Medical students use both types of coping strategies; the extent of one vs. the other differs from one student to another. Research has demonstrated that students who predominantly use avoidant coping strategies tend to have higher levels of stress.[viii]
This concept may be compared to the previously mentioned concept of inhibited temperament.
The use of avoidant coping strategies maintains the novel aspect of stressors in medicine, thus leading to distress and negative thought processes.
Surprisingly, you may actually feel like your coping strategies are adaptive if you circumvent feeling negative emotions. Similarly, you may accept negative thought patterns as being normal. This is why it is important to identify these patterns.
Do you identify with the following statements?
· I blame myself for my failures
· When an exam is coming up, I act like if it does not exist because it helps me feel more relaxed
· I often turn to alcohol when I am stressed
EXTRINSIC FACTORS (what is imposed on us)
Our negative thought patterns can also stem from how we are instructed to think. But by whom? The medical system, your attending physician, your patients, your colleagues, and even your loved ones…
THE EXPECTATION TO BE PERFECT
While medical students may feel the need to be perfect, imposing this on themselves, perfection may sometimes be expected and even imposed on them.
For instance, take the last time you thought you might have failed an exam. Did someone in your surrounding automatically tell you that it is impossible for you to fail? Do people in your surrounding always assume that you will great straight As? You may also get comments like “You must be very smart if you are in medicine!”
When you start clerkship, some attending physicians may get angry if you forget to ask a question during history taking, or if you forget a step during your physical examination.
This need to be constantly on your “A-game” can lead to the same negative thought processes as intrinsic perfectionism. However, as they do not stem from within, they are egodystonic, i.e. not in harmony with their own desires, thus adding even more distress to the medical student.
THE EXPECTATION TO
Perhaps your surroundings don’t expect you to be perfect, but to the least, they may expect you to never fail.
This is an important concept because from the first day in medical school, failure is often demonstrated to the extreme: missing a diagnosis or being unable to save a patient’s life. You are expected to pass every single exam, and eliminatory OSCEs are present in practically every single medical school in Canada. Patients also rely on you to not fail them with a missed diagnosis or a wrong treatment, and their lives are often at stake. Medical students may feel distress when faced with this expectation. Failure can lead to feeling inadequate and fear of having disappointed those around them. The decisions of medical students are often fixated on never falling short.
Some may argue that the previous points are acceptable and even necessarily in medical training. Others may question this same training. The aim of this paragraph is not to question whether it is justified or unjustified for medical students to have little room for error, but rather to simply point of its existence.
BEING IN A PROFESSION THAT FOCUSSES ON PRODUCTIVITY
Medicine is a career that is rewarding, but also demanding. When you start clerkship, the maximum hours worked per week can go up to 70 hours, which often exclude study time: this represents almost the double of the maximum hours of work of other jobs. Some residency programs have 24-hour call shifts. Physicians receive phone calls at any hour of the night. Despite this heavy schedule, several news articles have been written, stating that physicians do not work enough hours. This kind of statement may perpetuate this notion of never working enough and can lead to a constant feeling of inadequacy.
Even before we enter medical school, we have pressure to stand out: having the perfect academic record, perfect letters of references, a unique personal statement, and stellar interviews.This form of approval seeking transforms into periodic exams, small groups and OSCEs. As early as our first clinical rotation, we are being evaluated in a clinical setting. Although our title is still “student” and our primary goal is to learn, we have the constant stress of being evaluated. There are expectations for us to stand out from the very beginning. The thought process of medical students may be molded by the constant need to stand out and to receive that “stamp” of approval.
THE STIGMA OF ASKING FOR HELP
In medical school, we are taught to be problem solvers, to be resourceful and try to find answers on our own, before asking for help. This way of thinking becomes so ingrained that we internalize it... and even apply it in our personal lives. When dealing with hardships, some students may be resistant to seek help because of associated stigma. As a result, people may feel ashamed, see it as failing oneself or even as a sign of lacking strength – when in reality, help-seeking behaviours are a sign of courage and capacity for introspection.
As much as our society has advanced in acknowledging and supporting mental health issues, we still have room to grow. One of our goals in this website is to promote the existence of mental health struggles among medical students and practicing physicians, and advocate for self-care.
THE RESPONSIBILITY OF MEDICINE
A career in medicine comes with numerous responsibilities. We are often reminded of what we can and cannot do. What we should or should not post online. What we can or cannot comment on a news article.
We are reminded that whatever we say is linked to the medical profession. We are told that we cannot make decisions that may bring shame to the profession. Patients may also view physicians and medical students as required to maintain a certain social “image”.
Again, some may argue that this concept is reasonable, while others may encourage a clear division between personal life and a professional career. What is irrefutable is that students may have a certain thought process or make specific decisions only because they are taught to act a certain way.
SOCIAL MEDIA: TOO CLOSE FOR COMFORT?
Medical students are not immune to the advantages and disadvantages of social media.
We are living in a world where we are exposed to snapshots of people's lives that appear to be perfect. People choose to share the highlights of their lives, which lead us to believe that it is their constant reality. We may feel like we are alone in our struggles or that we are not achieving as much as others. This can lead to negative thoughts patterns.
[vi] 16. Krohne HW. Vigilance and cognitive avoidance as concepts in coping research. In: Krohne HW, editor. Attention and avoidance: Strategies in coping with aversiveness. Seattle (WA): Hogrefe & Huber Publishers; 1993. pp. 19–50. [Google Scholar] [Ref list]
[vii] You want to measure coping but your protocol's too long: consider the brief COPE.
Int J Behav Med. 1997; 4(1):92-100.