Mental Health and Medical Education

Abstract

According to the National Institute of Mental Health, nearly one in five adults in the USA met criteria for a mental illness in the year 2016. Among the most common mental health challenges that are present in young adulthood are anxiety disorders and mood disorders (including depression). Given the probability of mental health challenges during medical school, students, faculty, and administrators should arm themselves with information regarding the most prevalent mental health challenges, how these impact medical students specifically, approaches to mitigating the impact of mental health challenges, the legal requirement for the provision of reasonable accommodations for students with psychological disabilities, and accreditation guidelines for health-care services and well-being programs.

Appendix A: Top 20 Tips for Medical Students and Administrators

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Students should seek treatment during the first year of medical school for specific phobias. These phobias can limit their opportunities and they are treatable.

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Students who experience anxiety around presenting students or clinical encounters with patients may find relief using the basic principles of systematic desensitization, whereby schools expose the student to incremental patient encounters or patient presentations using a simulation lab and standardized patients.

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Students who experience anxiety while engaging in small group discussions or presentations should reach out to counseling for assistance. Performance can improve, and students will enjoy the experience.

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Students who experience panic attacks while on the wards can use bathroom stalls as safe space to regroup and meditate or medicate. Bathrooms are usually close by when students feel an impending attack, and social graces dictate that others do not place critical inquiry on time spent in a restroom, giving the student a short, but much needed and socially accepted reprieve.

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Students who lose the ability to enjoy things that usually bring them pleasure may be experiencing anhedonia, one of the key symptoms of major depression.

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Medical students with a history of mental health concerns or treatment should get connected to a mental health provider as soon as they arrive at school. Establishing care and a relationship with a provider is imperative, even when things are going well.

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Students having thoughts of suicide should have access to an emergency contact person at the school, and the National Suicide Prevention Hotline should be posted in multiple, easy-to-access locations (online, student handbook, badge stickers). The NSPH number is 1–800–273-8255 and is staffed 24/7.

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Students should aim for 7 hours of sleep per night or “restful” sleep that ensures optimal performance and concentration and should practice good sleep hygiene and remove electronic devices from their sleeping space.

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Students who try to learn when exhausted don’t perform well. Sleeping for even a few hours and then returning to studying can be far more effective than studying while exhausted.

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Provide students with the opportunity to share their experiences. Often, a second- or third-year student discussing the benefits of mental health services can be a great motivator for first-year students, still navigating the medical school environment, to seek help.

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The first-year curriculum, while challenging, often includes a more predictable and flexible schedule. It is the perfect time for a consultation and possible treatment if a student has any mental health concerns or finds themselves developing psychological symptoms.

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Students who require hospitalization in the clinical year may be able to step out of rotation and re-enter without causing major disruption to their plan of study or graduation. Students should be aware of this option to encourage help-seeking behavior for students in acute distress.

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Medical schools should espouse a balanced approach to the Step 1 exam. There are students who fail, retake the exam and pass, and go on to be happy, productive physicians.

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Remediation and support teams should be more robust immediately preceding and following the Step 1 administration. Schools should be aware of students who fail in advance and reach out to offer support and future-oriented plans for remediation that focus on positive outcomes. As noted above, students should have information on hand for the suicide prevention hotline.

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When students find themselves more anxious and tense, they should ask for objective feedback and review the table on adjustment vs. symptoms of anxiety/depression.

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Schools should offer students objective feedback when they notice a change in behavior or mood. Schools can review Table 2.2 with students, helping them identify whether their symptoms are due to adjustment or if there are reasonable concerns about anxiety/depression.

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Students with psychological disabilities that impact functioning should seek accommodations in medical school and on high-stakes exams.

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Medical schools should consider embedding protected time into the curriculum for all students to attend to medical or mental health needs.

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Medical schools should explore ways of utilizing telepsychiatry/teletherapy, when clinically appropriate, to enable this generation of tech-savvy students, often pressed for time or at faraway locations, the chance to get the mental health care they need.

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Medical schools should consider maintaining disability insurance for all students. The very small investment provides excellent coverage, which may be the catalyst to ensuring students take a LOA and seek help when needed.