The Vicious Cycle of Over-Thinking: Strategies to Help Learners

By: Lindsay Roberts, PharmD and Jaclyn Boyle, PharmD, MS, MBA, BCACP

What can lead to over-thinking tendencies?

Are your learners hesitant to commit to decisions or lack confidence in their knowledge? Pharmacy schools historically attract students who predominantly have a Meyers Briggs personality type of ISTJ, or the ‘Logistician’ personality type.1 At their best, Logisticians are calm, practical, responsible, and enforce order. The weaknesses of this personality type include risk-aversion, unreasonable self-expectations, and inability to see things in anything but black and white. While they are loyal, dutiful and rule-following employees, they can be seen as stubborn or resistant to change. With this personality type in mind, it is interesting to think about significant barriers that students may face when presented with decisions or situations that are not black and white.

Aside from decision-making, student well-being can be impacted by the need to continually strive for perfection. One study of student well-being described that learning environments promoting perfectionism cause distress for students when their performance does not achieve this high level of perfection.2 While health professionals agree that Just Culture is an important construct to operate under, perfectionistic tendencies foster the antithesis of these concepts.

As most pharmacy school environments do not allow students to fail without dire consequences, growth mindset is stunted and a natural aversion to failure may be heightened. By not allowing students to fail in a safe environment, they will continually strive for unachievable perfectionism, setting them up for rude awakenings in their future. Students may view failure as consistently ‘bad’, rather than using those opportunities to learn and apply their learnings to future assessments. Therefore, students may get stuck in cycles of excessive rumination over problems or situations due to the internal driver of the need for perfectionism.

How do we help our learners stop over-thinking?

First, let’s identify some signs of potential emotional distress that our learners may possess:

●     First, students may be on auto-pilot, leading to a vicious cycle of analysis paralysis.3, 4

●     Catastrophizing could become excessive, leading to poor time management, as the student may have wasted time being enveloped in their own negative thoughts.4

●     Additionally, students may struggle with big life decisions that are not black and white in nature, such as residency rank lists, or deciding on job/career paths when many options are available. Because of the fear of making the ‘wrong’ decision, students may be stuck, preventing them from ever coming to a confident conclusion about their career.4

Next, let’s explore some strategies to help learners stop over-thinking. As a means of capturing this professional growth, these discussions could be incorporated into personal and professional development courses, advising, or considered as students navigate co-curricular activities. 

●     Help your learners develop confidence and courage.3  It is important to understand that going from good to great takes time and does not happen overnight. It takes hard-work and is achievable when the effort is taken.

●     Remind them of Occam’s razor concept.4 Students may need to be reminded to stop looking for a zebra when the hoof sounds are usually a horse. Remind students to not get caught up in details that may be insignificant. Sometimes the answer to the problem may be right in front of them and could even be the simplest solution.

●     Coach students around career decisions.5 Suggest completing self-assessments or career related books (Reinventing You by Dorie Clark, Pivot by Jenny Blake, and Now, Discover Your Strengths by Marcus Buckingham, to name a few). Encourage students to think about priorities, deadlines, and set career-related goals. Have the student consider what things they would like in a career versus dealbreakers. Emphasize that their thoughts are valid, and gut-feelings may tell them a lot.

●     Have students practice making small decisions.3 Starting with smaller decisions can help learners develop confidence and work towards bigger decision making.

●     Discuss perfectionistic tendencies.3 As mentioned, pharmacy students and pharmacists may consistently strive for perfection. Setting boundaries and priorities for tasks can be helpful. Also, encourage students to limit stress over small things, such as a perfectly worded email.

●     Help learners develop self-care strategies. Help students develop the habit of taking a break when they notice they are over-thinking. They can go for a short drive, drink coffee on their back porch, take a hot shower, put 5 things away in their house, or listen to their 2 favorite songs, as a few ideas.

While we recognize that not all learners will face the challenge of over-thinking, as faculty who are helping students grow personally and professionally during pharmacy school, this issue can be self-limiting for those who experience it.

Have you seen any of these tendencies in yourself, your colleagues, or your students? How might these tendencies be curbing the potential of our learners and future pharmacists?

References:

  1. Lowenthal W. Meyers-Briggs Type Inventory Preferences of Pharmacy Students and Practitioners. Evaluation & The Health Professions 1994;17(1):22-42. Accessed on November 24, 2021.
  2. Babal JC, Abraham O, Webber S, et al. Student Pharmacist Perspectives on Factors that Influence Wellbeing During Pharmacy School. Am J Pharm Educ 2020;84(9):ajpe7831. DOI: https://doi.org/10.5688/ajpe7831
  3. Taibbi R. Do You Have Analysis Paralysis? Available from: https://www.psychologytoday.com/us/blog/fixing-families/201904/do-you-have-analysis-paralysis. Accessed on November 3, 2021.
  4. Smith M. Analysis Paralysis. EMS World 2012;41:26. https://www.proquest.com/docview/912757391/fulltextPDF/922F9DB343D649F3PQ/2?accountid=36418
  5. Segal AM. How Analysis Paralysis Can Kill Your Career. Forbes. 2018. Available from: https://www.forbes.com/sites/forbescoachescouncil/2018/02/14/how-analysis-paralysis-can-kill-your-career/?sh=77aa7ad25161 Accessed on November 3, 2021.

Author Bios

Jaclyn Boyle, PharmD, MS, MBA, BCACP, is the Assistant Dean of Student Success and an Associate Professor of Pharmacy Practice at the Northeast Ohio Medical University College of Pharmacy. Her educational interests include professional development, student affairs, and leadership. Jaclyn is very active in professional organizations. In her free time, she enjoys spending time with her family and friends, spinning, and yoga.

Lindsay Roberts, PharmD is the PGY-2 Ambulatory Care Pharmacy Resident at Summa Health System, and is an Assistant Clinical Professor at the Northeast Ohio Medical University College of Pharmacy. Her educational interests include mentorship and professional development. In her free time, Lindsay enjoys trying new coffee shops, spinning, and playing tennis. 


Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

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