What the 2016 MCAT Dates Mean for You
August 31, 2015EAF Advocacy Trip: Update 1
September 8, 2015
By: Cheri Dijamco, MS4 at UT School of Medicine at San Antonio
Social Media Coordinator, Grassroots Organizing Action Committee
It is well known that suicide rates among physicians in the U.S. are high compared to the general population. According to the American Foundation for Suicide Prevention, approximately 300 to 400 physicians commit suicide each year, which is equivalent to roughly 1 physician suicide per day. Medical training involves many risk factors for mental illness, including role transition, decreased sleep, relocation (resulting in fewer support systems), and increased feelings of isolation. So, if the problem is wellrecognized by the medical community, then where does the solution lie? In 2015, JAMA Psychiatry published the paper “Depression and Suicide Among Physician Trainees: Recommendations for a National Response”, which suggested that national organizations should address the mental health of residents and fellows by proposing strategies for comprehensive education, screening, and treatment. However, we propose that the answer to addressing these ongoing issues lies primarily in mental illness monitoring and wellness promotion earlier on during medical school.
It’s no surprise, then, to see how the cycle of stress, anxiety, and depression takes root during medical school since students frequently lack time for enough sleep, healthy eating, regular exercise, and smaller support systems. In a study published by Academic Medicine in 2009 called “Distress among matriculating medical students relative to the general population”, it was found that matriculating medical students (MMSs) began training with similar or better mental health than agesimilar controls. Therefore, the high rates of distress reported in medical students and residents support concerns that the training process and environment contribute to the deterioration of mental health in developing doctors. Interventions targeting physicians, therefore, should take place early in training during the first year of medical school.
A study by Ludwig published in BMC Medical Education in 2015 demonstrated a significant increase in the proportion of students at risk for depression in their third year as compared to their first year and an increase in perceived stress. The study, which followed students at Albert Einstein College of Medicine, implemented a comprehensive program to address student wellness, including efforts to target issues specific to individual clerkships during the third year of medical school.
In 2009, Academic Medicine published a study by Goebert that concluded depression remains a significant issue for medical trainees. Depression rates were found at a higher rate among medical students versus residents as well as at a higher rate among women versus men. The highest rate of suicidal ideation was found among black/African American versus Caucasian respondents. This study highlights the importance of ongoing mental health assessment, treatment, and education for medical trainees. The pattern of unhealthy behaviors and thoughts persist into residency with 3⁄4 of residents experience burnout, leading to increased rates of medical errors and communication failures with patients.
Another article published by JAMA in 2003 called “Confronting depression and suicide in physicians: a consensus statement”, concluded that the culture of medicine assigns low priority to physician mental health despite convincing evidence of untreated mood disorders and an increased burden of suicide among physicians compared to the general population. The study cited several negative barriers to doctors seeking help including: discrimination in medical licensing, hospital privileges, and professional advancement. To encourage more physicians to seek help, we must help transform professional attitudes within the medical community and work toward changing institutional policies. As barriers are eliminated and doctors become more comfortable discussing the topic of depression and suicide with their colleagues, the medical community is more likely to identify and treat mental illnesses in patients, physicians, and medical students.
As medical students, we can help start the process by simply promoting safe spaces to discuss mental health issues on campus by promoting candid discussions and opening up to classmates about our own struggles. On KevinMD.com, one brave medical student with anxiety and depression published in a guest post: “I avoided treatment at the beginning of med school for those same reasons. Admitting to “mental illness” seemed like admitting to failure – after all, who would ever want to see a physician who had struggled with anxiety? Who would ever want to talk to a psychiatrist who had experienced depression?” To which the author adds that he actually would see those kinds of doctors, claiming that more people would probably agree with him if they realized how many physicians gained more insight by facing their own problems.
The AAMC Reporter published an article in 2013 that points to a few examples of how medical schools can take an active role in reducing students’ stress and anxiety. Given medical students’ reluctance to seek help for emotional problems, medical schools must play an active role in helping their students deal with these issues. Some have suggested changing medical school curricula to pass/fail grading, reducing the volume of material covered in classes, and lowering the number of classroom hours to reduce stress/anxiety over grades. Saint Louis University School of Medicine (SLU) has begun promoting student interests related to medicine through learning communities focused on as service, advocacy, research, global health, wellness, and medical education through nongraded elective coursework. Dr. Stuart Slavin, dean of student affairs at SLU, believes that these student groups may increase the chance for students to form meaningful relationships, which can sometimes get overshadowed in a competitive academic atmosphere. Yet another approach SLU has taken to promote student wellness is implementation of courses to teach coping methods and stress management.
Innovative programs for promoting student wellness have increased over the past few years, including implementation of extracurricular activities that focus on community building among students. At Vanderbilt University School of Medicine, a student run Wellness Committee splits the first year class of medical students into colleges that compete in recreational athletic, trivia, and cooking competitions throughout the year. According to Dr. Scott Rodgers, the associate dean of student affairs at Vanderbilt SOM, “You don’t want to lose your humanity by becoming a doctor. Students should participate in activities outside of medicine, maintain personal connections, and make their own physical health a priority.”
Additional research is needed to evaluate whether or not these new medical school programs have a positive influence on rates of depression and burnout in medical students over time. However, the shift in medical students’ attitudes regarding seeking help for mental health issues is a positive sign and shows significant promise for a brighter future for physician wellbeing. If our goal is to achieve a culture of acceptance and openness regarding mental health issues, then medical students must begin taking charge by advocating for increased educational opportunities related to selfcare, improved access to mental health services on campus, and greater availability of peer support groups to deal with academic stress.
In our opinion, the opportunity to make this world a reality, where mental health is considered as important as physical health, is a huge undertaking that physicians, students and educators must tackle together with a sense of urgency and optimism.
7 Comments
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Couldn’t agree with you more. Our mental health issue is a huge undertaking that everyone needs to address together .
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As a parent on a Med student, the mental health problem on student is something new to me. I read your articles, articles on the American Medical Association and some studies from other countries. This is not a new situation. The first thing to comes to my mind is why we don’t hear anything about it? When I say “we” means general public. What is been doing to decrease or eliminate this situation? Why a situation that is directly related to the human been (physician), related to the patients and to the families is maintained in the shadow? Who benefits of having this on the shadow?
You raise an excellent point, this was a topic of discussion at last year’s AMSA Convention with keynote speakers Pamela Wible and Robin Symon who have both worked extensively on this issue. Check out their work to see the kind of advocacy going on with this issue. AMSA also focuses on med student mental health and we have a few initiatives planned for the coming year to build awareness. Thank you for contributing to the conversation on this important topic!
This makes me happy seeing you guys care about our mental health. I am someone who never suffered for anything and after a while being in Medical School I started having problems. The thing is I knew I had them but I was scared to go to a psychiatrist or ask for medications. I tried everything to relax but with pressure of school it was just impossible. I have had always all A’s and B’s. My STEP USMLE 1 I passed but it was not represented at ALL to the scores I was getting in practice exams. I couldn’t answer 20 questions in each block. I blocked. It happens to me a lot actually. I could never get extra time because they needed evidence since I was little girl however the anxiety –> Panic attacks started in Medschool. But I was still doing well. I just keep thinking wow if I was stable how better I would be doing. I can be easily not sleeping like 3 days straight nonstop with caffeine. So Ive been getting anxiety and panic attacks and would block only in exams and I thought it was temporary. Med school just keeps getting more stressful, I feel that third year is even worst because everything you do doesn’t matter because the shelf is 20% fo the grade but they don’t even give you time to study because you have to rotate and also they give you extra exams besides the shelf while your rotating all day. The thing is my anxiety got so bad and worst that then something happened where I couldn’t concentrate, I would just sleep 24.7 I could be days, I didn’t want to speak to anyone, I would literally just be in the dark watching Netflix, feel hopeless, insecure, cry for no reason and thats when it hit me. Im DEPRESSED. Never in my life that happened. A week later I had my shelf of surgery after christmas break. I didn’t study that well to be honest, however, I had all As in that clerkship. Literally all A’s. And when i took a practice test i got a high score two times so i was feeling good. When I got to that exam I could not focus, I literally BLOCKED i don’t know how to explain it. It was horrible. I just couldn’t think and I knew everything coming out of the exam which is the worst part. I couldn’t answer almost half the shelf exam. And because of that, they have a rule that even though you have in everything A, if you get in a shelf less than the minimum they ask for they make you repeat it in summer when you take step 2CK also, and it doesn’t matter the score you get (but have to pass with minimum). You can get an A on the shelf and had everything A but since it was a repeat you get a C. I didn’t pass the shelf with the minimum bc i had a panic attack during the exam. But even though I didn’t pass it I calculated my grade and it came out to an 85 B on the class. But since the rules are that if you don’t get the minimum in the shelf you get automatically a C without counting the other grades now I got my first C ever in my transcript on clerkship of surgery. All because I couldn’t control my anxiety and the weird part is I slept the night before and rested and was prepared bc I did practice exams. There wasn’t that much time for so many questions and the questions were so long and you had to think more than what u normally would think like for step 1 bc here they put a disorder with labs and they ask an indirect question so you have to first think in what is the diagnosis, then what step went already, what are in labs, what can be next MOST APPROPRIATE, or next BEST, or next most ACCURATE and I froze, my throat felt like it was closing, I got tachycardia, I started sweating and I felt I couldn’t breathe so I couldn’t think. It was horrible. It also happened in step 1 but thank god i passed just with not the score i would normally have gotten So now I just feel because of that C in my transcript i lost sumacumlaude which i was going to be for next year in graduation.. im not anymore… my first C and now residencies for match will see that…. now i feel the triple pressure and im also scared for step 2 ck that I froze and don’t finish the exam and questions like what happened with surgery shelf… So I went to the psychiatrist. I asked him why am I depressed if i have friends and family who support and love. My parents give me everything. A lot of people have it worst then me. Yeah, I don’t sleep some times and im always anxious and stressed but thats normal in medschool i think? and he told me the reason you are depressed is because you’ve been dealing with all the pressure and stressors of medschool + anxiety on top of it that your brain couldn’t anymore. It made you depressed so then he offered SSRIS for anxiety (since its the primary cause of the depression this is what should be treated, however depression is also treated with SSRI) and I was so desperate after being resistance for years, I took it…… I definitely feel a LOT better. Not like before, still struggling because of medschool. Too much pressure on us but I do feel better and I can’t believe it took me this long to go to a doctor, maybe I would ve been happier in medschool if i would’ve done it from before…so this is me telling those medschool students that if u know u have a problem go to a psychiatrist and don’t be scared to take meds, i take the lowest dose and apparently its temporary. The ironic part is that Ive changed so much to the person I was before and it’s not because I don’t like medical school. Its because every person is different and handle situations differently. Everyone has a type of personality. So unfortunately even if i tried exercise and eat clean I have not been mentally healthy. Im definitely not my own self which I miss a lot sometimes. Its actually a little sad because sometimes I think about I still have residency to come and Ive been all this time battling anxiety and now depression all because I couldn’t control it and I just wonder, when I finish i will be older and maybe i will probably think like damn, i lost myself and went thru hell for so long. And let me clarify, I swear it has nothing to do with me liking or not medical school, believe me, I know i LOVE it because Ive gone thru so much and so many changes that I still want to be here. I would’ve left already. Thats how much I want it, But yeah, unfortunately I handle stress and pressure more difficult than other people. I also study REALLY SLOW which I don’t know if thats normal or what but thats another problem which I take time to study and I almost have NO TIME to study because of rotations being all day, departmental exams and quizzes, OSCES, presentations weekly so you are focusing on rotation(7am-5pm) + all those stuff mentioned and then at the end its the shelf when u finish all of these stuff so where u had actual time to study for shelf? and its 20% of the grade, that is the worst part. and if you don’t get the minimum you fail, have to repeat and get a C even if you pass it again with A or right now with he nonplus you calculate and get B, still get C.. And then for example if you , And another thing is that we don’t even learn in the rotations. All the ones we have been (exception psychiatry) we haven’t learn ANYTHING, They don’t let us do anything. So besides having to be all day there we don’t learn or do anything. By far I find first year and the third year being a lot worst than first year. I haven’t even done research and apparently residencies look at that and every time i write to a doctor(already like 70 not joking) they all say they don’t have or not accepting students right now. Which Im also freaking out because of that bc matching is in august. Also. I was crying one day in the school and I was told that Im being a drama queen. And I was crying because I was expressing how I was feeling and struggling with. They told me I needed to toughen up and learn to deal with it since Im going to be a doctor and Im going to have to deal with these stuff all the time. Im far from my family also which doesn’t help either. Its just a lot of things that I feel need to be changed. I don’t think medical school is hard at all, when I mean not hard I mean the material to study. Its just the time, pressure and environment +stressors caring one to get anxious and depressive and thats when no motivation or focus at all its the worst but i definitely feel so much better now. Started 3 weeks ago lexapro of 10mg. I cried today actually a lot which i didn’t cry for a long time but it was because i asked to go to a clinical rotation in a hospital close to my house and i was told no which is fine but i don’t know i just reacted like that. Hate feeling lonely while im anxious or sad, it just makes it worst because I get like scared.
The bizarre part is you would’ve met me a few years ago I would’ve never been saying these things. I was a COMPLETELY different person. Never went thru anything. And oh well, I just hope I could’ve spread some awareness which is something I want to start doing by research and public speaking(still not there yet).
P.S. The depression is gone with the pills, feel less anxious than before, a lot less but the panic attacks and block during exams keep happening. I don’t know what else to do. And I have step 2 ck on summer so im scared. If you have any suggestions it would be appreciated.