1. Navigating the Rapids: Completing the Journey through Medical School
Presented by
Alan Korinek, Ph.D.
Director, Program of Assistance for HSC Students
The Counseling Center at TTUHSC
January 14, 2019

2. When We Hit “Rapids”
“Rapids” are stressful events (e.g., Step 1) that can dysregulate us emotionally
Hyper-arousal and/or hypo-arousal are experienced
Hyper-arousal – feeling panicked, angry, overwhelmed
Hypo-arousal – feeling numb, disconnected, no energy
Catastrophic thinking can result
Overestimating the probability of bad things happening (aka, “worse case scenario” thinking)
“Fight or flight” impulses can occur, including thoughts of suicide

3. Impact of Stress on Brain Functioning
Our Two-Tiered Brain:
Upstairs/Rational Brain (the Rider)
“Thinking Cap” used to problem solve, create, innovate, and imagine
Manages the downstairs brain, but only if engaged
Downstairs/Reptilian Brain (the Horse)
Emotionally reactive and always on; goal is survival
Amygdala is our “sentry”
High stress causes “emotional flooding” (flash flood or rising waters); when that happens:
Survival instinct unseats good intentions and “amygdala hijackings” (fight or flight) may occur
Cognitive difficulties result; cannot process information or make necessary neural connections (i.e., learn and consolidate critical concepts); memory and recall are compromised

4. Managed Stress Benefits Us
Benefits of managed stress include increased alertness, heightened focus, and enhanced cognitive performance
Good stress management prevents flooding, or allows us to get back into our upstairs brain if flooding begins
PERFORMANCE
Low
STRESS
High

5. Keys to Navigating the Rapids
Practice self-care
Proper diet; exercise; mindfulness* and relaxation; smiles and laughter; practicing gratitude (*apps: Headspace, Calm)
Be self-aware and emotionally intelligent
Recognize the signs of emotional dysregulation and activate coping to get the “rider” back in control of the “horse”
Keep your self-talk positive, encouraging, and hopeful
Avoid ruminating about the past or worrying excessively about the future; check out “The Single Most Important Thing You Can Do to Manage Your Stress”:

6. Keys to Navigating the Rapids
Avoid “flight” behaviors, such as:
Isolating
Abusing or misusing substances
Escaping into video games or online activities
Or any other unhealthy “emotionally-driven” behaviors
Seek support, especially if you are having any suicidal thoughts
PAS counseling and support is free and fully confidential
Seeking support is not a sign of weakness; it’s a sign of emotional intelligence!

7. Keys to Navigating the Rapids
Get adequate rest
Adequate sleep strengthens the nerve circuits underlying learning and memory, allowing the brain to make and consolidate new and essential neural connections
Distribute your time wisely by using effective time-management strategies
Identify your “time bandits” and avoid or manage them
Set and keep a schedule and/or track how you use your time
Employ effective study techniques
For example, the Pomodoro Technique (25 minutes studying, 5-minute break)

8. One Final Appeal As you care for yourself, care also for one another
You are all having to navigate the same “rapids”, though in your own way, so encourage one another and support one another as you have opportunity
Be especially sensitive to any signs that a classmate is really struggling and may be having suicidal thoughts (e.g., isolating themselves, becoming emotionally dysregulated, appearing depressed or behaving differently)
Remember the QPR training you all received:
Question, Persuade, and Refer

9. Tips for Better Sleep (aka “Sleep Hygiene”)
Dim the lights one hour before sleeping; use only soft, warm lighting (no “blue light” from electronics)
Adopt a regular sleep schedule, even weekends, to reset circadian rhythms and increase melatonin production
Don’t engage in “brain work”, have emotional discussions, or make complex decisions, 2-3 hours prior
Curb your appetite: no heavy meals 4 hours before sleeping or light snacks 2 hours before sleeping
Curb caffeine use in the evening