Healing the Very Youngest Healers (AAMC)

from SCMS BULLETIN - November 2022

Calendar of Meetings and Events for 2023

Healing the Very Youngest Healers

AAMC News

By Amy Paturel January 21, 2020 Almost 30% of medical students and residents suffer from depression and 10% report having suicidal thoughts. Now, a growing number of medical schools and teaching hospitals are developing programs to identify and help at-risk trainees.

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Rahael Gupta was leaving the library one night in 2015 when she stepped into a dark, poorly lit street hoping to collide with an oncoming bus. The second-year medical student at the University of Michigan Medical School envisioned her head hitting the asphalt, her brain banging around inside her skull, and the driver leaping out of his vehicle in horror to locate her body.

Gupta had never been diagnosed or treated for depression prior to medical school. But like many medical students, she was overwhelmed. She had moved from Oregon to Michigan — hundreds of miles from close friends and family. She was suffering from chronic stress, anxiety and exhaustion. And then she failed a neuroscience sequence. "I just wanted to end it all," she says.

Unfortunately, Gupta's experience is not uncommon. In a recent study, 9.4% of fourth-year medical students and residents reported having suicidal thoughts in the previous two weeks. According to the American Medical Student Association (AMSA), medical students are three times more likely to die by suicide as their same-age peers. And while it’s unclear how many physician trainees die by suicide each year, suicide is the leading cause of death among male residents and the second leading cause of death among female residents. These figures first came to light several years ago. In response, a growing number of leaders in academic medicine have been launching initiatives aimed at helping students and residents navigate the difficult training years. Some schools have instituted small learning communities and developed resilience curricula. Others have implemented interactive online screening protocols and launched extensive support services. Still others are shifting to two-tier, pass/fail grading systems. For residents, national medical organizations are calling for creating more positive work environments and reducing sources of physician burnout, particularly those that do not contribute to patient care. Many of these recommendations are outlined in a 2019 report released by the National Academy of Medicine (NAM): "Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being." "Academic health centers have been real leaders in terms of trying to put programs in place to help counter burnout, depression, suicide and related problems," says Darrell G. Kirch, MD, co-chair of the National Academy of Medicine

Action Collaborative on Clinician Well-Being and Resilience

(NAM) and president emeritus of the AAMC. The goal? To ensure young physicians-to-be can access the support they need to feel safe, be healthy and derive purpose from their work.

A Population at Risk

Medical training is intense. Medical students and physician trainees study and work long hours, often in stressful environments where they must confront death on a regular basis. According to NAM, overwhelming job demands and insufficient resources can lead to burnout — a workplace syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment from work. Burnout can have far-reaching implications. It can impact job performance, increase turnover, and lead to medical errors and clinician suffering. "Students will see people suffer and die with illness. They will see families struggle with the loss or impairment of their loved ones and they will confront the issue of patients who can’t afford care. All of those things create enormous stress for people who are in training," says David Muller, MD, Dean for Medical Education at Icahn School of Medicine at Mount Sinai in New York. "We're so focused on taking care of patients and providing quality care that absent from our education is how we take care of ourselves." Studies show that students arrive at medical school with the same or better mental health as their peers. But after two years, they tend to suffer significant burnout, stress and anxiety. As they continue to progress in their training, they are at significant risk for depression. In a 2014 Academic Medicine study of medical residents, 60% met the criteria for burnout, more than half screened positive for depression, and roughly 8% experienced suicidal ideation. Excessive stress can create a short path to developing a mental disorder, depression and suicidal ideas and behavior," Kirch says. Many of these trainees know they're in crisis. But only onethird of medical students experiencing burnout or depression seek help — mainly because they're afraid of what it might do to their careers.

Destigmatizing Mental Illness

Confronted with the startling statistics around burnout and depression, academic medical centers across the country are increasingly making physician well-being a top priority — not only for faculty but also for students and residents. The first step for many of these institutions is hiring a "chief wellness officer."

"That job description creates a whole kind of ethos the institution is concerned about wellness," says Michael F. Myers, MD, Professor of Clinical Psychiatry at State

University of New York (SUNY) Downstate Medical Center

and author of Why Physicians Die by Suicide: Lessons Learned From Their Families and Others Who Cared. Those officers are then charged with developing programs, policies, and procedures that support physicians’ mental health and well-being. Several medical schools, including Johns Hopkins

University School of Medicine, Saint Louis University

School of Medicine, and Weill Cornell Medicine, are folding resilience training into students' coursework. In 2016, on the heels of a fourth-year medical student's death by suicide, Mount Sinai developed a four-year wellness curriculum cocreated by senior students and residents in psychiatry. The

PEERS (Practice Enhancement, Engagement, Resilience,

and Support) program at Mount Sinai enables students to meet in small groups with a faculty facilitator twice a year to tackle stressors specific to each stage of training. Its goal is to provide learners with tangible skills to help manage personal and academic challenges and thrive. Other institutions are hosting town hall-like forums where discussions about the "second victim phenomenon," stress and burnout take center stage. "There's a lot of suffering among medical students, residents and physicians. As leadership, we can act to decrease their suffering. We can be a voice for cultivating compassion," says Sunny Smith, MD, Clinical Professor in the Department of Family Medicine and Public Health at the University of California San Diego (UCSD) School of Medicine. The increasing push toward small learning communities, as opposed to massive lecture halls, also allows faculty to more easily recognize when a student is struggling. "With learning communities, faculty members know when students don't show up or when they show up with tears in their eyes — and they can connect them with the available resources," Smith says. The smaller, more intimate learning approach also encourages peer support. Some institutions have even made peer support part of their mental health assistance protocol. At Johns Hopkins, Harvard Medical School and Temple University School of Medicine, peer support programs are available to students, practicing physicians and faculty. "When a crisis hits, we want the person sitting next to our resident, regardless of profession, to know how to get someone help and resources," says Jessica Kovach, MD, Vice Chair of Clinical Psychiatry and Behavioral Science and Associate Professor and Director of the Psychiatry Residency program at Temple University School of Medicine.

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