To get into medical school, we are taught to be uber-competitive from a young age. It has never been easy to be a doctor. Most medical schools require you to have a minimum of 3 As at A-level, as well as high grades at GCSE. You are then expected to compete with others to get work experience placements and extracurricular activities to make you stand out. Then you have to complete your UCAT (and in some cases BMAT), and then carry on competing at your interview. You would think that once you’ve got your foot firmly in the door of university, the competition at medical school ends. Unfortunately, it doesn’t. Even at medical school, we carry on competing to pass, to get your F1 jobs, to get the best opportunities and more. This mentality of constantly needing to be on your A-game can be exhausting. It leads to feelings of imposter syndrome when you’re not getting top grades, and anxiety around every exam season. The fear of working hard and just not being “good enough”. But, this isn’t the case. We are just as worthy with a pass and with a fail. Our worth is not determined by a place in a grade ranking, or a score on a piece of paper. Competition breeds unhealthy relationships with your peers and within yourself. Instead of worrying about what the next person got, we should be encouraged by our own achievements, by doing better than your last grade - not someone else’s. Competition and medicine go hand in hand, and it can be demoralising to never feel secure, to always feel like you’re fighting the next person to achieve the future that you’re working so hard for. Competition can create toxic work environments and can lead to life-long hold-ups about achievements. You can never be happy for yourself or anybody else if you’re constantly fixated and needing to be the best. And this isn’t just a personal problem, it’s a systemic one. Medics are practically bred to be success-hungry and motivated individuals because we don’t have a choice. Medical school is so competitive for two main reasons: 1. Medicine is Difficult: Medicine is considered one of the hardest courses at university, and therefore, medical schools want students that they believe can keep up with the workload. Hence, the grade boundaries are so high. 2. Medicine is Attractive: In 2021, there was a 20.9% year-on-year increase in medical school applicants which is fantastic! It’s great that so many people are wanting to become doctors. However, universities have a limited number of places and resources available. This means that not every applicant can get a place. These things make getting into medical school really tough. And once we graduate, not everyone will be able to get the foundation job that they want, because there are finite numbers of everything. Competition can drive us to burning ourselves out in order to do the best we can be. It can also make us desensitized to our own achievements, instead focused on doing better and passing, rather than congratulating ourselves for how well we’ve done. Medical school is really difficult. It can be really easy to be hyper focused on achieving the highest grades because that is what we’ve been taught to do. You don’t need to. A good doctor isn’t defined by being the top of the class. A good doctor is defined as having clinical competence, being compassionate, and committed to medicine. As long as you are those things, you’re doing the best you can. Passing your exams is enough to show that you have all the information you need to be a competent doctor. You don't need to and shouldnt strive for perfection at the detriment to your own mental health. Focus on competence, not competition. If you want to read more about competition at medical school, there’s a blog post here. It highlights how as medics, we are part of a wider team, and should be taught that from the start, rather than competing with each other. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com. If you’re struggling with any other issues, have a look at our website to find some resources that may help you.

Sometimes all the support you need is to hear that someone else is feeling how you feel. This year, that’s been even tougher, with many of us isolated, without having the chance to speak to other medics, it’s really easy to feel as though you’re the only one struggling or not understanding something. This can make you stressed and anxious, and being out of touch with your peers can make you doubt whether you’re cut out for medicine at all, but that’s not the case. We all need help sometimes. There will always be content that you don’t understand, questions that you don’t get right and that’s okay! Because we all do. No doctor or medical student is perfect, and we’re not supposed to be. It can be really difficult coming from sixth form getting the top grades, only to be very humbled by your first formative at university. Remember that these tests are there for you and you only, to understand where you went wrong and where to improve. Now, more than ever, it’s okay to feel overwhelmed. We’re in a completely unfamiliar situation, that, at times, can feel really lonely and isolating. But you’re not alone, and there’s plenty of resources and people to talk to if you feel that way. Medics are allowed to make mistakes, we’re allowed to laugh at our own misunderstandings, we’re allowed to grow and to learn - that’s what we’re here for! The most important thing is for medics to feel supported by one another, and that can’t happen until we create a dialogue where we can freely speak about our mental health and when we feel alone or isolated. Right now, you may feel isolated, seeing all your friends go out now that things are open, and you’re too anxious to join in. That’s fine and completely normal. If you’re not comfortable going out, maybe make connections in another way with a video call or a socially distanced picnic. In first year, you might think that you’ve drifted away from your friends at home, and that they don’t want to talk to you anymore. It’s very unlikely that that’s the case. They might feel exactly as you do, waiting for you to reach out. Here are some ways to feel less isolated at medical school: 1. Join a Society As things open up more, there are now more COVID-safe ways to join in and meet people at societies. This is a really great way to meet like-minded people or step out of your comfort zone. There are lots of medic-specific societies, or if you want to branch out a bit more, join a university one at https://su.nottingham.ac.uk/shop/fields/1946. 2. Reach Out to Your Peers So many people are in the exact same position as you, worried about making friends, but may feel intimidated or embarrassed about reaching out. If you feel comfortable, ask someone to go for a coffee or to go over some course content with you. 3. Stay in Touch with Family Speaking to your family can be a great way to lift your spirits and vent about how you’re feeling. It can make you feel more connected to home and make your transition to university life a little bit easier. 4. Join Group Chats If you haven’t already, join group chats for your course and accommodation. This is a great way to keep up with things and to meet new people. A lot of the time, we impose loneliness and isolation on ourselves. You may convince yourself that no one wants to talk to you, or that you won't make friends at university. That isn’t the case, although sometimes it can definitely be difficult. The best way to avoid isolation is by putting yourself out there, which may be really daunting, but you can meet new people and build your confidence in your social and educational life. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com. If you’re struggling with any other issues, have a look at our website to find some resources that may help you.

What is burnout? Burnout is caused when you overwork yourself for prolonged periods of time, which can lead to exhaustion, heightened anxiety and irritability. While using all of your available time to do university work or revision may seem really productive, in the long run it can damage your productivity. During the pandemic, it’s been easy to sit at home and just work because you have nothing else to do, with a lack of routine. This can lead to sleeplessness, confusion, anger issues, depression and weight gain. Burnout is common in medical students, especially as exam season is coming up. Lots of you may be pushing yourself to your very limits, focused on getting your exams out of the way. “It’s only a few more weeks”, you tell yourself. But creating a routine to help you avoid this high pressure working can actually leave you feeling happier and less stressed. Going into exam season at the end of your tether, tired and irritable is not how you are going to perform your best. Instead, planning and spacing out your revision, not cramming at the last minute, and enriching yourself with activities you enjoy will lead you to having a less stressful exam season. Burnout can lead to a wealth of problems, most of which are the opposite of what you’re trying to achieve. It can lead to reduced creativity, poor performance, a lack of self confidence, and physical symptoms such as headaches and stomachaches. These feelings can impact on your relationships with your friends and family and how you interact with your patients. It’s really important to try and avoid burnout, not just for our professional and educational development, but for our mental health as well. Most medical students will experience burnout at some point in their medical school career, and that is completely normal. The best thing you can do is avoid getting burned out altogether, but it’s just as vital that once you are in a period of burnout, you know how to deal with it and have resources on hand to help yourself. Here are some ways of avoiding and coping with burnout: 1. Allocate yourself work and rest days The best way to avoid burnout is by setting yourself a realistic plan of what you want to get done each day, and giving yourself regular breaks away from your work. This way, your working will feel more structured and sustainable. It will also help alleviate any anxiety over when you need to get tasks done if you’ve planned all of this out in advance. Visit https://getrevising.co.uk/planner to start your own planner. 2. Talk to other people on your course Talking to other people who are in the same boat as you can be a really useful way of expressing any worries you may have, and most of the time finding that other people are struggling with the same things that you are. Group study sessions are a great way to do work, while also getting out and seeing people, to avoid being stuck in your room all day. 3. Eat, Sleep, and Drink Make sure that you’re getting enough sleep, and not constantly pulling all nighters. This will only make you feel worse in the long run and will damage your productivity. You should also be making sure that you’re drinking enough water to keep you hydrated and prevent headaches as well as making you feel more focused. Try as best you can to eat a balanced diet and to be eating enough each day. Skipping meals will make you tired and agitated. 4. Tell People How You’re Feeling If you are in a period of burnout, don’t feel guilty about pushing back non-urgent matters to take some time for your mental health. Don't be afraid to say “I’m burned out with work right now, can we push it back?”. Don’t feel the need to take on additional responsibilities. Most people will be understanding and will then know to ease up on the pressure that they put on you. Burnout is a completely normal thing that is extremely prevalent in medical school. The best way to avoid burnout is to speak to your peers and create a sustainable routine. Having a life outside of medical school is a priority, even if that means occasionally putting your studies aside in order to have some you time. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com. If you’re struggling with any other issues, have a look at our website to find some resources that may help you.

As medical students, we are taught to prioritise our patients. To treat them with empathy, compassion, and respect. To focus on their wellness, to do no harm. Less so, are we taught to do this for ourselves. It isn’t often that we treat ourselves with compassion. Most of the time, we overwork ourselves and feel guilty for taking breaks, ashamed of making mistakes, afraid of not being good enough. But caring for yourself is the only way you can be in a position to care for your patients. Self care does not mean absence of illness, anxiety or self doubt. It means to take time for yourself outside of your work. This can be having a bath, eating a food you really enjoy, or spending a few hours scrolling through TikTok. Self care does not need to be productive, it just needs to be time for you to unwind. You should care for yourself with the absence of guilt. Don’t feel guilty for taking a break to do something meaningless. It doesn’t matter if you didn't finish your goals for today, there is tomorrow. We, like our patients, are not perfect people, and you should be under no illusion that we ever need to be. As exam season comes up, it’s so easy to push yourself to your breaking point in the name of productivity, to tell yourself that you only need to be going at 100 miles per hours for a few more weeks. Productivity is not working 24/7, instead, take regular breaks for things that you enjoy, rather than overworking and burning yourself out. It’s easy for medics to feed into the notion that medicine is your life, rather than a part of your life. Medicine is not all that you are or all that you need to be. You can only be the best version of a medic if you are the best and happiest version of yourself. The first stage of this is your own self care. This past year, for a lot of us, self care and routine has gone out of the window. We’ve been isolated, bored, and worn out. Here are some self care resources that you may find useful: 1. Breathe Self care doesn't have to be face masks and bubble baths. It can be talking to someone and focusing on your own mental health. Thanks to funding from the British Medical Association, Breathe is offering free counselling to doctors and medical students. You can chat to someone confidentially about whatever you want, whether you’re stressed with work, your family, or if you just need to unwind. Visit breathe-uk.com if you’re interested. 2. Pamper Sets If face masks and bubble baths are your thing, here are some pamper sets that you can relax with. Taking time for yourself is really important. Switching off from a screen even for 20 minutes to do some self care can be the boost that you need. Take a look: Radox Detox Bubble Bath - Boots, £1.20 Dove Perfect Pampering Duo - Superdrug, £5.50 Spa Gift Box - Etsy, £13.50 3. Podcasts If you’re looking to unwind or want something to listen to while you’re working, make it something that you enjoy! Spotify has a wide range of free podcasts to listen to, ranging from true crime, comedy, beauty, sports and more. It’s a really good idea to set aside some time for things that you enjoy and that you’re interested in outside of medicine. Podcasts are a great way to get some you time while you’re on the move. Go to spotify.com to find something that suits you. 4. Take Up a Sport Sport can help people to unwind, get moving and make friends. You can do some exercise alone, or join a team at the university, whatever level you’re comfortable with. Joining a team can be a great way to meet some new people with a similar interest to you and get your mind off of work. Visit our Healthy Lifestyle page to find out what activiteis the university have to offer. 5. Meditation and Yoga Meditation can be a really useful way of de-stressing yourself and focusing on your mind and how you’re feeling. It can help you clear your head, especially before bed after a long day. Check out headspace.com to get started if you’re interested. Yoga is great for those of you in small uni accommodation. It doesn’t need much room and it doesn’t have to be high intensity. Getting up and moving is a good way to break up your day. Here’s a playlist of yoga for beginners that you may find useful: There are so many other things that you can do as part of your self care, such as talking to a friend, going for a walk, or even going to bed an hour earlier. Self care doesn't have to be one massive change - it can be lots of little steps that mean you focus on your commitment to yourself rather than others. That can be a difficult thing to do, and it can feel overwhelming taking time out of your other commitments to care for yourself. At times, it may even feel selfish. But, little by little, you may find that setting time aside purely for yourself actually makes you more productive. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com. If you’re struggling with any other issues, have a look at are website to find some resources that may help you.

Dana 1st Year GEM Student Diagnosis of Grave “Diagnosis of grave”, a few words that have stuck in my mind after listening to the TED TALK by Elyn Sacks following the launch of her autobiography “The centre cannot hold”. “Diagnosis of grave” was the paraphrase used by Sacks’s psychiatrist to describe a state of such severe mental illness where a person is physiologically functioning but emotionally the impending sense of doom is such that the feeling is about not living, being buried. I have experienced that very emotional state: being physiologically alive but emotionally dead. With a diagnosis of Complex PTSD and traits of Emotionally Unstable Personal Disorder, mainly due to serious traumatic events in childhood and adolescence, at times my only purpose in life has been self-destruction. My main goals were to punish and inflict all the pain possible to the person I was, a person who was not worthy of life. The only mitigation to that feeling, the only moments of joy were given by academic success. Postgraduate studies and post-doctoral appointments in prestigious universities in bioethics had stopped the vicious circle of self-destruction for a few years and made my usual symptoms more easily tolerable. Then academic positions rejections, loss of loved ones, inability to find a purpose in life outside the comfort zone of academia became the reasons behind a bad relapse. And the vicious circle of self-destructive behaviour, hospitalisations, crisis team interventions went into full activation once again. Until one day, at the lowest emotionally and physically in ICU, one of the doctors assessing me, with moving kindness told me “As a doctor I wish I could prescribe something for you that could make you see the beautiful, intelligent person you are, that could make you realise how much you have to offer. Think about what is that you would like to be.” I was so positively surprised by those words that my answer was “A good doctor like you.” That emotional response turned into a more structured plan of action for the future. I needed to start from a clean slate with humility to rebuild my life. So I decided that I wanted to try Graduate Entry Medicine. While preparing for entrance I studied A-Levels in Maths, Chemistry and Biology and worked as an HCA in a psychiatric unit. Working through the goal of getting a place into a medical school has been a powerful motivator in my recovery process, a focus beyond the self-destructive impulses. When in May I ended up with 3 offers for a med school place out of 4 interviews, after a long time I felt sheer happiness. Now I have started GEM Medical school in Nottingham and though there is heavy workload, usual problems associated with the running of NHS and universities, the pleasure of studying medicine is undimmed. This joy of the practice of medicine has given me emotional strength that has had a very positive impact on my overall mental health. There are some tricks I use for my own wellbeing and promoting an open dialogue about lived experience of mental health among medics is one of them. You will be surprised at the number of people with similar experiences of suffering and recovery. Sharing together in safe places is extremely beneficial when struggling emotionally. I also love cats and spend time with them as much as I can either volunteering in cat shelters or cat-sitting. Ballet classes and walking by the sea are other hobbies that make me feel relaxed. I find it also a game-changer to reach out to friends and spend some quality time with them. I am a late-thirties, foreign medical student with a diagnosis of severe MH AND A PROSPECTIVE DOCTOR. Passion for medicine has given me a new lease of life. Suffering from mental illness and being open about it has not made me a worse medical student than others. Quite the opposite: having declared my mental illness fully from the very start I have received the right support from university. Currently I have full attendance and done well in my initial assessments. Only anecdotal experience: but still a few words to encourage med students to reach out for help when struggling emotionally. Also a humble example that suffering or having suffered from mental illness does not prevent an academically talented individual to become a doctor. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com or fill out the form below. If you’re struggling with any other issues, have a look at our website to find some resources that may help you including our CRISIS page.

Annonymous F1 Doctor I have just started my FY1 training after graduating from Nottingham medical school this year. It has been such a journey and I couldn’t have achieved it without the support of my friends and family. I have struggled with my mental health since I was 18, experiencing both anxiety and depression throughout medical school. At times I did not think I would be able to get through it but by opening up about my mental health I found great support that enabled me to flourish. Now as an FY1 I look back at my time in medical school with great joy as it was one of the best experiences of my life. There were times when I cried, failed exams, burnt out and even had to repeat a year but all of this made me stronger and more equipped to deal with life working as a doctor. If you are struggling with your mental health, please know that you are not alone as more people than you realise will be in the same boat. By talking and opening up about how you are feeling, people around you can support you. Even the simplest things like asking how your day was can be the thing that keeps you going. Never feel ashamed, nobody goes through medical school without having doubts or times where things seem impossible. Be assured that even by being in medical school you have achieved so much and help is always out there! Be kind to others and most importantly yourself. Nothing is ever as bad as it first seems. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com or fill out the form below. If you’re struggling with any other issues, have a look at our website to find some resources that may help you including our CRISIS page.

Laura Oler Nottingham Alumni Mental health can affect anyone but given the age of most university students and the additional pressure, it is highly likely to happen whilst at university. They’re meant to be the days of your life but life doesn’t always work like that… I never thought it would happen to me. I always thought anxiety happened to people who worried about things. To people who got stressed about every little detail. I thought it was more of a personality trait than an illness. I’m not an anxious person, I thought. I always thought people who were depressed were negative. I thought they were lazy and didn’t do enough to help themselves. I didn’t understand. Suicide was something I was exposed to at a young age. It blew my mind that people who went to my school felt that hopeless that they could do that. I saw the effect it had on a whole community. I thought I would never ever consider it. But then I got that low. It’s not a selfish decision, in fact it feels selfless, and like your life is a massive burden and it’ll be a relief to everyone. It’s a dark place that is incomprehensible until you’ve been there. I also thought people with mental health conditions wouldn’t make good doctors. That they would never cope in a stressful environment. I went through years of naivety and blissful ignorance. It then crept up on me. The first few times when I felt hopeless and hated myself and my life, I pushed down those feelings and used avoidance tactics such as watching endless episodes of comedy TV programmes, pushing my body to its limits in triathlon training and going out and getting blackout drunk. For a brief period of time it did work. I recovered and it cemented my belief that I wasn’t ill, that I could help myself. Friends encouraged me to talk to someone, but I never did. I often think would things be different if I’d sought help earlier? Would I have even got ill if I hadn’t gone to medical school? Life is full of what ifs and there’s no point agonising over them. By the time I got to 4th year I was very much in denial of my own mental health. I used avoidance tactics all year and it almost worked. Almost. I made excuses and told myself I was just stressed and everyone was in the same boat. And to be honest, most of us were. The year was 42 weeks long with lots of emotionally taxing placements and an unrealistic workload. This, alongside a 20% fail rate, made for a real battle with any demons that were pre-existing, as well as bringing in new demons. I wasn’t coping. I buried my head in the sand. I ended the year underweight, exhausted and seriously mentally unwell. I failed my exams, let’s face it I was just not well enough to pass. In our practical OSCEs, anxiety does you no favours. I completely froze up in one station and ended up getting 4% in it! After failing my exams I cried all day. I was on holiday at the time, and again buried my head in the sand and continued the holiday like nothing had happened. When I got back things were bad. I felt worthless and couldn’t concentrate on anything. I had absolutely no self-belief. With resits coming just 1.5 weeks after result, I had no hope. There simply wasn’t enough time to get the right help. My friends were there for me and eventually I told my parents honestly how awful I was feeling and my mum came up to stay. Then my family went away on holiday. Well, I wasn’t about to ruin their holiday was I? I had to start the next year before knowing results and if I’d be staying. That was hard. I refused to go to the year group photo as I knew I wouldn’t be in the year for long. I saw the GP for extenuating circumstances, they gave me some meds and waved me away. I agonised over the decision of whether or not to take them in the end I did. It had helped friends, and I was desperate, I’d try anything. A good friend of mine recommend a different GP, I saw her and felt super supported. I was referred for CBT on the NHS. I recovered. A mix of settling into a new year, being surrounded by supportive friends and family, therapy and medication helped. But that wasn’t the end of it. I had a good year. I spent more time with friends, got into a relationship, started to excel on the course and I signed up for an ironman. Mistake number 1. Because I felt well I felt like I had to do everything at once and make the most of it. Ironman training was hard. Starting 5th year was hard, I went from knowing all the answers to once again feeling out of my depth. I had also accidentally (yes, really) come off my SSRIs, I kept forgetting to take them and felt I didn’t need them anymore. I moved house, with housemates who weren’t around as much and didn’t know me as well. The ironman didn’t go to plan, the bike was cancelled due to flooding. There was no one trigger but multiple things added up and contributed to poor mental health once again. This time I knew what to do. One night I went to bed early as I was shattered and I couldn’t sleep. My heart was pounding and my thoughts were spirally anxiously. I booked a GP appointment the next day and restarted the medication. The problem with antidepressants is that they can take weeks-months to work and the initial side effect is worsening of anxiety and suicidal thoughts. Great. The next few months were a real battle. I got lower than I’d ever been before. I would go to bed at night hoping not to wake up in the morning, not so much in that I wanted to die but more that I didn’t want to wake up in the middle of the night with the awful physical anxiety symptoms and go through it all again. I started another medication, which helps with anxiety and sleep. And eventually, 3 months later I recovered. In this time I had a total of 7 days off placement. For me, being busy kept me going, it distracted the anxiety and was an outlet for the nervous energy. It doesn’t work for everyone but it worked for me. My medical school tried to push a year out but I resisted and wow am I glad I did. Because I’m proud and grateful to say that today I found out that I passed my final exams and will start working as a doctor in August. I am proud to say I’ve battled anxiety and depression. I am pleased I have insight into my condition and know what helps me. I truly believe I have a lot more empathy and maturity because of it and that it will help me and not hinder me in my future career. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com or fill out the form below. If you’re struggling with any other issues, have a look at our website to find some resources that may help you including our CRISIS page.

Libby Smith 5th Year Student, University of Nottingham People who know me, and even those who don’t, probably know the following about me: 1. I’m welsh 2. I get migraines The first is because I’m fiercely patriotic and will bring it up any chance I get (apologies to my housemates for my behaviour on match days). The second is because when my migraines were at their worst, I’d be taking 2 or 3 days off placement some weeks, and that sort of thing rarely goes by unnoticed. I was diagnosed with migraines in second year, and it was hardly a breakthrough – my mum and granny have suffered with migraines for as long as I can remember, and as soon as I got my first, I knew that I’d lost this particular round of the genetic lottery (my sister is unscathed). As medical students, you can probably recite the symptoms: throbbing, unilateral headaches, nausea, vomiting, photophobia etc etc. What people don’t understand however, is that it’s not just a bad headache; it’s as if someone’s turned on a tap and drained you of all your energy whilst repeatedly kicking you in the brain. My friends and family can tell when I have a migraine, sometimes before the headache even kicks in. They’re better at picking up the little ques than I am: the exhaustion, the non-existent appetite (which is a huge red flag for someone as persistently snacky as myself), the aversion to strong smells, the permanently half closed, sensitive and sore eyes. Most of the time I wake up and I “just don’t feel right”. And to add insult to injury, to pour salt on the wound, to kick a man when he’s down: if the migraine was a particularly bad one, or if the stress behind it hasn’t been addressed, I get what I’ve coined a “migraine hangover”. The “I just don’t feel right” feelings described above can persist into the next day, vanquished only by sleep. Back in second year, the migraines were a once a month sort of thing, though they upped their ante come exam time and I ended up sitting my REN exam in the throes of a migraine, squinting at the ROGO screen so as to reduce the pain the blinding white screen was causing my eyes. Mercifully, after exams my migraines settled down to rearing their ugly head only once a month, and I could deal with that. A day off every four weeks is allowed in my opinion. I should also mention that I became a pretty frequent visitor to Cripps Health Centre in my quest to find a medicine that would treat my migraines. Paracetamol and ibuprofen didn’t come close, neither did high dose aspirin, or over the counter anti-migraine tablets, and finding a triptan that didn’t make me feel even worse was no mean feat either. The first triptan I tried, sumatriptan, made me confused and drowsy, made my nose and scalp burn in a pins and needles sort of way, and I had to make sure I was within 15 minutes of a bed before I took them because I’d have to sleep through the worst of these effects. Thankfully, after much trial and error, I’m now on frovatriptan, which isn’t perfect, but at least I can take them and still function, and rather importantly, they can get rid of a migraine. And then along came third year, more specifically CP1. I had gone through a breakup in the November just prior, so wasn’t in the best frame of mind (and now, with the benefit of hindsight, the no sleeping, no eating and complete anhedonia was likely depression). I wasn’t expecting CP1 to be all rainbows and fairies, however I also wasn’t prepared for the paralysing anxiety and panic attacks, the stress of which catapulted the frequency of my migraines from a manageable once a month to a crippling twice or thrice a week. Couple this with the fact that the sumatriptan made me feel ten times worse, and the foggy day after the migraine before, and I was looking at being effectively out of action for 3 or 4 days a week. Rather understandably, this didn’t have a soothing effect on my stress levels, and so the cycle perpetuated. I was lucky enough to find a teaching fellow who I trusted, and with his support, started getting help. I then went on the fun explorative journey of finding a preventive drug for my migraines. I tried beta blockers, which might as well have been sugar pills for all the good they were doing (and rather interestingly had no effect on the anxiety I didn’t know I had at the time). I was then put on pizotifen, which made me so unbelievably drowsy that I was drinking 4 coffees a day just to stay awake and was still asleep by 9 (and yes that much caffeine probably wasn’t good for the anxiety, panic attacks or migraines). Only after months of suffering did I finally tell my GP that I’d been diagnosed with social anxiety and panic disorder by a therapist I’d been seeing on the down-low, and asked if he thought an anti-anxiety would help. I’m still ashamed that I found it so easy to talk about a physical health problem (my migraines), but tried and failed to tell my doctor on several occasions about the therapist I was seeing with Trent PTS, because of my own internalised stigma with mental health issues. Now whether it was the CBT or the sertraline that finally did the trick I don’t know, but as soon as I was in control of my anxiety, my migraines dissipated once more. I’m now into CP3, and although I still get the odd migraine, and they will likely become more prolific as we head towards the dreaded 5th year exams, I’ve never felt more in control of my body and my health. I finally understand my migraines, what triggers them (sorry alcohol but we cannot be friends come March), and how to best ease my stress and anxiety. Those 18 weeks of CP1 were the longest, most gruelling weeks of my life, and I’m not going to shy away from the fact that I was closer to quitting than anyone knows. But now I’m on the other side, I couldn’t be prouder of myself (c’mon, if I can’t blow my trumpet who will?), and I feel ready to face whatever else medical school has to throw at me. And so, what have I learnt from this year long saga I hear you ask? 1. It’s ok to not be ok 2. See your GP sooner rather than later, and let them in on the whole picture 3. Tell someone in the university. Anybody – welfare, a friend, a clinical fellow – at the end of the day there is a little bit of wiggle room where you can sort your health out, but people need to know before they can help you 4. No matter how much I try to deny it, alcohol is a sure-fire way of making sure I’ll get a migraine the following day (no clear links to chocolate and cheese though thank god) - find your triggers and work around them 5. A headache / mood / food diary will help you make sense of it all 6. Everyone is going through something, you may notice, you may not, but everyone is human, and illness is a part of life 7. Those gel eye masks you can put in the fridge are an absolute GOD SEND 8. If you need to take some time out, medical school will be exactly where you left it – you have one body and one mind - don’t you dare neglect them. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com or fill out the form below. If you’re struggling with any other issues, have a look at our website to find some resources that may help you including our CRISIS page.

The Medical Student Scared of Wards Libby Smith 5th Year Medical Student, University of Nottingham I can’t tell you how many times I’ve opened a blank word document that I’d pre-emptively saved as “panic attacks blog”, only to close it after the enormity of the task dawned on me once more. How am I supposed to put in words the most tortuous time of my life, with the intention of sharing it with the internet? But that’s exactly why I feel compelled to. A reluctance to talk about mental health, be it due to fear, shame or denial, feeds into the already damaging narrative of secrecy that perpetuates the stigma seen at medical school and beyond. So here it is. Here’s the story of how someone with no prior mental health problems went from fully functioning CP1 student to a ball of anxiety too terrified to enter a ward. The start of CP1 involves 2 weeks of pretty intense lectures and skills practice, in the comfort of seminar rooms and lecture halls, and I won’t lie, I loved it; I’d been waiting two and a half years to finally get out of LT1 and into the front line. Pre-clinical hospital visits gave me a joy de vivre that told me I was exactly where I needed to be. In the third week, I’d been inducted into Southwell, a respiratory ward in city hospital that would be my home for 9 weeks. That Wednesday, I had a doctor’s appointment at Cripps to have a review of my migraines, and it felt like it was the first time I’d stopped in weeks. As I walked up Cripps Hill, it started. My throat felt like it was closing up, and I thought I was having a delayed anaphylactic reaction to something I’d eaten. My tongue felt too big for my mouth, which seemed to be instantly devoid of any saliva and my hands and toes went numb. A rush of heat started from my stomach and swept over me, leaving me faint and sweaty, and my heart was beating so fast I feared it would burst out of my ever-constricting throat. I went into panic mode, as I think anyone who thought they were dying would, and after what was only probably a minute but felt like at least 10, I managed to control my breathing and start walking again. It was only then that I realised that there were tears streaming down my face. I never told my doctor what happened just minutes before. I’m so ashamed to say it now, but I was afraid he’d think me weak. I was afraid he’d think me unable to manage what seemed like every other CP1 student was managing just fine with. In fact I told no-one that day, and went to bed with an anxiety that had crept into every corner of my mind, and an inescapable fear of the day’s events repeating themselves. Fear is defined as an unpleasant often strong emotion caused by anticipation or awareness of danger. It is what grabs hold of those suffering with panic disorder and squeezes harder and harder, leaving them terrified of anything that could bring on a panic attack, manipulating any place or scenario that coincided with a panic attack and turns them into triggers, leaving fewer and fewer fear free places or situations. I got my second on the way to a ward, and from then on hospitals presented a very real danger to me. I remember walking up 3 flights of stairs to get to an AMU (lifts were a big fat no due to me now being scared of confined spaces, or a lack of immediate exit), getting to the door of the ward, and feeling that rush of terror crash over me. I ran down those stairs 3 at a time, fumbling for my phone, and ran out of south block hyperventilating and crying, desperately calling members of my family for reassurance. I called my mum, no answer. Called my sister, brothers, no answer. I wouldn’t normally disturb my dad in work for something as trivial as being too scared to walk onto a ward, but you have to understand that in that moment walking onto that ward was the worst thing I could possibly do; it was terror inducing. He answered, thank god, and spent 10 minutes talking me down from dropping out of medicine. At that moment I thought I had well and truly gone mad. The anguish of forcing yourself into panic inducing scenarios day in day out took its toll on me, and I started getting near constant migraines, which in my current state was almost a relief. Alas, a physical health complaint I can use to excuse myself from a ward. How much easier it is to say “I’m sorry I can’t come in I have a migraine” than “I’m sorry but the prospect of walking onto your ward makes me want to simultaneously cry, vomit, faint and run away, and I have absolutely no idea why”. Of course, I couldn’t spend the whole 18 weeks avoiding wards, and so I finally mustered up the courage to talk to a teaching fellow and I decided to reach out to one from the induction weeks who seemed particularly approachable. As I sat in his office and spoke aloud for the first time about what I was going through, I finally snapped. Migraines were now the least of my worries, as the hopelessness of having panic encroach on more and more aspects of my life made me depressed. Imagine feeling like you had absolutely no control over your body, how it reacted to harmless scenarios and how that would make you feel. I doubted my future vocation daily – surely no successful doctor has ever been too terrified to enter a ward? Confiding in someone was my turning point. The teaching fellow submitted a support form to the university on my behalf, and as a reply I was told to make appointments with the welfare team, a clinical sub-dean and university counselling service. I will say, to any of the powers who’ve gotten lost and found themselves reading this blog – one meeting with a counsellor is useless, as is the fact that I had to take even more time off placement to go to these meeting which were all at QMC or university park. I was told time and time again that distraction techniques would fix me, which is total bullshit, and when they didn’t work made me feel even more broken than I already did. One good did come of it, as I was told after my 1 counselling session that I could self-refer for CBT online. I did it that night, and poured my heart out on that application form, which is probably why I was offered an appointment 3 days later. That first appointment involved me crying non-stop for about an hour, but after the second, the panic seemed to melt away. What caused this miraculous recovery? Education. My therapist explained the cycle of emotions, thoughts, physical reactions and behaviours, and suddenly there was a reason why I was reacting so irrationally. We spent the next few sessions challenging thoughts, inducing panic attacks in a safe environment, graded exposure and discouraging safety behaviours. I got given homework to do, and she gave me resources that helped to educate me about the condition. I also came out with a diagnosis of social anxiety, but that’s a story for another time. Recovery was by no means overnight, and I still have some residual anxiety, but I can now subdue feelings of panic before they become full blown panic attacks, and I’m infinitely happier. I owe my happiness, my still being on this course and my sanity to my therapist. I ended up having 8 sessions, but I’ve been thinking recently about re-referring myself for help with my social anxiety. I’m now onto CP3, I loved GP, obs and gynae and paeds more than I ever thought possible, and I’m forever grateful that I’m still training to do my dream job. I’m also on sertraline to keep my anxiety and mood at a more manageable baseline, which I’m no longer ashamed of. My name’s Libby: I have panic disorder; I have social anxiety and generalised anxiety disorder; I take sertraline and propranolol. Reaching out for help was terrifying but I’m forever grateful to my past self for doing it when I did, and for being brave enough to go to therapy. Because it is brave. Admitting you need help is courageous. Asking for help is heroic. Getting help is revolutionary. And you deserve it. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com or fill out the form below. If you’re struggling with any other issues, have a look at our website to find some resources that may help you including our CRISIS page.

Testimony to Getting Help - Anonymous I’ve grown up in a world, like many medical students, where everything and everyone seems to be perfect. Everyone is so intelligent, sociable, confident; everyone is always travelling to exciting places, doing amazing things and doing all of this with other perfect, bright people. If you know me, you probably consider me to be one of these people. When I think about it like that, it makes me realise how wrong those impressions can be. My difficulties with mental health started at a very young age. I struggled with self-confidence issues as a toddler, which persisted and progressed into more complex issues around friendships and relationships as a young teenager. In my teens, I was bounced between therapists when I was struggling with self-harm. Applying to medical school, I was terrified that my mental health would prevent me from getting a place. People told me I wouldn’t have the resilience to make a good doctor. I really thought that this could be true. But I made it, and here I am in final year. For the most part, I have had the time of my life at university. But, unknown to most, there have been periods throughout medical school where I was having severe panic attacks and episodes of self-harm almost daily. In my darkest moments, I have considered taking my own life. And I was too frightened to get help, for fear of not being allowed to graduate and for fear of not seeming perfect. I have been so lucky to be surrounded by so many fierce friends at medical school. Without them, I’m not sure where I would be today. One of my closest friends went with me to see a doctor and since then I’ve been under the care of a psychiatrist, on the right medication, getting the right therapy. I am a million times better than I was this time one year, two years and three years ago. So, my advice to you reading this is this. If you feel that you are struggling with your mental health, don’t be afraid of it. Instead, be proud of yourself for recognising it. Tell someone you trust, ring your GP, get in contact with the welfare team. If you have the emotional insight to recognise you are struggling then you are not just going to be a good doctor, you are going to be a brilliant one. You will never, ever be punished for seeking help. As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com or fill out the form below. If you’re struggling with any other issues, have a look at our website to find some resources that may help you including our CRISIS page.

Imposter syndrome is loosely defined as doubting your abilities and feeling like a fraud. It disproportionately affects high-achieving people, who find it difficult to accept their accomplishments. Because of this, it is something that plenty of medical students experience and is rife in medical school. Imposter syndrome can negatively impact your self esteem and make you feel like you aren't good enough. If imposter syndrome is left unaddressed, it can lead to anxiety, burnout, and emotional exhaustion. A study of imposter syndrome in medical students stated that 38.09% of the sampled medical students had moderate imposter syndrome and 54.49% had severe imposter syndrome. When you get to medical school, you might feel like you've gone from being top of the class to being surrounded by lots of people at the same ability as you. You might not be doing as well as you did before, you might have lost the academic validation you once had. That doesn't mean that you're not worthy of being in medical school. Even though imposter syndrome can be a really common thing for medical students, it's not something you just have to live with. Some ways to help with the feelings of imposter syndrome are separating your feelings from fact - even if you feel like a fraud, you have earned everything that you've received. Celebrate your successes and reward yourself. Practice positive self-talk, accept your mistakes, establish a support network, and rephrase your negative thoughts. While imposter syndrome can be really unpleasant, it does not have to be permanent. You are completely worthy of being at medical school and you have more than earned your place. Don't let your self-doubt stop you from getting the most of your experience. If you're feeling this way, reach out. Plenty of people are there to support you. By Aisia Lea.

Sometimes in medical school, there is a huge amount of pressure to be perfect and not to get anything wrong. It can feel like if you don't understand something, you're not cut out for medicine. The truth is, while failing an exam can feel really disappointing, you're not the first to do it and you won't be the last. Plenty of medics will fail an exam and have to do a resit. This doesn't make you a 'worse' student than those who pass first time, it just means your path is a little bit different, and that's perfectly okay! It can feel like a taboo subject to talk about when we fail, or when we get something wrong, but that should never be the case. It's only by speaking about our own experiences that we can support each other. Failing is not something to be ashamed of. You should feel proud of yourself for attempting something difficult and having the courage to attempt it again. That resilience is what medicine is about, not passing an exam first time. As medical professionals, we should be aware of our own bias and not jump to feeling ashamed if we don't quite get it right. Normal people are not perfect and they make mistakes. It's something to learn from and that is an invaluable experience. Don't allow your self-esteem to be negatively impacted if you don't do everything perfectly. By Aisia Lea.