Studying for the USMLE can feel like an exercise in social isolation.

Even for those (especially for those?) of us who live amongst our medical school classmates, which in theory ought to be less isolating, the whole process seems to reward those who either hermit up or awkwardly dodge the 500 pound elephant in the room  that we’re studying for the most important exam we will have taken to date.

The truth of this  that we are spending 10-12 hours a day preparing for an extremely important exam  is enough to drive anyone crazy. But there seems to be something about the human condition that fosters a deeper and more troublesome tendency to drive itself further into oblivion by insisting to itself that it is completely alone during difficult times.

I want to take a moment to tell you that you are not alone in this.

We all feel this way.

More specifically, we all feel that our USMLE world scores are stagnant or not moving upward quickly enough. We all feel that our friends are grasping some vital element of exam strategy that is entirely lost on us. We all feel confused by the ways in which our medical school classmates’ personalities seem to profoundly change at the end of second year, in a way that, well, makes us feel more than just a little alone.

And we all feel stuck between a rock and a hard place because people in our non-medical social networks “just. don’t. get. it!” and the people who do understand are unwilling or unable to relate to us meaningfully during the process.

There are no easy solutions to the problem of social isolation, but I hope that you’ll consider employing the following strategies as a means to dealing with some of the unexpected psychological challenges.

1. Set Boundaries

One of the best ways to protect yourself from loneliness or the sensation that you’re the worst-off of all your friends is to establish clear boundaries early. I implore you to know yourself well  a process that involves introspection regarding the ways that you’ve responded to academic and social stress previously  before determining the best way do this. If you know that you tend toward competitiveness, I suggest that you explicitly discuss strategies to maintain healthy friendships with your medical school classmates during this time. Perhaps this would sound something like:

“Hey man  I know we’ve been supporting each other and hanging a lot during the last two years and I’m so glad for your friendship. I think it would be great to hang out and decompress with one another during this stressful time period. But can we agree not to discuss specific scores? I don’t want that to get in the way of our friendship.”

2. Identify a Safe Place

Take the time to inform one reliable, non-medical person in your life exactly why this study period is so important and what your struggles and concerns are as they relate to the exam. This way, you’ll have a ready-made individual with whom to share your trials and tribulations.

Moreover, identifying an upperclassman within medical school is another great way to remind yourself that you aren’t alone while tapping into the wisdom of someone with experience under his or her belt.

3. Be The Change

Competitiveness has been engrained into all of us by the long, academically arduous path to becoming a physician. Your medical school classmates have the potential to be both your greatest allies and your deepest source of stress during this time. Whenever possible, do what you can to play an active role toward fostering the former and avoiding the latter. Toward this end, I find it helpful to remind myself that, one day, the comparisons will end. The NBME or USMLE world point differential between our teammates and us will not matter. In residency, you and your fellow residents will become a true team, instead of one whose members have to work together while finding subtle ways to distinguish themselves. Doesn’t that sound AWESOME!? With effective communication, it can become a reality sooner rather than later.

Studying for the USMLE is hard  perhaps one of the hardest things you’ll ever do. But it doesn’t have to be lonely. Keep the faith!