Severe ADHD in med school

[curr4410]

Hey all. So, I’ve always known I had ADHD, but I’ve never needed medication or real special accommodations (beyond testing in a separate room) for it before. I have since discovered that’s mostly because of my amazing compensatory skills, which just aren’t cutting it anymore. I finally took an official diagnostic for the school’s satisfaction, and scored a ZERO in sustained auditory attention and 1 in visual. It’s so bad, they actually asked me if I had any history of brain damage because it borders on a neurocognitive disorder (I have had 1 TBI and multiple fevers that max out thermometers since I was 6 mo old).
Does anyone have any tips or tricks to studying or focusing on longer question stems? I’m still passing, but not nearly as well as I’d like, and have not done so hot on our last 2 long tests - and if I don’t do well on them soon I will fail a class. I’m trying to learn mind mapping and memory palaces, I’ve invested in models, and even pick up shifts at work as an RN (with my instructor’s encouragement), where the doctors are happy to give me cases similar to what we are studying whenever they are available, given my strong lean toward hands on learning. These seem to help with comprehension and actual learning - but I could use whatever tips anyone might have!

I currently use Sketchy and Draw it Know it with some success And make up little songs and dances. I study with friends and review things every day and use spaced repetition.

Thanks all!

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[curr4410]

I guess I should add I’m currently in the process of getting accommodations for testing to include time and a half for more frequent breaks and time to comprehend the question. My goal is to build enough skills I will not need these accommodations by the end of Fall semester 2020.

 

[sab3156]

First thing would be to quit your job and actually spend that time studying. Working while in medical school is a good way to screw yourself. I think you are fooling yourself if you think you're actually being efficient in learning at work.

Are you currently taking medication? Get to a physician and talk about perhaps getting a prescription for adderall. It might do wonders for you.

 

[BorntobeDO?]

Hey all. So, I’ve always known I had ADHD, but I’ve never needed medication or real special accommodations (beyond testing in a separate room) for it before. I have since discovered that’s mostly because of my amazing compensatory skills, which just aren’t cutting it anymore. I finally took an official diagnostic for the school’s satisfaction, and scored a ZERO in sustained auditory attention and 1 in visual. It’s so bad, they actually asked me if I had any history of brain damage because it borders on a neurocognitive disorder (I have had 1 TBI and multiple fevers that max out thermometers since I was 6 mo old).
Does anyone have any tips or tricks to studying or focusing on longer question stems? I’m still passing, but not nearly as well as I’d like, and have not done so hot on our last 2 long tests - and if I don’t do well on them soon I will fail a class. I’m trying to learn mind mapping and memory palaces, I’ve invested in models, and even pick up shifts at work as an RN (with my instructor’s encouragement), where the doctors are happy to give me cases similar to what we are studying whenever they are available, given my strong lean toward hands on learning. These seem to help with comprehension and actual learning - but I could use whatever tips anyone might have!

I currently use Sketchy and Draw it Know it with some success And make up little songs and dances. I study with friends and review things every day and use spaced repetition.

Thanks all!

I think pomodoro method works well for those who are distracted. You time the study portion and the breaks so you don’t get off track. I also recommend the Long Beach community college study skills videos (there are 14). I have found both those things to be very helpful. AnKi can be a big help as well if you have a group making cards or cards from upper class men.

 

[LatteColoredDO]

I have ADD and medication has worked wonders for me. I used to be embarrassed about it but it helped me perform way better in classes and exams second year compared to first year.

 

[Alkaidius]

You are probably one of only 5 people I’ve heard of that actually works outside of class...exactly how many hours do you do? Just so it’s clear, in the event that you fail a class because you’ve got side activities going on...I sincerely doubt program directors will give you any sort of leniency. You won’t get a “oh well this candidate survived with okay grades while working, so it makes sense that they’d fail something.” No. You’ll get a “Failed a class? Next.” Are you sure it’s worth it? You’ll get hands on when you need it 3rd and 4th year. Even just 1 hour of extra studying a day can do wonders.

 

[curr4410]

You are probably one of only 5 people I’ve heard of that actually works outside of class...exactly how many hours do you do? Just so it’s clear, in the event that you fail a class because you’ve got side activities going on...I sincerely doubt program directors will give you any sort of leniency. You won’t get a “oh well this candidate survived with okay grades while working, so it makes sense that they’d fail something.” No. You’ll get a “Failed a class? Next.” Are you sure it’s worth it? You’ll get hands on when you need it 3rd and 4th year. Even just 1 hour of extra studying a day can do wonders.

I only work on break (so over winter break or spring break since we’ll be between blocks, and over summer). I use it as an opportunity to solidify concepts I’ve learned. The thing that I’m struggling with isn’t necessarily studying, I’m passing every single shorter exam or quiz with 80% and above. Any exam over 60 questions or so I struggle on. We’re looking at meds, it’s just getting an appointment to actually get in and see a doctor to get the prescription. I tried to study ahead for cardio block over winter break as I know that’s a system I’ve traditionally struggled with, and while I’m doing very well on our short quizzes, etc., the 150+ tests are really nailing me. I fall asleep, or get distracted, or just get so overwhelmed with the long questions I don’t read them. I’ve been working pretty closely with instructors too on approaching different question styles, etc which resulted in a noticeably better grade on an exam earlier this week. I need tips on focusing or compartmentalizing information for both studying and reading these questions. I struggle with breaking things down into manageable tidbits. 20% of our class failed the last exam and the super long questions is one of the most common reasons people seem to mention for difficulty. I know it won’t get any better and I’d like to do better than the basic average.

 

[Sardonix]

Just finished a rotation with an ADHD specialist. Here's some "focus" tips that you would "ideally" use all of, but realistically can pick and choose from:

1. Sleep Hygiene: regular bedtime, regular wake up. No naps over 20-30min. Avoid any screen time for 60min before bed. Keep sleeping room cool, dark, and don't watch TV there.
2. 30-60min cardio activity each day
3. Avoid multitasking during studying at home or school
4. Avoid fruit juice (high sugar) and soda/artificially flavored drinks due to negative effects on gut microbiota (thereby affecting gut-brain axis)
5. Related to #3, when you start a study task, finish it. Don't do multiple at once.
6. Prioritize cognitive tasks for early morning or early afternoon as possible for med school (allows maximum focus during "non-fatigued" times)
7. Avoid night work
8. Use a paper calendar to organize your days. This provides a consistent source for planning and helps reduce anxiety about "missing something."
9. No alcohol
10. No caffeine
11. No marijuana or mood altering substances
12. No smoking/vaping
13. Use pomodoro technique = 30min study, 10min relax blocks
14. Mindfulness/meditation/self focus to help dissipate stress/anxiety/confusion
15. Set weekly and daily goals, coordinated with your written planner. Set consequences for goals failed, set rewards for goals accomplished.

 

[ciestar]

Just finished a rotation with an ADHD specialist. Here's some "focus" tips that you would "ideally" use all of, but realistically can pick and choose from:

1. Sleep Hygiene: regular bedtime, regular wake up. No naps over 20-30min. Avoid any screen time for 60min before bed. Keep sleeping room cool, dark, and don't watch TV there.
2. 30-60min cardio activity each day
3. Avoid multitasking during studying at home or school
4. Avoid fruit juice (high sugar) and soda/artificially flavored drinks due to negative effects on gut microbiota (thereby affecting gut-brain axis)
5. Related to #3, when you start a study task, finish it. Don't do multiple at once.
6. Prioritize cognitive tasks for early morning or early afternoon as possible for med school (allows maximum focus during "non-fatigued" times)
7. Avoid night work
8. Use a paper calendar to organize your days. This provides a consistent source for planning and helps reduce anxiety about "missing something."
9. No alcohol
10. No caffeine
11. No marijuana or mood altering substances
12. No smoking/vaping
13. Use pomodoro technique = 30min study, 10min relax blocks
14. Mindfulness/meditation/self focus to help dissipate stress/anxiety/confusion
15. Set weekly and daily goals, coordinated with your written planner. Set consequences for goals failed, set rewards for goals accomplished.

Yikes, i fail at so many of these

 

[curr4410]

Yikes, i fail at so many of these

funny thing is, I actually do almost all of these on a regular basis. I haven’t exercised quite as much lately but everything else I do very often.

 

[Sardonix]

funny thing is, I actually do almost all of these on a regular basis. I haven’t exercised quite as much lately but everything else I do very often.

Then it sounds like you need to actually see a psychiatrist get a diagnosis and discuss meds. If you've truly, consistently, attempted lifestyle changes but are still struggling professional help can't hurt.

 

[Sardonix]

Yikes, i fail at so many of these

Join the club. But I also don't have ADHD. I'm just lazy.

 

[curr4410]

Then it sounds like you need to actually see a psychiatrist get a diagnosis and discuss meds. If you've truly, consistently, attempted lifestyle changes but are still struggling professional help can't hurt.

just waiting for the appointment!

 

[joeception]

Attending regular psychiatry sessions and receiving meds will definitely help a lot, but it isn't a fix all and it does not work everyday the same way. You might also want to consider getting screened for other disorders as having ADHD as an adult there tends to be comorbidities.

Get a pair of noise cancelling headphones to try and minimize stimulus when studying, I recommend also if noise sensitive listening to pink noise as it really helps to drown out the hundreds of little stimuli that most people do not pay any mind to. For working at home I also like to have some form of white noise machine (usually just a small fan).

Everyone experiences ADHD differently and there definitely is a spectrum if you have difficulties with sense of time and hyper focus it can be good to use some method like the pomodoro technique as mentioned before.

I would also consider attending counseling if available in addition to the psychiatry sessions as medical school tends to exasperate symptoms to extremes at times and unfortunately even those without any conditions prior to medical school will have high rates of depression and anxiety while in it. Which is why it is great to try and be proactive as much as possible and getting help early on.

 

[curr4410]

Yup! I’ve been seeing a psychiatrist and neurologist regularly, due to another condition, and I’ve been treated for ADHD before so it wasn’t a surprise when the official diagnostic came back glaringly positive - though the severity definitely was! I also have the school counselor and an outside counselor too. My psychiatrist appointment was bumped up to Spring break so we can try a new medication outside of school for a week to see how it goes. In addition, I’ve now talked with learning specialists, instructors, and other faculty/admin. I knew with my Comorbidity I might struggle and attempted to prepare for it as much as possible.

I don’t go to lecture anymore and it’s been agreed that is the best course of action to continue for me. I have new books to read in addition to our assigned and optional readings, and we’re looking at the potential for virtual reality and models as a learning tool, given that I learn very quickly when I get my hands involved. I also spend time in the anatomy lab looking at the organs we’re studying.

It’s also been encouraged by the faculty I’ve spoken with to spend a few hours a week at the hospital shadowing a physician instead of just working on breaks, as a trend has indeed been noticed that I do better on test subjects where I have been able to describe an actual patient encounter - virtual reality encounters should help with this as well while also offering a focused learning environment (if we can figure it out - this one has some logistics yet to be ironed out). I learn very differently from my classmates, so it’s been quite the week talking with lots of instructors, the school learning specialists, admin, and school counselors and the docs. Lots of appointments over the next few weeks! Im lucky to be in an incredibly supportive school who is embracing my adapted learning style and helping me to incorporate it - after all, it’s been made clear I’m perfectly able to learn and retain, I just don’t learn it the ‘traditional’ way.

I’m still passing everything, and now I feel much more secure that won’t change any time soon! I’ve been working with my instructors and the learning specialists since the first week of school, but I’m really glad we took this next step as my grades started to fall some. It gave us all the opportunity to sit down and figure out some ideas to move forward with and I think will be a huge help in grasping concepts in a way that will also make it easier to remember long term. In the past 10 days I’ve completely overhauled my whole study routine - I ‘study’ less, and instead make drawings of the lectures, and listen to Raps about systems one of our students makes, and the things mentioned above. I have yet to get less than 100% on the quizzes since starting that. I’ve also been working on testing skills for the long exams I’m concerned about, and we will see how that goes next week. Overall, things are moving quickly now that we know what’s up, and I’m lucky to have faculty, etc willing to work as hard as me to help me figure it out.

 

[razanac15]

Hey guys, I just joined. Im a US IMG and I have ADHD. I ve struggled for years with consistency. Just wanted to say that Im happy that there is a group of people just like me struggling with the same issue.

 

[curr4410]

Hey guys, I just joined. Im a US IMG and I have ADHD. I ve struggled for years with consistency. Just wanted to say that Im happy that there is a group of people just like me struggling with the same issue.

Glad to 'meet' someone else!

Also, update to this thread: Finally got talked into trying medication this year, went from just passing to all A's and B's. Never thought I'd see that day in Med school. I also have accommodation for my testing (x1.5, with unlimited breaks), but have been working on trying to get within the 'normal' time to prepare for boards. I'm applying for accommodations for Boards, but I also know that can be pretty difficult so I am doing my best to get to a point where I don't need the accommodations for exams over 3 hours (that's about my limit currently before I HAVE to take a break due to attention issues). It's definitely been an interesting process!

I still don't attend lecture on zoom, but can pay attention long enough to listen to the recordings on 2x speed (something I couldn't do last year), and I can also take notes now without getting lost or confused. I've found I can't handle sketchy too well yet, but picmonic has been a huge resource for me that has proven very helpful for short, simple overview of topics. I also write 2nd and 3rd order questions as part of my study strategy - it lets me think about what the questions will look like AND I have to understand the material to write the question, so once I get to the actual exam it's not new or overwhelming - sometimes I even see a test question that looks almost identical to ones I write! That has helped a ton, and my classmates like using them for practice as well.

I still work, and I occasionally 'shadow' some of the physicians - they usually let me do things start to finish with supervision and they ask me questions, while I get to ask my own. I've had the opportunity to try and interpret lab results, x-rays, CTs, etc, as well as write up SOAP notes, determine differentials, and do a complete physical exam (a little different than the ones we do as nurses!). It has greatly helped me draw connections to disorders as well, which allows me to quickly rule out at least 2 options on every exam so far this year. I'm hoping that skill will be helpful for boards as well. Because of COVID, I am limited on when I can work so it is few and far between, but a wonderful way to give my brain a break for an afternoon or day so that I can return to my books refreshed.

I hope everyone is doing all right with COVID protocols, staying safe, and maintaining some social interaction (via zoom or something safe)! I know someone above mentioned mental health can be a concern in med school, and isolation can exacerbate that even further. Stay safe everyone, and thank you all for your suggestions this spring.

 

[razanac15]

I wanted to know how you guys especially with ADD, handle sleep?

 

[curr4410]

I wanted to know how you guys especially with ADD, handle sleep?

Hygiene, Hygiene, Hygiene. I also exercise in the evenings just before shower and bed - for me, the expenditure of energy allows my body to relax enough that I am able to fall asleep more easily. I don't keep electronics in my room and usually read a book before going to sleep. Routine is helpful. If I REALLY can't sleep, I take very high dose Melatonin, and if that doesn't work, I have Ativan to knock me out, though I very very rarely use it, since I need it to be effective if I end up manic (Bipolar 1). It's a balancing game for sure, but the routine and decreased stimulation can be very helpful for me. And that last bit of energy expenditure is very helpful for me personally, though some people find it wakes them up and makes it more difficult to relax. I also drink some coffee about an hour before bed, but that's not something I'd recommend for most. I have ADHD combined type which I know has some different approaches to ADD. If you have a counselor or psychiatrist, they frequently have some great ideas to try.

 

[razanac15]

Hygiene, Hygiene, Hygiene. I also exercise in the evenings just before shower and bed - for me, the expenditure of energy allows my body to relax enough that I am able to fall asleep more easily. I don't keep electronics in my room and usually read a book before going to sleep. Routine is helpful. If I REALLY can't sleep, I take very high dose Melatonin, and if that doesn't work, I have Ativan to knock me out, though I very very rarely use it, since I need it to be effective if I end up manic (Bipolar 1). It's a balancing game for sure, but the routine and decreased stimulation can be very helpful for me. And that last bit of energy expenditure is very helpful for me personally, though some people find it wakes them up and makes it more difficult to relax. I also drink some coffee about an hour before bed, but that's not something I'd recommend for most. I have ADHD combined type which I know has some different approaches to ADD. If you have a counselor or psychiatrist, they frequently have some great ideas to try.

I have the low energy type. but thanks for the help. i will definitely look into this.