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The real reason why med students only talk about school

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

On a recent Friday, I went out with a handful of classmates for some food to celebrate the end of a particularly long and tiring week of school. Interestingly, although we had spent hours each day shuttling between lecture halls, the hospital, and clinical exam rooms, the conversation kept drifting back to one, very familiar topic: school. We talked about everything we had endured that week, compared notes on our different experiences, and looked ahead to our future plans. This isn't a new phenomenon, by any means; in fact, almost all of our off-campus gatherings are intruded by talk of school, to the extent that it only stops when somebody finally says, “Can we not talk about school for a few minutes?”

So, why is it that med students seem to only be able to talk about school when they get together after class? Contrary to popular belief, it’s actually not because we’re so busy that we don’t have time to have a life outside of school. My classmates are athletes, musicians, entrepreneurs, husbands, and mothers – there is plenty to talk about in the world that’s not medicine! Similarly, I don’t think it’s because we’re such science nerds that we just love to talk about medicine and science all the time. Most of us need a break from that every once in a while.

What I’ve discovered over time is that we talk about school so much because the process of debriefing with our peers helps us to stay healthy as students. When we’re in class, patient sessions, or the hospital, we’re (rightfully) expected to maintain a certain professional demeanor; this can prevent us from expressing our emotions and understanding the experiences of our peers in the present. Looking around the table during an emotionally charged and difficult encounter with a patient struggling with mental illness, I see only faces of peers that appear calm and composed. Only by talking about it afterwards, in private, does it become clear that several of us are undergoing strong feelings – of sadness, nervousness, discomfort. It's incredibly easy in med school to think that you’re the only person in the room feeling a certain way, until you find out later that every person in the room was feeling the same way.

What we’ve learned from these exercises is that nobody knows better than your immediate peers what you're going through as a med student. Faculty and mentors have been through it themselves but are many years removed from the process and may have had very different experiences. Family and close friends know you better than anybody but often have difficulty relating to the more unique aspects of medical school. This means that there is no substitute to having peers that you can rely on.

Finally, I think it’s critical to highlight the point that being able to debrief openly and honestly couldn’t be more important in a profession like medicine, where the high stress makes rates of mental-health problems particularly high. Unfortunately, physicians seem to have a long tradition of sweeping emotional challenges and mental-health issues under the rug, in fear that they'll be judged and ostracized by their patients and colleagues. We owe it to ourselves and our patients to try to change that culture, and I’m hopeful that our tendency to keep an open conversation with peers will help to keep all of us healthy.

Nathaniel Fleming is a second-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Photo by Norbert von der Groeben

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