Chapter 15: Changing Medical Education to Support Emotional Wellness

INTRODUCTION

For clinicians to deal effectively with emotions—their patients’ and their own—it is critically important to preserve student and trainee wellness across the education continuum. Unfortunately, substantial evidence exists that, at least for physicians, this goal is not being met. This chapter will focus on the educational path for doctors-in-training, but many of the problems and challenges found in medical school and residency also likely exist in the educational paths for nurses and allied health professionals. In describing the problems, challenges, and potential solutions in this chapter, evidence will be drawn when possible from the medical education literature. When evidence is not available, I will base my assertions drawn from experience over the past several years of my career in which I have been invited to and visited more than 25 academic medical centers. The primary purpose of these visits was to give talks and workshops, but they allowed me, in committee meetings, in one-on-one conversations, at lunches and dinners, to hear from countless medical students, residents, and faculty about the challenges they faced in their professional and personal lives. Those conversations, and those that preceded them when I was Associate Dean for Curriculum at Saint Louis University School of Medicine, have informed and guided my work and I am immensely grateful to those who have shared so openly with me.

Unfortunately, significant numbers of medical students and residents suffer from mental health problems during their training. Meta-analyses have found that 27.2% of medical students and 28.8% of residents are clinically depressed.^1,2 (Notably, a meta-analysis found an even higher rate, 34%, in nursing students.³) The anxiety rate in medical students globally is 33.8%, and 35.1% of residents are estimated to meet criteria for burnout.^4,5 Burnout is somewhat dependent on medical specialty; a national study of surgical residents found a burnout rate of 69%.⁶ Suicidal ideation is commonplace in medical school, with 11% of medical students reporting suicidal ideation in the previous year.¹ In a recent study, suicidal ideation was reported by 4.5% of surgical residents.⁷ The suicide rate for residents is lower than the national average for age-matched peers in the general population, but it is the second leading cause of death in residency.⁸ And the impact of a community member’s suicide is often profoundly traumatic for that community, both for their loved ones and for the broader community. Unfortunately, the rate of medical student suicide is not known as no national database of medical student deaths currently exists.

In response to this substantial and growing evidence of distress, medical schools, hospitals, and residency programs have made substantial investments in the well-being of their learners. In white coat ceremonies at the beginning of medical school across the country, administrators pledge each year that students’ mental health is their top priority. Despite these investments and commitments, the mental health of medical students is not improving. In the Association of ...