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Managing Stress in a Stressful Time

With Mental Health Awareness Month wrapping up, we decided to reach out to NBOME National Faculty members who have helped osteopathic medical students maintain their mental health and keep working towards their dream of becoming osteopathic physicians. Here they offer their thoughts and advice.

Ryan Smith, DO, PhD, MBA, MSEd, is the chair for the NBOME National Faculty Department of Psychiatry, Neurology, and Clinical Neurosciences. He also is the associate dean of pre-clinical education and professor of psychiatry at the proposed Orlando College of Osteopathic Medicine, and is physician-in-charge at the New Hampshire State Psychiatric Hospital in Concord, NH.

Robert G.G. Piccinini, DO, serves on the NBOME Board of Directors and is in private practice in Sterling Heights, Mich.


Preparing for and taking COMLEX-USA exams can be stressful. What are some ways that students can manage their stress in healthy ways?

Smith: A reasonable amount of stress can be motivating for you to maximally prepare for your school and national board exams. 

However, excessive stress can contribute to metabolic syndrome and lead to health concerns and also can impair one’s ability to learn and retain in both the short- and long-term.

Reserve time for exercise, healthy eating and cooking, spending time with friends and family doing leisure-based activities, and, in general, ensuring that things that make you happy are priorities.

Piccinini: Make sure you are eating as healthfully as possible, and scheduling light to moderate exercise. It can be something as simple as going for a walk for 15-20 minutes. Also, when you schedule time for studying, you should schedule time to step away from it. It can be overwhelming, trying to learn so much information–there is a saying that medical school is like trying to drink from a fire hose. Schedule time for breaks, and also for things you like to do–don’t give up on those hobbies. Also, medical school can sometimes feel very isolating, so it’s important to keep in contact with friends and family and talk about your stressors.


Why is it so important to develop healthy coping mechanisms?

Smith: Healthy coping mechanisms, such as humor, mindfulness, relaxation, meditation, volunteering, etc., are all adaptive and can help you through difficult times.  Unhealthy (or maladaptive) coping strategies, such as excessive use of alcohol or substances, can impair your ability to learn, and negatively impact your health and ability to rise to the challenge of medical school. You cannot ultimately support patients if you, yourself, are not taken care of.

Piccinini: Simply put,

it doesn’t get easier after medical school. From the moment you start your career, you’re dealing not only with continuing to learn new information, but also employers, patients, and families (both patients’ and your own) who all have expectations of you.

Developing healthy coping mechanisms in medical school will help set you up for a better future. It’s similar to financial investing: you can do small things to start that will pay off in the long run.


Some research suggests that medical students have higher instances of mental health issues than their counterparts in the general public. What are some early warning signs to recognize that something may be off, and how can those be managed?

Smith: This is an absolutely critical concept to address.

In many cases, others may see signs of mental health distress before the affected person does, or they are unaware of the impact it is having on them.


Ask loved ones if they may have noticed anything that has changed.  If you do realize that you are starting to feel more depressed, anxious, and scattered, or see yourself falling into negative coping strategies, please reach out to a mental health professional. Each COM has dedicated mental health services available to each student 24/7/365 – take advantage of this if it is necessary for you!

Piccinini: A behavior change is a classic sign that something is going on. This could present as maladaptive behaviors–such as drinking, drug use, or partying heavily–or, it could be someone who normally is outgoing is now isolative. Sudden irritability or aggression can also be a warning sign. Sometimes, the person suffering may not realize it, which is why it is so important for them to check in with family and friends. If loved ones see these changes, they can discuss that with them.


How can students or their loved ones tell if bad feelings are in response to something specific, such as the stress of studying for exams, or if it’s something more chronic?

Smith: Some of us can experience symptoms of conditions such as generalized anxiety disorder (GAD), which are isolated and transient and related to an identified stressor (such as feeling anxious and keyed up around the time of COMLEX-USA).  This is normal!  Anxiety can be helpful–such as running away from rustling in the bushes. It can keep us safe. But you don’t want to be in a state where the anxiety is constantly plaguing you and is out of proportion to the stressor.  That may be an indication of a disorder, which can significantly impact your day-to-day functioning. If you think the latter might be the case, please seek help from some of the many resources available.

Piccinini: Whether you didn’t perform well on your COMLEX-USA exams, or your clinicals didn’t go well, or a patient yelled at you, bad days will happen. And those aren’t inherently bad–having bad days are how we recognize and cherish the good ones. But it’s the way we react to them that can signal trouble. 

If you feel like you’re in a perpetual “bad day” for more than a few weeks, or if you start to feel like you’re worthless or life isn’t worth living, those feelings warrant seeking help.


What piece of advice do you offer students to help maintain their mental health?

Smith: Seeking help for a mental health difficulty is not shameful, and does not make you seem “weak.”

It shows that you are utilizing the resources available to you, and seeking to improve yourself and prevent any further worsening of symptoms you are experiencing.  Remember, early treatment is best for most conditions, and that includes psychiatric disorders.

Piccinini: As you’re trying to study, it can feel like you’re sacrificing your life for medicine, especially if you see friends on social media enjoying a vacation or doing things you’re not able to do right now. But it’s important to remember this is just a fixed point in time; keep your eye on your goal, work your plan, and reach out if you need to.

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