In medical school, the only currency of value is The Grade—something money cannot buy. Students pay their tuition and dive straight into the deep end of a curriculum that, right or wrong, is judged almost entirely on test performance. They strive to achieve the highest grade necessary to earn a ticket to the best residency. Students cram as much as they can to prepare for the exam, then forget the information as soon as the test is over. It becomes an endless cycle that generates huge levels of stress and anxiety and leaves students struggling to succeed—and hoping others fail to make up for their own poor performance.
It’s a destructive occurrence with potentially deadly results. Research shows that more than a quarter of medical students (27.2%) struggle with depression, and over 11% have reported suicidal ideation. For these students, the optimism and resiliency that characterized the start of their medical school days quickly deteriorates. Some students suffer in silence until life feels entirely unbearable. Alarming statistics reveal that a growing number are even taking their own lives.
A leading concern is the prevalence of depression among medical students, which if left untreated can result in devastating outcomes. Depression contributes to various physical and psychological conditions, often hampering a student’s motivation to continue with their educational track. Further complicating this condition is the added stress of massive student loans that often accumulate throughout medical school.
Understanding the root causes
From day one, medical students have been socialized to believe that success lies in the details. A student may have been accepted into medical school simply because they remembered one more 6-carbon structure than the rest of their class. Ultimately, this theory generates the belief that a good grade equates to a sense of self-worth.
Students who qualify for medical school are often accustomed to achieving greater academic success than many of their peers. It’s not unusual for these overachievers to experience a sense of shock when confronted with the magnitude of information and complex work that comes with a medical school curriculum. They are surrounded by people just like them—the best of their class. The struggle to maintain high grade point averages and achieve top Step scores to qualify for a quality residency program can be overwhelming. These demands may also lead to feelings of isolation, which exacerbates mental health issues. For the first time in more than two decades of education, many of these students must confront the reality that they no longer rank first, further depleting their self-esteem.
Once accepted to medical school, these hypercompetitive students soon become buried in work and take on massive financial debt, while sacrificing hobbies, health, and relationships. Students often lose sight of anything beyond their temporary adversities; they become consumed with thoughts of competition, imperfection and, at times, hopelessness. Students assume the belief that only one thing marks their worth: the grade. They tie their value to a score and a proposed future of acceptance or rejection into residency—an even greater burden.
By the third year of medical school, students experience burnout and depression, and oftentimes exhibit signs of deteriorating physical health. A study published in Annals of Internal Medicine revealed that approximately 50% of medical students experience burnout. Another study found that 32.5% of medical students meet the diagnostic criteria for alcohol abuse or dependence—a rate nearly double that of the general U.S. college-educated population.
Also contributing to negative academic experiences and mental health issues are poor reinforcement and support from upper-levels, residents, and attendings. When students look to their superiors for guidance, they are confronted with over-worked, apathetic individuals. Emulating them is a natural reaction. Thus, it remains vital that we continuously remind students that the material they are learning, and the seemingly routine tasks that they will perform, will be powerful and life-changing.
To help break the cycle of depression and anxiety, students must have access to resources that help alleviate the factors contributing to mental health issues. For an increasing number of medical students, those resources are technological, such as mobile applications that assess burnout rates and help direct them to relevant services.
Students can also leverage digital learning platforms to help reduce exam-related anxiety—a key contributor to the development of mental health issues. According to a study, medical students reported that the use of online learning platforms enhanced their understanding of essential clinical skills and improved their performance in a structured clinical examination of those skills. Because these learning platforms help enhance academic performance, they contribute to a reduction in stress levels.
Although the various educational platforms available to medical students may all appear helpful, most lack one vital component: Education taught by individuals who are both skilled doctors and teachers.
When students have access to a comprehensive, multidimensional educational resource built to effectively teach medical education, they can finally breathe easy. These platforms, make learning essential information and concepts more effective and efficient. It frees time that students can instead spend on more valuable pursuits, such as applying what they have learned on real patients and possessing the emotional bandwidth to become healthy, well-rounded individuals. It is great people that become great doctors, not those who merely regurgitate information for an exam.
The advantages of digital learning platforms
According to Ian Drummond, a Case Western Reserve University School of Medicine student, “One of the hardest, most time-consuming things for medical students to do is to form mental frameworks for their medical knowledge and to see the bigger picture of how clinical subject matter connects.”
Advanced solutions provide multiple learning modalities, coordinated to teach various subjects in a consistent manner and voice. This way, students are supported throughout the entirety of their program, in a manner that satisfies all learning styles. These modalities include instructional videos, flashcards, and clinical vignettes, designed to support all learning styles and ensure key concepts are reinforced and retained. Ultimately, this style makes learning faster, easier, and more reliable.
In the case of one student who initially failed the Step 1 examination, consistent use of a digital learning platform significantly increased their Internal Medicine shelf score, enabling them to pass both Step 1 and 2 examinations.
Providing students with solutions to improve their psychological well-being by enhancing academic performance equips them to learn material at their own pace and in their preferred learning environment. When freed from the worry of the test, these exemplary students can move forward with the confidence that they know the required information at the level they need to know it. Ultimately, these powerful tools will help break the pervasive cycle of mental health issues and allow the next generation of doctors to embark on their new careers as confident, focused and healthy individuals.
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Dustyn Williams, MD
Dr. Dustyn Williams received his undergraduate degree from Yale University, then spent two years as a paramedic before entering Tulane University School of Medicine. He is now Co-Founder and Lead Educator of OnlineMedEd and Co-Founder/Chief Medical Officer of DoseDr, a diabetes-management telemedicine application. Dr. Williams is also a hospitalist at Baton Rouge General Hospital, affiliated with Tulane University School of Medicine, where he serves as the Clerkship Director for Tulane students in the LEAD curriculum and Core Faculty for the Baton Rouge General Internal Medicine Residency Program.