ADHD Among Med Students and Doctors Is More Common Than You Might Think
There’s a pervasive assumption that you can’t get into medical school (or succeed as a doctor) and have ADHD (Attention Deficit Hyperactivity Disorder). That’s just not true. And it’s an overlooked issue we need to talk about.
Over the years, we’ve worked with many intelligent, driven, high-achieving med students and physicians who have come to us because they were struggling with ADHD and needed strategies to help manage it. Others came to us for assistance and later found out they were dealing with undiagnosed ADHD. How’d they get this far in their academic or professional careers without hitting hurdles? Well, nothing’s a problem until it’s a problem. Med students and doctors are crazy smart and driven. So they’re often able to compensate for issues like ADHD — until they go up against med school or boards. Then, the speed, volume, and density of information coming at them is too much, and it breaks the systems or workarounds they’ve used in the past.
Navigating ADHD in Medical School
In this new video series, we examine life as a medical student or physician with ADHD. We outline how ADHD affects your ability to study, take tests effectively, and manage your time.
And we dig into five areas where students may struggle with ADHD in medical school. These include:
- Distractibility
- Impulsivity
- Organization
- Time Management
- Workflow and Productivity
“These issues can likely be mitigated and managed with proper methodology. Because methodology does matter — especially when studying and learning in med school.”
— Ryan Orwig
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Transcript
Ryan Orwig: Hi everyone, Ryan Orwig here from STATMed Learning, where we talk about the challenges of learning in medical school and performing on medical board exams. Today, I wanna talk about what it’s like to be a med student with ADHD. As always, this also includes physicians and those unrelated medical fields like veterinarians and Pharm DS.
I call this talk, “it’s not me. It’s my ADD.” This is a quote from what my earliest memories of working with a med student who definitely had ADHD. To start it’s fair to ask: “Is it possible to get into medical school or beyond without diagnosing or treating ADHD?” The answer is absolutely. Now look, I’m not a clinician. I’m a learning specialist. I just wanna share my insights about working with scores of med students with ADHD over the last 15 plus years. That starts with understanding that bright, motivated, elite adults can indeed get to med school or get into residency, or even into practicing with undiagnosed or unaddressed issues with ADHD.
The way I look at it is this, it’s only a problem when it becomes a problem. By this I mean, smart, motivated high achievers can indeed get by – some of them indefinitely, but others only up until a point. These are the folks I’m talking about. And if it becomes a problem, then in this case, ADHD, it needs to be addressed.
I’ve heard many horror stories over the years from med students and physicians looking for help regarding ADHD. And they were told things like, you can’t have ADHD you’re in med school, or you’re a doctor or worse. You can’t have ADHD because you’ve gotten to our med school. Or I’ve heard just take meds or just get accommodations or just exercise. If any of those fix the problem, then great. That means it’s no longer a problem.
But if this is not enough to manage someone’s ADHD, then you guessed it: it’s still a problem. And I’ve heard stuff along the lines of “maybe you don’t want this bad enough” that that’s why they’re having problems. Or “just get organized.” Or maybe “you’re just saying you have ADHD as an excuse” or “everyone always says they have ADHD. Is that even a real thing?”
This is all terrible stuff. And while I assure you it’s real. And I think these med students with ADHD are sprinkled everywhere in every med school at least a few per class, hidden, struggling, looking for answers, looking for ways to put themselves in control of their learning and their careers.
Before fixing the problem, though, we always have to start by understanding the underpinnings of the problem. And that’s what we’re talking about here. Let’s start over exploration of med students and physicians with ADHD by first defining what ADHD is. ADHD stands for Attention Deficit Hyperactivity Disorder. You can find the definition and criteria for adult ADHD lots of places. Over here is a checklist from the Mayo clinic, for example.
I’m going to proceed as if we at least all have an understanding of the broad strokes of what ADHD is. And here’s a nitpicky fun fact. Technically, even though people still say ADD, ADD is no longer an official diagnosis, not since the DSM-5 came out in 2013 making all subtypes fall under the umbrella term of ADHD. So nowadays to be specific, the proper diagnostic term is ADHD with a sub category. There are three main ones.
First you have ADHD inattentive type, which I think is what most people mean when they use the term ADD. This is where the distractions are happening internally and invisibly while it’s not exclusive loads of our med students and docs with ADHD are ADHD inattentive types. Number two, then you have ADHD hyperactive type which is characterized by a more physically overt high energy impulsive bouncing off the walls type of presentation. This has more of the classic caricature of old school ADD. And I’ve certainly met these guys too in my years working with medical professionals. And then the third type is called ADHD combined type where both internal and external manifestations are present which again, we certainly see and know a lot about.
We wanna start our discussion about ADHD in med school by identifying five broad ways ADHD might manifest as a problem for a med student, a physician or someone in a related medical field like veterinarians, PAs, or Pharm Ds. These are my own observations and they definitely overlap in certain ways. And I wouldn’t expect to see one med student with all of these issues. In fact, for one med student, it might be just parts of one pattern, for another it could be four of them. While these patterns help guide us, everyone is a little different. Please keep in mind, this is not diagnostic and these issues are only relevant if they actually cause problems with academic performance or board scores.
So number one is distractibility. This might mean problems based on focus issues where we zone out, get lost, get derailed or can’t stay on track during lecture or while studying reading, thinking, talking, presenting, et cetera to the degree that it is truly impairing performance.
Number two deals with impulsivity. This indicates a lack of self-regulation. From not controlling when you get off task and lecture or while studying, to experiencing impulsive test taking issues. For example, a med student with ADHD might miss a test question, then read the answer explanation and say, Whoa, what happened? I knew that that was a dumb mistake. I do that all the time. But for the ADHD brain this could be part of an underlying impulsivity pattern. It’s not just a “dumb mistake.”
For example, a pattern could be the student latched onto a single word or phrase then predicted the answer based on that single clue not factoring in the other clues in the passage and thus missed the question. Another pattern could involve seeing an answer option down below in a fraction of a second. So they see that concept down there at D then when they’re up there reading the passage loosely and impulsively, they are shaping in twisting clues to fit that desire to answer option. All happening at an astonishingly, impulsively fast rate. These negative behaviors can be rooted in impulsive behaviors. And it is very common to see this with a med student or a doctor with ADHD, therefore proper methods need to be installed to offset these damaging behaviors.
Number three relates to organizational issues. Issues with learning and med school often start with a breakdown in organization. While most people think this means physical organization, which can certainly be a problem. But I’m really talking about is conceptual hierarchical organization of any given topic being studied. I mean, just a given lecture can absolutely overload a med student with ADHD organizational system. If you have ADHD, you likely have what is called executive dysfunction, meaning the way your brain manages itself including organization is weaker compared to those of your peers, certainly in med school. And this might be where things are breaking down. The med student with ADHD, who is struggling in this regard is likely trying to do too much internally and implicitly, and they just don’t have the executive functioning bandwidth to manage it all. You could say in previous academic arenas where they found success their bandwidth limited as it was, was sufficient. But now in this arena in med school or boards that bandwidth is maxed out and that’s why they’re in trouble. Therefore proper tools should be used externally and explicitly to empower the student with ADHD so that they can be in control of their organization and thus their learning. Because again, to tie it back to learning in medical school has to start with finding and encoding hierarchal organization of all the information they have to learn.
Sort of related to this is number four, time management issues. And this can cover quite the spectrum. It can be big picture stuff like issues managing your day or your week or your overall study plan. It can also be much more boots on the ground issues and you lose time getting enough stuff done while studying.
That is still in part time management to me because time is the most valuable and limited currency in med school life. So it can relate to this space in between where you’re just hemorrhaging time between or during study activities. Then just not knowing where the time went. This aspect of time management issues likely connects to issues with low yield study methods. So to quote one of my favorite all time TV shows the show called “Dark” on Netflix. “Everything is connected.”
Then we have our fifth and final big pattern: issues with workflow and productivity. This is where you can’t control when to start studying, staying on task when studying, or completing a specific study-based task. Likewise, I think an underappreciated skill in med school and in life is the ability to create an exploit workflow. This is the heart of autonomous independent learning. And with the ADHD mind where aspects of executive functioning are impaired. We might see a lot of struggle in this area which could look like a variety of things such as not knowing where to start, when to switch to another topic, what steps you will use to work through studying a lecture or a chapter while studying, how to keep track of what you have already completed. Not knowing when to come back to something you’ve already studied, et cetera. Not controlling workflow and productivity under the demands of the speed volume density equation of med school and board study can be a crippling factor. And like all the rest, these issues can likely be mitigated and managed with proper methodology because methodology does matter especially when studying and learning in med school.
So those are the big five patterns we often see in some form or another with med students and physicians who have ADHD. An important caveat for this list is this many med students might see this list and say, hey, I experienced that issue with say impulsivity and distractibility, and I deal with it just fine. Or I just go to the gym and that fixes it well, good for them.
The key thing to consider here is that not all med students are the same, and that we have to remember. It’s not a problem until it’s a problem.
In my next videos about dealing with ADHD in medical school and on boards, we are going to do three deep dives into three specific ways. We might see ADHD manifest as a problem in studying, in time management and when taking board style tests.
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