By Trent Reed and Sunny Nakae
Many medical students struggle with fear, pride, priorities, regrets, and insecurities, but the liberty to disclose such feelings may be limited. Students often avoid sharing their challenges and feelings with their peers for fear of looking weak or due to shame. How can we destigmatize sharing among students to build resilience, foster community, and improve well-being?
A week prior to match day we received almost 70 anonymous secrets from our senior medical students at Loyola University Chicago Stritch School of Medicine. Dr. Reed solicited these messages from the students by explaining the premise to them. The exercise is based on the work of Frank Warren who created postsecret.com. The students were not given guidance regarding topics or tone; they were simply asked to submit an anonymous secret…
Approximately 60% of the comments related to personal challenges, 20% were affirmative in nature, and 20% were mixed. The comments were often raw and heartfelt but none were in isolation. The secrets had common themes which created an impression that community and even solidarity exists among the members of the class.
- “I am afraid I won’t be able to inspire my patients to believe in themselves when I often struggle with believing in myself.”
- “I’m afraid of making mistakes and hurting my patients.”
- “The problem with medical school is that no student is willing to admit to their peers they are struggling mentally, physically, or emotionally, though we all are in some form. Throughout the past 4 years I have suffered silently in order to maintain this harmful facade.”
- “I worry I have let go of so much during medical school. So many of my hobbies and friends I have lost touch with due to long shifts and being tired. What further will I lose in residency? Would my M1 self like the person I have become?”
- “My biggest struggle during med school was separating what I actually wanted vs. what I believed others want or what society would think highly of me.”
- “Knowing what I know now, I would not recommend to people who I love to go to medical school.”
- “Even after these long years I still feel like an imposter sometimes – waiting for someone to call my bluff – like I’m just ‘pretending.’ I know it’s just anxiety, but I do hope it eventually goes away!”
Although we were not surprised by what our students shared, we did reflect on why it was that so many of them experienced their fears and feelings privately, all the while believing they were the only ones. What is it about medical school that makes it so incredibly difficult to be vulnerable or reach out to others for support? How can we as educators be more intentional about providing opportunities for our students to come together and be more authentic with themselves and each other about their medical school experience?
We submit that in order to encourage the sharing of vulnerability from students, we must model it ourselves. In addition to teaching content, we should also pay attention to the process. How often do we take time to share our struggles or challenges with our students? How often are we, ourselves, vulnerable? When, as part of the education we provide, do we create space and time to discuss the experience of medical school? As we give ourselves permission to be vulnerable, we can encourage our students to do the same. Parker Palmer, author of The Courage to Teach, very astutely asserts that “we teach who we are.”(Parker 1997) If we can be more authentic, we can increase empathy and real connections. In doing so, we nurture seeds of resilience in our students and in ourselves. As we reach out and tell our stories we can begin to change medical school’s culture of silent suffering.
To conclude we offer a few secrets of gratitude and hope that were submitted. Gratitude is another element in building resilience.
- “I wouldn’t have made it without my family and friends. I am so grateful for their love and support.”
- “You are special because you are you, not because of what you do.”
- “I have only my sincerest gratitude and respect for my Loyola mentors; they have forged opportunities and given much needed encouragement and advice in times of both celebration and adversity.”
Trent Reed, DO, FACEP, Professor of Emergency Medicine and Medical Education, serves as the Assistant Dean for Simulation Education and directs the Emergency Medicine clerkship at the Loyola University Chicago Stritch School of Medicine.
Sunny Nakae, MSW, PhD, is a clinical associate professor of social medicine, population, and public health and Associate Dean for Student Affairs at the University of California-Riverside School of Medicine. She has previously held administrative positions at the University of Utah School of Medicine, Feinberg School of Medicine at Northwestern University, and Loyola University Chicago Stritch School of Medicine. She is the author of Premed Prep: Advice from a Medical School Admissions Dean (Rutgers University Press, 2020)
Parker J. Palmer, The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life. San Francisco: Jossey-Bass, 1997