How to Identify Cognitive Distortions in Interview Season
Written by Shelly Mishra
With residency application season underway, the stress fourth-year medical students face waiting for interviews grows. Despite the dozens of articles with advice on how to focus on wellness, it is easy to perseverate on maladaptive thoughts that increase anxiety. It’s important to identify common cognitive distortions that medical students face as the first step to improving mental health during tense times, including those in medical school and beyond.
Cognitive distortions have been described in detail by a psychiatrist, Dr. David Burns. He describes these distortions in detail in his book The Feeling Good Handbook. Many resources detail the cognitive distortions, and the ones mentioned are from the following link: https://arfamiliesfirst.com/wp-content/uploads/2013/05/Cognitive-Distortions.pdf
Overgeneralization. You view a negative event as a never-ending pattern of defeat. (or for positive events as a never-ending pattern of success)
Medical school and medical training come with many challenging days. Maybe you didn’t get the score you wanted on an exam, your plan during rounds was criticized for being unrealistic, or you get a few rejections from residency applications before you get your first invite. In these cases, students tend to overgeneralize and believe that this pattern will continue forever. Perhaps you think you will “never” match after a few rejections or will “never” have a good patient plan. In these cases, one should pause and examine the evidence. You might have just submitted your applications a week ago and most other people are not getting interviews or rejections too, yet most people still match. You might have just started your third year and are learning the ropes of medicine; learning how to do a good patient plan takes years of practice.
Mental Filter. You dwell on the negatives and ignore the positives.
Most often after an event has happened, students will focus on all the negative things that they did and ignore any positives. After a STEP exam, people will remember all the questions they struggled with or all the points in their application that make them weaker as a candidate. In these cases, you can ask yourself, what would you tell a friend who presents with the same problem as you? Often, we are harsher on ourselves then we would be with others and need to offer ourselves the same compassion that we would to our friends. You are stronger and better than the small negatives that you think define you.
Should Statements. You make yourself miserable with “shoulds”, “musts”, or “ought-to”.
Hindsight is always 20/20, especially for medical students. You “should” know for Step 1 that Niemann Pick Disease has hepatomegaly but Tay Sachs does not. You “should” have gotten the pimp questions during that kidney transplant operation. These statements lead to guilt, worthlessness, and self-hatred. Medicine is an incredibly difficult field and it is impossible to know everything or do everything right the first time around. The concept of “should” is emotionally loaded. Yes, perhaps it would be better if you did know the nuanced details of genetic diseases, but a “should” or “must” principle implies you are an inferior physician if you did not know, and this is simply not true. The acceptance paradox (better described by Dr. Burns in this article: https://feelinggood.com/wp-content/uploads/2022/05/25-paths-to-acceptance-v-6.pdf) implies that accepting yourself for who you are is one of the best first steps towards growth.
