I was privileged to be invited by THE FORUM, alongside one of my teachers, Dr Achiaka Irabor, to have an interactive session with Clinical Medical Students of the Alexander Brown Hall of the University College Hospital, Ibadan, yesterday.I was to address specifically, how to cope with stress in Medical School, while Dr Irabor spoke about looking after their physical health and well-being. My talk was in two parts: What are the causes of stress in medical school (Pre-clinicals and then Clinicals), and then how best can we cope with the situation? Happy reading.
Every year, several young, fresh, overly eager and brilliant minds gain admission into the available medical schools in the country. Each and every one of them, confident and self-assured, and about to commence the biggest journey of their life…. towards becoming a world-famous physician/surgeon who would revolutionize the world. After all, he/she (the male pronoun is used subsequently, but applies to either gender really) is already a celebrity in his family and his secondary school. His SSCE results and JAMB scores were out of this world. All the sleepless nights and hard work laboring tediously over past questions and struggling to solve all the exercises in 3 different physics and chemistry textbooks have paid off. He is here now, and it is official: He is now a medical/Dental student of the University of Ibadan.
During the orientation and registration process, he is eager to show off and ensure that his other classmates recognize him/her as a true superstar. So, he brags to the quiet guy in front of him on the queue that he scored 72 in Chemistry, which was very tough in that year’s JAMB. But the guy smiles and informs him that he scored 78. What? Someone actually performed better than he did? Is that even possible? After all, he is the most brilliant student ever to have passed through his school….his Cowbell and JET Competition laurels attest to his brilliance. Anyway, slightly ruffled but still eager to establish his superiority, he then enquires about his new friend’s score in the other subjects and then realizes with a sinking feeling that he performed consistently below this quiet, unassuming guy. His confidence takes a hit. After a week of trying to compare stripes with a couple of other medical students, he is truly humbled and his ego and self-esteem takes a major hit.
Afterwards, lectures start and quite a number of lecturers seem to derive sadistic pleasure from reminding the class that even though their admission letters bear Medicine and Surgery/Dental Surgery, their names are still written in pencil as far as the University is concerned. This is because, they are required to pass the requisite 100L courses in order to successfully gain promotion into 200L where they begin to take actual medical courses (Anatomy, Biochemistry and Physiology). “Some of you will have your names erased after 100L and you will have to look for other courses and complete change of course forms, thus ending your dreams of becoming a doctor. Therefore, don’t jubilate yet, you have not yet arrived.” So, for the entire first year in the University, the confident self-assured youngsters scurry around to ensure they excel in the pre-requisite courses and have their names written in ink, rather than being erased. As predicted by the lecturers, some students drop off at this stage.
After successfully scaling this hurdle, you proceed into 200L and 300L. Here, you are bombarded with the precise details of the origin and insertion of various muscles, innervation (nerve roots and branches), embryology, and histology. Histology is particularly tough, as you agonize over the microscopes and struggle to make out features that appear so distinct in your Wheaters textbook but appear blurred on the slide. Until you become experienced at memorizing the images or your eyes ‘open’ under guidance from the tutorial instructors. You struggle mightily with the Kreb and TCA cycles as well as the intricacies of the physiology of all the systems. And you are constantly reminded that only half of your class will eventually succeed in passing the almighty first MB exams that will qualify you to cross over as a Clinical Medical Student. This comes with the ‘perks’ of relocating to the University College Hospital, wearing ward coats and carrying a stethoscope around. While the fantasies of life in UCH are dangled before your eyes, the first Anatomy test is suddenly upon you. Traditionally, this takes place on the 31st December – perhaps an ingenuous way of making nonsense of the Christmas break and an opportunity to visit family (and to replenish your self-esteem with adulations from family).
You were all surprised at the intricate details you were expected to master and came out shaken from the Hall. The results come out within 72 hours and the results are staggering. The highest score was 41. Your score was 23. And then the whispering starts. Maybe it was marked over 50, instead of 100. And then it dawns on all of you that it is clearly written on top of the results that it is out of a possible score of 100. So, the entire class failed the test. Everyone goes into mourning and the rat race to pass the first MB and ensure you make it to the promised land (UCH) starts.
Serious discussion groups spring into life, and most students begin to explore how to reduce sleep to no more than 3 hours on a daily basis. Many discover the joys of coffee and bitter cola while some others are even more adventurous. Pervading the renewed vigour to study and remember hard facts across three major courses (Anatomy, Physiology and Biochemistry) is an overwhelming fear of failure and anxiety: Am I truly good enough? Is it possible to really commit all these details to memory and recall them when needed? A crisis of self-confidence ensues, and is not helped by the show-offs who would have spent the entire night memorizing a particularly difficult topic and will come to class in the morning to bamboozle everybody else with their off-hand delivery of all the things they had studied overnight. Yet failure is NOT an option. Your parents and family friends have started calling you doctor from the day your admission letter arrived. How would you go back home to face everyone and admit you were not good enough? You remember the pride in your mother’s face as she beamed with joy at your matriculation and the smug smile of satisfaction on your father’s face. You imagine their crestfallen faces and their disappointment, and you resolve to give it all it takes.
Your plight is further worsened by the realization that you are in essence, required to cover essentially the same material and in great detail, over 3 semesters, what other students require 3 years to master in order to gain a BSc in Physiology, Biochemistry or Anatomy. Thus, the pressure stems not only from the difficulty of the material, but the sheer volume you are required to cover in seemingly no time. Not everyone is suited to high octane pressure that is unrelenting. Poor coping mechanisms begin to surface. A few more students begin to crack under the pressure. From mild problems, such as anxiety and worry, to more serious issues such as depression or psychotic break downs. Others suffer silently and experience emotional turmoil and pain but maintain a façade of normalcy. They are the ones who are learning fast about how to succeed in medical school: bottle your emotions, your worries and personal problems; focus on the task and perform – no matter the cost. Of course, some students again drop off at this juncture and never make it to UCH.
STORY PAUSED: Does this mean that everyone who gained admission to study medicine and surgery and subsequently withdrew voluntarily or could not cope are failures? Absolutely not. I know quite a few who have gone on to make an outstanding success of their lives in other areas of human endeavor. It may be due to several factors: a). They should never have come into medicine in the first place but parental and societal pressure as well as poor career guidance and counselling combined to put them in this situation. Their strengths lie elsewhere and they can be super brilliant and exceptional given the right situation. Or b). They are very brilliant and truly wanted to study medicine but simply could not cope with the pressure. Without the pressure, they would have done very well and excelled.
Therefore, two questions come to my mind here:
1. Can we do something about providing adequate career guidance early in secondary school?
Indeed, this is actually not all about Medicine. My personal story was an ill-fated misadventure into Engineering, due to poor counselling and peer influence. I was in the secondary school class designated for the best science students and we were the only ones offering Further Mathematics. And all my best friends were determined to study Engineering and our Further Mathematics teacher actively encouraged and fueled this interest. I joined the bandwagon and ended up as an Engineering student of FUT Minna (1993/94 Session). But I had enough self-awareness to immediately realize I had made a mistake. I was not as thrilled by the prospects of Engineering Maths and solving problems using calculations for the rest of my life; as compared with the opportunity of exploring the workings of the human body. Additionally, I have always loved studying human behavior and so the prospect of interacting with individual human beings – all of whom will be unique in their own ways was a strong attraction for me. So, I quietly sat for JAMB again, without telling my folks at home and chose Medicine and Surgery in UI. I gained admission and resumed in 1995. And I am happier for it now, while my folks and childhood friends from Okene who continued with Engineering are also happy, breaking grounds and doing excellently well. They include: Ahmad Sadiq, Lasisi Salami Lawal, Kovo Abdulsalami. Ahmad is a serious Entrepreneur, CEO and software Engineer while Lasisi and Kovo both have PhDs in Engineering from top UK schools. So, the key is finding what gets you so excited that you are happy to be up and about every morning that you wake up. They understood their calling while I foolishly tagged along.
2. Can we reduce the pressures of medical school and make it more humane and user-friendly?
Starting from better orientation and support systems from pre-clinical school and through clinicals. I will say YES, most certainly.
To be continued.