“1 minute and 36 seconds” is the name of the book written by Pilar Burillo Simões. A brave young doctor who never abandoned her passion for writing, even in the darkest moments of her academic training. The title suggests what goes on in the Exam, so well-known and feared by our medical students, the National Exam of Access to Specialized Training (NEAST) - A “Cape of Storms” lasting 4 hours, which requires the analysis of 150 clinical cases and the response capacity of 1 minute and 36 seconds per question.
She admits that throughout her academic career she has had many extracurricular activities, and despite having tried to close all these chapters in time, in order to prepare for the fire test, her passion for writing led her to give continuity to her logbook: The Nutsbook - the blog she started writing in 2017 and that she never stopped adding to, even in the most demanding periods of the degree, and which served as the basis for the publication of her first book.
Pilar Burillo Simões is currently a General Training Intern at the Northern Lisbon University Hospital Centre (CHULN) and has recently collaborated with a company dedicated to the training of health professionals, which aims to prepare newly graduated doctors who will take the NEAST. She completed the Integrated Master Degree in Medicine in June 2019 at our Faculty and was part of the group that had to deal, for the first time, with the new model of the exam.
Pilar, for someone with the gift of writing and who has already won some literary prizes, how do you end up choosing Medicine?
Pilar: I didn't end up choosing medicine, I started by choosing medicine! I never wanted anything else, at least consistently. Being a doctor has always been the goal of my professional career since I opened the first science book, while writing was always what I wanted to do from a personal point of view. For me, it started, and always starts, as an exercise in intimacy, from me to me. Then I started to share it with the idea of common experience in mind. Everyone is different, but we often find ourselves in the same mental places and have similar experiences. Finding ourselves in others is a discovery that supports us, gives us a feeling of belonging, of understanding and it is in this perspective that I place the "published" writing, never done for professional purposes.
Given that year 6 of the Medical Degree is such a demanding year, where did you find the time to write a “logbook” and still a blog at the same time?
Pilar: I would say that the blog fed me and the book! I was a medical student with many extra-curricular activities, and before preparing for the exam, I ended as many chapters as I could of this phase of my life, no matter how beautiful they were. I even planned the route to leave nothing that I really wanted to do out, in order to be ready before the last year. I quickly realized that I would go crazy if I didn't have an escape, if it didn't give meaning to that experience beyond the very goal line which, when it starts, seems so far away. That escape was to continue to write, maintaining regular blog posts. And this book was born out of these publications
Under what conditions did you start writing this book?
Pilar: At the time, I was very scared. I think that almost everyone went through this, in the beginning, especially our group, the 2013-2019 graduates who were the first to do the new model of the exam. The feeling I had, as I describe in the book, is that I was an airplane about to take off fearing that the runway would be too short. Then, as the chapters were brought together, there was some consolidation. The certainty of the path trodden. Odds are odds, but I felt that I was doing everything to make them favourable to me and that was extremely important.
During the degree, did you ever felt like giving up?
Pilar: Yes! I found that idea very strange for most of the degree, but then it happened to me.
And what happened to you? Can you share it with us?
Pilar: I resat an oral examination that I shouldn't have done. The original grade was not bad, it was just below my usual grades. And I was already pretty worn out from the exams and also for personal reasons. It was a mistake. The lecturers who assessed me were particularly tough. We all have bad days and none of them knew my context, but the discussion quickly moved from my grade to whether or not I should continue in medicine. If I had the “right” to it. Not that I ever thought about wanting anything else. It was only suggested to me - after five straight years - that this was not my place. Barely comparing, it was as if I wanted to sing and the "Idol" judges told me that my voice was the worst they had ever heard.
How did you overcome this episode?
Pilar: I performed the supposed ritual in these circumstances, which is to cry a lot and ask everyone close to me if I was in the right place. Everyone called me an idiot. And everyone was right. After a day or two, I came to the obvious conclusions. I had passed the subject. I had passed them all before that one, with good grades. I loved what I did. And I dreamed of what I was going to do next. So I chose to ignore the only suggestion that I was be in the wrong place and embraced all the previous ones that shouted that my place was there. Until today!
After this sharing, the theme of Burnout seems unavoidable. Have you ever had an episode of Burnout during the degree? Or during the NEAST preparation?
Pilar: No, not really, but it is not because I am a superwoman or have the resistance of the President of the Republic. It has a lot to do with time management, with the optimisation of the various moments and with the concessions that we are willing to make. From the point of view of emotional support, it does not take that long to realise how ours is and to be present. It is necessary to remember to do this, to write it down in the agenda, the same way we write down the deadlines for submitting assignments. This is not only doable, it is ESSENTIAL. From the point of view of what is now called "selfcare", I tried never to lose sight of the number of hours of sleep I needed to "function" normally. If I slept too little, I made up for it the next day. And that was it. I had support, rested and liked what I did. That's how I did the degree. The NEAST was more difficult, because there is more at stake and the journey is very long. My last two months were all about a battle against my own exhaustion. And for that the cure was to write. Understanding that the accumulated tiredness was a sign that the route was going to end soon and that only one last effort was needed. But this final stretch can be quite complicated and, for me, it was the most demanding period.
In your opinion, what initiatives could be created in medical schools in order to support students and prevent episodes of Burnout?
Pilar: I think we've come a long way since I started the degree. The Mentoring Project, whose Organizing Committee I had the privilege of being part of (and in this context I also founded the Solvin'It Project), has expanded and been embraced by the Faculty, becoming a fundamental tool for supporting and integrating students in our faculty. At national level, all medical schools now have a Students Support Office, from the point of view of mental health. Therefore, this structure exists. But it is little publicized. In addition, we are far from living in a society where we talk about the care and preservation of our mental health and well-being with the same naturalness as we do in relation to physical health. That is the main change that has yet to happen.
Can we say that your book "1 minutes and 36 seconds" is a message of courage and resilience for medical students?
Pilar: I wish it is seen that way. I feel that there is enormous solidarity between colleagues throughout the degree. However, the isolation that inevitably ends up taking place somewhere in the middle of the marathon makes us less supportive of each other at this stage. The main purpose of publishing texts is to convey the idea that all marathons will be over and that what matters is to continue the journey, personally and professionally.
Is there any part of the book/chapter that you enjoyed writing the most and why?
Pilar: The last chapter was particularly special. First, because there were many moments when I doubted that I would be able to complete the project. While studying, I did not always feel like writing and I did not always see clearly which angle to follow. It is an inner process that also depended on luck, because the starting point was to write the various chronicles in the order in which the fourteen medical specialties appeared in the bibliography and it was a happy coincidence that the events of my life were also happening in a chronological order. That has allowed me to stay true to that sequence that I proposed to myself in the beginning. And also because the last chapter is Psychiatry, and it is inspired by a patient I had and who perfectly represented the final message that I wanted to leave, to take care of ourselves while we make our way. Sometimes we may have a concept in mind and not know how to represent it. The experiences we have afterwards help us to complete the picture.
Are we going to continue to hear about you? When's the next book? Still on the importance of academic students' mental health?
Pilar: It's hard to say! This book was the result of a very beautiful combination of factors, pandemic included. This postponed the development of the project long enough for it to being presented at the Lisbon Book Fair. At the moment, I continue to write in The Nutsbook and I have some ideas in progress which, for now, will remain in the notebooks. If any of them becomes a project with sufficient scope to be able to consider its publication, we will have to see if there is interest on the part of the public. For now, the answer has been quite positive, especially considering that I am an unknown author and that we are in a pandemic context. If publication is not possible, the blog will be the final destination for this type of project, with open access to the community that has accompanied me. More than mental health, whose importance is unquestionable, I feel that my work will always focus on the human experience that, in its diversity, is common to all. That is my passion and I will continue to work on it, both in medicine and in writing.
Note: The book “1 minute and 36 seconds” can be purchased at WOOK and Bertrand bookstores, or found at the Library of the Faculty of Medicine, as the author donated a copy to our Faculty.
Isabel Varela
Equipa Editorial.