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  • Medical Students and Mental Health



    We’ve talked a lot about coping with stress on Wellness Wednesdays. The AAMC recently published an article that uses some startling numbers to give credence to our assumption that you all are stressed! They note that while the mental health profiles of students entering medical school are similar to those of college students, many end up dealing with a mental illness during their four years. To make things worse, the most depressed among us are the least likely to reach out for help given the stigma.

    Another factoid gleaned from a 2005 NEJM article was that the suicide rates among physicians is higher than the general population: 40% higher for males, and 130% higher for females.

    The AAMC highlights three medical schools that are countering this known phenomenon with school-wide curricular implementations from year one. Read on to find out what Creighton, St. Louis, and Vanderbilt University Schools of Medicine are doing as a service to their students. Could this work at your school?

    To hear more, join us next Monday for the first day of Health Equity Week of Action (HEWA). At noon on Monday, January 20th, Michael Kavan, PhD, will lead a webinar to discuss mental health issues among medical and pre-medical students! Log on here

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  • Healthcare issues across the globe: Part II

    By Aliye Runyan, MD
    AMSA Education and Research Fellow


    Professionalism

    The conversation surrounding professionalism was fascinating and brought to light a huge unmet need in global medical education. The speaker from the World Federation of Medical Education (WFME) spoke about tenets of professionalism: social accountability of the physician, training to take into account needs of the changing face of medicine, adaptability, training students to understand their global responsibility, and of the need for role models for students. Another speaker pointed out threats to professionalism, including commercialization of medicine, the role of pharmaceutical companies and industry, the deteriorating doctor-patient relationship, and that there are MANY medical schools with no formal curriculum on ethics and professionalism. She described attempts at some formalization, but also brought to light the issue that a lot of professionalism standards are from a Western cultural mindset, and do not take into account vastly different cultural standards from Latin America to India (two of the examples she used). She stressed that professionalism attributes must be integrated throughout medical school curricula and not just taught as a standalone course (as many in the US are).

    This brought to mind incredible potential for the IFMSA pre-departure training for clinical exchanges (bilateral, international exchanges of clinical year medical students) to include a (student developed, faculty advised) curriculum on professionalism and medical ethics issues with a culturally sensitive perspective. Perhaps this could even be the beginning of cross-institution and student-faculty collaboration of professionalism courses that may eventually be integrated into formal medical education.

    Burnout and self care during training

    Burnout of trainees occurs as a result of many factors, including lack of time for self care, growing cynicism towards the system of practice, little time actually spent with patients, and as a result of poor role modeling from higher level physicians who can promote unprofessional behaviors towards patients and colleagues. Furthermore, there are hospital systems in many countries in which residents commonly work 36 hour shifts, a dichotomy from other systems which have recognized the unsafe consequences of such extended work with no sleep. There is the need to raise awareness of work hours reform, as well as proper role modeling for physicians in training.

    One speaker noted "new med students go from naive and idealistic [committed to the profession] to knowledgeable and cynical". Development of unhealthy (to the physician) and unprofessional behavior (toward patients and/or colleagues) is a function of context more than education - the hidden curriculum and role modeling. There was a call to action to redefine the definition of excellence for both teachers and students, leading to policy changes in assessment and promotion, which would ideally lead to those most qualified and in line with professional and healthy behavior to move to teaching positions and be promoted within the training process.

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  • Work-Life Balance of Residents

    Aliye Runyan
    Chair, AMSA Medical Education Team
    The University of Miami Miller School of Medicine

    I was recently talking to friend, who is an intern. She told me she didn't remember the last time she'd had a bite to eat. She'd been up for 16 hours. We talked about an article written by a classmate, also an intern, about the stress of his days. A fellow resident commented on it, something to the effect of "don't be weak, you haven't seen anything yet.”

    To some extent, this is the normalization/desensitization process that all residents must go through, in order to make it through the tough years of training, to be able to handle a full schedule with emergencies popping up at a moment's notice. This is understandable, it's what we go to med school for; it's what we train for.

    What is not understandable is how this aspect of the culture of medicine permeates to the very health and sanity of the physicians it trains. There is no honor in losing a grip on your own mental and physical well-being in the process of caring for your patients (which, as a resident, is less of that and more dealing with bureaucracy, paperwork, and miscommunication). The medical community, to some degree, has recognized this issue by way of one of its symptoms: patient deaths and countless medical errors, and had tried to deal with it in part with work hour regulations. This is surely a positive step; however criticized it may be as the regulations go from theory to practice. However, the onus is still on the community at large to self-police, and to shift perspective. 

    It begins with little things - a resident asking an intern if they have had something to eat (and vice versa), for instance, or finding more efficient ways to prioritize time with patients (more fulfilling than paperwork), and better care for the patient, which leads to higher satisfaction for the doctor. Honestly, it all comes down to the simplest concept - looking out for one another, as colleagues, as doctor to patient, as a community. There comes a point where the doctor is too sick, too tired, too burned out, too anxious - to be an effective clinician and decision- maker. 

    The analogy of doctors and pilots is sometimes overused, but the image works well. Would I want a pilot, having not slept for more than 16 hours straight, and not eaten for 8 of those hours, to fly the plane I'm on? The answer, without a second thought, is no. There is a very high likelihood, though, that your surgeon might be in this state. This should be a sobering thought. Providing good medical care need not come with the physical and emotional toll that is the status quo.

    I'll end with this: I was at a conference recently where an Australian physician gave a talk on work-life balance. I enjoyed his talk and went up to him afterward to say how hearing about balance is so necessary in our community, especially for young physicians as they go through training. I mentioned the work hour restrictions and generally explained the way hospital medicine is in the U.S. He looked at me incredulously. He works three days a week, taking care of his entire community in a small town in Australia. Work-life balance and preventive medicine is valued. "Come train with us!" he encouraged me. I'm more than a little tempted. Obviously, there are more than just work-life balance differences that make this lifestyle possible. The model, though, exists. 

    We have come far from the age of my grandfather's day as a doctor, where being a member of the "housestaff" literally meant you lived in the hospital. We have so far yet to go. As a community, let's strive for our health as well as the health of our patients. We are only as good of a doctor to our patients as we are to ourselves.

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  • One small step for a current student, one giant leap for me

    Andrea Knittel
    AMSA Member
    6th Year MSTP
    University of Michigan

    Post #7 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

    On Monday and Tuesday of this week, an incredibly gracious current M3 let me shadow him on the first two days of his inpatient pediatrics rotation. I would highly recommend this before returning from an extended absence, as it not only gives you a better sense of what will happen in the months to come, but gives the more advanced student a unique opportunity to demonstrate everything he/she has learned and to teach a newer student.

    The logistics: The MD/PhD program identified a willing volunteer who was on an inpatient pediatrics rotation this month, which is what I’ll be doing in either May or June, and put me in touch with him. I decided not to go to orientation, as I knew I’d get my own orientation soon enough, but met up with him following orientation before rounds started for the day. I only spent a few hours with the team on Monday, but I got a good sense of how the team works in the hospital, and when I showed up for pre-rounding on Tuesday, I got a real sense of what medical students do with patients who’ve already been in the hospital for a while. I went on rounds again, saw the med students present, and helped with the tasks that followed.

    The lessons: Do this! No amount of shadowing can prepare anyone completely for anything, but it can substantially decrease anxiety. I learned that even after eleven months of clinical rotations, there are still new things to learn and different approaches to adapt to on each service. I saw some great medical students in action, and learned that even folks who haven’t taken a break are constantly learning new things. I also learned that interns, residents, and even attendings are not scary (which should not have been surprising, as many of them were my med school classmates!), and are nice and helpful and willing to teach if you work hard, try new things, and aren’t afraid to ask questions. I also learned that “work hard” includes spending long hours at the hospital. I had a good sense before that this was the case, but spending just two half days in the hospital drove it home.

    The bottom line: I need to start believing folks that this will all be fine! There will be long hours, and lots of work, but nothing insurmountable. I’m certain that as crazy as next month may be, at the end of it, I’ll join the chorus reassuring you that you too, will be fine.

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  • Depressed medical students worry about stigma

    This week, researchers from the University of Michigan reported that depressed medical students are extremely aware of the stigma associated with depression. The study, Depression, Stigma, and Suicidal Ideation in Medical Students, showed that 53.3 percent of medical students who reported high levels of depressive symptoms were worried that revealing their illness would be risky. Almost 62 percent of the same students said asking for help would mean the student's coping skills were inadequate.

    "If medical students are critical of each other about depression, how does that transfer to patients? We don't want the medical education experience to make them less tolerant of mental illness. Stigma seems to be lessening among the general public. But it is possible the medical professional is lagging behind," says Thomas L. Schwenk, M.D., the lead author on the paper and the George A. Dean, M.D. Chair of U-M's Department of Family Medicine (University of Michigan Health System press release.) 

    "Somehow we have to change the environment in which we are teaching future physicians,” continued Dr. Schwenk.

    AMSA’s strategic commitment to humanism in medicine extends opportunities to physicians-in-training in the development of lifestyles that counter the deleterious effects of stress through creative expression, self-care, balance and holistic goals for personal growth and professional development.

    If you are a fourth year medical student, you might be interested in AMSA's Humanistic Elective in alternative medicine, Activism, and Reflective Transformation (HEART), a 4th clerkship accredited by the University of Florida College of Medicine in Internal Medicine, continues to be an empowering AMSA experience for students making the transition from medical school and preparing for residency training.

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