Episode 58: Today, I’m talking about the top 10 stressors experienced by freshmen college students.

Biggest Stressors PreMeds Face Every Day

 Of course, these same stressors do persist throughout all of your education, not just college but medical school and beyond as well. However, I think it’s important as I do more and more research, to go earlier and earlier in the process to get a better understanding of just who wants to be a doctor anyway?

This topic today was inspired by 2 purposes. One, I recently gave that publication that I practiced with you guys in our previous podcast in which I outlined the stress of exams and the evidence-based behind different interventions for stress on the Medical School Podcast. I presented that to a group of second year medical students and it’s right now, February of 2014, and this is a period where they really ramped up in preparation for the first major licensing exam. It comes up in the summer in about June every year where second year medical students take an exam to get … it’s the first of 4 … to get their license to practice medicine.

That content covers the first entire 2 years of medical school is by far the largest volume of information covered on a single exam and just about you have ever covered in your life up until that point. The MCAT stress in many ways is a little worse just because they are intentionally testing how you think, not what you know. At least, for the licensing exams, you’ve taken the class before. For the MCAT, you kind of can’t take the class. Yes, you take your prerequisites, but they’re going throw you in the scenarios and test how you think. They’re very, very good at it.

This study … the other thing that … I should say that the other thing that inspired this podcast episode was a recent publication in the psychiatric annals in December of 2013. It’s about these top stressors and resilience in college students. In this study, there was a sample size of 644 freshmen in college from 7 different universities in United States in the east. It’s a pretty good sample size, right? They administered a couple of instruments to them that could measure stress and asked them about what the different stressors were. Then they also had some questions designed to look at resilience and what the students felt were their strengths.

I’m going to go ahead and read what they said their top 10 stressors were. I’m going to focus more on other data presented in the study, specifically about different categories of behavioral, social, and health changes that are experienced. I summed up the human experience of these particular stressors and gave you a clearer picture of the impact these type of stressors, and perhaps, the way you navigate them. Whether you’re going to do good or not with each of these top 10 stressors, how that impacts your life.

The top 10 stressors beginning with the top 1 was completing homework. Number 2, making good grades. Number 3, studying. Number 4, meeting my own academic standards. Five, procrastination. Six, a heavy workload. Seven, writing assignments. Eight, too many responsibilities. Nine, meeting deadlines. Ten, not enough time to relax.

Doesn’t that sound like our life? You see how these stressors are pervasive, that they don’t really go away? This is a pretty sophisticated study that had a lot more granular detail besides these things, but it’s so interesting to me that if we stopped the podcast right there on the top 10, you’d already have enough information to paint a perfect picture for pre-med. Probably at the top of the list, for number 1 for the pre-medical student, you had put fear of not getting in a medical school or maybe other subservient goals such as a low MCAT score or a low GPA. Those things that, at least, you believe are closely tied to MCAT and GPA, not necessarily true if you’ve been masterminded appropriately and have the success philosophy embedded in your own way of thinking.

I’m going to turn the next chapter of this podcast into looking at behavioral, social, and health changes. There are several different categories of how this stress can affect your life and we will wrap up at the end looking at some resiliency traits and what the students said made them the most defended against the different stress and what was their strength and what do they lean on.

The different types of categories of how the stress can impact you is, number 1, the physical health; 2, emotional stability; 3, self-care behaviors; 4, your cognitive style, essentially your attitude; 5, concentration; and 6, the social connections. At the very top of the list, when you categorize the individual stressors, and now we’re moving on beyond just the top 10; there’s about 20 of these. I’m not necessarily going to read all of it, but I’m going to hit the top half of this chart. You can look at the report yourself if you want to.

The number 1 leading the list was worrying more. That was, in effect, that students noticed whenever they got more stress put on, they would worry more. Of course, that follows into the cognitive style. Your approach if it’s a worrying nature, it’s going to be accentuated. That, by far, leads the list making me think that it’s very much a robust trait. It’s not just those that have personality disorders or had a worrywart for a parent or somebody like that that had an influence on you, you picked up their style, would generally worry a lot in college is what this tells me. Of course, this is freshman. Perhaps this trails off.

Four out of the next 5 categories on the list of responses to stress affect the person’s emotional stability. Yes, the stress puts on. It gets put on you. There is a tendency to worry, very clear. We’re talking over half of the students, about 55% or so, worry more. Closer to 25% start getting it to more emotional stability such as losing their temper more, crying more, feeling depressed more often, and having more mood swings where you can  go from happy to sad or mad in the course of a day. Not a persistent depression or a persistent irritability, but swinging around depending on what’s going on.

My point here is that learning how to navigate these stressors, your response to them, and perhaps even looking deeper at what you really believe about the situation. Becoming a person that studies the facts of the situation and doesn’t get caught up into the emotion of a single bad grade, but really can develop your own objectivity, like a third eye or look at it from an objective perspective. Perhaps write it out or go over it with a friend or someone you could trust. Just make sure that if you’re really worrying a whole lot, that it’s for good reason and then to evaluate what good does that worry do for you? Is it helping you? Is it not helping you? That’s a cognitive style.

If ever you have a time in your life when the heat is turned on and it’s important for you to figure out how to set the tone for your own positive mental attitude in your life is when you’re a freshman in college, especially if you’re a pre-med. It is do or die time on the stage of life’s attitude. I’m going to say that again for emphasis. It’s do or die time for our freshmen pre-med, or really at any level, but we’re focusing on this study on the freshman. It is do or die time on the stage of life’s attitude. You alone control your response to the situations around you. The one thing you have complete control over is your attitude. You don’t have control over everything else.

I’ve said from the very beginning of my study techniques training not to blame yourself when the grades don’t workout. You blame your study technique. You blame your approach with an underlying premise that you can do this. You can overcome your stressors and you can excel in school assuming you’re going to put the work into it. There is a great tendency in our country for people to become lazier and lazier. We have generation upon generation of people learning that you can get something for nothing in this life, and it’s not true. There’s an epidemic of disability and inability out there and pervasive negative mental attitudes.

That is your fight. I would say really that your fight to overcome those negative mental attitudes weighs more on you whether or not you are first generation to go to college or trying to be the first doctor in your family. If you can win the battle of the attitude and you can become persistent and have a definite major purpose to become a physician. Nothing can really stop you. That’s only 3 of the 17 principles of success, but those are the three biggest ones (laughs), okay?

Let me just read a few of the other top responses to stress when people don’t do so well. Right in the middle of that, number 4, was get headaches or stomachaches. We call that being somatic. In other words, you’re experiencing the stress by paying more and more attention to bodily symptoms such as pain or discomfort. In neural networks in the brain, response to anxiety, stress, and pain follow the same highways. The same major networks can be tied up.

If you don’t navigate this stressful time in your life appropriately and perhaps you’ve been set up by bad examples or even abuse or neglect in childhood and you can be at a disadvantage. All the more important for you to mastermind, to overcome this stuff because if you don’t learn how to unhinge the pain, stress, anxiety from your life circumstances, this could set up a pattern for the rest of your life. It’s important that you learn how to do this right, not just cheat or get the next tip from somebody to pass the test to sort of squeak through. If you’re going to become a professional and you want to be physician, a very important part of your professional and personal development, is to truly look inward. “Well, here’s your step.” Facing the stress and anxiety as a freshman in college.

If you can handle this in a mature way, you’re going to set up a good precedent for yourself and be well on the road to having a healthy and productive career that’s not really threatened by stress or even job changes or diversion of your goal. You can overcome it. I did. Other people will have cognitive style deficit such as expecting the worst to happen more often or feeling hopeless. That’s very devastating and suicidal ideation can ultimately come in there. What are you going to do if you give up and you’re just completely hopeless?

Other people will get into trouble with concentrating. Now, we’re towards the middle of the road in responsiveness. About 20% of people will have trouble daydreaming more often or find yourself just distracting yourself, whether that’s on Facebook or video gaming or something. A pre-med does not need to play video games except in between semesters that they’re not doing a volunteer work. That’s just a rule of thumb. I’ve done it at times. I’m not saying it’s totally awful law or out of the realm of possibility, but if you’re not acing everything, you need to either be taking a mental break and playing some games.

If you have an obsessive compulsive personality or addictive tendencies, you need to avoid all those kinds of distractions. You’d be doing healthy, productive things such as exercising, spending time with family, learning more about your own diet and health, being a good example and doing some introspective work so that you can better answer questions on interviews at medical school. You need to be looking at those goals. You basically need to take this seriously. If you have not been working hard at this time and are skating through, but yet you have marginal grades or a problem with the MCAT, you need to quit spending so much at Starbucks. You need to get serious (laughs).

Few of you out there in the podcast went, “I needed to hear that.” I don’t normally talk like that, but I like to hear that kind of stuff. Please understand, I’m really not trying to be critical at all. I’m trying to be a different voice than you may have in your head so that you can look in the mirror at yourself and see aspects of yourself that are sometimes uncomfortable and that if the shoe fits, wear it, right? If it doesn’t apply to you, then don’t worry about it. These are some pretty common responses to stress overall.

I think laziness streaks can crop up in all of us. I, by no means, have contempt or look down on anybody out there in podcast line. If anything, I’ve done most of these things wrong in the past and got lucky, and then later masterminded so that I can now articulate and describe what I did right, what I did wrong and give you some evidence based tips for how to improve yourself.

Let me wrap up by talking about the traits that the students felt made them more resilient. What did they do to help them overcome the stress? The study wasn’t focused clearly on all the negative side and the negative responses. The number one thing that the freshmen thought was a strength was they’re independent. Of course, they just moved out of home, most of them, right? Also, positive family relationships, a sense of humor, belief in college success. I would say that’s a predictor of overall life success.

Also, assertiveness, and then right up there was not using substances. No drugs and alcohol. Don’t do it. It’s not worth it. If you’re experimenting with drugs and alcohol and you say you want to be a professional, you need to take a hard look at that because if you ever get a felony, you can never practice medicine. Think about that. You can’t get a license. Those are some of the top resiliency traits.

I’ll end up with an update on our AMPed Program, AMP, the Application Madness Program. It’s been a few years since I’ve been able to do custom coaching within individuals and I’m still a resident, but I can take a handful of students, about 4. By the time this podcast here is released, we should be close to wrapping up the first AMPed cycle where I literally go over every detail of some of this application to medical school or to residency.

I’m going to have medical students and pre-meds applying to be in that program and giving you my personal cell phone, that kind of thing. Looking at tour essay, helping editorially, and things like that. To give you your own custom auto suggestions, what positive beliefs can you have about yourself and what are your strengths and weaknesses, kind of an assessment numerically of your entire application and essay writing; whatever you need. It is completely custom, but we’ll start with the assessment form and that sort of thing. I’m getting excited as I am writing these details down. It’s about to launch this weekend. By the time this comes out, we’ll be about halfway through that cycle or more.

That’s the AMPed program. You can find out more about that at the pre-medpodcast.com on the Medical Mastermind Community. I’m your host, Dr. Dan, and you’ve been listening to the Pre-Med Podcast.