Research indicates that medical students are more likely to experience burnout and depression than other similarly aged individuals pursuing different careers, and this elevated risk persists into residency training. That reality has probably been exacerbated by the anxiety, uncertainty and stress associated with the COVID-19 pandemic.
What are the measures medical schools can take to promote well-being? An AMA STEPS Forward™ education module tackles that question. This free online module offers eight key moves medical schools and faculty can make to minimize burnout and improve mental health among medical students.
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Recognize shared responsibility. Individual medical students do have responsibility for self-care that includes participating in healthy activities such as maintaining a nutritious diet and getting adequate sleep. Still, within the demanding schedules students face, institutions and faculty must put in place well-being related strategies and the personnel to carry them out. That means having faculty, such as a director of student well-being who is able to carry out school-level changes and collaborating with clinical rotation sites to create a supportive learning environment.
Measure student well-being. Schools should routinely perform well-being checks using a standardized assessment. Aggregate student body results should be compared with national benchmarks to get a sense of how students are doing locally versus nationally. The module’s authors recommend brief, anonymous surveys to glean this information.
Optimize the curriculum. While a number of curriculum-related factors and their influence on well-being have been studied, the only tangible evidence of a curricular intervention that has a positive effect on well-being is pass-fail grading. The module states that “a large multi-institutional study of first- and second-year medical students, those NOT in a pass-fail curriculum had nearly double rates of burnout, higher stress levels, and were 60% more likely to consider dropping out.”
Help control student-loan debt. Three out of four medical students graduate with debt related to their training, and according to the Association of American Medical Colleges, the average debt load 2017 medical school graduates carried upon completion of training was $192,000. Schools are required by accreditors to provide counseling for students on debt management and to have measures in place to minimize direct educational expenses.
Optimize the learning environment and cultivate community. Learning environment, rather than workload, seems to be the culprit when looking for the roots of medical student burnout. Students need to be learning in an organized supportive environment that promotes their development. It is incumbent on the institution, the module says, to build a community between students and students and faculty. That can include the creation of study groups that create comradery and reduce stress and anxiety.
Promote self-care and resiliency. Knowing that students have a very limited schedule, the module calls for students to be “educated to strive for healthy self-improvement and to avoid the self-destructive and exhausting road of perfectionism.” Some institutions are offering students personal days during their clerkship year, as an intervention to promote self-care.
Provide adequate services for those already affected by burnout and distress. While efforts are being made to address student well-being, the module cites the facts that about half of medical students experience symptoms of burnout and nearly a third show symptoms of depression. A proactive approach, the module says, requires medical schools to offer barrier-free access to mental health care. To avoid stigma, “health professionals providing any services, including psychiatric or psychological counseling, should not be involved in the academic assessment or promotion of students in a medical school program.”
Fund organizational science around well-being. To identify solutions, it’s imperative, the module states, to understand systems-level factors that contribute to medical student distress. Well-designed studies that can ultimately offer solutions require institutional investment.
The AMA’s STEPS Forward™ open-access modules offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These courses can help you prevent medical student burnout. The CME module, “Medical student well-being: Minimize burnout and improve mental health among medical students,” is enduring material and designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit.
The module is part of the AMA Ed Hub™, an online platform with top-quality CME and education that supports the professional development needs of physicians and other health professionals. With topics relevant to you, it also offers an easy way to find, take, track and report educational activities.
Learn more about how to help medical students keep tabs on their mental health.
