by Roman Roque COM 2020

They said it was like drinking water from a fire hydrant. Ain’t that the truth. Medical school is overwhelming. The material is dense and the window given to master such a massive volume of information is relatively short.

There never seems to be enough time.

I remember attending a biochemistry lunchtime review at the beginning of first semester. The session naturally morphed into a Q&A between fish-out-of-water first years asking a second year how to succeed in medical school.

“How many hours do you study a day?” a classmate asked.

YESSSSSS, that question was on point! With a few weeks into the school year, I was already drowning while trying to make sense of nitrogen metabolism. More than understanding the material though, what I truly wanted to know was how many hours I needed to put in everyday to pass the upcoming exam.

I waited for her answer. Just. Tell. Me. A. Number. Plz. If it was something less than I currently did, then how come I felt so overwhelmed. If it was something more than what I currently did, then no problem. I just needed a benchmark of how many more hours I needed to put in.

“Around six,” she replied. The room erupted in collective freakout. I thought to myself: How can I possibly study six hours a day on top of 8AM-5PM classes? How should I split it? Three in the morning, three in the afternoon? What if I am a morning person? Is it ok to do four in the morning, and two at night? Is that even possible? How about Friday? Do I study on Fridays? Can I do less on Fridays if I do more work sometime earlier in the week? Weekends? How about the weekend? I love my weekends … do I really need to study on weekends?

It seems silly now, but my initial approach to medical school was formulaic; I operated with the same mentality that worked in undergrad. If I put in X amount of hours, then I will get Y results. My thinking was flawed because the truth is: there are never enough hours.

There are never enough hours not because I am not smart, or I am not efficient, or I am not disciplined, or I am not focused. There are never enough hours because true mastery of the field of medicine cannot be reduced to four short years of medical education, yet alone bouts of study sessions in the campus library.

To think that I can learn it all in such a short amount of time is misinformed, bordering hubris. It diminishes the complexity of medicine. The depth of knowledge needed in anatomy, pathology, physiology, pharmacology, and all other contributing fields, culmination of decades of lifelong research, cannot be summed up into a four year crash course called medical school. And that is just the science of it. In addition to factual knowledge, there are procedural and reasoning skills needed to interpret laboratory studies, perform physicals, or generate differential diagnoses. Most importantly, there are the interpersonal and humane aspects of medicine — the art of medicine — that cannot be learned through rote studying alone.

When I equated success to completion of a finite number of study hours, I stripped myself of the joy in learning medicine. Meeting the “study quota” and doing well yielded complacency and false confidence. There was no room to challenge myself to do better because simply doing enough is good enough. Conversely, meeting the “study quota” and doing poorly yielded insecurity. There was no space for self-evaluation: to think about how I was doing, what went well, what did not, and how I could improve. Not meeting the “study quota” at all produced a loop of anxiety, stress, and guilt. There was no room to breathe and take in the journey, nor flexibility to spend time and enjoy life with the people around me.

Unfortunately, there is no way around studying. Building skills and knowledge is an essential part of education. There are fundamental milestones that I need to achieve given my current level of training so I can progress and become a competent physician. Accepting that there is never enough time to truly know it all, however, has relieved me of the pressure of needing to constantly perform towards such a high degree of near perfect mastery. It has allowed me to practice self-compassion by shifting my journey from a place of lack and inadequacy to a place of discovery and wonder.

Instead of focusing on the quantity of my studying, I now focus on the quality of my learning — active recall, self-assessments, spaced repetition. More than that, I am no longer bound to learning only through studying in the library. I have become more mindful in deconstructing information I have absorbed by intentionally linking and connecting them to what I do everyday. I find ways to transform factual knowledge into real life applications and practice procedural skills when opportunities arise.

Although medical school can be overwhelming, learning should not. The study of medicine is enjoyable, life-giving, and fulfilling. It is a path that brings future healers one step closer towards greater appreciation of the depth, the complexity, and the magnificence of the human condition.

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W.A.R.M. Project

Shortly after school started, I joined the Wellness, Academics, Resilience, Mindfulness (W.A.R.M) Project at Touro University California. WARM seeks to transform the medical student experience by integrating well-being into the medical school curriculum.

There are six dedicated WARM hours per semester for us students to explore, participate, and cultivate wellness habits such as introspection, fitness, reflection, and life balance. It seems negligible compared to the total number of hours we spend each week in didactics, labs, and examinations. In addition to basic and clinical sciences, there are, after all, other equally important aspects of medicine that must be taught such as social justice, humanism, or interprofessionalism. Thus, to have time dedicated solely for the development of personal student well-being is truly groundbreaking. While the American Association of Colleges of Osteopathic Medicine values patient care, medical knowledge, and interpersonal and communication skills as core competencies deemed important in future physicians, Touro University California recognizes that it is just as necessary to produce physicians who are well, resilient, mindful, and academically successful.

Because of WARM, I have grown to understand the importance and urgency of cultivating my unique personal wellness routine early in my medical training. My pre-clinical years are the perfect time to explore health-empowering behaviors because there is relative stability around my built environment. Easily accessible support exists from peers, faculty, and community. Moreover, exams, while challenging, are not as high stakes compared to real patient encounters on the floor during years in clinical rotations and residency.

This year, I started practicing yoga. I have become better in my fitness and weekend meal preps, although I could probably be a little more consistent. I meditate, journal, and am still looking to reintegrate church back into my life. I make sure to carve out time each week specifically dedicated for my family, my partner, and my friends. I reflect after each test regarding my performance and seek ways to improve how I am doing.

I recognize that yoga and meditation is not for everyone. My way is not the only way. In fact, there is no one mold to follow because we all embark on our unique wellness journey.

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I enjoy working for WARM because it recognizes the importance of providing student-initiated and student-led opportunities to explore, recognize, and build our own brand of personal wellness. By disrupting traditional medical education through institutionalized hours dedicated to personal well-being, we are equipped to succeed beyond our pre-clinical years. We are given the space now to safely explore and establish wellness, resiliency, and mindfulness strategies that we will carry with us onward during clinical rotations, residency, and our lifelong careers as future physicians.

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