“Arguably, [medicine] is the noblest profession and we should not stress out our students and prevent them from becoming the best doctors they can be. This is a critical issue, it’s a crisis, and we need to have a sense of urgency about it,” Augustine Choi, MD, dean of Weill Cornell Medicine, said here at the first-ever National Conference on Medical Student Mental Health and Well-Being.

The 2-day conference brought together more than 350 medical school educators, students, and researchers to discuss the increasing rates of psychological distress among medical students nationwide and how to combat it.

The conference was hosted by Weill Cornell Medicine in partnership with the Association of American Medical Colleges, Associated Medical Schools of New York (a consortium of 60 medical schools in New York state), and the American Foundation for Suicide Prevention.

In his lecture on mental health and resilience, Richard Friedman, MD, professor of clinical psychiatry and the director of Weill Cornell Medicine’s Student Mental Health Program, touched on the question of whether medical students can “have it all.”

Friedman noted that medical students face unique challenges and stresses. Often separated from their friends and families, they face the temporary loss of their supportive social networks while simultaneously confronting the long hours and grueling intellectual demands of medical school. While they are likely to be physically healthy, they are an “at-risk” population for mental health disorders.

Medical students have higher rates of psychological distress, including anxiety, depression, and suicidal ideation, relative to peers in the general population.

Peer Support

At Weill Cornell, there has been a “steady increase” in the number of medical students seeking mental health treatment, Friedman said, a phenomenon that is not unique to this particular institution.

Identifying and treating mental health issues and fostering resilience in medical students should be a top priority of medical school administrators, said Friedman. Given the rising demand for mental health services, schools “need to provide more resources” for students, he added.

In a separate lecture, Elizabeth Gong-Guy, PhD, described the early success of the Screening & Treatment for Anxiety and Depression (STAND) program at the University of California Los Angeles (UCLA).

Gong-Guy is executive director of UCLA Campus and Student Resilience and associate clinical professor of psychology. Untreated depression and anxiety are leading causes of poor academic performance and dropout among students. UCLA needed a “scalable and accessible” treatment model, said Gong-Guy.

Launched in the fall of 2017, the STAND program combines evidence-based tools into an integrated “all in one” approach to rapidly screen, analyze, treat, and track outcomes for students with anxiety and depression.

In less than 2 years, the STAND program offered an initial screening to 44,000 UCLA students; registered 5700 students for anxiety, depression, mania and suicidality symptom screening; offered treatment to 1900 students using the program’s innovative tiered model; responded to over 650 real-time risk alerts for suicidality; and trained 450 “resilience peers.”

“Amazingly, we have never had to recruit people to become resilience peers,” Gong-Guy, who oversees the UCLA Resilience Peer Network, told Medscape Medical News.

“We have between 60 and 100 students every quarter who will come to begin engagement. We can’t accommodate all of them, but we take in as many as we can. They see a problem with their peers and want to be part of the solution,” she said.

The STAND program is part of UCLA’s Depression Grand Challenge research platform that supports iterative improvement in the program through rigorous testing and validation, allowing tracking and treatment refinements to be quickly incorporated, Gong-Guy said.

Potential Solutions

In an opinion piece published in STAT News ahead of the conference, Choi, the dean at Weill Cornell, offers several potential strategies to address mental health in medical schools.

First, he calls on medical schools to integrate comprehensive wellness and mental health support into the learning environment.

“One strategy Weill Cornell Medicine plans to implement is to assign all medical students to advisory groups that include physician wellness mentors. These coaches can act as role models for coping with adversity and stress during the training period and beyond,” Choi writes.

He also thinks medical schools should document and report anonymized data about psychological distress among medical students. “This will help further destigmatize it, allow us to better understand its causes and extent, and develop new solutions, Choi says.

Given that a major source of stress for medical students is academic, Choi thinks more medical schools should evaluate shifting to a pass/fail grading system.

“The competitive pressure to achieve top grades and honors runs directly counter to establishing healthy relationships among peers. Many institutions are already moving toward a pass/fail approach during all four years of medical school, according to the Association of American Medical Colleges,” Choi writes.

He would also like to see studies conducted to pinpoint the causes of mental health issues among medical students, “and, equally valuable, trace any links, internal and external, between stressed-out students and burned-out physicians. Teasing out cause and effect could enable institutions to better promote clinician resilience,” Choi writes.

Despite these challenges, he is optimistic.

“Medicine remains one of the most respected professions and continues to attract talented, idealistic students eager to make a difference. The millennials now enrolled in medical school are generally more willing than prior generations to admit to facing stress and seek help, and are more likely to see burnout as systemic rather than fault themselves for an inability to cope,” Choi concludes.