Keck Checks: Not-Quite-Mandatory Counseling
The views and opinions expressed in this collection are those of the authors and do not necessarily reflect the positions of the Association of American Medical Colleges.
Catherine Song is a second year medical student at the Keck School of Medicine of USC from Denver, Colorado. She is passionate about mental health and well-being, particularly among medical students. She serves as the Wellness Representative on her class student council and was president of a peer support group. She has organized events promoting wellness and the destigmatization of mental health such as a panel of students sharing their mental health journeys, and MedMeals, a program that facilitates bonding between faculty and students.
Chantal Young, PhD, is a clinical psychologist by training and had the privilege of seeing medical students as therapy patients before starting as director of wellness at the Keck School of Medicine (KSOM). She is passionate about helping intelligent, high-achieving people discover the benefits of radical self-care in their lives. She has created several initiatives to support medical students at the KSOM including Keck Checks, a Wellness Task Force charged with making systemic improvements to support well-being, and the required 30-hour Foundations of Physician Resilience curricular thread.
In the fall of 2016, Keck School of Medicine of the University of Southern California implemented “Keck Checks.” Chantal Young, PhD, director of medical student wellness, and Catherine Song, second year medical student, offer their perspectives on the implementation of these mental health check-ins.
When I started as director of wellness at the Keck School of Medicine of USC over two years ago, I was surprised to learn that the medical students suggested that everyone receive “mandatory mental health appointments,” giving each student a chance to meet with a professional without singling anyone out. As a clinical psychologist, I worried that students would find this intrusive, that it would compromise their sense of adulthood and autonomy, or at worst, undermine any potential therapeutic relationship. But I also trusted my students, and I knew we desperately needed fresh ideas to address the epidemic of depression, anxiety, and burnout in medical training. So we decided to give it a try.
The first time seeking help is the hardest. It’s especially hard as a medical student. We think a successful doctor should cope with all their difficulties on their own. Many of us wait until we are pushed to the very edge of our coping abilities, if we ever seek help at all. This is why the Keck Checks are so powerful. It is routine, just a normal part of medical school, to take that first step. We get a feel for counseling. We shift from thinking that meeting with a professional is something that we would only resort to in our darkest times, to considering whether it could be a potent resource for improving our quality of life.
In the fall of 2016, I started hosting 15-minute health visits for all first-year students called “Keck Checks.” The goal was to provide a brief mental health screening while reducing barriers to seeking treatment. We could not mandate the visits, but we could make it easy and nonintimidating to sign up, encourage students to attend, and make it clear that they could opt out for any reason (e.g., if they were already being seen for counseling or if anything about the appointment made them uncomfortable). We emphasized that the visits would be entirely confidential.
Over the course of the academic year, I managed to meet with most of the entire first year class, almost 190 students with a compliance rate of over 95%. Since then we have hired a second psychologist as an assistant director of wellness. Together we have split the task of completing the Keck Checks for the first year class, allowing me more programmatic time resulting in the development of a required physician resilience curriculum for all Keck students.
I personally found it to be 15 of the most supportive minutes of my life: to be listened to and validated in such a patient, gentle, and caring manner. My classmates, whose opinions I have heard in person or via an anonymous survey, expressed that they enjoyed their Keck Check and that it has encouraged them to consider mental health services.
A lot can happen in a 15-minute visit. Students might feel grateful, nervous, or apathetic about coming in. Sometimes students are guarded and don’t say much at all. Other times students disclose a lot. Students tell us about prior histories of depression and suicide attempts, struggles with addiction (from stimulants to internet), problems in their family (e.g., parents who misuse alcohol, have excessively high expectations, or depend on the student), devastating romantic breakups, uncertainty about becoming a physician, feeling intimidated by peers or faculty, profound loneliness, social and performance anxiety, or feeling out of place due to their ethnicity, sexual orientation, political beliefs, or socioeconomic status. Students ask questions, reflect, laugh, and cry.
As we go through medical school and face mounting challenges, the memory of the Keck Check becomes increasingly important. It’s easier to reach out, because we’ve already taken that crucial first step through the door.
In the Keck Checks, the aim is not to diagnose or treat. In fact, we don’t try to fix much at all. Sometimes we make a referral for mental health treatment. But mostly we do something deceptively simple: establish what could be one of the few truly supportive, nonjudgmental relationships in this competitive environment and decrease barriers to asking for help.
If I can simply be a friendly face that sticks in a student’s mind and heart, then the Keck Checks have done their job.