We’ve all heard it before: “Learning in medical school is like drinking from a fire hydrant.” Medical school is challenging enough without the added stress of a personal loss. Research shows that grief can have a significant negative impact on academic performance, so if you’re finding it difficult to concentrate, retain material, or take exams, know that this is normal.1-3 While we encourage you to seek professional help for your grief, you may also want to consider asking for additional academic support. Below is a list of academic resources curated from recommendations from accredited medical schools across the country. In addition to the resources listed, it may also be helpful to consider the following questions:
- What supplementary materials do students at your institution use to study for classes or board exams (e.g. websites, textbooks, question banks, etc.)?
- What kinds of academic support structures are available to students at your institution (e.g. tutoring, learning specialists, etc.)?
- What testing accommodations are available to students at your institution?
ACKNOWLEDGING THE DIFFICULTY
There’s no denying that the death of a loved one can be a traumatic experience. However, as medical trainees, we are faced with an additional challenge: while coping with our loss, we must also learn about the very diseases and circumstances that killed our loved one and are even expected to have in-depth discussions about them with our patients and colleagues. While some students may find this process motivating, others find it more challenging. There’s no right or wrong way to feel, but it’s important to recognize that grief can impact all aspects of your life, including your education. If you have lost someone close to you and are struggling academically, we offer the following suggestions:
It’s okay to put things off...to a point. Faced with the challenge of learning potentially overwhelming, painful, or triggering information, some students choose to ignore it completely, some prefer to learn just enough to pass their exams, and others force themselves to delve deeper. What you do is your choice and may change over time depending on your needs. But know that at some point, whether it’s an attending “pimping” you on rounds or a patient asking you questions about their health in clinic, you as a physician are eventually going to be responsible for mastering all of this material. Plan accordingly.
Ask for accommodations. Academic support at your institution may not be well advertised, but that doesn’t mean that it isn’t available. If you’re not sure about whether someone can help you, don’t be afraid to ask: If there are required lectures or small group sessions that you know will be difficult for you to listen to or attend, explain your situation to the relevant faculty member(s) and ask if you can be permitted to review the material at your own pace. If you’re having difficulty with your coursework, check if there are tutoring services at your institution or ask the course director(s) if you can delay an exam. If you think you would benefit from taking time off from school, speak with administrators about your options for doing so. There is no shame in asking for help.
Expect new challenges. You may discover that certain places, subjects, or people at work now trigger an emotional response in you or remind you of your loved one. At a moment’s notice, grief can force you to feel a whole host of emotions, some of which may be new or disturbing to you. If you are struggling to cope with these feelings, we encourage you to reach out to your friends, colleagues, or mentors for support and seek professional help early.
Reflect on your goals. With everything that you’re going through, it may become challenging to find the motivation or energy to focus on school. In these moments, try to take a step back and reflect on your long-term goals: What experiences inspired you to become a doctor? What impact do you hope to have on your patients or in the medical field? What steps can you take to make these goals a reality?
Take your time. In medicine, we are often expected to mask our personal feelings, but it can be helpful to recognize that it is actually normal to have an overwhelming emotional response to an overwhelmingly emotional event like the death of a loved one. Grief is an ongoing process that may affect you differently throughout the various stages of your training, so finding your “new normal” can take time. Be patient with yourself. Be forgiving of yourself. You will get through this.
THE BIG PICTURE
So you want to reevaluate your study habits. Where should you begin?
Let’s start broad: If you need some general advice for how to approach medical school, the students at the Albert Einstein College of Medicine created their MedMo Blog for just that purpose. They offer tips for academic success throughout the four years of medical school, so you can know what to expect from start to finish.
Several institutions also provide a broad range of academic resources for medical students. The Kansas University Medical Center, the North Dakota University School of Medicine and Health Sciences, and the University of Wisconsin School of Medicine and Public Health all offer an assortment of bite-sized tips for developing useful academic skills. They offer suggestions for everything from organizing your study habits to overcoming test anxiety to managing your time more effectively.
Are you looking for help with a specific problem? Take a look at some of the sections below for more in-depth support!
STUDY SKILLS
The University of South Dakota Sanford School of Medicine has a series of simple, interactive modules that prompts you to consider your unique learning style as well as the test-taking pitfalls you’re most prone to experiencing. They then offer suggestions for habits that are tailored to your specific needs. If you’re interested in taking a more granular test for determining your learning style, we also recommend the Index of Learning Styles Questionnaire developed at North Carolina State University.
The way that you study for one class may be different from the way you study for the next. And that’s okay! But cognitive psychologists have identified 6 key strategies for effective learning that can be applied to any topic, and the experts at LearningScientists.org have created infographics to explain how you can use them to optimize your studying: spaced practice, retrieval practice, elaboration, interleaving, concrete examples, and dual coding. The University of California San Diego School of Medicine has also created a guide for active studying that specifically applies these strategies to medical education. As you reflect on your own study habits, ask yourself which of these strategies you’re incorporating in your learning and which ones may be missing.
Taking notes in class or while you read can be helpful, if you’re doing it in the right way. The Zucker School of Medicine has created a tip sheet for developing effective note-taking skills that are tailored to your needs.
Lastly, many students find it helpful to use flashcards to supplement their more in-depth studying. Flashcards can improve your automatic recall of information, which is particularly helpful during timed exams, where every second counts. There are a lot of free flashcard apps out there, but Anki, Cram.com, and Brainscape tend to be the most popular among medical students because you can either make your own flashcards as you study or review expansive flashcard decks that have already been made by other students.
TIME MANAGEMENT
Do you ever feel like there aren’t enough hours in the day to accomplish everything you need? Do you struggle with procrastination? Do you feel overwhelmed by the dozens of tasks on your to-do list? You may benefit from reconsidering how effectively you’re using your time and energy.
This how-to guide from California’s Office of Statewide Health Planning and Development was created to specifically help medical students tackle a whole host of time management skills, from setting achievable and measurable goals to working efficiently in study groups to making daily and weekly calendars. Want to experiment with making a more detailed study schedule for yourself? Check out this study time calculator from the Virginia Tech Cook Counseling Center to calculate how many hours of studying you can reasonably complete in any given week.
If you’re struggling with procrastination, creating a schedule can certainly help outline everything that you need to do, but you may find that you need a little more motivation to get started. Prioritizing your tasks using a simple Eisenhower Box can make your life feel a bit less overwhelming, while some students find that using the Pomodoro Technique helps encourage them to complete the task in front of them in a timely manner.
TEST ANXIETY
As medical students, we’re under a lot of pressure to perform well academically. But while a certain amount of stress is healthy and can even help you perform your very best on an exam, that pressure can also become debilitating. How can you overcome it?
Feeling prepared for an exam can certainly help to reduce some of the stress you may be experiencing on test days. The University of Tennessee Health Science Center provides a helpful guide to actively reduce test anxiety throughout the test preparation process. If you feel yourself experiencing some of the physical signs of anxiety during an exam–increased heart rate, sweaty palms, tense muscles–it may also be helpful to take a short break with a deep breathing exercise or a quick stretch.
If you find yourself dwelling on thoughts of your inadequacies or the consequences of doing poorly on an exam, you may also want to re-evaluate your "self-talk." Self-talk refers to the running dialogue that you have with yourself, and negative self-talk that focuses on your failures or degrades your achievements can negatively influence your academic performance and overall well-being. Loma Linda University School of Medicine has a comprehensive resources that specifically focuses on helping medical students to develop important psychological skills such as healthy self-talk to overcome test anxiety and help you reach your goals.
BOARD STUDY
As you begin to prepare for board exams, remember the importance of developing a study plan. These exams cover a lot of material, so you’ll want to make sure that you have the time to master every topic. Your study plan will be unique to you and will depend on a number of variables: your current level of mastery of the material, the content resources that you plan to use, your own scheduling conflicts, and many more. The Stanford School of Medicine has developed a useful guide for creating a study plan for Step 1 that takes these variables into account. If you want some inspiration for your plan, check out these samples from students at the Loyola University Stritch School of Medicine. While these resources were specifically created to prepare students for Step 1, the same basic principles apply for creating a study plan for Step 2CK.
Practice tests are also commonly used to assess your progress throughout the board study period. The NBME’s Comprehensive Basic Science Self-Assessment (CBSSA) and Comprehensive Clinical Science Self-Assessment (CCSSA) are board-style practice tests that cover the content of Step 1 and Step 2CK, respectively, and offer comprehensive performance feedback. Multiple versions of the CBSSA and CCSSA are available for purchase, and you should check with your institution to see if they offer vouchers to subsidize this cost. The USMLE also offers a free 3-block practice test for Step 1 with an associated answer key on their website. For Step 2CK, some students find it helpful to take subject-specific practice tests using the NBME’s Clinical Mastery Series, which offers practice shelf exams with performance feedback.
There are a number of other sources of practice questions, as well. You can purchase practice tests from third-party companies like UWorld or create tests using your UWorld or Kaplan question banks.