Existing medical schools need support to improve dropout rateBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1871 (Published 02 May 2018) Cite this as: BMJ 2018;361:k1871
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I agree with Mayur Shah that medical schools need to do more to improve drop out rates.1 The support should include knowledge of important medical literature and the use of “state of the art” biochemical investigations to find out what is really going on.
Why are medical schools not concerned that hormonal contraceptives commonly cause depression in female medical students? It was a non-medical film studies student who interviewed me to make a film about why so many of her fellow students were depressed, or had been depressed, “on the Pill”. She was interested in our 1960s discovery that increases in progesterone in the premenstrual phase of a normal cycle, or during progestogen use, increases monoamine oxidase activity. This large increase matches the timing of premenstrual tension and the incidence of depression with progestogen dominant oral contraceptives.2,3 In 2014 the National Health Service mental health survey found that 26% of young women aged 16 to 24 years in England had mental health problems compared with 9.1% of young men.4 Has the Pill hormone cover up been so effective that the real truth about what is happening to young women not even being taught in medical schools?
Are any university students getting the help they need to explain why they are no longer able to concentrate on their studies? When exam marks drop from 95% at school to 20% at medical school, modern biochemical investigations should be carried out. Brain fog, chronic fatigue syndrome/myalgic encephalitis are conditions which are known to be due to mitochondrial dysfunction with possible toxic DNA adducts including nickel from stainless steel, cadmium from smoking, mercury from dental amalgams and chlorine from tap water.4 Such investigations should be generally available. Treatment includes avoiding exposure to toxic metals, drinking filtered water and eating a low allergy high protein diet plus supplementation of essential minerals, vitamins and polyunstaturated fatty acids.5
1 Shah M. Existing medical schools need to improve dropout rate. BMJ 2018;361:k1871
2 Grant ECG. Pryse Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases. BMJ 1968;3:777-80.
3 Grant EC. Hormonal Contraception and Its Association With Depression.JAMA Psychiatry. 2017 Mar 1;74(3):301-302. doi: 10.1001/jamapsychiatry.2016.3701.
4 Digital NHS. Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014. September 2016. http://content.digital.nhs.uk/searchcatalogue?productid=21938&topics=0%2....
5 Myhill S, Booth NE, McLaren-Howard J.Targeting mitochondrial dysfunction in the treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) - a clinical audit.
Int J Clin Exp Med. 2013;6(1):1-15. Epub 2012 Nov 20.
6 Howard JM. The detection of DNA adducts (risk factors for DNA damage. A method for genomic DNA, the results and some effects of nutritional intervention, J Nutr Environ Med 2002;12:19-31
Competing interests: No competing interests
I have read with interest the discussion surrounding the introduction of five new medical schools and have to agree with Shah’s point in needing to support existing medical schools (1). As a current UK medical student I feel it would be noteworthy to add my opinion on the matter.
During my first year of medical school, I had the pleasure to meet many bright individuals. All of us had excelled academically and been selected from a highly competitive process for admission into medical school. However, during second year a couple of familiar faces were lost. Unfortunately, some students lost their interest in Medicine, some struggled with examinations and many chose to drop out for alternative degrees. Hence, by introducing additional medical schools this problem will not be solved, and will only be exacerbated.
The recent financial restrictions to the NHS have caused multiple problems, from Doctor’s striking to increased workloads and reduced numbers of staff. This has had a knock on effect for medical students. For example, most students are allocated to various hospitals in small groups to attend ward rounds, clinics and teaching. As students we notice the stressed workforce, whether it be consultants spending less time teaching students in clinics, registrars rescheduling bedside teaching or junior doctors not being able to pass their wisdom onto future doctors. All aforementioned factors contribute to a demotivated and uninspired student which may lead to dropping out of medical school or being a less experienced doctor, which could present a risk to patient safety.
Consequently, rather than the introduction of new medical schools, greater effort should be placed on existing schools by increasing resources and support to improve the overall student experience. In additional, more work should be done to demonstrate the reality of medicine as a career to prospective students. This will ultimately lead to a motivated and knowledgeable group of future doctors.
1. Shah M. Existing medical schools need support to improve dropout rate. BMJ. 2018;:k1871.
Competing interests: I am currently a fourth year medical student.