Inside Tomorrow's Pharmacist (2001)

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Managing stress

Managing stress by Joanna Lumb

A certain amount of stress is useful. It acts as a motivator and helps you get things done. It is when stress levels get excessive that problems can arise. You need to learn how to manage stress, and there are a variety of ways of doing this. But if you find that you can't cope, for whatever reason, help is available. Informal support can be given by your friends and family, while the formal support network includes tutors, student welfare officers and university counselling services. Don't be afraid to ask for help if you think you need it.

Symptoms of stress

Symptoms of stress can include difficulty in concentrating, lack of motivation, fear of failure, irritability, worrying about the future, increased use of alcohol, increased smoking, sleep problems and more frequent physical illness.

Experts say that it is important to set yourself realistic goals and to accept that sometimes you are going to make mistakes. Everyone does! It's also important to take exercise, eat properly and have enough sleep, as this will help you to cope with stressful events.

Seek help

Steve Potter is director of the counselling service at Manchester University. They see around 1,500 students a year for coun-selling and that the vast majority find it a useful aid to resolving difficulties and improving capacity to cope. One of his aims is to reduce the stigma of seeking help. "There is a culture of self-reliance. People might confuse self-reliance with coping alone and not getting help. But seeking help at the right time is a very resourceful thing to do." The team offers advice to students who want help with personal problems affecting their work or general wellbeing.

Steve believes that there is much greater pressure on students to achieve these days and that this is possibly linked to the financial costs of university education. "There is a great pressure to do well, to get a first or 2.1. This can be rewarding, but it is also stressful."

What causes stress to get out of hand? Classically, a vicious circle is set up. A student may feel pressure to do well, and may be coping fine until some other problem comes along, eg, a relationship breaks up or there are family problems. This affects their work, which increases the pressure to get back on track and do well, which in turn increases anxiety, and so on. Help may be needed to break this circle of events.

There are practical ways of avoiding common academic "pressure points." Often small changes in behaviour bring big changes in attitude and self-esteem, Steve says.

Talking to friends is one of his tips for coping. "Compare notes, as this can help to keep things in perspective. It will help you realise, for example, that the whole world will not fall in if you fail one essay." Pace yourself, don't overwork, and be sure to have a variety of activities. Seek help from your tutor if you are having problems with coursework — don't postpone it and hope the problem will go away.

How do you know when you might need help? Steve's suggestion is to seek help if your normal ways of coping no longer seem to be working. You do not need to be in crisis to seek help. "It helps to talk a problem through early, whether you go, for example, to your personal tutor, to an adviser in hall, or to a university counselling service."

These are some examples of when it might be a good idea to seek help:

• If you are such a perfectionist that it is hard to complete work or hand it in
• If you can't switch off from work and enjoy other interests
• If fears of failure stress you out during revision
• If you find it hard to sustain concentration or motivation
• If despite past achievements you feel that you are not good enough and judge yourself harshly

Of course, emotional issues are not the only possible student problems. For financial problems, remember that you are able to apply for extra loans, that various universities have hardship funds, and that, for pharmacy students, NatWest has a professional undergraduate loan with preferential interest rates. For legal problems, the Students' Union might have access to free legal advice.

Pharmacy experience

Noel Wicks, immediate past-president of the British Pharmaceutical Students' Association, who owns a pharmacy on Stirling University campus, believes that the most stressful time for undergraduates is the first year. The culture shock, missing home and the need to make new friends can all produce stress — quite apart from the course work.

He advises students to look outside the pharmacy course and outside their hall of residence to find like-minded people, and to get involved in university organisations, such as sports clubs.

Who should students turn to for help if they feel stressed? For academic problems, you should see your tutor or another person in the pharmacy department. For other types of problem, you could approach the welfare officer at the Students' Union who will know what counselling services are available. "In the majority of cases BPSA has come across, we've found help is there when it is asked for," Noel says.

Students have different ways of handling the pressure of revision and exams. The key is to be prepared and not to leave everything to the last minute. Noel suggests that working with other students can help. "I had a revision partner — what he didn't understand I tended to understand and vice versa. We would go over things together, and this certainly helped me." And remember that it is not the end of the world if you fail a module, as these can be retaken.

Noel does not go along with the general moaning about the financial side of student life. He says you should look at it positively: "Yes you're going to come out of university in debt, but see it as an investment in your future. You are investing in a stable career."

Overseas students possibly have even greater stresses in settling in to university. And they can't go home for the weekend if things get too much. It is worth finding out what facilities are available, as many universities will have international societies or groups where you can meet people of similar cultural background.

When you get to the stage of planning for your preregistration placement, Noel's advice is to interview prospective employers as well as letting them interview you. Get to know everything about the job. Where possible go and visit the work place and meet the tutor before you accept a job.

Preregistration trainees

Unfortunately, student stress does not finish on graduation. Preregistration trainees can face difficult problems too.

These are frequently related to personality clashes and can often be sorted out by talking it through with the tutor. If this does not resolve the issue, or if you feel you cannot talk to the tutor, then you could approach the tutor's boss. Students in independent pharmacies obviously can't do this.

And what if this approach does not work? "BPSA does hear from a lot of preregistration students who are unhappy with their placement," Noel Wicks says. Its advice in such cases is for the student to contact the Listening Friends scheme.

This scheme, originally set up by the Royal Pharmaceutical Society to offer free and confidential help to pharmacists suffering from stress, is now open to preregistration trainees too. The scheme is run independently from the Society and is not only for work-related problems — other causes of stress, whatever they may be, can also be discussed.

If the adviser at Listening Friends feels unable to help, they might suggest that the caller contacts the Society's education division for advice.

The best way to avoid stress over the preregistration exam is to be well prepared, says Noel. "Give yourself time for revision; save some holiday so you are able to take a week or two off before the exam." And make sure you've got all the books you need. "This sounds obvious but I know people who have run around like headless chickens trying to get the right BNF or Drug Tariff at the last minute."

Most importantly, consider whether you are ready for the exam. "If you are so stressed that you don't think you will be able to do the exam, then don't take it. Give yourself more time. Yes, you may have to wait some months to sit the exam again, potentially losing a few thousand pounds in wages. But if you blow one of your three chances you could potentially be losing your career."

The Society's education division agrees with this advice: "If you think you are not going to pass, for whatever reason, you are advised seriously to think about not taking the exam," it says.

Ms Lumb is a medical writer from London