Pressured to excel among other high achievers, overwhelmed by the amount of information to absorb, plagued with self-doubt over their ability to care for patients, many medical students experience burnout and a significant number face clinical depression. On July 16 in Chicago, the AOA House of Delegates approved a resolution to increase awareness of depression among medical students and the availability of treatment options.
Resolution 205 (A/2011) cited research published in JAMA: The Journal of the American Medical Association, The New England Journal of Medicine and Annals of Internal Medicine indicating that medical students are more likely to be depressed than the average person.
“Medical school is the most intense environment med students have ever been in,” notes Garrett L. Kirkpatrick, OMS II, the president of student government at the Philadelphia College of Osteopathic Medicine (PCOM). “First- and second-year students typically spend every waking minute studying and are constantly worrying about how they will pass their exams.”
Studies show that depression, including contemplation of suicide, is even more prevalent among third- and fourth-year medical students. “I’ve been talking to a lot of third-year students who explain how overwhelming it is to suddenly go from two years of coursework into actual clinical settings with patients,” says Nikhil Mohan, OMS II, the student government president at the Lake Erie College of Osteopathic Medicine (LECOM) in Erie, Pa. “When you are in a clinical setting, you don’t have the same amount of time to think through your answers and decisions. Everything is then and there. You are with a patient and need to come up with something quickly.”
While first- and second-year medical students practice their clinical skills on simulated patients, interacting with actors and mannequins does not approximate the emotional experience of treating live patients, Mohan notes.
In addition, students on rotation may receive guidance from preceptors that conflicts with what they’ve been learning in the classroom. “The physicians will tell you how things really are, which doesn’t necessarily agree with what you’ve been taught,” Mohan says. Such discrepancies can fuel doubts and despair.
While research shows that roughly one-fifth of medical students suffer from symptoms of depression, Mohan suspects that the proportion is really higher because physicians-in-training are reluctant to get help. Indeed, studies indicate that nearly 25% of medical students suffering from depressive symptoms and nearly 30% with suicidal ideation do not seek medical attention, as Resolution 205 states.
“Because of the perceived stigma, depression is the last thing medical students would like to admit to,” says Steven Dalton, OMS II, the student government president at the Touro University Nevada College of Osteopathic Medicine in Henderson. “Medical students are constantly observed and evaluated by physicians in a competitive environment.” Thus, medical students may be hesitant to describe their depressive symptoms to their primary care physicians, who may also be their mentors, instructors and future colleagues.
“Medical students frequently feel a sense of isolation,” explains Catherine G. Babbitt-Cook, OMS II, who is the vice president of PCOM’s student government association. “It helps to talk to others about what you’re going through.”
Student leaders should talk to other medical students about the symptoms of depression and urge them to take advantage of confidential counseling services at their schools, Mohan suggests. “It is important to let students know that they are not alone in their distress and that help is available,” he says.
To help prevent and alleviate depression, Mohan encourages LECOM students to take part in intramural sports. In addition, becoming involved in campus clubs and organizations, such as a school’s student government association, helps promote collegiality, close connections with peers and a sense of belonging.
The spouses of married medical students also need to be educated on the stress and conflicting feelings experienced in the journey through medical school, Mohan observes. As LECOM has, schools should establish “student advocates” groups that enable spouses to connect with one another, better understand the pressures medical students endure, and provide more on-target emotional support, he suggests.
Resolution 205 sparked much emotional discussion during the National Osteopathic Student Caucus, held by the American Association of Colleges of Osteopathic Medicine’s Council of Osteopathic Student Government Presidents right before the House convened. But the resolution provoked little debate at the House.
One student, however, objected to an amendment to limit the resolution to osteopathic medical students. Depression is an issue that affects all medical students, stressed Madeline Tarrillion, OMS II, the president of student government at the University of North Texas Health Science Center Texas College of Osteopathic Medicine in Fort Worth, reminding the House that many delegates may have MD students as patients.
Tarrillion’s amendment to remove the “osteopathic” qualifier passed. The House approved “Depression Awareness in Medical Students” without dissent.