Wellbeing Blog

Hannah Clare: Burn-out and Escaping the Med-School Hamster Wheel

Kia ora friends. My name is Hannah; I’m currently between fifth and sixth year, doing a BMedSc(Hons) year. In honour of Wellbeing Month, I want to share the story of how and why I decided to jump off the med school hamster wheel for a while, and the lessons I have learnt along the way.

 

Med school is a long and wild ride

It’s safe to say that for all of us, medical school has its highs and its lows. Depending on the type of person we are, those ups and downs might happen at different points in the journey, and in response to different elements of the experience. Some of us thrive in the controlled, academic cocoon of the lecture theatre, but feel overwhelmed and adrift in the relative mayhem of hospital life. Others despise the study—test—repeat dreariness of preclinical; for them, hitting the wards feels like stepping into the sunshine. Regardless of when it hits, I doubt there are many of us who haven’t, in the darker moments, questioned our commitment to this daunting, consuming career path.

For me personally, preclinical years were pretty good and when I started hospital, I mostly liked that too. Fifth year has a reputation for being tough, but I walked into it feeling confident, bolstered by an intense but social, successful, and largely fun fourth year. I was ready to tackle fifth year head on, but in hindsight, I probably arrived already a little burnt out; not from anything recent, but from the compound effect of many many many years of pushing myself to the maximum. Fifth year med school marks eight years since we got onto the formal assessment treadmill back in high school (and that’s just for undergrads), and most of us have on it ever since. Maybe it’s not surprising that it’s a common time for cracks to start appearing. What I can say with certainty is that a few months in, I was not in a good place.

 

A textbook case of burn-out

I’d arrive at hospital in the morning, ready for the day, and within a few minutes want nothing more than to go home. I had a few consecutive attachments in departments where the level of cynicism among doctors, both senior and junior, was high. “What if becoming that cynical is just inevitable?!” I vented to my boyfriend in a fit of despair one evening. “None of these people went into medicine wanting to be so negative, so intolerant, and yet it happened to them anyway! What’s to say the exact same thing won’t happen to me?!”

What’s more, I had developed an unhealthy fixation on “being seen” to be doing the right thing; on looking intelligent, looking interested, looking engaged, looking like I was working hard. Somewhere along the way, getting ticks in the distinction boxes had become so important to me that I was sacrificing more substantial or efficient learning opportunities in a quest to collect them. I was relying heavily on arbitrary feedback and assessment grades for validation, instead of being driven by the internal satisfaction of seeking out genuine learning opportunities. (On a side note, this is a huge issue that probably deserves a blog post of its own; I think this aspect of med school alone can be hugely detrimental to wellbeing.)

My whole life just felt like a huge tangle of loose ends; there were so many parts of myself I wanted to develop or work on, but I was so busy just trying to keep my head above water at the hospital that I didn’t have the time or the energy. When, finally, I found myself in tears in front of a supervisor for the fourth time in six weeks, I admitted that this was something that no number of nice comments or good grades was going to fix. It had happened; I was burnt out, good and proper. Something had to change.

 

Plotting my escape

The idea of taking some time off had been brewing in the back of my mind for a while, but only in a very hypothetical “if only” kind of way. I started browsing job listings and “flatmates wanted” ads in London (yes, the most cliched destination of every fourth-generation Kiwi craving an escape) knowing I’d never actually go through with it. In another part of my brain, another possibility was niggling away; far more realistic and therefore far more intimidating to actually consider. The honours programme was something I’d always been vaguely interested in but written off without much consideration. I’d thought the idea of a research year sounded valuable, but not at the expense of “losing momentum” and being “left behind” by the rest of my beloved cohort. A few years earlier, when some friends and I had discussed it, I’d said, “I just can’t imagine that there’ll be any point during med school where I’ll want to take a whole year off.” Turns out, third-year Hannah was dead wrong… fifth-year me wanted nothing more than a time out.

Deferring for a year to take on a research project was a pretty frightening concept at first. I’d never done research in any shape or form and knew nothing about the process; on paper, this wasn’t an issue, but it meant I went into the application process (and the project itself, for that matter) completely blind. I didn’t really even know what area I wanted to do research in, for a start. The more I thought about it, though, the more benefits I started to see. Undergraduates in medical school have often walked very similar life paths to one another: the same three sciences/maths/English combo at school, straight into the same hellish pre-med year, and of course the same “clinically equivalent” hospital experiences. Although honours isn’t exactly a dramatic or radical deviation from that, it struck me as an opportunity to at least do something that was a little bit different, to have an experience that was just my own. I also saw it as a chance to take a breather from hospital life and tie up some of those loose ends that had been making me feel so incomplete.

“That doesn’t sound like a year off, that sounds like more stress,” said my brother when I told him my plan. He wasn’t wrong; honours doesn’t exactly have a reputation for being a holiday, but I wanted the freedom to at least take on and manage that stress on my own terms. I wanted a year where there were no distinctions to chase, where I didn’t have to put on an exhausting performance every single day for supervisors who were hardly watching anyway. I wanted to throw myself into something that I could take complete ownership of, an endeavour driven by me. I had no idea what to expect, but it felt like the right choice.

 

So, what’s it been like?

There are really great days and really hard days. One of the biggest joys for me has been the nature of my research; I got incredibly lucky and stumbled on a project that suits me perfectly. I’m working with high schools, implementing a digital screening tool for detection of mental health issues and risky health behaviours in teenagers. It’s a funny hybrid of population health, adolescent health, and psychiatry—none of which I’m necessarily going to specialise in, but all areas that I’m passionate about and wanted to explore a little further. My role has been to collaborate with on-the-ground school staff to codesign a programme that will work in a “real-world” setting; it’s very tangible, very satisfying. As someone with a head for words but not numbers, I’ve enjoyed sinking my teeth into the qualitative nature of it and have been able to steer well clear of any frightening statistical analysis. Being able to invest my time into a project I genuinely believe in, with people who I’ve come to love, has been a huge pro for me.

Another pro has been the very flexible nature of my schedule this year. Take this with a huge grain of salt, because many honours projects require a lot more contact hours than mine do, but personally I’ve had the freedom to work hours that suit me, and usually from a location that suits me too. That’s allowed me to fit in a lot more of the non-medical, non-work things that make me feel like myself—reading, writing, cooking excessive amounts of food, seeing old friends. I’ve even taken up boxing. I’m hoping that getting back into the habit of doing these things—things I used to do without thinking twice about whether I could “justify the time”—will help me feel more whole when I return to the hospital life next year.

Some aspects of this year have been immensely challenging as well. For one thing (and this is the flipside to the flexibility), you spend a lot of time in your own head. There are many days when it’s just you and the computer, and it’s all on you to keep yourself moving. As someone who has religiously completed every assignment since primary school at the absolute last minute, the lack of set deadlines throughout the year (there’s really just one be-all-end-all submission date in November) can seem completely overwhelming some days. It can also be lonely at times; I’ve made some truly awesome friends through honours, but you’re not necessarily guaranteed to see the same bunch of people every day, like you are in hospital, and I do miss the reliability and regularity of that daily social contact. 

The lessons I’ve learnt so far from this year have been enormous. Most notably, I’ve had to learn how to be okay with doing things wrong. Writing a thesis, I’ve come to realise, is something you can only learn how to do right by first doing it wrong many times. It was a shock to my perfectionist system to realise that are no guidelines, no boxes to tick—I just have to submit bits of work to my supervisors knowing that they will inevitably come back covered in comments about changes I need to make. More importantly, I’ve had to learn that my supervisors won’t think I’m stupid or lazy if I don’t get it right the first time; it’s a completely normal part of the process and they expect it. The people-pleaser within me came to believe, years ago, that by doing things wrong I was letting people down; it’s a deeply internalised mindset and I’m having to work hard to unlearn it.

Finally, there is no marking sheet this year. There’s nobody working next to me that I can look over at to see if I’m keeping up. Like most of us in med, I have spent most of my life measuring my outputs and achievements by the standards set by my peers. It’s weird not having a whole group of people doing the exact same thing as me to compare myself with, but I think it’s a healthy change. I’m learning to back my own instincts, keep myself accountable, and also (hardest of all) to give myself credit when I do things well, instead of waiting to see it reflected in a report or a result.  

 

My verdict

The development, personal and professional, that I’m gaining from this year is exactly what I wanted and needed. I would thoroughly encourage anyone who is starting to feel a little lost and disillusioned to consider stepping out of the med school fray for a year; all the “downsides” I perceived about it have turned out to be so insignificant when compared to the benefits. Even on the hardest days, I have these sudden moments of perspective where I just think, “Man, I love this. I am learning so much”.

The point of this piece is not be a plug for the honours programme; although I highly recommend it, it won’t appeal to everyone. It’s also not lost on me what a massive privilege it is to be able to do this, to stick another year’s worth of fees and living costs on my student loan based on a gut feeling. I think the experiences and emotions that led me to my decision to take some time away are shared by so many of us, and yet nobody really talks about what options are out there. This is just one over-achieving, people-pleasing girl’s advice to you all: if medicine has stopped feeling quite right, don’t be afraid to take a step to the side and shift your focus for a while—I haven’t regretted it for a moment.