Performed at Westminster Abbey. Competed in the Ironman at Kona. Founded a nonprofit. Published research in top biomedical journals. These kinds of résumé highlights are not out of place for an entering student at the University of Pittsburgh School of Medicine.

“When we get here, and you start your first class—and even in orientation—I think everybody kind of looks around and thinks, ‘Wow, these people are so amazing,’” says Juliet Jarrell, a second-year student at Pitt Med.

“And then you start class,” says Jarrell, “and the volume of material is so high. And you’re thinking, ‘Can I do this? Is it a mistake that I’m here?’ There’s this feeling that, ‘I must have just slipped in.’

“For me and for a lot of my friends, it was, ‘They’re going to find out I’m not supposed to be here’—which is a horrible feeling to have. And obviously not true, because we all deserve to be here. We all went through a rigorous application process to get here.”

The 153 members of Jarrell’s class were chosen from 8,393 applicants. She’s right, there are no slouches in the ranks.

The fear that you don’t measure up, that you don’t have the capability to do what you’ve been tasked with, is called imposter syndrome. It’s not unusual among med students—a population that will soon find themselves entrusted with the lives of others—and it can persist throughout medical training and beyond.

That’s why Pitt has brought in Barry Kerzin as an adjunct professor of psychiatry­—to work with med students to help them avoid imposter syndrome and other unhealthy mind states. A physician-scientist, Buddhist monk and personal physician to the Dalai Lama, Kerzin cuts a distinctive figure climbing out of an Uber in front of Alan Magee Scaife Hall in his burgundy robes and sneakers.

If students have trouble juggling the demands of medical school, they might assume no one else does. One student notes that it doesn’t help if she hears others proclaiming a test was easy—or talking about all the Anki cards they finished the night before. (Anki is a flashcard app.) “One thousand, really?” she says incredulously. “I don’t know if people need to voice these things out of their own insecurity, but when you didn’t find the test easy, you don’t want to hear it.”

Just as advertisers employ subtle messages that bypass our conscious mind, “we have subliminal messages we flash to ourselves to put down others and ourselves,” Kerzin says.  

“This is something we usually don’t even notice,” he adds.

Kerzin teaches people to notice what their minds are up to. He’s based in India, but he’s spending time here in Pittsburgh teaching med students how to become attuned to their inner lives—to cultivate, among other things, what he calls “healthy self-confidence,” so they will become able to turn insecurity into confidence, and arrogance into humility. (In "Cures for put-downs," he offers guidance on how to achieve this.)

The thought is that this level of awareness, of emotional intelligence, will enable med students to build the foundation for skillfully managing the stressors of their studies—and what’s to come in their training and beyond. The stakes are high.

National studies show that med students matriculate with healthier mental states than other recent college graduates who don’t pursue medicine; yet by their third year, med students are more prone to depression, burnout and suicidal ideation than are their contemporaries and the general population.

By incorporating secular insights and tools extracted from Buddhist psychology and philosophy—especially a capacity for mindfulness and compassion—into their professional and personal lives, students can ease the strain, says Kerzin. Studies consistently show that meditation and mindfulness approaches, including apps, significantly reduce stress and improve cognitive performance among nurses and other care providers and trainees.  

Kerzin’s work here complements a number of initiatives the school has put into place over the years to look out for its students, so that they in turn can look out for themselves and their future patients. Those efforts take the form of smaller communities of learners (matriculating students are put in “houses” with advisory deans); mental health resources that include psychiatrists, therapists and student advocates; and a host of wellness activities (from therapy dogs to family-style dinners). Even the newly launched curriculum incorporates six flex weeks and more small group sessions, which will reduce isolation as it promotes active learning. “We wanted a schedule that gave students time for self-care and exploration,” says Jason Rosenstock, an MD professor of psychiatry and associate dean for medical education.

Pitt’s Suzanne Templer, a DO associate professor of medicine and assistant dean for undergraduate medical student affairs, is the faculty lead for the student-run well-being committee. She introduces incoming students to mindfulness and meditation practices at orientation, during their very first days on campus.

Templer discovered the benefits of these practices after she suffered complications from herniated disc surgery. That operation was Election Day, Nov. 8, 2016.

“I was basically bedbound, staring at the ceiling. And it would come to a point around 4:30 in the afternoon that I had been up all day with my thoughts. I realized that being with your thoughts isn’t always a positive.
“That’s how I picked up this idea of slowing down and taking care of yourself before you can take care of others.”

As she explored the practice of mindfulness, she found it centering.

“I think [mindfulness] really helped me get through COVID,” says Templer, who is an infectious disease specialist. “[Without it], I would have felt lost. I was living and breathing anything COVID—webinars, articles, websites, listservs. There was no escaping it.”

She added a five-minute meditation each morning to her routine (which by then already included an evening meditation). “It was really helpful in keeping me level.”

Discovering the benefits of mindfulness “changed my trajectory,” says Templer. She was at Lehigh Valley Health Network at the time, where she became chief wellness officer.

“There were tools I could have probably been taught during medical school, or at some point in my training, that just were never taught.”

***

Personal difficulties led Kerzin to championing mindfulness in medicine, as well. His route, though, was more roundabout than Templer’s, taking him through the foothills of the Himalayas.

When he was 10 and growing up in Southern California, he often played outside with the other kids during long summer evenings. One of those nights, Kerzin developed a severe headache. The cause was a brain abscess that led to a coma and almost killed him. The subdural abscess rotted the left upper frontal area of his skull, requiring removal of that bone. He wore a helmet for the next couple of years until his neurosurgeon put in a plastic plate.

The 13-year-old Kerzin had a new hero: Maxwell Andler, the neurosurgeon who saved his life. “There were no doctors in my family, but I wanted to be like him. That was in my heart.”

Years later, after attending the University of California, Berkeley, and Lund University, in Sweden, to study philosophy, Kerzin chose to go into medicine instead. “My heart won out,” he says.

Five days before starting medical school at the University of Southern California in Los Angeles, his heart directed him again, and he married Judy, a UC Berkeley law student. After med school, he completed a family medicine residency and then established a small private practice in Ojai, California.

Just months after the practice opened, the Kerzins received devastating news. Judy, by then a lawyer, had ovarian cancer. She died three and a half years later. The other most important woman in Kerzin’s life, his mother, had died a few years before.

Kerzin took some time away from medicine, backpacking in India, Nepal and Sri Lanka for about six months to clear his head. “I was trying to figure out this grieving stuff, which was pretty heavy and intense.”

He eventually returned to the United States and to practicing medicine—first in California, and then in Seattle, where he accepted an assistant professor position at the University of Washington. One day he got a call from B. Alan Wallace, a friend and scholar of Buddhism:

“Would you travel to Dharamshala, India?” Wallace asked. “The Dalai Lama wants a Western-trained physician to interdigitate different medical systems, so that if one fails, the patient can avail another.”

Kerzin secured a six-month visa that he ended up extending, again and again, over the next 34 years. Throughout that time, he’s provided free medical care to Tibetan refugees, poor Indian families and to the Dalai Lama. He was fully ordained by the Dalai Lama as a monk in January 2003.

In 2005, the Dalai Lama asked Kerzin to teach. He happily complied, setting up the Human Values Institute in Tokyo, and more recently, the Altruism in Medicine Institute (AIMI) in Pittsburgh. Kerzin is particularly interested in helping health care practitioners. He’s been working with thousands of UPMC nurses since 2018, as well as other U.S. providers. He also teaches as an adjunct professor at the University of Hong Kong, as an honorary professor at the Mongolian National University of Medical Sciences, and in Russia, Ukraine, the U.K. and elsewhere.

He has codeveloped an app for health care providers, called AIMIcare, to help them rejuvenate and to cultivate mindfulness and compassion wherever they are.

In the United States, says Kerzin, “Upwards of 60% of third-year medical students, and in some studies, 75% of residents and doctors in practice are burned out. So, the majority of medical practitioners, including nurses, suffer from emotional exhaustion, loss of purpose and meaning in their work. This has been exacerbated by the COVID pandemic, but it existed before.

“We’re supposed to be back to normal. There’s no normal now. We haven’t healed from all of the trauma that we accumulated during the pandemic.” Providers are leaving the profession “in droves,” says Kerzin.

The World Health Organization has established a diagnostic code for workplace burnout, which is characterized as experiencing emotional exhaustion, a loss of meaning and a loss of a sense of purpose. In the clinic, burnout can lead to depression and “lateral violence”—i.e., aggressive behavior like backstabbing and bullying—as well as lower quality of care.

Templer notes that some of the risk factors for burnout are practically requirements for going into a caring profession—like making personal sacrifices (“What students don’t put patients’ needs before theirs?” she asks), being a perfectionist (in the hospital, accuracy can mean life or death) and lack of control (sickness and aging are part of life, after all).

That’s why, in addition to changing its learning environment and structure in the many ways mentioned earlier, Pitt Med is helping students develop tools to draw on.

Templer also tries to prepare them for a journey: “As they go through these different transitions, like switching to clinical rotations, or moving on to residency, this is when burnout can happen. They might experience a sense of loss of control. They may have felt that they had a good understanding of the expectations, and now they’re thrown into a completely different environment. They don’t know where to start again, and how to get their feet back on the ground.”

Templer finds it can be centering for students to devote a little time to think about why they’re in medical school. “A lot of times burnout happens because people forget the why.”

***

Emily Levin, a second-year med student and Zen practitioner, understands that students may not have the bandwidth to add one more thing to their schedules, even something as beneficial as meditation.

“I’ve wrestled with the question of injecting well-being into a system that’s burnt out. Sometimes you can’t add more to a system that’s already full.”

She shares the parable of a Zen master who is pouring tea for a student, but the student’s cup is full—still the teacher keeps pouring, and the tea just floods over and over:

“You need to empty the cup. You need to empty your mind to let in the new information.” She encourages her peers to take a few hours for themselves. And for those who are interested, she and some friends will be hosting a brief weekly meditation sitting in Alan Magee Scaife Hall—a chance to clear the mind a bit.

Tea will be served. (Third-year students who ran a group called Art of Living are passing along a teapot they used during sessions that they hosted before their clinical rotations started.)

“It’s low stakes for students to try,” says Levin, “and it’s something I want to do anyway.

“It’s my way of emptying my cup.”

More insights from Barry Kerzin, Emily Levin and the 14th Dalai Lama:

Cures for put-downs: Kerzin offers a lesson in healthy self-confidence. 

"There's no such thing as compassion fatigue": Kerzin urges a shift from empathy to compassion—and his patient the Dalai Lama explains why "doctors should think of their work as something almost sacred." 

No judgment: Emily Levin shares how she gains clarity and stays in the present moment amid challenging situations. 

Read more from the Fall 2023 issue.