AAMC Reporter, October 2000: 'The Right Thing to Do': Medical Schools Address Student Wellness

VOLUME 9, NUMBER 13

JORDAN J. COHEN, M.D., PRESIDENT

OCTOBER 2000

'The Right Thing to Do': Medical Schools Address Student Wellness

by Jennifer Proctor

From the first gross anatomy lab lesson to the first night on call and code blue, medical school involves numerous anxiety-ridden situations. Add to that the possibility of adjusting to a new town, eating and exercise habits gone awry, and lack of a social life, and the lives of medical students can prove downright trying.

Acknowledging these many challenges, medical schools are developing ways to ensure that the emotional and physical well-being - or "wellness" - of their students does not become an afterthought in the push to provide the best training possible.

Webster's Dictionary defines wellness as "the condition of good physical and mental health, especially when properly maintained." While medical students spend their waking hours studying and learning about disease and the body, they sometimes neglect their own mental and physical health. Schools are finding ways to help remind them.

"Addressing student wellness is the right thing to do," says Michael Kavan, Ph.D., associate dean for Student Affairs at the Creighton University School of Medicine. Creighton instituted wellness promotion programs several years ago. "Rather than waiting for students to feel overwhelmed and completely stressed out or depressed, we decided to take a proactive approach," he says.

Medical school students, often coping with a new environment, new school, and new schedule, can easily feel overextended. Dr. Kavan calls the situation new medical students face a "pressure cooker." He emphasizes that it's natural for students to experience some of the symptoms of depression or increased stress, and it's not an indicator of whether they will ultimately become successful physicians.

Creighton's program includes a wellness committee, comprised of two students from each of the school's four class years. The committee acts as a "barometer" of tension and stress. It also plans wellness programs and activities. One of the committee's most visible projects is its "Wellness Chronicle," a quarterly newsletter written by students that addresses exercise, nutrition, relationships, mental health, and spirituality. The articles coincide with life events for the students, for example, covering depression at the beginning of an academic year and stress near finals.

In addition, the school sponsors brown bag lunches and lectures, in which speakers from the community and various medical school departments talk to students about a broad range of topics, including relationships, nutrition, and exercise. Dr. Kavan says that one of the most popular topics has been nutrition, not surprising given the number of busy students who succumb to a diet derived from fast food restaurants and vending machines.

Creighton has incorporated wellness lectures into the formal curriculum of the medical school. Dr. Kavan, a psychologist, delivers some of the lectures himself and speaks on subjects including stress management and relaxation techniques. While students are not tested on materials presented at lectures, they are expected to attend the talks. The wellness committee provides input on deciding the most appropriate topics and refining lectures to best suit students' needs throughout the school year.

Recognizing that students' social lives often take a back seat to late nights spent at the library, on call, or absorbed in a microbiology textbook, Creighton sponsors social outings. The school will rent, for instance, an ice skating rink or a miniature golf course. Students can participate at no or minimal cost.

Dr. Kavan says the outings not only give students a well-earned break from their studies, but they also provide an opportunity for interaction outside of the learning environment. And activities such as ice skating are a fun way to exercise - an important tool in stress and depression management. Because the school plans the outings, Dr. Kavan adds, students are more likely to participate since they know their classmates will be there.

And the activities have proven popular with the students. A spring miniature golf activity boasted an attendance of about 125 students, more than a quarter of the school's student body.

But these proactive approaches cannot and do not wholly eliminate anxiety and depression. To help students grappling with more than average levels of stress, Creighton offers confidential counseling services free of charge. From the first day of orientation, Dr. Kavan emphasizes that stress and depression are very normal reactions to the rigors of medical school, and it is all right to seek help.

Creighton's student affairs office also maintains an open-door policy for medical students and specifically reserves Thursday afternoons for student visits. "Students sometimes come in just to shoot the breeze but end up sharing their issues with stress, depression, or anything that might be troubling them," says Dr. Kavan. The office aims to create a welcoming environment for students to come in and discuss issues with their medical studies or their personal lives.

Creating a Framework for the Future

Creighton University medical student
take time out to play miniature golf with their classmates.

Temple University School of Medicine has a wellness committee made up of students and basic science and clinical faculty. "We believe promoting a balanced life now helps students maintain wellness when they are doctors," says Albert Lamperti, Ph.D., Temple's assistant dean for Student Affairs.

The wellness committee plans lunchtime discussions of topics such as stress management, body image, exercise, and leading a balanced life in medical school. Dr. Lamperti says to help release stress, the committee also organizes humor sessions, such as a Three Stooges movie viewing.

Dr. Lamperti stresses that the proactive approach to wellness is essential; it helps students address problems early, preventing them from taking a leave of absence or dropping out altogether. He adds that it is also important for schools to tackle drug and alcohol issues, because depression and stress can manifest themselves through these more visible problems.

Each week, Temple medical students have the opportunity to meet one-on-one with an educational consultant to discuss stress management, study skills, exam anxiety, and other topics they want to talk about. The consultant provides students with concrete approaches to handling stress and stressful situations, Dr. Lamperti says.

For deeper-rooted issues, students can seek help from Department of Psychiatry faculty. And students who are uncomfortable with seeing a medical school faculty member have access to the main campus psychological counseling services.

Dr. Lamperti says it is his job and that of other student affairs representatives to listen to students and ask the right questions. "Sometimes they come out and tell you what's wrong. Other times, they may hint about something, and you can grab on and encourage them to get their problems out in the open." He stresses the importance of urging students to talk not only to administrators and faculty members but also amongst themselves - to roommates, lab partners, and in study groups.

In fact, many experts agree that encouraging students to talk about issues with one another is a key component of wellness programs. At the University of Virginia School of Medicine, for example, all students are invited and encouraged to take part in the Mulholland Society, the school's student government. "This society is by students for students," says Allison Innes, Ph.D., University of Virginia's director of Medical Student Affairs.

The society matches first-year students with faculty members and advanced students, thereby creating a "family" with whom students can participate in extracurricular activities or discuss issues or problems.

Improving Patient Care

At a Creighton wellness committee-sponsored outing, first-year students Trisha Wong (l) and Katie Swank (r) demonstrate their climbing skills.

"Medical students need to take a valid interest in their own health," says Suzanne Kunkle, Ph.D., director of Counseling Services at Indiana University School of Medicine. Dr. Kunkle, who is helping Indiana build its medical student wellness program, encourages the students she sees to set boundaries and make time for themselves.

In her experience, medical students often suffer strong feelings of guilt, which can evolve into depression or worse. For example, students may feel guilty because they are not spending enough time with a significant other, child, or on schoolwork. "I remind students that they don't have to be perfect, a hard thing to remember in the medical school setting."

Dr. Kunkle touts exercise as a way for students to start taking care of their physical and mental well-being. In addition to helping prevent cardiovascular disease and obesity, some studies show exercise can improve mood, increase brain function, and even prevent depression. "If students find ways to put exercise in their lives, I can almost always guarantee they will feel better."

Indiana's Counseling Services Center is experimenting with the best ways to reach out to students and offer support. In the past, staff put special treats in students' mailboxes, sponsored a luncheon during exam season, and even hosted a massage therapy event at which students received free massages. The center also holds evening seminars on a variety of issues, such as one on "medical marriage," which provided advice to married medical students and their spouses.

Wellness concerns do not end with medical school, and residents can benefit from proactive programs as well. Researchers surveyed internal medicine residency program directors about problem residents - "trainees who demonstrate a significant problem that requires intervention by someone of authority" - and the results appeared in the Sept. 6 issue of the Journal of the American Medical Association. While problem residents have issues that are complex and unique, the survey showed stressors and depression were the most frequently cited underlying difficulties.

Clearly, if stress and depression are not addressed in medical school, patient care can be compromised. Dr. Lamperti cautions, "If a doctor is dragging an anchor around, his or her interactions with patients and judgments about patient care will be affected." Creighton's Dr. Kavan adds, "How we treat students here is going to have an impact on how they treat others - patients, family members, and themselves."