The Thriver's Guide to Medical School

By Olivia Richman

Medical school is hard - but it won't be for you!

The Thriver's Guide to Medical School is a collection of personal stories from an underdog doctor who was once dismissed from medical school, combined with supporting insights from Harvard researchers, world-renowned physicians, TEDx speakers, and much

• Language: English
• Publisher: New Degree Press
• Release date: Jan 7, 2022
• ISBN: 9781637305010

Book preview

Introduction

Above all, don’t fear difficult moments. The best comes from them.

—Dr. Rita Levi Montalcini, 1909–2012, Italian physician and scientist who continued to study neurobiology while fleeing the Nazi regime

As I sat on my living room couch, anxiously scrolling through Instagram, I knew I was screwed.

It had been three days since I appealed my medical school dismissal. I was kicked out! It was the most humiliating and shameful experience of my life thus far, and although young, it felt like life was over. After all, my career was over, and it hadn’t even started. I mean, I really messed up. Not only was I booted from med school, I waited until the very last minute to fail. That’s right, I was dismissed for not passing my very last exam of medical school. I had made it this far, only for it to end miserably. Life was definitely over.

You see, my school mandates students to take a practice exam for the US medical boards before allowing us to sit for the real thing. Over the past year, after many failed attempts at this practice exam, the confidence I once had in my intelligence and capabilities as a medical student depleted and eroded away; slowly, yet steadily, draining from that elusive part of the brain in which lies the mind.

You know which part of the mind I’m referring to, right? It’s the voice that inserts comments on how awesome you are or how worthless you’ve become. The internal dialogue either reassures or destroys you. It’s the noise in your head that makes it seem like life is crumbling around you—in reality, it isn’t. Your internal dialogue can be your number one hype person or a destructive, abusive, ill-mannered asshole. In this moment, after failing this practice exam seven times over the past year (yes, seven), my destructive, abusive inner asshole was roaring loudly, "Loser, loser, your future career has imploded! You’ll never get readmitted, never!"

Despite my brutal masochistic self-talk, Why do you think they’ll readmit you? You’re not capable of passing this exam again! You’re a failure, and they know it, I still had enough faith to have requested an appeal. As I Instagram doddled my afternoon away with the goal of escaping my living nightmare, I held a false glimmer of optimism for my readmittance.

And then I heard it.

The alert Outlook makes when you receive a new email. Maybe it sounds like a chime to others, but to me, this sound created instant tachycardia and uncomfortable peristalsis in my throat. This physical manifestation is how non-life-threatening scenarios of fear prevail when you’re not aware of your own greatness and potential, which at that moment, I definitely was not. I closed my eyes, took a deep breath, and opened the email.

.

Above is a screenshot of the email I received. I’ve omitted the name of my medical school to protect their privacy.

Fuck.

I instantly felt hollow inside. As suddenly as the empty feeling came, it left, and my body swelled with emotion. I began to sob. I officially got kicked out of medical school from my last exam. How was this even possible? I missed the exam by one point.

Four years, dozens of exams, countless library hours, too much money, all down the drain because of my stupid inability to pass a practice exam. Then, that asshole inside my mind began to talk really loudly.

You idiot. How could you let this happen? You weren’t focused enough. You weren’t diligent enough. No, it’s none of that... You’re just not smart enough. Everyone else is capable, except you.

Without thinking, I hit reply. A quick word of advice: do your best never to hit Reply without thinking.

Please, I pleaded to the dean, I failed by one point! I’ve developed so much anxiety around this exam, and I’ve lost faith in myself after failing so many times! I’m seeing a therapist, and I’m working through this. This isn’t a knowledge issue. It’s a mental health one! I urged him.

I hit send and received a response within minutes.

Sorry, he replied, you’ll have to transfer schools and repeat your third and fourth years over again. Maybe you should reconsider a career in medicine.

These words crushed me. Repeat third and fourth year all over again? And how dare he suggest I reconsider my career in medicine? I spent four years in undergrad taking courses that had little to do with my efficacy as a physician and then another four years studying in the library for months on end, missing family parties, friends’ weddings, many birthdays, and even some holidays. I busted my ass day in and day out to become a doctor. This was my career! At that moment, I felt broken, depleted, hopeless, and utterly alone.

Feeling alone was the ironic part of this story—and that’s not just because I was in quarantine during the COVID-19 pandemic when I received this email. The last time I checked, it seemed to me medical school was, in fact, difficult, and other students also struggled. But where were these struggling students? No one at school or on social media flaunted their failures so it didn’t seem like these people existed.

In the back of my mind—past my inner critic who was taking her best shot at blowing what was left of my self-esteem to pieces—was the notion I wasn’t the only one struggling in this journey. And I don’t mean struggling with just exams, but with life in general. I knew, somewhere past my negative self-talk and anger, other medical students grappled with challenging times during their medical careers, too. I knew other students out there were also dealing with feelings of inadequacy, stressful situations, and anxiety around school. I knew these students strived to maintain a sense of happiness and fulfillment in life despite being a full-time student, just like me, but at times, had difficulty doing so. It was then the thought hit me: an impactful and long-term foundation advocating for the thriving mental health of medical students needed to be established.

During these uncertain months—the beginning of a global pandemic, and what I thought was the end of my medical career—I began journaling about my setbacks over the past four years.

Steve Jobs once said,

You can’t connect the dots looking forward. You can only connect them looking backward. So, you must trust that the dots will somehow connect in your future.

This failure was one of those dots. It didn’t make sense at the moment but looking back, that failure was a gift. I’ve thought a lot about the actions I took and the mindset needed to bounce back from that challenge and the ones that came since. Those journal entries are now the first drafts of this book.

I always thought suffering was a requirement throughout a medical student’s journey, but I never considered it is actually optional. Most regard medical students and doctors as Godlike, stoic, and knowledgeable figures who exist to take care of others. During this process, we tend to neglect our own emotional and mental health. We are human beings, and we’re not always okay. Discussing normal human emotions, like insecurities, loneliness, depression, and anxiety, is omitted entirely from the medical school curriculum. Providing medical students with coping mechanisms or tools that could help them work through a challenging period in their life is considered an individual issue, not one for the community to discuss, solve, or provide. But I’m here to argue otherwise. We can build a community where suffering in silence isn’t a prerequisite for medical school, residency, and beyond.

I wanted to know if there was any validity or reality behind my feelings of anxiety, burnout, and the stressors of attempting to reach perfection, so I did some research. And apparently, so did the Mayo Clinic and Stanford University. A 2014 study showed more than half of all US medical students had symptoms of depression, and 56 percent self-reported burnout. A 2016 meta-analysis (biostats, woo-hoo!) study showed rates of depression in medical students in forty-seven countries was 27 percent, a number much higher than rates in the general population (Choi, 2019).

On average, three hundred to four hundred physicians die from suicide every year (Colditz, 2004). That’s about the size of three graduating medical school classes. These numbers are devastating and reflect the lack of resources and shame our culture holds in asking for help. It’s time for these statistics to change, which is why I wrote this book.

My vision for our medical community is to promote vulnerability with one another so we feel comfortable sharing our challenges and setbacks, which will ultimately give us the power to overcome them. If we can discuss stigmatized topics, we can solve them. We can heal ourselves from the inside out. And if we don’t start talking about it now, we may burnout the most precious resource we have: our doctors.

Arguably, [medicine] is the noblest profession, and we should not stress out our students and prevent them from becoming the best doctors they can be. This is a critical issue. It’s a crisis, and we need to have a sense of urgency about it.

—Augustine Choi, MD, Dean of Weill Cornell Medicine, 2021, at the first-ever National Conference on Medical Student Mental Health and Well-Being in 2019

Even if you’re not contemplating suicide, the anxiety, stress, and burnout you might encounter before, during, or after medical school is real. I’m here to share my stories, along with other impactful anecdotes from people around the world who have exposed themselves and their experiences to help you get through difficult times. Sharing our struggles, although scary, allows for a deeper connection with those in our community and is often a powerful tool that is underutilized and overlooked. A strong sense of community can prevent feelings of loneliness, and vulnerable sharing can inhibit feelings of inadequacy. When we create a society of inclusivity, empathy, understanding, and connectedness, medicine becomes less isolating, decreasingly toxic, and more united.

The appearance of perfection won’t create perfection, but the vulnerability of sharing our failures could.

I hope to provide not only camaraderie in this book but also mental health hacks I’ve picked up in over a decade of life coaching, empowerment seminars, therapy, countless self-development podcasts, YouTube lectures, speeches, and personal-growth forums. Self-development is the desire to learn about yourself with the goal of being as happy, expressed, and authentic as possible (that’s my definition). These mental health hacks helped me bounce back from many challenging situations.

If you find yourself amidst toxic chaos, whether that be medical school, residency, family or friend drama, a break up, or even a failure, do you have the mental strength to bounce back? Do you have the ability to rebound into resilience, to turn that setback into a comeback? If you join me on this exploration, I’ll make sure you do, too, by the end of this book.

We may not always have control of external circumstances, but we do have control over our internal state (even if it doesn’t feel that way at times), and our internal state is what creates inner happiness, fulfillment, and abundant love for ourselves and others.

We can achieve greatness and be kind to ourselves. We can strive for excellence and show ourselves compassion. We can be exceptional doctors and extraordinary human beings.

My main point in writing this book was to solve a single problem: If other medical students fail, struggle, battle a toxic inner critic, and then subsequently suffer in silence, do they have the mental health hacks, perspective, and mindset to bounce back from seemingly impossible challenges? I was eventually readmitted to my medical school and will elaborate in more detail as the book continues, but I had to reevaluate myself to achieve my dreams. I put to use a toolbox of mental health hacks that preserved my happiness and intensified my purpose. Now I’d like to pass those mental health hacks along to you so you, too, can avoid burnout, silence your inner critic, shoot for the stars, and be the best doctor and person you can be.

On these pages are the tools to develop a resilient mindset, determined attitude, and un-fuckable-with mentality needed to bounce back from almost any situation you find yourself in. Even if your situation is different from any found in this book, the process to mentally work through it will be the same. Medical school can be demanding, draining, and confronting, so I wanted to provide guidance and support (maybe even friendship?) in your toughest of times, if, and when, you are feeling alone.

If you are a premed or medical student, resident, or even a seasoned physician, this book will not only benefit your personal and professional life, but using the tools in it will spark purpose, connection, and fulfillment within yourself and, in turn, those around you. My goal in sharing my stories, and the stories of others in this book, is to provide a silver lining perspective to any situation, insight into the challenges you face in your life, and an unbelievable amount of hope and inspiration.

If someone had given me a book to read while I was in medical school or residency, I would have rolled my eyes because I rarely felt like I had time to read. I structured this book in such a way you can flip to the chapter that calls out to you without having to read any of the previous ones. Open it up, read what you need to hear to feel connected and less alone. Whatever life and medical school throw at you, this book will help you become exceedingly capable and confident in your endeavors. Then, place it back on your bookshelf in between Netter’s and Harrisons until you need some more momentary life advice! You’re not alone in this journey, nor do you have to try and survive medical school. You can thrive in this environment, and as soon as you flip the page, I’ll prove it.

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Honorable Mention

Weill Cornell Medical School and University of Pittsburgh School of Medicine deserve honorable mentions here because they are the most progressive schools I’ve found thus far regarding removing the stigma and opening the conversation around mental