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Monday Nov 02, 2015

Med Students, Schools Must Safeguard Peers' Mental Wellness

My friend was brilliant. He graduated valedictorian of his high-school class and was salutatorian of his undergraduate department. He had other gifts, too, including a phenomenal singing voice that would put Sam Smith to shame.

He also had bipolar disorder, which recently led him to take his own life.

For some students at our medical school, the news of his suicide was shocking. For those closer to him, it was almost understandable.

 Nearly one-fourth of medical students meet depression criteria.

Starting from day one, medical school students are constantly exposed to a host of new and stressful experiences. Support from family and friends can make a big difference, but this type of encouragement may be limited for those who are in a completely new environment far from home. Too often, we try to process these situations in isolation, or we may try to cope in potentially harmful ways, such as through excessive alcohol consumption.

According to a study on mental health in medical students(jama.jamanetwork.com) published in JAMA: The Journal of the American Medical Association several years ago, 14 percent of students surveyed at the University of Michigan Medical School had moderate to severe depression, and another study suggested that nearly one-fourth of med students(www.ncbi.nlm.nih.gov) met depression criteria. More shocking, more than one in 10 students(www.ncbi.nlm.nih.gov) (11.2 percent) surveyed in a study assessing burnout reported experiencing suicidal ideation in the previous year. Third- and fourth-year medical students reported higher rates of suicidal ideation than did first- and second-year students. 

Although medical students are at particular risk for experiencing mental health issues, we’re unlikely to seek help(www.ncbi.nlm.nih.gov). One commonly cited reason is stigma. Earlier in our lives, we were somehow molded to react uncomfortably to topics such as depression, schizophrenia, substance use or suicide. Medical school culture then builds high expectations in which weakness is not accepted. Some of us think that disclosing a mental health condition would lead us to be viewed as incompetent.

Even when students decide to seek help, we face additional barriers. Oftentimes, our busy class or clinical rotation schedules prevent us from scheduling needed appointments. And even if we do have free time, getting an appointment with a therapist may take weeks, and it may be a few months before a psychiatrist is available.

Another friend battling depression sought help and found that the institution’s student mental health resources had a three-week wait. She decided to go to the emergency department that day to contract for safety.

Addressing student wellness has become a priority for medical schools. Initially, most schools focused on increasing access to post hoc, therapy-oriented services for individuals who develop mental disorders or significant distress. But in recent years, comprehensive wellness programs are increasingly being implemented to counteract or balance the negative experiences students may face.

My institution established a college advisory program modeled after Vanderbilt University School of Medicine’s wellness program(medschool.vanderbilt.edu). Students are divided into four colleges (similar to the Hogwarts houses in the Harry Potter books). Within each college, we are further divided into "molecules" of five students with one faculty member who advises us on wellness and provides career counseling throughout medical school.

We meet with our faculty advisers after each clinical rotation to reflect on experiences from the past eight weeks. The most recent discussion focused on personal growth. A third-year student tearfully spoke about the insecurities he faced on his first rotation. He thought he constantly disappointed his team because he hadn’t met clinical expectations. He didn’t realize the expectations of writing complete progress notes on every patient before rounds and providing sign-out to the night team were beyond the scope of a medical student. Furthermore, his team regularly criticized his oral presentations. Hearing fellow third- and fourth-year classmates relate to his experience and offer advice on future rotations seemed to comfort the student, but the fact remains that he should have been supported earlier in his clerkship.

Additional measures taken to improve student wellness have included a dramatic move from assigning grades (honors, high pass, pass, fail) to using a simple pass/fail system. During the preclinical years, most lecture days end by noon. This provides students time to pursue extracurricular activities that range from conducting research to playing intramural sports to visiting family.

Yet even with these changes in place, my classmate struggled with his mental illness. He refused to seek mental health services and attempted to self-medicate. Ultimately, his strongest support was a small group of classmates who, despite his initial resistance, constantly reached out to him during both his highs and his lows. When he first expressed suicidal ideation, our classmates brought him to the emergency department. When he had his first manic episode, those classmates called police for help. They went through so much with him, and now that he has passed, they are the ones left hurting. Their mental health cannot go unaddressed, nor can the mental health of my classmate’s family and loved ones.

This sad experience offers a strong reminder that we future physicians are not invincible. It is acceptable for us to show weakness and to seek help. After all, if we cannot care for ourselves, how can we care for our patients?

Tiffany Ho, M.P.H., is the student member of the AAFP Board of Directors.

Posted at 04:51PM Nov 02, 2015 by Tiffany Ho, M.P.H.

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