Tips for Mental Wellness in Your 1st Year of PA School

Imposter Syndrome

At time of writing, Katrina is currently completing her 2nd year as part of Class of 2018 McMaster PA Education Program! She is in her 1st clinical rotation in Geriatric Psychiatry.

Katrina Pullia Physician AssistantAbout Katrina: Katrina completed her Honours Bachelor of Science in Biology & Psychology at McMaster University. She worked as a Research Assistant and Clinical Study Coordinator in the Department of Psychiatry, Neuroscience & Behaviour at McMaster University prior to entering the McMaster PA Program in the fall of 2016. Her academic interests include mental health research, women’s health, and improving psychiatric access to care. When not studying, Katrina can be found playing video games and watching Netflix with her hamster. You can find her on twitter @katrinaccpa.

Welcome to your 1st year of PA school!

Hi everyone! It’s an honour to be writing for the Canadian PA blog, as Anne’s initial blog was one of my main sources of information as a Pre-PA student trying to decide if PA school was right for me. Since I was sitting where you are now one year ago today, Anne asked me to write about mental health and self-care for the first year PA student. Mental health is my favourite topic, and I hope you’ll find the information below useful as you navigate this year. Disclaimer: I am not a mental health professional and all information, unless cited, is from personal experience. If you feel that you need assistance with stress or mental health, there are a list of general resources as well as resources for each PA school (McMaster, UfT, and Manitoba) at the end of this post.

McMaster PA Class of 2018

First off, congratulations on your acceptance to physician assistant school! If you’re anything like me, you’re full of questions about school, your placements, the PA profession, and maybe a healthy amount of fear. You might be nervous about your courses (how am I supposed to memorize all of this?), your skills (will I really be allowed to suture wounds?), and everything in between (how do I describe what a PA is?). But what I really want to talk about is when the healthy amount of fear turns into an unhealthy amount of nerves and starts to get into the way of your life.

PA Students and Imposter Syndrome

There might come a point this year where you start to question yourself; your achievements, your grades, your knowledge, and start to think that maybe, you don’t deserve to be here. You might not feel as smart as your peers, or experienced enough, or that somehow you’ve managed to convince everyone in the program that you’re much brighter than you really are and one day, maybe soon, the curtain will come crashing down and everyone will see you for what you really are: a fraud. Someone, who through a combination of charisma and good luck, managed to get into a program surrounded by actually smart people. This phenomenon is known as imposter syndrome. A concept that describes individuals that are unable to see their own achievements and accomplishments and become convinced that they are simply putting on a facade and everyone will one day realize that they are not nearly as smart as their colleagues believe. If this sounds familiar, know that you’re not alone. Studies have shown that anywhere from 25-50% of medical students suffer from imposter syndrome. And it isn’t just doctors; CEOs, professional athletes, and oscar-winning actors have spoken about experiencing imposter syndrome at some point in their careers.

So what can you do to combat the voice in your head telling you that you’re not worthy of being here? The first step is knowing that everyone feels stupid from time to time. And I mean, everyone. Everyone, at some point in their lives, has looked around the room and thought, “am I the dumbest person in here?”. But knowing you’re not alone doesn’t always stop you from thinking that way.

Your brain with radical acceptance and recognition

I’d like to introduce you to the concept of “Radical Acceptance and Recognition”, a skill commonly used in Dialectical Behavioural Therapy. Radical acceptance is the idea that you accept something (a situation, a thought) completely, without judging or fighting it. And then, once you’ve accepted it, you recognize the fault in the behaviour and commit to changing your view for future situations. Here’s an example:

Situation: you’re sitting in tutorial, discussing cardiomyopathies, and you mix up the pathophysiology of dilated vs hypertrophic cardiomyopathies, someone points it out, the concept is corrected, and tutorial moves forward

Your brain: I made a terrible mistake, how come I didn’t know that? My notes are right in front of me, now everyone is going to know how stupid I really am. I don’t even know why I try, I’ll never be as smart as everyone else here. Don’t even bother trying to contribute anymore, you’ll just make more mistakes.

Imposter Syndrome

Radical Acceptance: I made a mistake. Everyone makes mistakes. I can’t change the fact that I made a mistake, it happened. All I can do is move forward and keep participating in tutorial.

Radical Recognition: Just because I made a mistake doesn’t make me stupid. I got into PA school! I might not know every answer, but I know the resources to use to look them up after class.

But, what if the feelings don’t go away and they start to get bigger and louder until they’re all you can think about? What if the very thought of speaking up in tutorial, or going to your first placement, makes your heart beat so fast that you’re sure you’re having a heart attack? What can you do if you start to feel not only that you don’t belong, but that everything is hopeless? Although it is easy to brush off imposter syndrome as a part of medical culture, it can be a sign of a larger mental health problem. Mental illness, just like physical illness, can take many forms and healthcare workers and students are not exempt.

Mental Health in Canada

Accessing mental health in Canada, published May 11, 2017 from Stats Canada

The purpose of this post isn’t to scare you, but the statistics speak for themselves. 50% of people suffering from mental illness don’t get the help they need. If you eliminate access to care difficulties, the most commonly cited reasons are fear of negative comments from friends and family, and repercussions from work. As a physician assistant student, you are a part of the healthcare force that the general population looks to for help and your behaviour and comments about mental health can help reduce the stigma. 88% of healthcare workers are experiencing symptoms of mental illness; these are your colleagues, your peers, and maybe yourself.

One in five Canadians will experience a mental health problem this year. Nearly 20% of Canada’s population, 6.7 million people, live with mental illness. That figure is nearly double the number of people living with type-2 diabetes (2.2 million) and heart disease (1.4 million) combined, diseases considered to be at epidemic levels in today’s society.

But what about the people treating this crisis? There are approximately 1.7 million people working in the Canadian healthcare system. In a national study, 88% of healthcare workers reported insomnia, headaches, depression, weight changes, and panic attacks related to work stress.

Over 40% of physicians and residents report feeling that they are in the advanced stages of burnout, with one study reporting burnout rates as high as 75%. The numbers are similar for nurses, with an additional 14% testing positive for symptoms of post-traumatic stress disorder. Although no Canadian data exists for physician assistants, US studies report similar findings of burnout for practicing PAs and PA students.

When compared to workers in all other sectors, Canadian healthcare workers are 1.5 times more likely to be off work due to illness or disability, with studies estimating that over half of those are related to mental illness. Further, physicians commit suicide at rates two to three times higher than the average population.

Strategies to Combat Stress of PA School

So what can you do to combat the stress of first year? My best advice is to schedule yourself breaks, and I mean put an event in your phone calendar (or gmail, agenda) and block off a few hours every week called “ME TIME”. And no matter what, during that time, do something for you! Whether it’s sitting at home watching netflix, going to a movie with friends, or doing a yoga class, whatever you want to do, do it. No guilt, no thoughts about school, no checking your emails allowed. It can be hard when life gets busy and exams start to pile up and you haven’t done your laundry in three weeks to find time to do something that you truly enjoy doing. And the same goes for studying, schedule yourself a study session (with breaks!) and if you get stuck, or find yourself taking too long, take a break. I promise, your anatomy book will still be there after a walk around the block to clear your head. And, if you feel like you can’t shake your negative thoughts, or the world starts to feel too much, reach out to someone – a peer, a preceptor, a friend, and tell them. Every university has a student wellness centre with counseling and other mental health resources available (information below). You don’t have to go through this journey alone.

I wish you all a fantastic first year and best of luck in this journey!

Mental Health Resources

General Resources

McMaster Students

University of Toronto Students

University of Manitoba Students

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