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Sunday, May 14, 2006

Stress-busters 

la..la..la... ikim fm

Stress-busters

This article talks of how to recognise and react constructively to stress throughout your career as a student
Publication date: 1 September 2000
Mark Brennan tells you how to keep cool under stress . . . and use it to your advantage.
A lot of what we consider to be good medicine is about prevention rather than cure. This applies as much to people working in medicine, as it does to patients. As you have probably discovered by now, medicine can be a stressful career. The stress can affect personal relationships and working life, and it can lead to a number of clinical conditions including depression, and substance abuse.
As you know, training to become a doctor can be stressful. Medicine is a long course - it's quite an undertaking to spend up to six years as an undergraduate student, followed by several years of postgraduate training. You will undoubtedly face stressful situations: exam stress, personal stress, stress at work. But don't forget - stress isn't always bad or harmful. One of the physiological effects of stress is to stimulate the flow of adrenalin, which can actually help us to perform better under pressure. It would be unrealistic to expect your life to be entirely stress-free. Stress is part of life and part of what makes us human. What we need is to develop strategies which help us to cope with it. Let's start by identifying some of the major causes of stress for medical students.
  • tiredness
  • financial pressure
  • ward-rounds
  • examinations
  • lack of knowledge
  • lack of confidence
  • fear of the unknown
  • fear of failure

Dealing with tiredness

It may seem blindingly obvious but nature did not intend us to go without sleep. Recent research indicates that sleep deficit is becoming a major problem in our society and can lead to illness and accidents. Too many late nights will have a detrimental effect on your ability to perform during the day. This may lead to criticism for a lack of professionalism which is one of the common reasons for medical students being asked to leave medical school. Part of becoming a professional is learning when to take time off to rest and recuperate. Your body needs a break from time to time; this includes getting some early nights to recharge your batteries. Living in halls of residence or shared student accommodation can make it difficult to sleep - too much noise from impromptu parties and hi-fi systems is a common cause of sleep deprivation in students. Try simple solutions like earplugs and natural sleep-inducers such as eating carbohydrates, having a hot bath or a warm milky drink before you go to sleep. If the noise levels are seriously disruptive, remember you have a right to your sleep and a right not to be unduly disturbed by others; friendly negotiation may be needed with fellow students or flatmates. You may have to resort to speaking to the university authorities or your landlord.

Coping with examination stress and ward-rounds

Exams and ward-rounds, like any form of testing, are inherently stressful. You can reduce some unnecessary stress by doing the groundwork before you sit the exam or go on the ward round. Nowadays in medical education, exams can take many forms including video critiques, computerised mannequins, OSCEs (Objective Structured Clinical Examinations) and OSLERs (Objective Structured Long Examination Record). Prepare for exams by talking to your tutors about what is likely to be tested. Talk to students in the year above about how they found it. Start early - don't leave your revision until the last minute.
Team-test each other - form a revision group of friends and work together in the evenings over a pizza or a curry. Research the likely questions and topics; past papers are often available for reference in your medical school library and then you won't be surprised when you turn over the exam paper! Prepare for ward-rounds by looking smart, talking to the patients, learning as much as you can about their medical history, getting to the ward early before the arrival of the consultant and being keen and enthusiastic.
Find out from other students (or the nurses) what kind of questions your particular consultant tends to ask and pre-empt them! Sir Lancelot Spratt types are less common than they were, but even the Sir Lancelot types respect students who make an effort even if they don't know all the answers yet.

Dealing with the fear of failure

One reason why doctors suffer from stress is that they tend to be very hard on themselves. They set high standards that are sometimes impossible to achieve. Sometimes just good enough is enough - you don't have to excel at everything.
Many doctors and medical students tend to be highly self-critical, but the criticism is often more negative than positive. We tend to focus far more on what we think are our faults than our strengths. Psychologists suggest that people need at least three positive comments for every negative comment; to quote a phrase, we need to accentuate the positive! One way to relieve stress is to apply what is known as a positive critique to ourselves and others; this relies on two key questions: what has gone well?' and 'what could be improved?'. The majority of what we do is good or adequate; it is often only the minority that could be refined and improved.

Fear of the unknown

Frequently, student doctors become stressed by their fear of the unknown (often fear of the impending house year) in particular of 'getting it wrong'. This is entirely natural and yet frequently causes more stress than anything else. Take heart - the PRHO year is an educational one and you are not expected to be good at everything yet. You are expected to ask for help and advice. There are always people around who can help you, even if sometimes you get rebuffed; don't be fobbed off if you don't get their cooperation at first - be courteous but persistent.

Stress enhancers and their antidotes

  • Poor diet;- Too much junk food can affect your ability to respond to stress; try to eat as healthily as possible, keeping an appropriate balance of carbohydrates, proteins, calcium and vitamins.
  • Storing things up; People need to talk when things are going badly OR going well, share it with others. When friends and family are too faraway and you need to sort out a problem, then speak to your personal tutor or another teacher that you trust, a student counsellor, or your GP.
  • Not enough physical exercise; Try to find opportunities for exercise, even if it is just walking around the hospital or university campus. To keep fit, your body needs at least three periods a week of physical exertion - an activity which causes your heart rate to increase. Check the sports or recreational activities that are available through your university and student union.
  • 'All work and no play'; You need time out from work and study to enjoy life; treating yourself to a regular night (or day) off is important to your mental and physical health.

Dealing with lack of knowledge

There is a lot to learn as a student doctor, but there are ways to make the learning easier for yourself. Make friends with your medical school librarian - she or he can be a huge help in finding articles, books and other information; they are specialists in finding things out. You will never 'know it all' but you probably already know more than you think you do! Senior students and junior doctors can help you to focus on what is most important to learn and why. You have limited time and limitless information available to you, so you must prioritise.
Ten top tips for busting stress:
  • talk
  • keep fit
  • prioritise
  • be positive
  • eat healthily
  • pace yourself
  • get some sleep
  • work at friendships
  • keep a sense of perspective
  • pamper yourself every now and then
There is a positive side to every situation; what makes medicine such a fascinating and enjoyable profession is its sheer variety and unpredictability. Stress is a natural response which can, properly handled, produce good results. This article should help you to recognise the symptoms and cope with stress, turning it to your advantage in becoming a good doctor.
Mark Brennan is a lecturer in medical and dental education at University of Wales College of Medicine and senior lecturer at the Royal College of Surgeons in Ireland.



posted by al^asma at 1:27 pm ::

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