Culture of Medical Training and Student Well-Being

Sad surgeon
Sad surgeon
Changing the learning environment and reforming programs is important to improving the well-being of medical students.

It is time to take a more critical look at the culture of medical training, and new steps are needed to assess and monitor student well-being, according to Stuart Slavin, MD, associate dean for curriculum and professor of pediatrics at Saint Louis University School of Medicine in Missouri. 

In a recent issue of JAMA that focused on medical education, Dr Slavin published an editorial in which he contends the well-being of medical students must be viewed as an environmental health issue.1

“I worry that we are sowing the seeds for poor mental health of physicians by creating such adverse educational environments in medical school,” said Dr Slavin. “Ultimately, it is about culture. Efforts need to be made at all levels of medical education and training to create more supportive and nurturing educational settings.”

He also noted that medical schools need to address the newly recognized mental health crisis among medical students.

In a new systematic review, researchers searched EMBASE, ERIC, MEDLINE, and other sources for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students. The studies were published before September 17, 2016, in the peer-reviewed literature.

The review included 167 cross-sectional studies including 116,628 participants and 16 longitudinal studies involving 5728 participants from 43 countries. Overall pooled crude prevalence of depression or depressive symptoms was 27.2%.2 In the longitudinal studies assessing depressive symptoms before and during medical school, the researchers found that the median absolute increase in symptoms was 13.5%,2 and the percentage of medical students with positive screening assessments for depression and seeking psychiatric treatment was 15.7%.2 

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“The surprising finding was that depression in particular is 2- to 5-times higher in medical students compared with similarly aged individuals in the general population,” said study co-author Douglas Mata, MD, MPH, resident physician at Brigham & Women’s Hospital and a clinical fellow at Harvard Medical School in Boston, Massachusetts. It is important to look at all the available data on this topic in order to know the true prevalence, he explained, noting that these findings should help motivate policymakers and individuals in hospital administration because now they have actionable data.

He said that if they are in a good state of mind, students and residents can learn better. The current depression levels found in this review are abnormal, and that is due to system-wide issues. 

“Depression is endemic in medical students,” Dr Matta told Endocrinology Advisor. “There are a multitude of steps we need to take.” 

What Changes Are Needed?

Researchers have also been studying what undergraduate medical education learning environment interventions may be associated with improved emotional well-being among medical students. They found it may be time for program reforms when it comes to mental health programs, wellness programs, and mentoring programs. Data also appear to support a preclinical pass/fail grading system.3