Medical Schools Take Active Role in Reducing Students’ Stress and Anxiety
AAMC Reporter: January 2013
—By Rebecca Greenberg
While medical students train to improve the health of others, they often lose sight of their own. Besides having little time for sleep, meals, and recreation, studies have shown that students are prone to neglect their mental health. Many suffer silently from anxiety, depression, and burnout. In response, medical schools are taking proactive measures to support students’ mental health and general wellness and find ways to support them when problems arise.
According to a 2006 Mayo Clinic study, students enter medical school with mental health profiles similar to their peers from college. But they begin to show higher rates of mental distress as they progress through medical school. The same study found that the most depressed students often are the least likely to reach out for help because of stigma related to mental illness.
Lisolette Dyrbye, M.D., lead author of the Mayo study and an associate professor of medicine at Mayo Medical School, began looking at mental health among medical students after a 2002 Annals of Internal Medicine study showed that three-quarters of residents experienced burnout, and those residents were more likely to make medical errors and not fully discuss all treatment options with patients.
But students, like physicians, are reluctant to seek care, according to Dyrbye. “How do we make a culture change where mental health is treated like hypertension or diabetes?” she asked. “How can we tackle things in the hidden curriculum like the stigma associated with mental health problems?”
With students showing such high levels of distress, Dyrbye said the burden of seeking help should not fall on them alone, adding that institutions should play an active role in helping students handle burnout or depression.
“It’s certainly important for the student to learn the right coping strategies, time management skills, and stress reduction techniques,” Dyrbye said. “All of that is important, but it is not the entire answer. We also have to look at school-level initiatives. There needs to be organizational change.”
In fact, studies such as Dyrbye’s, which have shown that beginning medical school can put students’ mental health at risk, have prompted many medical schools to change their institutional culture to address mental health issues. Some have made adjustments to their curricula, including pass/fail evaluations, which have been shown to reduce stress and anxiety. Others place more emphasis on wellness. And some schools are finding strategies to reduce the stigma associated with seeking help for mental health issues.
Stuart Slavin, M.D., dean of student affairs at Saint Louis University School of Medicine (SLU), started working on a “multifactorial” approach when he found students at his own school showed a high prevalence of mental distress. At the same time, he considered the suicide rates of physicians compared with the general population—40 percent higher for male doctors and 130 percent higher for female doctors, according to a 2005 New England Journal of Medicine study.
“By definition medical school is stressful,” Slavin said. “We wanted to do what we could to reduce unnecessary stressors without compromising the quality of education.”
In 2009, SLU implemented a number of curriculum adjustments, including pass/fail grading for the first two years of medical school and a reduction in both the volume of course material and the hours students are required to spend in class.
In addition, the school is offering electives—ranging from teaching a high school class to working with immigrant populations—that give students the opportunity to step outside the classroom. SLU also has developed learning communities in service, advocacy, research, global health, wellness, and medical education. Slavin believes these communities increase opportunities for meaningful relationships, something that can get lost in a competitive academic setting.
Another component of SLU’s program involves a mandatory resilience and mindfulness course for first-year students that enhances coping methods and stress management techniques. Ginny Fendell, a local mental health clinical social worker, helps teach the classes. She recalled a student who was considering dropping out of medical school because she was having trouble grasping an important concept. Fendell used a cognitive technique to put the situation in perspective for the student and help her see it as an opportunity rather than a catastrophe.
“We point out that distorted ways of thinking can have consequences,” Fendell said. “If you can learn to think more accurately and rationally about a situation, it increases your options for how to respond.”
Creighton University School of Medicine also is taking a proactive approach to mental health issues, according to Mike Kavan, Ph.D., the associate dean for student affairs.
Creighton’s wellness program, which has evolved since 1996, incorporates a pass/fail grading system, supportive faculty, sessions on positive teaching, and an administration that meets with students regularly. Moreover, the faculty try to impart a message that seeking help is a strength, not a weakness.
“Students fear that acknowledging depression and getting help might affect their career in some way,” Kavan said. “We make it known that they can come forward. If they don’t, it could play out academically or professionally. Learning how to deal with these issues correctly is such a better path than letting them continue to impact you.”
Another approach to supporting students’ mental health involves building a sense of community through participation in extracurricular activities. At Vanderbilt University School of Medicine, the student-run Wellness Committee divides first-year students into colleges that train and compete each year in The College Cup. The event features athletic and nonathletic events, including 5K runs, trivia challenges, and cooking competitions.
“It’s perfectly okay to come here and study hard and do as well as you can, but it’s also okay to take care of yourself,” said Scott Rodgers, M.D., associate dean of student affairs at Vanderbilt. “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.”
While medical school should be challenging, it also can be fun, Rodgers added. “We feel our students are achieving more than ever before.”
Ongoing research will shed light on how new wellness programs are affecting depression and burnout in medical school. At SLU, Slavin and his colleagues are conducting a study that tracks the mental health of its students since introducing the program.
Creighton’s Kavan hopes changing attitudes toward mental health will result in “more well-rounded physicians, who are more connected and empathic, but who also take better care of themselves and can serve as role models for their patients.”
“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.”
—Scott Rodgers, M.D.