Medical student wellness and health priorities
The transition from layperson to medical student to doctor is challenging in many ways. Just as students are learning how to be doctors, they are learning how to live as doctors. Patterns of behaviour developed during this time can be long lasting so it is important to prepare well for a career in medicine by having your own GP and developing a social support system with outside interests.
While most young people are physically healthy, medical students are subject to many of the same health issues as qualified doctors. Both US and Australian studies have found high rates of depression and anxiety among medical students[1,2]. The Royal Australasian College of Physicians has also warned that “patterns of overwork, neglecting one’s own health and disengaging from social and family connections may be established during medical school and persist throughout doctors’ careers.”
“Medical students’ stress can be unique because the environment in which they are studying is very high pressure, the things they are exposed to can be challenging and they don’t have the time or financial wherewithal to do much outside medicine to recharge,” says Ben Veness, 2013 President of the Australian Medical Students’ Association (AMSA).
“The added problem is that because they’re generally physically well, their access to care for mental health issues can be impeded because they’re not regularly engaging with their own doctor,” he says.
Barriers to care
Research by Jill Thistlethwaite, Professor of Medical Education and Director of the Centre for Medical Education Research and Scholarship at the University of Queensland, has highlighted significant barriers preventing medical students seeking support to maintain their wellness.
“Once you say to anybody you are a medical student, you are not treated the same way as if you are a layperson,” she says.
Students from James Cook University have reported to her that treating doctors may assume medical knowledge on the part of the student that they don’t have, or they try to give them a tutorial about their symptoms. The patients must then decide whether to own up to their GP that they are medical students.
“These factors may lead to high levels of self-treating, ‘corridor consultations’ with colleagues and educators, or a reliance on students’ own medically trained families”, says Professor Thistlethwaite, who would like to see more education for students about how to maintain their health.
“That also means educating the educators”, says Dr Margaret Kay, Secretary of the Doctors’ Health Advisory Service Queensland.
“When the students start talking about stress to their mentors, they fear they will be seen as weak. They should be able to seek support without having to be concerned that this will impact upon their academic success or that they will be reported,” she says.
AMSA has produced a policy focusing on the mental health of all students, calling for better pastoral care and access to GP and other appropriate health services for students.
Life outside medicine
It is important to maintain outside interests and a supportive social network within the confines of a heavy academic load and long work hours at hospital.
“Academically, we have a heavy load, but it’s good fun. There may be a protective factor in enjoying what you are doing and we are lucky to have such a collegiate culture compared to some other disciplines, with supportive peers.” says Ben Veness, “An increased focus on wellness is important, and is about how you prevent problems from developing, about being as happy and healthy as you can throughout your life, starting as early as possible.”
Medical students priorities and concerns
Feedback from a small competition survey among Avant student members in 2013 suggests that attitudes to health and wellbeing among Australia’s future medical practitioners are changing for the better in that the focus on wellness is increasing.
Views expressed by medical students in the competition to attend the Health Practitioners’ Health Conference reveal a desire to ‘get on top of’ personal health and wellness issues before their career goes into overdrive. A clear message was that students see managing their own health and wellness as a professional responsibility in that neglecting their own health ultimately affects the quality of care they deliver to patients.
“I am growing passionate about raising awareness, reducing stigma, creating a culture of self- and peer-care within my medical school and ultimately preventing anxiety, depression and suicide,” wrote one of the first year medical students.
Top health concerns
The survey also asked students to identify their top personal health concerns. Achieving a healthy work-life balance and attending to self-care were ranked first and second priority for survey students.
Importantly, the third most important concern was maintaining a healthy and resilient mind and a concern about more work needed to destigmatise mental health issues in the medical profession.
“High pressure, prolonged stress and perfectionist personalities predispose medical practitioners to mental illness”, wrote one third year medical student from UNSW.
Other concerns participants raised in the survey included burn out, the need to develop a supportive culture in the profession and challenges of dealing with stress and anxiety.
Medical school is both rewarding and demanding but maintaining balance is critical
When Avant interviewed Victoria Cox in 2013 she was a fifth-year medical student at the University of Adelaide undertaking a cardiology and renal medicine rotation at the Royal Adelaide Hospital. Victoria was awarded a Bachelor of Medical Science (First Class Honours) after undertaking cardiovascular research at the Royal Adelaide Hospital in 2011.
Avant asked Victoria her views about the personal challenges of being a medical student and its personal impact. She shared her advice with us.
“Being a medical student is incredibly rewarding but not without its ups and downs. It’s really important to prioritise your study whilst not losing who you are as a person. For the first couple of years of medical school, I don’t think I had good work-life balance, but now I am better at doing the things I want to do – I compete in triathlons and play the violin in a number of orchestras across Australia.
I love being an active member of the Glenelg Surf Life Saving Club, where there’s such a friendly atmosphere and positive culture. I’ve also had the opportunity to mentor at-risk South Australian high school kids through the Operation Flinders Foundation, walking on 100km field exercises in the Flinders Ranges.
I don’t think people appreciate the toll the years as a medical student take on you as an individual. It’s a long degree and you need to look after yourself both physically and mentally, to ensure that you achieve the most you can out of your medical degree.
Do the things you love and don’t fall into the trap of saying ‘yes’ to things that perhaps you don’t really want to do. We are lucky to have so many opportunities, but it’s about having really clear goals and deciding how you’re going to achieve them.”
- Leahy C. Peer responses to psychologically distressed tertiary students [PhD thesis]. Adelaide: University of Adelaide, 2009.
- Ghodasara SL, et al. Assessing student mental health at the Vanderbilt University School of Medicine. Academic Medicine 2011; 86(1): 116-21.
- Royal Australasian College of Physicians. Health of Doctors Position Statement. Royal Australasian College of Physicians: Sydney, 2013.
- Thistlethwaite JE, et al. Medical students seeking medical help: A qualitative study. Medical Teacher 2010; 32: 164-166.
- Australian Medical Students’ Association policy 2013.