Student Life Balance

Dating in Medical School

Chanpreet Mangat

Medical school is a lot to handle. It can be so difficult to simply take care of yourself, let alone another human being. Therefore, dating in medical school can feel like an almost impossible task. How do you give somebody else energy and time when you barely have time and energy for yourself? Whether you go into medical school in a relationship or you start dating during medical school, it is definitely a transition. I went into medical school with my boyfriend (now fiance!) from undergrad who is not in the medical field at all, and here are some tips and tricks that I feel are valuable in making a relationship work during such a busy and stressful time.

Tip #1: Schedule time together

It might seem obvious, but just like studying requires some scheduling, so do your relationships. In order to have a successful relationship, you have to make sure that you are giving it the time and attention it requires. That said, it’s a fine balance ensuring that you’re able to keep up with school as well as give the person the attention they deserve (and you deserve)!

That’s why personally I schedule some time every night before I sleep to call my fiance! I cut myself off from studying around 930 every night so that I have 30 mins to an hour of uninterrupted time to give to him. This helps both of us immensely knowing that we have a free period of time in the day that is guilt-free where we can simply talk, and that if we are consumed by our days we always have that period to have ourselves heard. I also try to schedule a weekly date so that we both have something to look forward to, and it lets me plan my studying around it. By scheduling in the time to spend together you can guarantee that your school work gets done and that your relationship is not left neglected.

Tip #2: Communication is key

Keep the communication line open! There isn’t time during medical school to be playing guessing games with your partner. If you enter medical school already dating somebody, make it clear that it’s going to be a huge investment and adjustment for both of you in so many different ways, including mentally, financially, and timewise. Share your schedule so that they know when you’re in class, the hospital, etc. Discuss your time constraints clearly so that there are no surprises.

If I have an exam coming up and need to spend more time studying, that is on me to make it clear to my partner. Communication is key in any relationship but completely integral to keeping your relationship healthy during medical school. Be realistic about your time, and have the means to explain to your partner what you want and need. If you only have a certain amount of time in a day or a week to talk or spend together, make sure that you are using it productively. Good communication prevents a lot of headaches later.

Tip #3: Have honest conversations

Medical school is so selfish. You pack up your bags and go wherever it is you are accepted for medical school and residency. And that can mean leaving a lot of things behind that you may not want to, including a significant other. It’s a long road and long-distance will inevitably take a strain on a relationship. Be honest about this with your partner so that they’re aware of it from the get-go. If you think that you may have to move somewhere, let your partner know so that they can make an informed decision as to what they may do.

Be honest about all your problems. No matter how small or big the issue, talk it out early. Medical school is stressful, and I always say that medical school is so stressful and that the only way a relationship can thrive in it is if you have a real understanding partner. But remember that any relationship is a two-way street and requires you to be understanding and honest about how you will make it work.

Be honest about the future. When I entered medical school, my fiance and I were both honest that we likely wanted to get married after I finished medical school, and that helped the both of us have a clearer timeline and know that we were both in it for the same reasons. This helped us both pour energy into making our relationship thrive because we had the motivation and there was a point to which it would progress.

Tip #4: Have healthy coping mechanisms

There are times you’re going to burn out in medical school. And regardless of whether your partner is in medical school or not, they will have their own things happening in their lives that affect them. Make sure that you have healthy coping mechanisms when it comes to dealing with school and that you both are able to deal with the constant daily struggles without letting it affect your relationship.

One thing that I strongly believe in is having an external support system. I love keeping my medical school friends involved in my life because there’s nothing quite like going through things with your peers. Although my fiance hears many of my medical school complaints, I can’t expect him to have all the answers for me, as he is not going through it with me. Having that external support system keeps me sane and keeps me from putting the burden of all my complaints on my fiance.

Tip #5: Make priorities

The studying quite literally never stops. You could study forever if you let yourself. Know when to stop yourself and when to give your attention to your partner. You have to be able to draw that line and create those priorities for that person or it will never work, and vice versa! If your relationship is a priority in your life it deserves its own time.

For me, this comes back to scheduling time for my priorities. I treat my relationship like other facets of my life. I schedule in time every day to work out, eat healthy, and talk to my partner (guilt-free)! Life never stops, it’s up to you to carve out time for the things that matter to you. If one day you end up having to stay at the hospital longer than you anticipated, or are studying longer than you thought you’d have to, make that time up later to show your partner that they do matter to you. Show your partner that you value your relationship.

Tip #6: Stay connected

There will be times you may have to be away from your partner due to extensive studying, clinical rotations, residency, etc., and that means it’s more important than ever to find a way to stay connected amidst that! There likely will be some long-distance incurred at some point. It’s important to find ways to create common ground no matter your circumstances. Watch the same movies together, make a playlist for them, work out together, etc. Find those things to keep you connected.

Tip #7: Remember that your partner is human too

Sometimes when we’re so immersed in our lives we forget that our partners have lives too.

Be open and honest with your partner with your expectations, needs, and the reality of your medical career. Don’t expect them to come in already knowing everything.

Remember that they have things going on and that their lives are just as important, with their daily ups and downs and their problems. Make sure that you are there for them too. Talk about their problems, their interests, their day. Medical school can be so consuming, sometimes I don’t realize how long has gone by before I’ve talked to a certain friend or family member. Give undivided time to your partner and show them that they are a priority in your life too.

Dating in medical school can be difficult to navigate, but it’s by no means impossible. If you follow these tips and show your partner that you value the relationship and keep the communication open, there is no reason why you can’t have a thriving relationship in medical school!

by tamaradhanda@gmail.com

February 24, 2021

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Active vs. Passive Learning

Mitali Chansarkar

Everyone has different learning strategies. In undergrad, I was more of a passive learner. But upon entering medical school, I had to incorporate a lot more active learning to my schedule. What is active and passive learning and how do you optimize both to your advantage?

Topics

What is Passive Learning?
Pros and Cons of Passive Learning
Strategies to Optimize Passive Learning
What is Active Learning?
Pros and Cons of Active Learning
Ask Questions
Repeat, Repeat, Repeat
Practice Questions
Teach

What is Passive Learning?

Passive learning is, as the name says, passive. There is not more thought put into it and it is relatively simple to do. It is when the listener receives information, but doesn’t receive any feedback, like watching a documentary, listening to a lecture, or reading nonfiction.

Pros and Cons of Passive Learning

Passive learning has its advantages. First off, it’s easy. Whether you are listening in class or to a video/audio recording, your presence is all you need.

Unfortunately, passive learning is not efficient in the long run, since you will not know whether you are ready to apply the information or even if you really remember it. A few gifted students may be able to read a passage and remember it by heart, but most need more active strategies to achieve the same goal.

Strategies to Optimize Passive Learning

Even though passive learning may not be the most efficient, there are ways to use it to your advantage. You can listen to audio lectures during the day while driving, cooking, walking to class, or when you are on the treadmill

During my first semester, usually by the end of the day I was tired and couldn’t actively study. To make good use of my time, I actually rewatched my histology lectures just before going to sleep. Listening to the lectures was a good way to prime my brain into absorbing for the next day.

Another way is pre-reading or pre-watching the night before lecture. For example, for pathology, I watched the Pathoma videos on the topic for the next day. This strategy gave me an overview of the information, so that when I was listening to a lecture I was not lost.

What is Active Learning?

Active Learning is when a student is involved and cognitively engaged in the learning process. This type of learning takes more effort and interaction, but is a much more durable method

Pros and Cons of Active Learning

There aren’t many cons to active learning, but active learning is not easy. It takes a lot of practice and discipline since it requires a lot more thinking.

That being said, the pros outweigh the cons. Active Learning is the most beneficial way of learning. Research shows that when students are engaged, the retention is better, providing long term support. Also, you can further develop collaboration, foster problem solving skills, and improve critical thinking. Types of active learning include asking questions, repetition, doing practice questions, and teaching others. I will go through each of these below:.

Ask Questions

Application is key. A simple example of application is knowing why the action potential of a muscle is done and why it is different from cardiac cells. When you understand a concept, the less you have to memorize. One way to do that is to ask questions.

Everything happens for a reason, and if you don’t know, then look it up or ask someone. Remember, when you understand the concept, the less you have to memorize. Also, answering questions becomes a lot easier through application.

Sitting through a lecture is a passive learning activity, but you can make it more active. If you don’t understand something in lecture, ask about it during or after the lecture. You can also jot down questions you have for your personal study. If you have a tutor or the professor offers office hours, study the material and have a conversation about it. Collaborating with your colleagues about questions you have can spark an interesting discussion and promote long term retention and a healthy learning environment.

Repeat, Repeat, Repeat

After you understand the concept, you have to memorize the rest. Repetition is key. The more you see the concept, the more you will retain it according to the chart. The key is to do it consistently everyday. You can do it through using Anki cards. Throughout a course, you can make our own Anki cards and practice them on a regular basis. Or you can use a premade Anki deck and allocate a certain amount of new cards to do everyday.

I loved asking a friend to quiz me because it was a lot more interactive than doing flashcards on a screen. At the same time, I set aside thirty minutes to an hour of time at the end of a day to practice my Anki decks as a quick review.

Practice Questions

Practice questions are not only a good way to practice repetition and application, but also to practice test taking. Since multiple choice questions are the most common way of testing, it is important to practice in such a format.

The first step is to figure out a strategy for how you want to tackle these practice questions and how you want to review them. For example, some people like to read the question first then the answers or read the answer choices first and then the question. Figure out which strategy works best for you.

After answering the question, regardless of whether you got it right or wrong, analyze the answer choices. Understand why you chose your answer and why the other answer choices are incorrect.

Teach

There is a common saying in medicine: “See one, Do one, Teach one.” It is true. Teaching is one of the best ways to solidify what you know because you have to know the material and explain it.

There are different ways to approach this. For example, in one of my study groups, each of us was assigned a topic and were responsible for teaching it. This was a much more interactive way of learning, as each of us became an expert on our topic and learned from each other.

Another way to utilize this strategy of active learning is to become a tutor. During my second year I started peer tutoring and it really helped me refresh topics such as biochem and physiology. Remember, a lot of what you learn in basic sciences comes back for Step 1. It is to your advantage to revisit material you have studied in the past.

Conclusion

Overall, active learning is much more beneficial than passive. Try to optimize more active learning in your study schedule and you won’t regret it. Happy learning!

If you have any questions or want to see my life through medical school, find me on Instagram @future_artist_md

by tamaradhanda@gmail.com

February 10, 2021

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How Bullet Journaling Saved My Sanity

Paula Danika A. Binsol

I could never find a planner that fit. I wanted something that had monthly calendar pages, but also had pages that showed my week at-a-glance and allowed me to put in deadlines and plan my day. I wanted two-page spreads, but I also wanted enough room to write in to-do lists and notes that came up while I was sitting in conferences. The more I searched for a system, the more I realized that the system I wanted did not exist.

After spending my first year in med school with my head barely above the water, overwhelmed and completely confused ninety-percent of the time, I knew that I needed an organizational system that would change, grow and adapt with me. And after a few weeks of Google searches, I came across this article on BuzzFeed about bullet journaling. The rest is history (and therefore, in my planner).

But what is bullet journaling?

A system created by Ryder Carroll, much of his creation began when he realized that nothing he was looking for could be found in a store-bought book. This is also what prompted me to started looking and thankfully, I stumbled upon his website which got me to exploring his system! His premise is that bullet journaling is a purposeful productivity, it is mindfulness disguised as productivity, and while keeping us focused, also provides an outlet for our creativity. I find that it also is a safe space that can help relieve mental exhaustion by providing one’s mind a place to rest.

How did I start?

It was hard. But articles like these encouraged me to keep at it, to keep experimenting and to figure out what worked for me, even if it was a more functional setup. My planner situation at the time was a store-bought planner that didn’t have the space I needed to lay out my monthly/weekly/daily deadlines and I wanted to create a space for those things. I started with a list of what I needed (a monthly layout, a weekly overview, and a daily log), chose a blank notebook (I started with a charcoal grey Leuchtterm 1971) then let my system evolve from there!

What problems did it solve for me?

I was having so many issues with medical school as the year moved forward, with 15 classes a semester, we took an exam in every class every day on top of daily recitations, weekly case presentations (per class!) and then of course, regular exams and group projects (Fishbone diagrams, I’m looking at you). Like many medical students, I was overwhelmed. I knew something was going wrong, my time management was off and I was missing assignments or forgetting readings which caused me even more stress! And while setting aside time for planning didn’t seem ideal when I was so strapped for time already, in hindsight, it is really what I needed to make sure that I maintained focus and also stayed productive without losing my mind.

The first thing it fixed for me was my panic. Forcing myself to settle down at the end of every week (Sundays for me!) and flip through my syllabi and class schedules to write or adjust things in my planner became an enjoyable ritual. I would stream my favorite show, make a cup of tea and sit in my chair while I cross-checked my schedule with any announcements that spoke to changes in deadlines or in our schedules for the week. These little Sunday rituals became my source of calm and helped me ground myself before the start of each week, helping me to mentally prepare for the onslaught of work that would inevitably come.

The second thing it fixed was my haphazard brain. I am constantly worried about missing something. This system provided me a simple way to triple check myself constantly. On my monthly spreads, bright red would scream that there were exams coming up, while purple denoted short quizzes or assessments. Blue was for written assignments and lectures that would require advance preparation while black was meant to signal me to tasks and homework I needed to complete. Green was a special color, designated to fun events like sem-ender parties or the planned dinner outing with classmates. I kept my color code consistent throughout my self-created planner so that the monthly spreads could be copied directly into my weekly overviews and my weekly overviews would relate directly with my more detailed daily task lists. The daily tasks list was my favorite part of each week as on the left it detailed the daily assignments for each class and on the right I would note reminders and to-dos throughout the day like “Print out lecture slides for tomorrow” or “Professor wants a copy of our PowerPoint slides for the case” or “Check if the deadline has been changed later.”

The third thing it fixed was a need for a creative outlet. In addition to my class schedules and assignment deadlines, I took ideas from other bullet journalers like a daily memory log (a sentence a day for each day of the month), productivity charts and mood trackers and incorporated them into my monthly sections. I left pages blank in the back of each of my journals for me to write in. I scribbled about things I was grateful for on parts left blank and filled the others with decorative stickers or memorabilia. Looking through them now, I can look at an old stain and remember where I was that day or see the crinkled edges of the journal and recall when it got wet as I was running through the rain.it is clear that they’re not only a detailed record of my assignments but a curated collection of memories and fleeting moments.

How did I make it work for me as a student and even post-graduation?

The best part about this system is that it is flexible, adaptable and it’s completely customizable. Post-graduation, I no longer needed as much detail because I didn’t have nearly as many deadlines or as many assignments, so I recalibrated, keeping the monthly and weekly overviews, but removing the daily logs and adding more creative spreads that allowed me to practice more writing, jot down random ideas and keep some more memories! Today, my bullet journal serves mostly as a guide and a really fun hobby – it helps me keep track of my Step studying and adapts to my needs as the weeks move forward and my exam date approaches.

What is my current set up?

These days, I find that preparation for the Step exams and studying takes away from the time I have to create so in the past year, I’ve gone from using blank dot-grid notebooks to pre-made planners with a lot of flexibility. The advantage to this is that I no longer have to complete every single spread for each month and week from scratch. After a lot of research, my current planner of choice is the Jibun Techo in A5 Slim which I find to be the perfect size to carry around in a purse, backpack or messenger bag. I love its layout, it’s got a monthly spread and a vertical weekly spread, which I love because it gives me an overview of my week while simultaneously letting me see what my day will look like. Not to mention that the paper is absolutely luscious.

What are my favorite tools?

I am a self-proclaimed pen snob, so even when taking notes, I’m picky about what I use and the paper that I write on. In my bullet journal, I am currently loving the Unistyle Fit which allows me to take three colors on-the-go! I also discovered this amazing correction fluid that is off-white, which means that my mistakes no longer glare at me from inside the pages of my meticulously maintained system! And finally, for the inevitable changed plans, I love the Tombow 2558 pencil in graphite grade B because it comes with the best little on-pencil eraser that I have ever experienced in my life and writes so smoothly, it’s satisfying.

After the initial fear and anxiety and then the additional insecurities about my lack of creativity and artistic ability, I am proud to say that I have been happily bullet journaling for the last four years. There may be a little bit of a learning curve, and I would be lying if I did not tell you that it is a rabbit hole that you may never claw yourself out of; but the system that began as a way to organize my to-do lists quickly became one of my favorite hobbies.

by tamaradhanda@gmail.com

February 3, 2021

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8 reasons why every non-US medical student should study for the USMLE

Richard Zhang

If the title wasn’t self-explanatory enough, this blog is basically an open letter to my fellow FMGs about why studying for the USMLE is a great idea, even if you don’t currently have plans to do your residency in the US. As someone who can’t fathom leaving Australia as an intern (great working conditions, guaranteed employment, higher pay) to go to the US, I still found the knowledge and additional skills I gained by studying for the US board exams to be invaluable, as they helped make my life in medical school easier. Here are some of the reasons why:

Retaining knowledge

It’s always helpful to reinforce your knowledge from multiple different learning scenarios. It’s the whole basis of spaced repetition and it explains the popularity of apps like Anki. You learn a concept, and then repeat that concept until you understand it. Studying for the USMLE is a great way to revise concepts in a slightly different light than what you may have encountered in your medical school. Tackling the same concept multiple times, in slightly different manners, is sure to really reinforce that understanding in your mind and help you retain that knowledge for longer. Also, most USMLE preparation content, such as Physeo’s, is delivered in the form of short (10-15 minutes or less), condensed lectures, which means if you ever need to revise a particular concept, you can simply pop up the relevant video and cover that content in minutes.

Opening doors

Maybe you’re not currently planning to go practice medicine in the US. But what if you decide that you’d like to in the end? Particularly if you’re already studying medicine in a foreign country, it’s always best to keep as many options available to you as possible. It’s very difficult to take the board exams (particularly Step 1) after medical school, because by that stage, you’ll have forgotten much of the basic sciences material that that exam revolves around. Chances are, you probably won’t be able to remember the mechanism of the second-line drug to treat that bizarre, super-rare metabolism defect when you haven’t touched biochemistry since your first year of medical school. So if you can afford it, taking the USMLE exams can help keep doors open further down the track.

Identifying your weaknesses

Medical students have trouble identifying their weaknesses, because there’s just so little way to know what you don’t know. Fortunately, many learning resources such as Physeo contain USMLE-style questions that can help you measure your performance. The Physeo questions also label which discipline and topic (e.g. endocrinology/pathology or cardiology/pharmacology) every question is, so you can identify exactly where your weaknesses are, and work on them. Alternatively, you can also invest in a questionbank (we particularly like Amboss and UWorld), which will do the same thing.

Making sure you’re on track

Similar to the point above, studying for the USMLE can help you not just identify your weaknesses, but also track your progress. Maybe you have an exam or quiz coming up, and want to see if you’ve improved your knowledge base after your week of revision. By checking your performance in a particular topic before and after your revision, you can see exactly how effective that week of revision was, and whether you need more revision or can move on to the next topic. More broadly, you can also track your progress over time, to see whether you’re improving your knowledge base or whether you’ve forgotten some things and need to brush up on some old concepts.

Extending yourself and learning new things

The USMLE covers more content than most medical schools cover in lectures, even in medical schools in the US. As such, board exam resources such as Physeo are likely to go into more concepts and in greater depth than your medical school lectures will as well. For example, medical schools in Australia have less of a focus on the basic sciences, particularly things like anatomy, because the assumption is if you’re going into fields that require that knowledge, you’ll learn those just before or during your specialized training, so Australians keen on surgery might do a masters in surgery or an anatomical dissection course before training to be a surgeon. This means if you’re keen on extending your knowledge beyond what is expected of you at your medical school, studying for the USMLE is a great idea. It can help you stand out in classes with your extra depth of knowledge and can make exams just that little bit easier.

Studying on your own terms

Studying on your own terms and your own schedule is incredibly liberating. If I want to cover concepts before my medical school does, I can. For more difficult concepts, such as eye physiology, I’ve often watched the relevant Physeo video a few days before my scheduled lecture. This allows me to gain a good understanding of the basics before the lecture itself, so that I can have an easier time keeping track of what’s happening in the lecture and therefore get the most out of it. Currently, I often use Physeo, Amboss or First Aid as a super quick revision of some important concepts before heading off for my rotation, which allows me to integrate basic sciences knowledge with clinical skills, and also allows me to not look like a fool when my attending asks me questions.

Exposing yourself to a different line of thinking

In most medical schools in Australia and the UK, and even in the US, we learn medicine quite differently than what gets tested in the USMLE. I can’t speak to how medical schools are run in other countries, but certainly for these three, most learning revolves around systems and case-based learning. So a typical tutorial might involve a brief discussion of symptoms and treatment plans of a few common presentations, followed by an in-depth discussion of one particular case, tracking it from the very beginning (probable history and examination findings based on the presenting symptom) right til the very end (list of 5+ differentials, followed by treatment and discharge plans). Very rarely do we ever get a rapid-fire sequence of presentations and have to identify a single detail in that patient’s singular most likely diagnosis or their management, which is quite typical of most USMLE-style questions. Being able to think quickly and focus on minutiae is also an important part of medicine, so to improve those types of skills that aren’t so commonly assessed in your medical school’s curriculum, studying for the USMLE would be a great idea.

Knowing more than your friends

This might be the most important reason of all for some, but studying for the USMLE will certainly give you an edge over your friends who haven’t studied content outside of your medical school’s curriculum. One time, a professor asked a question to the team, and once the answers started drying up, I butted in with an “orotic aciduria”, and the number of dirty looks my friends shot me gave me a level of satisfaction I literally cannot even put into word s. So if that’s your jam, start studying for the USMLE.

by tamaradhanda@gmail.com

January 26, 2021

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To Fail Isn't Failure -Five Things I Learned After Failing Step 1

To Fail Isn't Failure Five Things I Learned After Failing Step 1

Paula Danika A. Binsol

I can honestly say that the fall to rock bottom never hurt as much as it did that morning. I held my breath as I waited for my score to load and when I saw the three big numbers, emblazoned in red and the bold FAIL right next to them, I asked myself for what seemed like the hundredth time that month, why are we doing this again? I was frustrated. And even more than frustrated, I was infuriated. I cried for what seemed like twenty-four hours and when the tears ran out, I sat there in silence because words were not enough.

I would be lying if I said that I got right back up the next day and went full-force back into studying. The truth is, I had to take a long and hard look at the work I had done so far and do quite a bit of self-reflection both on my study techniques and test-taking methodology but also on my approach and perspective to this process as a whole. But having failed at something is not the same as being a failure, and though it took me a while to figure that out, I did learn some things along the way.

Lesson #1: Self-doubt and fear will be your undoing

Remember the saying “confidence is key?” Post-failure, I understand it more and more each day. When you self-deprecate, when you think to yourself “I’m such an idiot, how could I miss that?” or “There are thousands of people that pass this test on the first try, my degree is a joke,” then you inadvertently start to doubt your abilities, which leads to doubting your knowledge, which ultimately and subtly leads to second-guessing yourself on your exams.

I first noticed this while answering questions in a random practice block on UWorld. My inner trauma of believing myself to be a failure and unworthy of the MD began to manifest in my thought process. I would choose the correct answer, but then ask myself if I was sure because you thought you were sure last time, but obviously you weren’t, and end up getting the question wrong. Rinse. Repeat. For a month until I figured out that once again, it wasn’t my lack of knowledge or content deficits that were causing this part of the problem, but my own self-doubt and fear. Confidence is key.

Lesson #2: Remember your why.

Why did I put myself through this? Is an example of the wrong question to ask yourself after you’ve failed. Why do I still want to be a doctor? Is better, but still difficult to answer while experiencing the level of devastation you’re feeling after failing. Why did I start? Is the question that I chose to begin with. And my answers varied from things like: because I always wanted to be a doctor, because it’s my childhood dream, because I love helping people… and as I began to list my reasons for starting, they evolved into the reasons that I stuck with medicine to begin with: because there is nothing else that I can imagine doing, because I remember assisting in an OR where I got to see the human brain and it was amazing, because I realized in my four years of school that I can do anything as long as I want it and work for it.

When I realized how much this process helped me learn and grow and how much medicine has given me (pitfalls and all) and how it has never taken away, I remembered my why. That I was doing this because I loved it. And love means keeping at it, especially when it’s hard.

Lesson #3: Let people love you.

It is no secret that there is a sort of unspoken shame placed on those who have failed, like a dark (but extraordinarily heavy) cloak. We hear about “red flags” and how “that’s the worst possible thing that could happen,” but then it happens. And the world begins to feel like a sinking ship waving a red flag, too scared to send out an S.O.S. We are afraid to tell our parents. We don’t want our study buddies to know. We can’t imagine our classmates finding out. We did not plan for this, and yet here we are.

We live in a world where the 250s, 260s, and 270s reign. We see their posts, read their advice. We pressure ourselves into trying to fit that model and yet, despite our best efforts, we end up at the other end. The best thing I did for myself in the aftermath of my failure was sitting down amongst the pieces of my broken plan and texting a mentor that I had failed and thanking him for his help. He texted me back and asked: “Can I call you tomorrow?” and in a state of disbelief mixed with gratitude, I told him yes. That single phone conversation saved me from the season of doubt I was sure to have entered. “Pau, it’s okay,” he said, and even though I replied, “but it’s not okay!” He repeated himself: “It’s okay. You took the exam, one of the hardest exams in the world. Next time, you’ll kill it.” And hearing that from a success story, from someone whose opinion I deeply valued, made the difference. So let your friends love you. Cry on the phone. Text them when you’re feeling down. Let them know you are stuck in a rut and that red flag escapes becoming the white flag of surrender and turn into your banner of triumph.

Lesson #4: Stuck is not stagnant.

Having failed in the midst of a pandemic, my CS exam canceled, my CK exam date nowhere in sight, and a retake of Step 1 looming in the future, I felt that I was living my worst fears. Most people say they’re afraid of being alone? I have always said that my biggest fear was stagnancy; looking around in five, ten, twenty years and realizing that I have not grown, changed or improved. Failing Step 1 made me feel as if a year of my life had been wasted.

Being stuck, though, is different than being stagnant. Because when you’re stagnant, you have stopped all efforts. You stop moving, you stop fighting. You have given up and given in. I imagine being stuck more like a car in a mudpit, where you’re revving and revving and pushing that gas until somehow, someway, you’re vaulted out of that pit, mud splattering everywhere, dirt dripping down your front, your hard work and struggle clearly visible. And no matter how long you spent with your tires squelching, fighting against what feels like a bottomless expanse, you never stopped moving. And now, you’re on your way again!

Lesson #5: Make things new.

One of the first things I thought about after failing was this can’t happen again. But how do you pass a test you already failed? The first thing I thought was, I’m going to have to take a look at how I was studying because obviously the way I was doing it the first time just did not work.

And so back to the drawing board I went, listing out resources, ruling out methods that didn’t work for me (sorry, Anki) and discovering new methods that did (hello, Divine Intervention podcasts!). I stopped burning through UWorld just to “finish my first pass” and started approaching the questions by system, creating small notebooks of UWorld journal entries, littered with bright pink Post-It notes of concepts that still didn’t make sense to me. I asked for advice, I sought comfort, I watched videos on test-taking strategies and question approach until finally, I did it: my study methods were reborn and more effective and the results showed.

I went into my exam that morning in March being so afraid of failure because of all the warnings I heard in the months, weeks, and days leading up to test day: anything is better than failure, you don’t want a red flag, just pay the test fee again because you don’t want that on your record. Post-failure, I spent weeks processing, being so angry with myself and at the universe, wondering why months spent preparing went to waste, berating myself for everything I should have or could have done, hating myself for the day I took off six months ago or the nights I was too tired to watch Pathoma. And for the first time in my life, I spent time entertaining Plan B, a life without and away from medicine, one that would earn me a comfortable living without having to take the USMLE Step Examinations. Tempting doesn’t even describe it.

Then, a switch flipped. I stopped tolerating my self-inflicted doom and gloom thoughts and decided to start studying again. I decided to move forward with a post-failure timeline I laid out in a moment of lucidity and began reading, doing UWorld (slowly and without the added pressure) and in the last three weeks, have seen significant improvement in both my assessment scores and more importantly, my understanding.

So yes, maybe I don’t have to be a doctor.

But in the marrow of my bones, I know that I need to be.

by tamaradhanda@gmail.com

January 22, 2021

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How to Tackle Seasonal Depression

Noon Hagmusa

December has come to an end and we are almost halfway through January, which means winter has officially settled in. Snow has started to fall in some areas and the days are getting progressively shorter. Some of us are starting to deal with low moods, slumped energy levels, and a range of other symptoms. If those feelings come along every year with a certain season, you could be dealing with Seasonal Affective Disorder or Seasonal Depression.

This year, Covid-19 has put a lot of mental and emotional strain on plenty, from the stress of massive changes in our day-to-day lives to coping with quarantine. It has been tough. But that does not mean we have to give in, if anything we must push harder to get through these times.

Definition

Seasonal Affective Disorder (SAD), or seasonal depression, is a major depressive disorder characterized by depression that is affected by seasons. Most commonly people associate it with the winter months, however, it could be associated with any other season. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) specifies that in order to diagnose SAD “depression should be present only at a specific time of year (e.g., in the fall or winter) and full remission occurs at a characteristic time of year (e.g., spring).”

Causes

The exact cause of seasonal depression has not been pinpointed, however, there have been several hypothesized causes. These include :

Changes in the Circadian Rhythm; The body’s Circadian Rhythm, or the ‘body’s clock’, is responsible for regulating your sleep, mood, and other functions. It can be disrupted by the shorter days and a decrease in the amount of sunlight available causing major disruptions in body function.

Increased Melatonin levels; Melatonin is a hormone produced by a tiny part of your brain known as the pineal gland (as shown below) in the brain that is responsible for the sleep-wake cycle, it is produced when we spend time in the dark. The longer nights during winter may cause your body to produce excess melatonin, playing part in the symptomatology of SAD.
https://teachmeanatomy.info/wp-content/uploads/Anatomical-Position-of-the-Pineal-Gland.jpg
Decreased Serotonin levels; the decreased amount of sunlight during the winter days will cause a drop in serotonin levels. Serotonin is a neurotransmitter in the brain that plays a role in mood, learning, memory, and various other functions. A decrease in serotonin can therefore cause a decrease in mood and concentration.

Signs and Symptoms

SAD can present with multiple symptoms; some physical and others psychological. If you find yourself having a range of the symptoms listed below you might be dealing with seasonal depression:

Tips

First and foremost, you should remember that you are not alone, and that a lot of us deal with SAD. According to a 2016 study conducted in Groningen in the Netherlands, “the prevalence of SAD is between 1% and 10% of the population”. That’s up to 30 million individuals in the United States alone!

Now here are a few tips to tackle seasonal depression and make your days a bit more jolly.

Seek out a Professional
Seek out friends and family
Sunshine
Light therapy
Exercise
Layer up and eat warm food
Stick to a schedule
Take a vacation
Supplementation (vitamin D)

1. Seek out a Professional

SAD is a type of depression after all, and seeking out professional help is important, especially if you cannot cope with your own symptoms. Speaking to a professional can help you understand SAD better and help you find ways to cope with your symptoms. You can go to your family doctor or general practitioner first, they are well equipped to help you deal. However, if you feel like you need more help then you can go to a psychiatrist who can evaluate your state and then give you therapy sessions or medication to help accordingly.

2. Seek out friends and family

During the winter months, we tend to stay indoors longer, which means our social interactions become less and less frequent. Nowadays with Covid-19 keeping us indoors and limiting our social interactions even further, we must turn to alternatives. Picking up the phone and calling your mom or video-calling your loved ones might do the trick.

3. Sunshine

As we mentioned earlier, one of the causes of SAD is decreased exposure to sunlight. Although the sun might only shine for a couple of hours a day, try to make the most of them. Even if you cannot leave your house, sitting on your balcony or cracking the window open will do wonders. My friends like to go out for a walk during the day, that way they put in some exercise and get the sun exposure they need.

4. Light therapy

If you live somewhere where getting sunlight is harder than you would like, another solution is investing in a sun lamp or a dawn simulator. These devices use light therapy, or phototherapy, to supplement natural sunlight into your daily life. Light therapy has been shown to be effective within a few days to a few weeks of regular use. The duration and amount of light you need can be determined by a professional, as some people might need a higher dosage than others.

A sun lamp, or a SAD lamp, is a special type of lamp that can emit up to 10 times the intensity of regular sunlight. A sunlamp can be used for the treatment of seasonal depression, jet lag, and other conditions. The advantage of a sunlamp is that you only need to sit in front of it for half an hour to an hour while doing other activities to boost your circadian rhythm and effectively your mood. Here is a list of the best sunlamps to purchase.

On the other hand, a dawn simulator is a device that acts like an alarm waking you up with increasing amounts of light. It is much easier to use than a sun lamp as the regular exposure in the morning saves you the hassle of having to designate time to sit in front of a sunlamp. The light from a dawn simulator enters your retina through your eyelids and effectively wakes you up just like sunlight does. Here are a few dawn simulators to choose from.

5. Exercise

Exercise can do wonders in many aspects. Going for a jog outside during the day is most beneficial as you get exposed to sunlight while you’re at it. But that does not mean that you shouldn’t exercise just because you can’t go outside, exercise indoors can also do wonders. Exercise releases endorphins in the body temporarily improving mood and effectively offsetting the weight gain caused by SAD. Interestingly, many studies conducted in relation to depression have found that those dealing with depression have a smaller hippocampus compared to those who aren’t. Exercise has been shown to increase nerve cell growth in the hippocampus, alleviating some of the symptoms associated with depression.

6. Layer up and Eat warm food

Staying warm can be a great solution to seasonal depression. Wearing multiple fuzzy layers and turning on the heater can do wonders to our body chemistry. Studies have shown that lower temperatures can cause us to want to slow down and not do much throughout the day. Therefore the best temperature to keep your house at is within the range of 18C and 21C (between 64 and 70F). Warm food can also help keep your body warm and merry on the inside; soups, hot chocolate, and all that good comfort food.

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7. Stick to a schedule

Keeping a full schedule will keep you busy and allow time to pass easier. Doing things, even if you aren’t in the mood to do them, will eventually bring you great pleasure. No matter how unlikely it feels, you might feel much better once you’re in the midst of it. Keeping a schedule also helps with your sleeping habits. One of the symptoms of SAD is hypersomnia or insomnia, keeping a tight schedule knowing when to sleep and when to wake up might help with the symptoms of seasonal depression.

8. Take a vacation

Just like birds like to migrate during the winter months to warmer climates, maybe we should fly away too! Plan a vacation if you have the time and finances, not only will it give you a break from your everyday responsibilities, but the warmer climates can help battle the biological causes of SAD. Even if you end up travelling for just a few days within those winter months, their effect will last for at least a few weeks afterwards.

9. Supplementation (vitamin D)

Giving your body the nutrients and vitamins it needs is vital to maintaining a healthy body and healthy mind. Multiple studies have researched the effect of different supplements in regards to mood. One of those studies encompassed the role of vitamin D in depression. They found that “Vitamin D supplementation (≥800 I.U. daily) was somewhat favorable in the management of depression”. Therefore, it might be beneficial to test your vitamin D levels at your next doctor’s appointment and get supplementation if required.

Conclusion

Although you might be suffering from seasonal depression, try to remember that there are things that bring you joy during the winter months too. If it is sitting with your family, enjoying a warm drink next to your fireplace, or simply the holidays. Keeping a cheerful attitude and seeking help when we need it are key to getting through these tough times. Remember we are all here to help each other, and a positive attitude goes a long way.

“Positive thinking is powerful thinking. If you want happiness, fulfillment, success and inner peace, start thinking you have the power to achieve those things. Focus on the bright side of life and expect positive results. ”

– Germany Kent

References

by tamaradhanda@gmail.com

December 31, 2020

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You Got a Bad Grade. What Next?