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Improving the state of wellbeing of medical students
- William R G Perry (18 December 2008)
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William R G Perry, President The New Zealand Medical Students' Association
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I read with interest the letter on December 2nd entitled “Researching students’ wellbeing”. Such apparent limitations imposed by University bodies around the collection and publication of medical student wellbeing data is detrimental to effecting changes aimed at optimising the state of medical student and health professional wellbeing. These are important issues as highlighted by the recent BMA-AMA-CAM International Conference on Doctors’ Health – Finding the Balance. One can naturally understand a University’s fear of repercussion or potential unwanted ramifications of publication relating to medical student wellbeing – I am aware that the London medical school referred to is not the only University to have made similar decisions. There is seemingly a concern about the negative impact on the reputation of the school, and isolation from other medical schools in the region. The reality is that this is not a problem specific or limited to any one University or School. It is a universal issue that affects the international medical student body and wider medical profession. Literature has supported the notion that medical students are similar, with regards to mental wellbeing, to the general student population prior to the commencement of their course (1-3). However, an environment of multifactorial stressors sees medical students exhibit lower psychological wellbeing than age-matched peers and the general population (4-10), and this continues on into their professional careers. It could be suggested that the refusal of a University to support research into medical student wellbeing, such that ethical approval is not granted and publication is prevented, is in fact unethical itself. Without allowing such data to be collected and published, the ability to understand the issue and implement suitable intervention strategies and focused support services for medical students is limited. In other words, it becomes hard to change the status quo. It effectively means that we continue to accept our future doctors carrying a lower state of wellbeing than the general population and all the implications of that. These include potentially negative impacts on their own professional development (11), their personal health (12-13), and importantly on the quality and safety of care provided to patients (14). I believe this situation needs to be re-thought. Ideally student bodies and Universities should work together to find ways to address this important issue. I am pleased to see that the project is under way again and is running across all London medical schools. I hope, however, that a way can be found to maximise the potential benefits of the research, including allowing for publication of the results. The ultimate aim has to be continued efforts at improving the state of wellbeing of the future health workforce. William Perry
References: 1. Rosal M, Ockene I, Ockene J, Barrett S, Ma Y, Herbert J. A longitudinal study of students’ depression at one medical school. Acad Med. 1997; 72(6): 542-546 2. Carson AJ, Dias S, Johnston A, McLoughlin MA, O'Connor M, Robinson BL, Sellar RS, Trewavas JJ, Wojcik W. Mental health in medical students. A case control study using the 60 item General Health Questionnaire. Scot Med J. 2000; 45(4):115-6 3. Singh G, Hankins M, & Weinman JA. Does medical school cause health anxiety and worry in medical students? Med Edu. 2004; 38(5): 479–481. 4. Aktekin M, Karaman T, Senol Y, Erdem S, Erengin H, Akaydin M. Anxiety, depression and stressful life events among medical students: a prospective study in Antalya, Turkey. Med Edu. 2001;35:12-17 5. Henning K, Ey S, Shaw D. Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Edu.1998;32:456–64. 6. Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. Compr Psychiatry. 1984;25:552–65. 7. Toews JA, Lockyer JM, Dobson DJ, Brownell AK. Stress among residents, medical students, and graduate science (MSc/PhD) students. Acad Med. 1993;68(10 suppl):S46–S48. 8. Toews JA, Lockyer JM, Dobson DJ, et al. Analysis of stress levels among medical students, residents, and graduate students at four Canadian schools of medicine. Acad Med. 1997;72:997–1002. 9. Psujek JK, Martz DM, Curtin L, Michael KD, Aeschleman SR. Gender differences in the association among nicotine dependence, body image, depression, and anxiety within a college population. Addict Behav. 2004;29:375–80. 10. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: a cross-sectional study. Med Educ. 2005;39:594–604. 11. Dyrbye L, Thomas M, Shanafelt T. Systematic review of depression, anxiety, and other indicators of psychological distress amongst US and Canadian medical students. Acad Med. 2006; 81(4): 354-374 12. Ball S, Bax A: Self-care in medical education: effectiveness of health-habits interventions for first-year medical students. Acad Med. 2002;77:911-917 13. Gutgesell M, Reeve R, Parsons B, Morse R. Exercise and alcohol consumption among medical students. Acad Med. 1999;74:750–51.177 14. Shanafelt TD, Bradley KA, WIpf Je, Back AL. Burnout and self- reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358-67 Competing interests: Presenter at BMA-CMA-AMA International Doctors' Health Conference and researcher in the field |
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