chest freezer as a holiday gift to increase the interval I could go between cooking sessions.  By putting in the time up front, I had all the microwave convenience of take-out without the nutritional or financial drawbacks.

4.    Non-food rewards:  I noticed that if I had tough day or was feeling celebratory, I would head to a bakery cafĂ© or treat myself to a fancy chocolate.  At some point in medical school, likely after learning about all the sequelae of diabetes, I started looking for non-food rewards.  They were as simple as taking 20 minutes to read a short story or buying myself flowers.  Writing a letter to a friend or spending extra time playing with my cat were other substitutes for the chocolaty pastry I might otherwise nibble on.

5.    No caffeine after 1pm:  I started sleeping much better after I adopted this habit.  Barring extreme circumstances, all PM coffee was decaf.

6.    Ask for help: I’m lucky to have a partner who will follow-through when I ask him to bug me to go for a run or who will make a recipe I print out.  Even if you aren’t in a relationship with someone who will cook for you or motivate you to exercise, friends are great resources.  I’ve had grocery-cooking dates with friends, and it always feels worse to cancel on a gym session if a buddy is counting on you to show up.

7.    Be honest with yourself: perhaps the most effective strategy of all was to think deeply and honestly about the reasons why, despite knowing so much about the importance of healthy habits, I would find myself eating candy for supper.  Eventually I realized that I was embracing a very narrow view of productivity in which I only considered academic activities to be worthwhile.  I consistently discounted the value of time spent on an outdoors run or meeting a friend to catch up.  Who wants to become so unidimensionally focused on medicine that there isn’t space for other aspects of human flourishing including being healthy or connecting with others?  I’ve tried to abolish the guilt of putting down a manuscript by remembering that working out, eating well, and spending time with important people are just as valuable and important as being a diligent medical student.

Surgical internship is on the horizon, and with that will come even greater stressors and challenges to living a healthy, balanced life.  I’m sure I will need to develop different strategies to minimize the damage that surgical residency can wreak on a person’s body and mind.  Likely there will be periods of intense imbalance when it will feel impossible to muster the energy to climb one flight of stairs or make a peanut butter sandwich.  Yet no matter how many times I catch myself eating pretzel M&Ms for dinner, one of my goals is to be a surgical resident who never gives up on aspiring towards fitness and wellness.  Surgery is an incredible field, and I plan to enjoy the training and rewards of practice for as many healthy years as possible.  


Sophia is a dual-degree M.D./Ed.M. student at Harvard Medical School and the Harvard Graduate School of Education. She received the 2012 Association of Women Surgeons Patricia Numann Medical Student Award and spent a year as a Zuckerman fellow at the Center for Public Leadership at Harvard Kennedy School. Sophia is passionate about medical education, and she hopes to be an academic surgeon who brings educationally-sound innovations to surgical training. She will be begin a categorical general surgery residency at Massachusetts General Hospital in June 2014.


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