A final year student shows how building the habits of self-care early on, will give you the tools you need to forge a healthier medical journey.

You’ve made it. You got the marks, you aced the interview, and you’ve accepted your offer. 

It’s easy from here on out, right? A breeze, surely?

But then it’s the end of your first day. You have pages and pages of pre-reading, somehow heaps of laundry to do already, meal prep for the week ahead (the free barbeques don’t last forever) and are yet to go for a run. 

You don’t quite know what to expect as a medical student. Even if your sister completed med, you had a friend who described their experiences to you, or you’ve done A LOT of research - there will still be more to learn about what works, what doesn’t work, and how to best rise to the challenge of preclinical medicine. 

The course requires different things from different people and it can be really hard to know what med wants from you at the beginning of the journey. It’s easy to feel overwhelmed as you begin your preclinical studies, and hard to figure out what to do about it. Even after you feel settled in, a new little scary piece of content or life challenge seems to pop up here and there. This piece is to guide you through taking care of yourself during preclinical years - why it’s important, what to do, and how to troubleshoot if it doesn’t work out!

Why Self Care Is Important In Preclinical Years

Before we kick off, burnout was trustily defined by the WHO as ‘a syndrome conceptualised as resulting from a chronic stress that has not been successfully managed.’ I chat about the specific signs of burnout later in this guide, but burnout often comes from overworking yourself and manifests as an inability to do so, or to do so at the expense of your mental, emotional or physical wellbeing. To prevent ourselves from reaching this point, self care is SO important. As described by Deborah Sherman, an Associate Professor in palliative care, self-care refers to ‘the self-initiated behaviour that people choose to incorporate to promote good health and general well-being.” Self-care has a huge scope. It ranges from showering, to a weekend away; from a quick chat with a friend, to deleting a social media account. It can be difficult to know where to begin with self-care, particularly if you (like me) enjoy a short definition, a quick how-to guide or a step-by-step manual.

Self-care isn’t something you need to ‘save up’ for clinical years, or something you ‘don’t deserve’ right now. Setting up self-care while you’re well ensures that you’re a) less likely to burn out and b) have strategies in place if you do. Unfortunately, there is a culture within medicine which fosters burnout, particularly as you move into clinical and vocational training. Medical students also tend to possess the intrinsic characteristics which predispose us to chronic stress and anxiety, increasing our likelihood of burning out. 

This isn’t here to scare you, this is here to emphasise the importance of looking out for yourself early in the journey. While you are building your bank of medical knowledge and skills to move into the big wide world of clinical medicine, you should also use your preclinical period to build the personal bank of healthy coping skills you need.

Step 1: Setting Reasonable Expectations for Yourself

Compared to highschool, or even undergraduate university, there is much less pressure to score highly in preclinical medicine. It’s all about setting a foundation for the clinical learning and practice you’ll do alongside the biochem and anatomy. Feeling more solid as a future doctor is far more important than memorising 100% of the content and regurgitating it on an exam. I, and many of my peers, found this crazily difficult to wrap our heads around - but reframing my expectations was crucial to a healthy mindset in medicine and set me up to succeed instead of failing against unreasonable ideas of what I should be achieving. 

Putting 100% into your studies doesn’t mean spending 100% of your time on it. It means being able to give 100% in the time you do allocate. If snickers sold self care instead of chocolate, they’d be telling you “you’re not you when you’re burnt out” - and that is absolutely true. If you’re not looking after yourself, you can’t possibly reach the potential of a well you. Be wary of your time, but most importantly be wary of your effort because as you’ll constantly learn, prophylaxis is better than a cure. Schedule time out in the same way you would schedule ‘time-in.’

You might have heard the overused (but irrefutably true) phrase - “you can’t pour from an empty cup.” Let’s explore some ways to keep that cup as full as possible. 

Step 2: So… what do I actually do for “self-care”?

The most important thing to remember is the “self” part. Self care is, by nature, subjective. It’s what works for you, so don’t get caught up in the buzzwordy self-care rituals gracing social media. In saying that, here’s a set of broad areas which might help you maintain your sanity in preclinical years. Take everything with a grain of salt and an open mind - don’t be afraid to experiment as you go along. 

The Basics

It should go without saying, but often we forget to look after the bare minimums, the things that keep us going. Unfortunately a bubble bath won’t replace the hours of sleep you might be missing and a quick run won’t give you enough serotonin to make up for undernourishing your body. Beyond Blue found that sleep deprivation was both a cause and byproduct of workplace stress amongst almost 30% of respondents. Making sure to reset, refresh and recharge are crucial. As someone who has both stayed up late cramming for exams and forgetting to eat, and then tried the healthier option of hitting the 8 hours of sleep and making sure to consistently fuel my body - the latter saw me get better marks, but more importantly become less of a zombie. 

Socialising 

You might be like me, taking a global pandemic and forced isolation to realise that, yes I do rely on connections with friends, family and peers. Even as a self-proclaimed introvert, I struggled moving interstate for my degree and needed to make new connections to ease the transition. 

If you’re on-campus, immerse yourself in the community by attending organised events or putting together your own in order to meet new people. If you’re not, look at joining different social groups, try chatting to people during orientation or before/after your tutes. Not only do friends and family make amazing company, they might notice when you start to struggle and can be an amazing safety net through the highs and lows of medicine. 

Enjoy life 

It can be hard to find the time, or even justify picking up or continuing hobbies as you start medicine. However, stepping outside of the study/work bubble can truly maintain your sanity during your preclinical years. For some people, maintaining enjoyment inside and outside of medicine might look like a structured hobby - playing an instrument, knitting, sketching, gardening, or anything you find enjoyable. For others, it might be implementing purposeful relaxation strategies, like meditation, or fun-finding! An example of this is setting aside ~5 hours a week to pursue your passions - filling this with creative endeavours (if that’s you!) or putting aside money for a “Friday night FUNd” to try new things while taking a break from the books. 

Exercise 

Take advantage of the chance to set a new routine to pick up a new sport, particularly with the structure that preclinical years tend to have (compared to clinical!). Some universities have associated gyms with reduced student prices, or sports teams you might be able to join either socially or competitively. Exercise and joyful movement aren’t just hitting the gym or playing a sport - you might prefer cycling to uni, going on a hike or yoga. I’ll say it again - you do what suits your needs!

Student Societies and Extra-curriculars 

Both of these are more “structured” breaks from the study circuit, but are productive ways to “take a break,” meet like minded people and really grow as a human (not just as a med student!). There are so many committees, subcommittees and special interest groups both within and between different universities, within medicine and in other areas such as photography, sport and pop culture. You can explore your passions while developing yourself as a leader - you’ll be surprised at how something completely different to your degree can enhance your skills within med!

Similar to hobbies, having something other than your uni work to focus your mind on is literally all that’s required from an extracurricular. Some people (like me!) enjoy writing alongside medicine, you might decide to join a research team or organise large events through organisations such as the Australian Medical Students’ Association. Remember: this doesn’t need to be a medical society, or medical student group. In saying that, med societies, med orchestras and the like are more likely to fit around your timetable, rather than you fitting around theirs! The beauty of preclinical medicine is that you get more of an opportunity to be involved in societies and extracurricular activities across the whole university, so make the most of it. 

Volunteering 

You might have mentioned in your medical interview that your goal is to help people, but why wait until the end of the degree? I was fortunate to be part of a leadership program in first year that paired me up with a volunteering position reading school books with disadvantaged primary school students, and in second year I began volunteering with the Ronald McDonald House as a part of an assignment (which we were lucky to have!). As a volunteer, I met new people, attended amazing events (including the Ronald McDonald Charity Ball!) and was able to gain insights into the experiences of others which are inevitably an asset to my future practice. Look for opportunities advertised through your university, or via websites such as Seek Volunteer, your local neighbourhood house or even going basic and checking the notice boards at supermarkets.

Work

It goes without saying that studying can be EXPENSIVE.  I have several jobs alongside my studies but it’s not all about having the money to pay rent. Becoming competent at a particular task (or tasks!), working with different groups or people and exploring my passions outside of medicine bring satisfaction you can’t find in a lecture and reward you don’t get from a good mark. With a fairly full-on timetable, you need to be mindful that the work you are doing is enhancing, not detracting from your work-life balance. Casual reception work, tutoring or sport refereeing are common due to the flexibility of hours and avoiding those late nights. You can find more info about holding down a job in medical school here.

Step 3: Putting together the “self-care puzzle”

Implementing one strategy in isolation, or all of them for only a short period of time is like giving a diabetic patient medication without suggesting dietary change, or stopping an antibiotic course a couple of days in. Actively integrating what works for you is crucial and this can (once again) look different for each person. Self-care and how to fit it in with a busy life comes up very often in my work with headspace so I’ve distilled down to a few key ideas or strategies to try: 

• Schedule it in: all my “fun” activities are in pink in my google calendar. I aim for a healthy ratio of pink to everything else each week because what gets scheduled, gets done 
• Stay accountable: create a self-care pact with friends, or pick up similar activities if you have shared interests 
• Track it: in a journal, or even downloading an app to help you out 
• Keep at it: it takes an average of 66 days for a habit to become automatic. If you want you incorporate self-care into your life, it can’t just be a “one-off” and you might not reap the rewards for some time
• Learn from others: ask senior preclinical, or clinical students what works for them and test it out. If you’re part of a mentoring program, this can be a fantastic topic to discuss
• Keep an open mind: treat self-care as an experiment if you’ve just come off a year 12 or undergrad study grind and be patient with yourself - creating a new habit isn’t easy, but this particular one will save you down the track
• Make time: there will always be something that “seems” more important to do. Integrating self-care into your life, and looking after yourself during preclin, requires you to prioritise yourself. Trust me - it’s the best investment you’ll ever make.
  

Troubleshooting

Sometimes the self-care strategies you usually rely on just aren’t cutting it. It’s okay not to be okay. But it’s not okay to stay that way. The first step is knowing when self-care isn’t cutting it, and the second is knowing what to do with that knowledge. 

How do I know?

During first year I was taught about the signs of burnout - lack of motivation, emotional exhaustion, depersonalisation and… burnout. In all seriousness, you’ll probably feel the burnout before you can define it BUT here are a few different “symptoms” of burnout you might notice:

1. Exhaustion: you might literally feel tired all the time, physically, emotionally or mentally. You have less or no energy to tackle the day. 
2. Lack of motivation: the things which previously brought you joy or pushed you to study are no longer doing their job. You might feel like it’s harder to get out of bed in the morning or drag yourself to class. 
3. Depersonalisation: is difficult to articulate and often happens later in the story, but you might feel like you’re watching yourself performing daily tasks with no control of what you’re doing - a dislocation of mind and body. 
4. Relationships: you might find yourself snapping at friends and family, struggling to interact with people or withdrawing from social situations.  
5. Neglect: you might be getting less sleep, not eating enough or finding yourself moving less. On the flip side, you might be drinking more coffee, alcohol or engaging in other “unhealthy” coping mechanisms. 
6. Preoccupation: being a medical student might feel like your entire identity, but you shouldn’t be thinking about your studies all the time. Being unable to switch off from med, might be a sign it’s burning you out. 

If you’ve ever been burnt out, I would encourage you to think about the changes as you progressed to this stage - jot them down, share them with others and create a “toolkit” of sorts for recognising it.

What do I do?

I’ll say it now: I’ve had to reach out to my wellbeing advisor. I’ve had to apply for special consideration. I know so many people who have had to defer exams to look after themselves. Yes, there’s stigma, but don’t let that make you feel ashamed. Burnout is not a trophy. In fact, working to look after yourself and normalising this act in medicine makes you stronger. 

Now, for the practicalities!

1. The simple stuff: what areas of the above tips are you neglecting? When you’re burnt out, even the basic, essential methods of coping seem to take more effort then they’re worth, but after a bit of a push they can really pull you out of a rut. Start with setting a sleep schedule. Move to regular meals. Reintroduce exercise/hobbies/interacting with others and go from there. Be kind to yourself and take small steps rather than trying to fix all the problems at once will help you get back on track instead of feeling even more overwhelmed.
2. Reach out for help: depending on how serious your burnout is, this could be simply talking to friends and family. Know that it’s never too early or too late to reach out for professional help
3. Reevaluate your priorities. It might feel like “giving up” at that moment, but there is only so much you can fit on your plate before the plate breaks (or you get awful indigestion). Tip the balance back to allow space for yourself and the things you enjoy. That might mean cutting an extra-curricular, or even shaping your study or results expectations. 
4. Take time off: admittedly, the structure of medical degrees are against this by nature. HOWEVER as a preclinical student, you likely have more built-in time for breaks, and the benefit of a semi-regular timetable. During the semester; however, time off can look like an evening away from medicine, pushing back tasks until next week or keeping one day a week free from med/other work. Albeit in my clinical years, I had to take a couple of months off placement for my health - and that is OKAY.
5. Utilise your university. As a preclinical student, you likely have access to both your faculty and central university wellbeing and support services. Use them. Apply for special consideration for assignments if you need the extra time, reach out for free counselling if your university provides it or seek assistance in the particular areas (e.g. financial) that you might need help with. 

These services will require different processes/documentation depending on which university you’re at so I would suggest seeing if your medical society has any guides to navigating student support, or if any similar resources are provided by your faculty directly. If you can’t find this information, or have further questions, faculty student services (or equivalent) will likely point you in the right direction. During orientation, the relevant contacts will be shared with you. Write them down, put numbers in your phone. You might not need them now, but you might one day be looking for support. 

Your takeaway

I recently attended a seminar and heard the most amazing analogy from Maddison O’Gradey-Lee. At any one time, we’re juggling glass and plastic balls. It’s practically impossible to stop any from falling, and doing so would exhaust us, making it impossible to juggle any balls at all. So, rather than burning yourself out with all of them, focus on the glass balls - you can always pick up a plastic one later. As hard as it might be to believe, medicine is a plastic ball. You can drop it, you can take time off, you can ask for help. But, the most important glass ball? That’s you.