Robin Saide-Hershkowitz, LCSW-R, Amy Stern, LCSW-R, and Kathryn Spanknebel, MD
This distress may persist and later extend into practice, as evidenced by adverse mental health outcomes in the physician workforce.1 Studies have shown concerning prevalence rates of medical student depression (27%)2 and anxiety (33%)3 that exceeds those of age-matched, non-medical peers.2, 4 As a group, medical students experience alarming suicidal ideation rates (11%) that extend beyond the US alone.2 This data underscores the necessity for medical students to deliberately acquire emotional care strategies during their education, and to learn how to appropriately utilize such strategies.
Medical education programs are demanding, and it is unrealistic to imagine that students will be unaffected by the stress of coursework and clinical placements. As such, it is reasonable to develop medical school programming that empowers students to find ways to manage and reduce the impact of this known pressure. Identifying, accumulating, and actively engaging in self-care activities provides such a means.
Self-care activities are the tools with which students promote their own mental health and develop the ability to regulate their emotional state. Self-care is a loosely defined term that can look different to everyone; a walk around campus or a coffee date with a friend can address the essential need of attending to one’s own physical, psychological, and emotional needs. What the activity is matters much less than the simple act of engaging in the activity itself.
Students may feel unable to effectively prioritize self-care during their medical school years, inaccurately perceiving such activities as an indulgence rather than behaviors that will enhance performance and are vital to success. One way to easily introduce self-care is to schedule time for enjoyable activities, the way one might put an appointment or study session in a calendar. People are more likely to do something if it is planned. Engaging in meaningful activities, even if it is only for a short amount of time, can often elevate one’s mood and offset the negative impact of ongoing stress. The idea is that it is always better to do something in a modified way than to not do it at all. Approaching self-care activities with flexibility also increases accessibility.
Self-care can be as simple as being attuned to one’s physiological needs, such as good nutrition and obtaining adequate sleep. Evidence shows that good health practices contribute to positive shifts in mood and concentration, as well as improved academic performance. Physical exercise and relaxation techniques (such as deep breathing or guided meditation) can improve brain health and mitigate the impact of stress, leading to an improved ability to regulate emotions.
A regular practice of self-care equips students with the skills to navigate periods of intense stress or difficulty. Self-care can take the form of coping strategies that enable students to tolerate distress that can often exist for a prolonged time period. The practice of self-care can be applied as needed but may be optimally beneficial when viewed as a form of preventative care and a way to strive for emotional equilibrium. A regular self-care practice can create a change in perspective and lifestyle that builds resiliency, enabling students to thrive long-term.
Finally, knowing when to ask for help is a crucial component of this equation. If a student tries these self-care strategies and continues to struggle with depressed mood or anxiety, it is recommended to seek out a licensed mental health professional. It is not a deficit or weakness to struggle. It is a sign of strength to recognize when additional support and intervention are needed and allow oneself to access all the supports available. Students should inquire about what is offered through their medical education program. Students should also be aware of the 988 Lifeline, a national resource that they can call, chat, or text and is available 24/7 to provide free and confidential emotional support to anyone in crisis, anywhere, any time of day.
The experience of pursuing a medical degree is appropriately challenging. Seeking and accepting help allows one to better care for others by caring for themselves, now and throughout their career.
References:
1. Harvey SB, Epstein RM, Glozier N, Petrie K, Strudwick J, Gayed A, Dean K, Henderson M. Mental illness and suicide among physicians. Lancet. 2021 Sep 4;398(10303):920-930. doi: 10.1016/S0140-6736(21)01596-8. PMID: 34481571; PMCID: PMC9618683.
2. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016 Dec 6;316(21):2214-2236. doi: 10.1001/jama.2016.17324. PMID: 27923088; PMCID: PMC5613659.
3. Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, Ho RC. The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis. Int J Environ Res Public Health. 2019 Jul 31;16(15):2735. doi: 10.3390/ijerph16152735. PMID: 31370266; PMCID: PMC6696211.
4. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–373.