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Coming into Focus: Med Students & ADHD

Long underdiagnosed and long misunderstood, persons with ADHD are success stories all over the world and are all over the world from performers like Adam Levine, all the way up to Olympians like Michael Phelps and Simone Biles. Defined by the Mayo Clinic as “a chronic condition that affects millions of children and often continues into adulthood. (It) includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.” It includes both inattentive type (who are easily distractible and struggle to maintain attention), hyperactive type (characterized by impulsive actions and movements), and combined type.

Having grown up with ADHD in the 1990s meant that the answer was often pills and more pills. Stimulants like Ritalin and Concerta were attention driving but did not come without a cost. ADHD Actor Channing Tatum once talked about being on stimulants by saying “I did better at school when I was on it, but it made me a zombie.” That was my experience as well. Either I was an unmedicated distraction, or a medicated miserable shell devoid of the human dignity that would have appalled Immanuel Kant. Studying while I was young was always impossible and I fell into an odd middle ground. Smart enough to pass the classes, but never applied enough to succeed in them.

I stank at studying, for the longest time. This led me to graduate a sparkling 141th out of 167 in my high school class. #Yikes, amirite? But then I finally 1) found something I loved enough to dedicate my life to and 2) watched someone I admired push themselves to study and give everything to their goal. The former was a desire to help people and solve complex problems, with medicine being the marriage of those two ideals. The latter was happenstance. I joined the Filipino Peace club at my community college enticed to join by a friend of mine who was the most fervent studier I had ever seen. She was studying to be a nurse and watching her study showed me that if I actually wanted to make this dream a possibility, that it could be done. Seeing a peer I respected follow a self written well organized plan taught me more than any authority figure trying to lecture me. This is in fact common in the disorder, that peers as mentors are much more powerful agents of change than anyone else.

If you have ever met someone with ADHD, it’s pretty obvious they are really good at some things and almost inexplicably bad at others. That has to do with the pathophysiology of the disorder, which causes hyperfocusing on things that the person finds worthwhile or enjoyable, with frustrating inconsistency when that person is forced to do something they find without worth. This can be difficult for a pre-med or medical student who has trouble bringing themselves to study ‘necessary evil’ topics like non-mammal biology in premed or clinically low yield basic science details in pre-clinical. This can even carry over into third year clinical rotations that the student is not interested in.

I suffered from all of these and needed to come up with clever mind frames to solve them. Some were easier than others: If I could find a way to approach it as something which would help me later treat patients, it became easier to be more motivated. I came into medical school on Year 1, Day 1 wanting to go into Emergency Medicine and oftentimes I would try and see whatever rotation I was on through the lenses of my future emergency medicine practice. For example, when on psychiatry I was tasked with coming up with a topic presentation. I chose to do it on the best practices of pharmacologically and non-pharmacologically subduing an agitated patient. This allowed me to study the techniques and medications that would serve me well in residency, and at the same time make the attendings in psychiatry happy.

The good thing is that ADHD can be used as a strength in medicine and studying. Once the sights are set and the target locked in, the drive is there to find success. This was true for my studying for the MCAT, Step exams and Emergency Medicine rotations. The next task is overcoming the disorganization synonymous with the disorder. For me, a well designed spreadsheet with a macro and micro schedule was super helpful. For example, my macroschedule told me that I should be studying cardio from Monday to Thursday. My microschedule would then tell me Monday I was to do a UWorld block in the morning, Anki in the afternoon, etc.

The best advice I can give to ADHD students trying to accomplish goals is:

  • Write down your goals on paper. Writing them down defines them, and defining them is the first step towards both organizing and planning for success.
  • Trial and error often. You will learn what works best for you over time, and oftentimes is off the beaten path. Some are morning people, many are night owls, and once you learn your optimum routine it will be easier to stay organized. Some people gain much from stimulant medication, others myself saw net negatives. In this new era, nonstimulant ADHD medications have shown promise.
  • A wise person once told me “Anyone with a heartbeat can benefit from therapy.” This is incredibly true of those with ADHD who have higher than baseline levels of anxiety and depression. Make sure to keep your mental health front and center.
  • Ask others for feedback often. One of my biggest problems was self awareness. I didn’t know what I didn’t know. So asking friends and preceptors for frequent feedback both helped me get better and let others know that even when I made mistakes they were in good faith.
  • Find mentors you respect and pick their brain. Seek those who want to teach you, instead of educate you. Those who are willing to be patient and help mold your flaws into strengths. Especially those who show similar symptomatology to yourself and already beat the challenges you face. Frequently I am approached by ADHD students who come and ask me how to beat the MCAT and STEP because they know I already took my bumps and have some best practices to share. Once you have beaten challenges, the best thing you can do is mentor the next generation of learners.

Whatever it is, you can still accomplish it as a student living with ADHD. Reach out to others early and often, search for different resources, and don’t be afraid to try something new. Expect to struggle and expect to need some extra time coming up with a plan and feedback to titrate said plan. However, if you work hard you can conquer whatever challenge is coming your way!