In our April issue of Academic Medicine Slavin and colleagues describe an initiative at St. Louis University School of Medicine to improve student mental health. Unlike many programs that have accepted the environment of medical school as a given and provided counseling and other supports to help students cope with their anxiety and depression, Slavin et al. decided to attack the problem at what they believed to be its source – the medical school curriculum. They reasoned that they could prevent students from suffering the ill effects associated with medical school by changing the social learning environment. They focused on such stressors as competition for grades, lack of time for study and self-care, isolation, and fragmentation, and attempted to create a supportive community with faculty mentors and peer support. They still had resources for those students who experienced anxiety and depression, but the number with signs of psychological distress was far less than had occurred previously.
Medical students continue to suffer from suboptimal learning environments and various forms of mistreatment. We describe recent research in this area by Gan and Snell also in the April issue. Through six focus groups of students they were able to describe the continuum of mistreatment from suboptimal learning environment to more overt mistreatment. Students tended to describe factors such as time spent on non- educational work activities and sleep deprivation as suboptimal learning environment and verbal or physical attacks as mistreatment. However, there was some overlap in how these experiences were labeled by students. The study reminds us that it is important to understand the meaning behind a common term such as “mistreatment” that may appear in a survey if we are to take the correct steps to remedy the problem.
In our May issue, Mavis and colleagues describe the history of questions about mistreatment in the graduation questionnaire and the persistence of high rates of problematic responses. Although most medical students will complete medical school and go on to practice as caring and competent physicians, there is now ample evidence that many of these future physicians will suffer psychological distress and erosion of the empathetic feelings during their medical school careers. As we celebrate the recent medical school match and prepare to welcome new students into our medical schools it is time to consider how we might redesign our learning environments and curriculum with the psychological well-being of our students as a primary areas of focus. The article by Slavin and colleagues should encourage us to think creatively and expansively so that we design our medical school curriculum to provide the support our students deserve.
Coming up this month, AM Rounds will be publishing a series of posts on mistreatment from a few experts in our community.