Wellbeing Resources – STEP 1

I thought this would be a good time to share some thoughts and guidance from the Medical Student Wellbeing program about coping during this unique time of STEP 1 preparation and to remind you all that we are here for you.

• Step 1 is a profoundly unusual and challenging experience that you will never have to repeat – thank goodness. Give yourself lots of credit for facing the beast.
• Try to keep Step stress in a healthy zone: too little (ignoring) or too much (getting overwhelmed) can both impact your performance and your mental health.
• Getting overwhelmed? Don’t just accept your fears (which drive anxiety)! Question yourself through rational thinking:

Fear: “I need to learn all this material, and it is too much. I should have started sooner.”
Challenge: “I have the ability to focus my mind in a helpful direction right now. I can focus intentionally on just the bit of information I need to take in today. Berating myself about past choices or worrying about the next week or two is not helpful right now. I can let that go. I have actually been studying for STEP since the start of med school.”

Fear: “I want to keep my career options open so I should prepare as though I might go into the most competitive of all possible specialties or residencies.”
Challenge: “I can only give my best possible performance without sacrificing my sanity. If that is not ‘competitive’ enough for a specialty or residency, then that option may not be for me, and it doesn’t mean I failed or cost myself an opportunity. This period of my life matters too. It is okay to go with a different choice if it means keeping myself sane and above water during this time. It is not always reasonable to keep every opportunity available at all times”

Fear: “I am thankful it is pass/fail. Wait… what if I don’t pass?”
Challenge: “I trust my preparation, practice test scores and academic advisor’s advice for when I am ready to take the exam. I will take the exam with acceptance that I am ready and that I will deal with that outcome when and if it happens. I have confidence that I will deal with whatever outcome I get and its consequences, with support from others. I don’t have to figure all that out right now.”

Fear: “I can’t stop worrying about the potential of not passing.”
Challenge: “Any thoughts related to the outcome are not useful. I can refute them and focus back on the simple process of studying. I know how to study, I’ve been doing it my whole life. Anything else is a ‘later worry’ and just interference from the task at hand, which is learning and recalling the material.”

Fear: “Now that my STEP score is pass/fail, I worry more about my clerkship grades, STEP 2 score, and extracurricular activities.”
Challenge: “I am going to focus on this exam only and not my Residency application at this time -why take on more than STEP 1? Isn’t that enough? I will focus on the rest after STEP 1 and when it is the right time. I will have lots of support from Career Advising for that process”

Consider seeking counseling to deal with any long-standing academic or mental health issues, or just simply for support and encouragement. Therapy and medications can really make life and STEP studying easier if needed. Possible concerns include:

• ADHD. Yes, med students often struggle with ADHD that has gone undiagnosed due to their natural intelligence and work ethic. Difficulty with focus can be diagnosed and treated.
• Anxiety. Untreated general anxiety, OCD, and test anxiety can interfere with academic performance and Step in particular. Just a couple counseling sessions with cognitive-behavioral techniques can make a big difference.
• Depression can cause low energy, motivation and focus.
• Dealing with difficult family and/or romantic/friend relationships: counseling can make such a difference in understanding complex family and relationship dynamics. Learn how to set and keep healthy boundaries without guilt.

Life happens: please reach out for support with navigating difficult life events. You can explore the options with Dr Juliani in a confidential manner. No need to handle how to manage coping with unexpected circumstances on your own.

Recognize that the “sophomore slump” is typical during Semester 1 Year 2. This can be a time of confusion for students – academically, professionally, socially, and spiritually. This state responds well to extra self-care, small changes in routine, self-forgiveness, and radical acceptance.

Reflect on your past experiences with exams. What can you learn from your MCAT experience to gain confidence or adjust your thinking/approach?

Explore new sources of motivation for yourself. Focus on the satisfaction of having finished this exam and getting to move on to clinical rotations.

Think consciously about your self-care plan without beating yourself up about it:

Increase positive self-talk (“I’m strong, I’ve got this”). Visualize being in your zone on test day and being successful.

If you get agitated or panicky, go online and look up a guided relaxation, breathing exercise, or brief yoga practice. These really do work to calm the body. The calmer your body is, the more focused and in control of your thoughts and feelings you will be.

In a loose way, try to maintain regular sleep, exercise, social connection, and Step-free zones when you aren’t studying. Know your limits. When your brain is done, take a half to full day off to restore, without guilt.

Self-care can come in smaller doses. You don’t always have to go for an hour run – you can do a 15-minute walk when you hit a wall. Don’t fall into the med student trap of going big or going home.

Positive Coping Skills only: Watch your alcohol and substance use, and other compulsive behaviors (food/exercise restricting or binging, video gaming to excess, gambling, etc) .

Ask for help! Counseling, academic support, and occupational therapy can be extremely useful, especially if you are noticing any avoidance or procrastination.

At the same time, don’t put too much pressure on yourself to “be well.” One study of 354 medical students found that well-being prior to taking Step 1 was not associated with exam performance once MCAT and GPA scores were controlled for. These findings provide some reassurance that the degree of stress or well-being you are experiencing is not in and of itself indicative of poor performance, nor should it be the sole reason for considering a delay in taking the assessment.

Explain to your loved ones what is going on. Have these conversations before the stress level is high. Let your parents, partner and social support circle know, “I may need to call you every night to complain – don’t worry, I will be fine, but I need to vent to you.” Or: “Please don’t take it personally, but I may need some space and may only call once a week. I love you, but I need some space.” For some people, sex is a way of relieving stress, and for others, libido may go down during stressful situations. Have that talk with your significant other. Be clear what you need from your friends. Do you want your med school BFF to share their practice exam scores with you, or not?

And finally: have compassion, compassion, and more compassion for yourself. You are an amazing, beautiful human being who could never be reduced to a test score. You will get through this, as you have gotten through everything else in life. We are so proud of you, for being WHO YOU ARE!

Dr. Maria Juliani
[email protected]