I came from Malaysia dreaming of completing my residency in the U.S. and becoming a nephrologist. Luckily, I interviewed for programs before COVID-19 shook the world, and I began my residency at Yale University Bridgeport Hospital in June 2020. Having just reached my target score for the United States Medical Licensing Exam (USMLE) after graduating from UCSI University in Malaysia, I empathize with current students struggling to study for their USMLE. Aspiring physicians have to take so much independent responsibility to succeed on their exam, but social distancing has curtailed the student peer groups, medical electives, shadowing opportunities, and in-class lessons that students typically need to thrive. Physical constraints apart, the limitations of our minds might prove to be the toughest one as this pandemic plays out its prolonged course. John Milton says in Paradise Lost, “The mind is its own place, and in itself can make a heaven of hell, a hell of heaven.” Could the lockdown of traditional educational routes awaken our potential to be resilient, reflective, and mentally strong learners? Here I’ll lay out some practical advice for students aiming high for their USMLE despite 2020’s obstacles. Maintaining motivation When you are happy, you are inclined to be future-oriented. Although motivation is intrinsic, it can expand beyond proportion by extrinsic manipulation. I find that motivation is primed by happiness, kick-started by a routine and schedule, and maintained by goals and rewards. Your imagination runs amok from the limitations the pandemic presents regarding your ability to properly study for the USMLE and the residency spots in your favorite city. The reality is that you are anxious about the health of your loved ones, your grades, and the virtual peer-study groups and residency interviews during this pandemic. There is one thing within our realm of control amidst all the uncertainties: our inner peace and serenity. When you set out to study, narrow down your focus to the “here and now.” Tackle the chapters one step at a time. Make yourself at home (as you already are). For me, I hum a tune, sing a little, and make a cup of tea. I also have sticky notes posted everywhere repeating motivational quotes back at me. You are the privileged few to learn medicine, and how many working adults can confess that their passion is aligned with their pursuit? This craft’s art takes its form from the bonds you share with your patients and the precise homeostatic mechanisms that keep us alive. The boards, the academic rigor of medicine, and the lives you touch in the hospital wards—all of these experiences will shape you into a mature, humble person who sees joy through the hard times and the easier ones. Establishing a schedule Once you are equipped with the right frame of mind, go on and stick to a daily study schedule. You can have as much spontaneity as you want in what you learn in the course of your day, but make sure that the first few hours are planned ahead. When you wake up at 5 a.m. and ask yourself “What should I read now?” chances are you will have a “to read or not to read” mental tug-of-war. Avoid this mental push-back by making a to-read list before you hit the sack. In this way, you can automatically kick-start your day with the well-defined task at hand. When I was studying for the USMLE, I used online tools from UWorld to help me juxtapose the score I’d get at that moment with my target score. From there, I decided how much I wanted to study each day and in what areas. Once you get into the flow of studying, the rest of the schedule will be easier to follow through. For each topic that you read, worry less about the answers than the questions. Ask yourself as many questions as you can. For example, tumor lysis syndrome (TLS) is diagnosed based on laboratory criteria. If you are a practicing physician in the emergency department who does not have uric acid or phosphate results yet, what would prompt you to suspect this as TLS? Do the vitals provide information? What does the published literature say about the other clinical manifestations of TLS? Out in the field, you’re handed the responsibility to be the master of both questions and answers. We can only continue to do something persistently without burnout if it is pleasurable. So make learning fun, and stay curious! Virtual peer study If you have a keen interest to dig further into a topic, you’ll stumble across new information along the way to finding the answer to your question. This method keeps boredom at bay and will make you an expert on the topic. To reap the greatest benefit, brainstorm questions with your peers. Be proactive and invite your friends to gather virtually on a regular basis. Reaching out to others and maintaining social connections go a long way in maintaining your well-being. Your peers will have different thought processes and contribute to the “learning pool” with newfound perspectives. Equally important is that you all get the opportunity to share ideas and practice thinking on the spot through frequent exchanges with your counterparts. Even if your campus is inaccessible, your study group has got your back. It is a massive, often underutilized learning resource that you can tap into. To go the extra mile, have everyone in the group list out their academic goals for the week and help each other achieve them. The efforts you put into your studies will inspire others to do the same. Like the “butterfly effect” in chaos theory, you exude this positive energy will come back to you multiplied many times from your friends. No one can foresee when this time of virtual learning will end. Whatever is to come, always remember why you started. The point of this journey is to learn, adapt, and evolve as a person. Acknowledge the frustrations and the inconveniences caused by this pandemic. Rather than impediments, the inconveniences merely show you that nothing can stop you from reaching your goals. Try these simple tricks to regain your perspective. Write a story about a patient or academic experience you deeply cared for or that changed your perspective. Make a note of the latest discoveries about a disease you want to eradicate. Stick motivational quotes that hit home in every nook of the house. Share your opinions with other medical students around the world through forums. Use your medical knowledge to help your surrounding community to understand COVID-19 and bust the myths about facial masks. Sometimes, it takes solitary confinement during a pandemic for us to realize that we are interconnected in an inexplicable way. It also grants us the opportunity to foster self-reliance and independence in motivating ourselves to get better each day. When the time comes for us to unite again, we will do so with a newfound appreciation for friendship, teamwork, and simply the sense of togetherness. During the pandemic, medical education has indeed reached new heights in raising a generation of particularly reflective and mentally strong physicians. Jia Wei Tan is an internal medicine resident. Source
