To Your Health: Achieving Well-Being during Medical School

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Thomas M. Wolf

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    Dedication

    This book is dedicated to all the Louisiana State University medical students who have enriched my life and who have taught me so much over the past 25 years.

    Foreword

    If the major goals of medical schools are conducting health-related research and teaching technical knowledge and skills, they do an excellent job. If another goal is to graduate well-adjusted physicians with good self-care skills who can relate compassionately with patients and others, they do not fare as well. Medical schools' emphasis on technical excellence is sometimes at the expense of the social and emotional development of those they train.

    As their lives become progressively more restricted, medical students may eventually realize that the single-minded pursuit of professional achievement, though stimulating, leaves them emotionally or physically impaired. To reduce this risk, it is important for medical schools to establish programs for well-being throughout the medical school curriculum.

    To Your Health: Achieving Well-Being During Medical School evolved from such a program developed in the mid-1980s by Dr. Thomas Wolf at the Louisiana State University Medical Center (LSUMC), now called the Health Sciences Center (HSC). It should be required reading for anyone going through medical school or considering a career in medicine.

    Thomas M. Wolf, PhD, Professor and Chief of the Section of Psychology in the Department of Psychiatry at LSUHSC, has taught and supervised medical students, psychiatry residents, psychology interns, and other trainees for more than 25 years. At LSU, he developed a health promotion program that equips students with the tools for their own physical and psychological health and well-being during training and beyond.

    This book will help you to recognize the importance of self-care during medical training and provide practical ways for you to develop and maintain your physical and psychological health. Self-care during medical training is clearly in everyone's best interest—that of yourself, your family, the faculty, the administration, and the patients that you will serve.

    Robert HolmanCoombs, Professor of Biobehavioral Sciences UCLA School of Medicine, Series Editor

    Preface

    Dear Premedical or Medical Student,

    Why did I take the time to write this book? Why should you take the time to read it?

    I have had close contact with medical students like you for more than 25 years through my teaching, clinical supervisory, and administrative responsibilities. As a result, I quickly came to recognize that although the practice of medicine can be a rewarding profession, there are risks and health hazards for each of you going through medical school. Will you get through medical school easily? Or will you acquire unhealthy or even destructive ways of coping with the stress of medical education, putting yourself at risk for later burnout and impairment?

    I have published many articles on your lifestyle changes, coping, and health. What practical difference can these research findings make for improving life during medical school? These questions persuaded me to develop a health promotion program for Louisiana State University (LSU) medical students, which was instituted in 1986. It is described in the appendix.

    I was delighted to be asked by Dr. Robert Coombs of the UCLA School of Medicine to submit a book proposal on medical student well-being as part of a book series on medical education published by Sage Publications. It has been a challenge to write this type of practical book, for I am more accustomed to writing research articles. I have drawn on my own work as well as that of others for useful information on such topics as time management, relaxation, and communication that I think will enrich your life during and after medical school.

    Now, why should you read this book and how will you benefit from it? First, this is a, hands-on, how-to, practical book. Gaining an intellectual understanding and mastery of the material will not be enough. It is essential that you try out the exercises and techniques covered in this book. They are simple, easy to implement, and not time consuming. Each of you has a busy schedule, and the key is to build in time for these exercises. If you practice regularly, you will feel better physically and psychologically. Furthermore, attending to your personal well-being is likely to enhance your school and academic performance. If you take good care of yourself and become a proponent for preventive health care, you will model healthy living and encourage it in your patients. If you and your patients live a healthy lifestyle, the quantity and quality of life in our society will improve.

    Acknowledgments

    It has been a pleasure to collaborate with many medical students and colleagues since joining the Louisiana State University (LSU) faculty over 25 years ago. The individuals who have touched my life are far too many to acknowledge, but I do want to highlight a few of them. The following students and colleagues at LSU have provided ongoing support, constructive comments, and recommendations on multiple drafts of this manuscript: Michael Levitzky, Professor of Physiology; Glese Verlander, senior medical student; and Michael Webster, coordinator of the LSU Health Promotion Program. Thanks to Mike Webster for his consultation and help on exercise and physical activity; Barbara LeGardeur, Assistant Professor of Clinical Medicine, on nutrition; and Vernon Smith, from the Blue Cliff School of Therapeutic Massage, on massage and physical contact. Howard Randall, Associate Dean for Student Affairs and Records, has been a valued collaborator on numerous research projects as well as the development of the health promotion program. The LSU Student Health Committee, chaired by Elizabeth Humphrey, Dean of the School of Nursing, has been instrumental in providing financial and psychological support for the health promotion program over an extended time period. I have received longstanding support through the Chancellor's Office for the initiation and growth of the program and in particular want to thank former Vice Chancellor for Clinical Affairs Donna Ryan and Vice Chancellor for Academic Affairs Marilyn Zimny. Ben Lousteau, Coordinator for the Section of Psychology in the Department of Psychiatry and a computer whiz, was patient and constructive in typing the manuscript from beginning to end. Thanks to Virginia Howard for assistance with providing editorial services. I acknowledge Tara Guillermo for taking photographs at the fitness facility shown in Chapter 4.

    I have also had some wonderful collaborators outside of LSU. Robert Coombs of the UCLA School of Medicine is the driving force behind this book series. This book would not exist without his overture to me to submit a book proposal. I want to thank him for his wisdom, generosity, and good judgment. His wife, Carol, has served as an outstanding editor, and I have benefited greatly from her thorough reading of all drafts and valuable and constructive recommendations for improving the manuscript. Robert and Carol make a great team. Thanks to my sister, Andrea Wolf, for her thoughtful reading of the manuscript and constructive recommendations.

    I want to thank the staff at Sage Publications for their help in making this book become a reality. In particular, I want to acknowledge Heidi Van Middlesworth, Editorial Assistant, for her insightful observations and recommendations, good judgment, and good sense of humor.

    Finally, I want to express my gratitude and thanks to my wife, Valerie, who was always there for me during all phases of this project to discuss ideas, organization, and writing style.

    I look forward to a continuing, rewarding collaboration with medical students and colleagues both within and outside of LSU.

    Introduction

    How can you maintain a healthy balance between your personal and academic life during medical school and beyond? Will you tip the balance in the direction of personal well-being and run the risk of academic problems and possible failure, or will you tip the balance in the direction of academic excellence and possibly forego family, friends, hobbies, and interests? A major challenge and struggle for each of you is to find a way to balance and fulfill a variety of needs. Each of you is different and must realize what is most important in your life.

    This book provides you with a practical approach to caring for yourself and developing effective coping strategies for dealing with the stressors that you will encounter throughout and beyond medical school. To see how well you are taking care of yourself, complete the two questionnaires about your personal lifestyle that begin at the bottom of this page. Please complete them now, and you can refer to them as you read this book. As you make lifestyle changes, you will probably notice some changes in your responses to the questions. Understanding yourself better is a prerequisite for making enlightened lifestyle changes.

    Diagnose Yourself

    How are you currently living your life? What are your personal health habits and lifestyle characteristics? Are you taking good care of yourself? What are your top priorities? How are you perceived by others?

    You can get answers to these questions by completing two questionnaires. The first is the SPICES for Life (Social, Physical, Intellectual, Career or School, Emotional, and Spiritual).1 Louisiana State University (LSU) students complete this questionnaire in terms of their current activities and behaviors, as well as proposing positive changes to enhance their own well-being. Some of the common activities and behaviors mentioned by LSU students are listed on the questionnaire.

    The second one, the Lifestyle and Health Habits Questionnaire, I developed specifically for this book. It consists of three questions for each of the 10 practical areas covered in Part 2 of the book, which deals with practicing healthy living. The three questions will also be repeated at the beginning of each of these 10 chapters as a way to jog your memory about how you meet your lifestyle needs. After completing both questionnaires, you will be in a better position to decide which of the practical recommendations and exercises you need to implement.

    Spices for Life

    Instructions: Please describe the activities and behaviors you engage in relating to these six wellness dimensions. Consider and describe the changes you want to make in each area that are most consistent with your needs.

    • Social—having lunch or dinner with family or friends, seeing movies, attending your kids' school or sports events, making phone calls to friends and family, going out to clubs, participating in outdoor activities (walking, hiking) with friends
    • Physical—walking up and down stairs at hospital or school; walking between hospitals; taking walks around the neighborhood; running in the park; riding a bike; working out—weightlifting, hiking, canoeing; doing push-ups and sit-ups at home
    • Intellectual—reading for pleasure, seeing intellectually stimulating movies, discussing ideas with friends, attending seminars, listening to tapes while driving
    • Career/school—attending seminars and meetings; reading papers, books, journals; studying
    • Emotional—talking to friends and family, spending time with your kids, listening to music, participating in outdoor activities (going to the beach, hiking, camping), relaxing, taking time for self, engaging in daily self-evaluation to sort out your feelings about handling problem situations and concerns
    • Spiritual—enjoying nature, beauty and wonder of the outdoors; praying; going to religious services; reading the literature of your faith
    Lifestyle and Health Habits Questionnaire

    Instructions: The following sets of questions cover varied areas of your personal lifestyle. How are you doing in each area? What changes can you make to improve your lifestyle? Some exercises will be presented later. Review your answers at that time to make informed choices about changes you might want to make.

    • Time Management
      • Are you always in a rush? Yes ___ No ___
      • Do you do more and more in less and less time? Yes ___ No ___
      • Do you lack adequate time for yourself and your family and friends? Yes ___ No ___
    • Exercise and Physical Activity
      • Do you exercise three to four times a week? Yes ___ No ___
      • When you exercise, do you feel slightly short of breath but not gasping? Yes ___ No ___
      • If you engage in aerobic exercise, is it for 20 to 30 minutes? Yes ___ No ___
    • Relaxation, Meditation, Visualization, and Imagery
      • Do you feel a lot of muscle tension and anxiety? Yes ___ No ___
      • Do you experience a lot of headaches, stomachaches, and other aches? Yes ___ No ___
      • Do you spend a lot of time obsessing about things? Yes ___ No ___
    • Spirituality
      • Are you a spiritual person? Yes ___ No ___
      • Do religion and God play a central role in your life? Yes ___ No ___
      • Do you talk with your classmates/patients about their spiritual concerns? Yes ___ No ___
    • Communication Skills and Social Support: The Art of Medicine
      • Do you have family and friends with whom you feel close? Yes ___ No ___
      • Are you open and appropriate in expressing your feelings to others? Yes ___ No ___
      • Do you listen to your classmates/patients and respond to their concerns? Yes ___ No ___
    • Cognitive and Coping Skills
      • Are you more likely to perceive stressful events as challenging or threatening? Challenging ___ Threatening ___
      • Are you more likely to engage in positive self-talk or negative self-talk? Positive ___ Negative ___
      • Do you feel that you have to excel in all areas of medical school? Yes ___ No ___
    • Nutrition
      • Do you eat plenty of grain products, vegetables, and fruits? Yes ___ No ___
      • Do you limit your intake of fat, sugar, and salt? Yes ___ No ___
      • Are you overweight? Yes ___ No ___
    • Substance Abuse
      • Do you have trouble setting limits on your intake of alcohol and other drugs? Yes ___ No ___
      • Are you worried about your tobacco, alcohol, and drug use? Yes ___ No ___
      • Are you spending more money than you can afford on alcohol and drugs? Yes ___ No ___
    • Humor
      • Do others see you as funny and humorous? Yes ___ No ___
      • Do you appreciate the jokes and humor of others? Yes ___ No ___
      • Can you laugh at yourself? Yes ___ No ___
    • Touch and Massage
      • Do you think touch is therapeutic? Yes ___ No ___
      • Do you enjoy being touched or massaged by others? Yes ___ No ___
      • Do you enjoy touching or massaging others? Yes ___ No ___
    Note

    1. The SPICES acronym was introduced by Julie Lusk, Mercy Holistic Health and Wellness Center, Cincinnati, Ohio, and is used with her permission.

  • Helpful Daily Reminders

    • Listen attentively and make eye contact with others.
    • Express your feelings to those you feel comfortable with.
    • Seek out and connect with family, friends, and classmates, particularly outside of medical school and in the community.
    • Clear your mind, breathe deeply, and focus on a calm and pleasant image, word, or phrase.
    • Eat breakfast and lots of fruits, vegetables, whole grains, and legumes.
    • Think positively and focus on your strengths.
    • Use your humor and appreciate the humor of others (laugh early and often).
    • Say a prayer for yourself and others, and get in touch with your spiritual side.
    • Build in time each day for fun, play, and creative activities without feeling guilty.
    • It is a strength to ask others for help if you need it.
    • Exercise vigorously a few times a week.
    • Engage in physical activity every day (walk steps, take a stroll with a friend).
    • See the best in yourself and others.
    • Make physical contact with others.
    • Attend to high-priority items and put off low-priority items.
    • Appreciate nature.
    • Keep an open mind to new experiences.
    • Reward yourself for a job well done.
    • Be content with your achievements and don't compare yourself with others.
    • LOOK AFTER YOURSELF NOW!
    The reader is encouraged to photocopy this page for handy personal reference.
    From Thomas M. Wolf, To Your Health: Achieving Well-Being During Medical School. Copyright © 2001 by Sage Publications, Inc.

    Appendix: The LSU Medical Center Health Promotion Program

    Because many of my recommendations for living a healthy lifestyle during medical school arise from my personal experiences at Louisiana State University (LSU) School of Medicine during the past 23 years, I present background information about the LSU Medical Center (LSUMC) Health Promotion Program, including an update on current developments. A convergence of events led to the development of this program, which was formalized in 1986–87. Initially, I became intrigued by the beneficial and harmful effects of medical education on the personal development of the individual student (Wolf, Randall, & Faucett, 1990). My interest developed from my close personal contact with students through the coordination and team teaching of a required behavioral sciences course for freshman medical students. This experience led to a program of research relating to the lifestyle changes, stress and coping, and health of medical students. Discussions with students, faculty, and administrators and data collected on medical student stress, coping, and health made it obvious that it is essential to equip medical students with adaptive ways of coping with the stress of medical education. I, as well as others (particularly the Associate Dean for Student Affairs and Records), proposed that the development of a health promotion program would meet this need. The Vice Chancellor for Clinical Affairs, who was responsible for overseeing LSUMC Student Health, was fully supportive of proceeding with such a program, although no formal funding was available. During the same period, medical students approached the dean about the desirability of establishing a society for impaired medical students because the stress of medical education can lead to substance abuse and emotional problems. Consequently, the Phoenix Society for the impaired medical student was established in 1985. A prevention component was one important ingredient of this program, which emphasized promoting the mental and physical health of each medical student. This prevention component meshed well with the goals of the Health Promotion Program.

    The program has evolved over the past 12 years. For those of you who are interested in reading more about the program's background, a case study was published in 1990 (Wolf et al., 1990). The program operates under the umbrella of LSUMC Student Health, which is funded through a mandatory student health fee that covers medical and counseling services in addition to health promotion services. The primary funding through Student Health for the Health Promotion Program covers a full-time coordinator. In addition, many faculty volunteer their time. A subcommittee of student representatives from all five schools of the Medical Center in New Orleans (Allied Health, Dentistry, Graduate Studies, Medicine, and Nursing) provides the major impetus for the implementation and development of new program components.

    The major features of the LSUMC Health Promotion Program include the Fitness and Wellness Center; a noon-hour wellness presentation series, now offered for 1 hour of elective credit for students enrolled in the Schools of Allied Health, Medicine, and Nursing; special interest classes; student support groups; and “Health Care Professionals in the Schools” (initially called “Docs in the Schools”). A yearly brochure highlighting health promotion services is distributed to all students. During orientation, freshman students receive a brief presentation about the various program components, with an invitation to tour the Fitness and Wellness Facility.

    The Fitness and Wellness Facility is conveniently located in the student residence hall. It consists of fully equipped cardiovascular weights and aerobics rooms. Aerobics classes are offered twice per day, Monday through Friday. Fitness and wellness program consultation, weight room instruction, and body composition analysis are available on request from the coordinator. This facility is particularly attractive for freshman and sophomore medical students, who spend most of their time in the classroom and laboratory with little opportunity for physical activity. For the 1997–98 school year, an average of 80 to 100 students used the facility on a daily basis. An average of 8 to 10 students attended each aerobics class on Monday through Thursday. Karate classes were held twice per week during the fall and spring semesters, and each class was attended by about 7 students. Because of crowding problems at peak hours, additional equipment and upgrading of the facility are needed.

    The noon-hour presentation series is held on Mondays from 12:00 to 1:00 p.m. during both the fall and spring semesters. Each session includes a free lunch funded primarily by pharmaceutical companies. During the 1997–98 year, an average of 40 students attended each of the 26 presentations. During the fall semester, 12 nursing students, 2 medical students, and 1 allied health student took the course for elective credit; during the spring semester, 13 medical students and 11 nursing students took the course for elective credit. Most of the speakers were faculty and students from within LSU.

    On the basis of the feedback and recommendations from the Health Promotion Student Subcommittee, the following topics have been covered in recent years: fitness, nutrition, time management, stress management, progressive relaxation, communication with family/friends and patients, spirituality, and complementary medicine (massage, acupuncture, aromatherapy). The schedule for the 1997–98 year included presentations on

    • Introduction to wellness
    • Culture/family environment
    • Time management
    • Conflict resolution
    • Effective communication
    • Physical fitness
    • Prevention—treatment and rehabilitation of musculoskeletal injuries
    • Nutrition
    • Aromatherapy
    • Chemical dependency
    • Spirituality
    • Proper back care
    • Healing touch
    • Effects of smoking on society
    • Self-defense
    • Cardiorespiratory response to exercise
    • Treatment of anxiety
    • Progressive relaxation
    • Weight management
    • Identification and treatment of rape victims

    The “Health Care Professionals in the Schools” program enables LSU students to volunteer and visit public elementary schools to teach students about general science and prevention. During the 1997–98 school year, a total of 16 classes covering the heart and circulatory systems were taught during eight school visits. These school visits were extremely rewarding for the participating medical students, particularly for students in their first 2 years, who have limited patient contact.

    Many support groups have been offered over the years. During the past few years, the Office of Students Affairs has matched faculty members with freshman medical students. Faculty members typically volunteer to meet with small groups of about 8 to 10 students, with the meeting time, frequency, and overall length left up to the individual groups. As a faculty volunteer, I have found this small-group experience to be particularly rewarding, and at times I have followed students through all 4 years of medical school. The students receive and give support to fellow students and often come to recognize that their adjustment to medical school is similar to that of their classmates. This recognition is of some comfort to them, for many originally think they are going through a highly unusual personal experience. These freshman students often develop friendships that last throughout and beyond medical school.

    Many self-help workbooks are available on stress, coping, and relaxation that are valuable for students. I have found The Relaxation and Stress Reduction Workbook (Davis, Eshelman, & McKay, 1995) to be particularly well received by medical students and have placed multiple copies on reserve as part of a special section on health promotion in the LSU Library. For students with significant academic, emotional, or social problems, it is important to seek out professional help through medical, psychiatric/psychological, or academic services. Many LSU students with problems initially seek out help through the Office of Student Affairs.

    I hope this overview gives you some appreciation for the growth and development of the Health Promotion Program at LSU. Financial backing from your medical school is certainly helpful. Much of our success, however, is because many dedicated faculty and students were willing to volunteer their time. I usually thank our noon-hour speakers and say they will have their honoraria doubled for the next year. They typically smile, realizing that $0 × 2 = $0.

    References
    Davis, M., Eshelman, E. R., & McKay, M. (1995). The relaxation and stress reduction workbook (
    4th ed
    .). Oakland, CA: New Harbinger.
    Wolf, T. M., Randall, H. M., & Faucett, J. M. (1990). A health promotion program for medical students: Louisiana State University Medical Center. American Journal of Health Promotion, 4, 193–202. http://dx.doi.org/10.4278/0890-1171-4.3.193

    About the Author

    Thomas M. Wolf, Ph.D., is a clinical and developmental psychologist, professor, and Chief of the Section of Psychology in the Department of 1Psychiatry at Louisiana State University School of Medicine in New Orleans. He received his doctorate from the University of Waterloo (Ontario) and completed a postdoctoral fellowship at St. Louis University. He conducts research on the stress, coping, perceived mistreatment, and health of medical students and has published over 50 scientific articles and chapters. He initiated the LSUMC Health Promotion Program in 1986 for medical center students to take responsibility for their physical and psychological health and well-being. He teaches and supervises medical students, psychiatry residents, psychology interns, and social work trainees. He received the LSU Medical Center Dr. Ernst Lederle Award for Excellence in Research, Education and Patient Care and the Senior Scientific Achievement Award from the Louisiana Psychological Association.


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