Medical schools should teach us how to cope

"It is hopeless trying to keep up."
"I feel stupid."
"I felt so discouraged by failure that I considered changing course."
     First year medical students, University of Edinburgh¹

Many recommendations have been made and implemented to counter the stresses of studying medicine since these students spoke out (see box). But medical schools should consider integrating training in coping skills as part of the medical curriculum, to make sure help reaches those most in need.

Stress in medical students is common, ^2,3 even in the early stages of training. In one study, 62 out of 172 first year students (36%) in the north of England had probable psychological disturbance according to a well recognised psychological questionnaire.⁴ On entering medical school, students experience a rise in depression scores that persists over time.⁵ Overseas students have the extra burden of adapting to a new cultural environment.⁶

There are many causes for psychological distress in medical students. Training is long and hard, and character traits such as perfectionism have been associated with depression and anxiety both in medical students⁷ and doctors.⁸ Medical students with low A level grades, an anxious personality, and reliance on avoidance coping strategies are also at risk.³ Students commonly worry about the curriculum, personal competence, endurance, and finding time to have a life outside medical school.³

Research shows that students with active coping styles (those who can tackle problems in a positive and straightforward manner) have lower levels of psychological distress.³ In addition, preliminary evidence suggests that teaching medical students more effective coping strategies reduces distress in the short term⁹ and provides long term protective effects.¹⁰ Helping students develop better ways of dealing with stress at an early stage of their medical undergraduate training needs to be considered, as students who suffer from distress in the first year of the course are at the highest risk of developing symptoms of stress later on. ¹¹ In view of the potential long term benefits of managing stress in a more effective way, it may be important for students to develop such skills early on in their medical career.

Medical schools should consider incorporating training in coping skills into the medical curriculum to reach the students who need it most. Emphasis should be placed upon the prevention of distress, rather than the stigmatization of those who experience it. Although support systems are in place in most medical schools, a significant number of students fear that seeking advice or help from staff may be damaging to their career.¹² Both medical schools and health services need to take this problem seriously. To retain the workforce of tomorrow, we need to make changes today.

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