Medical school can be brutal, and it’s making many of us suicidal
In August, a medical student at the Icahn School of Medicine at Mount Sinai in New York jumped out of an eighth-story window to her death.
Stories like this are too common among budding doctors across the United States. In May, a medical student at the University of Southern California took his own life. At the University of California at San Diego, a third-year medical student killed himself last year. Two years ago, when I was a medical student at Harvard, a fellow student died of suicide.
We don’t have great data on how many of the nation’s 80,000 medical students take their own lives each year. Few studies have addressed the issue, with varying results. But suicide is a major issue for medical schools. In surveys, roughly 10 percent of medical students have reported having thoughts of killing themselves within the past year.
What drives these bright young people to take their own lives?
Research has found that students may arrive at medical school feeling less burnout and depression than other people of their age. Yet once in medical school, they go on to have greater risk of mental-health problems and suicidal thoughts. According to the American Foundation for Suicide Prevention, medical students suffer from depression at rates 15 to 30 percent greater than the general population.
Academic competition might explain these findings. Thousands of applicants compete for spots in these schools. In 2015, the average medical school accepted just 6.9 percent of applicants, according to U.S. News and World Report; Mayo Medical School had the lowest acceptance rate at 1.8 percent. By screening for the best and the brightest, these institutions can serve as breeding grounds for competition and feelings of inadequacy.
The academic burdens at these schools can be intense. Medical students must learn a startling amount of material in a short time. For example, in our anatomy class, my classmates and I had to dissect and learn the entire human body in a matter of weeks. A well-known saying is that “medical school is like drinking water from a fire hose.” Students grapple with high-volume workloads while studying for multiple rounds of national licensing exams and preparing applications to residency programs.
Outside the classroom, medical students face additional stressors. Entering clinical settings brings students face to face with sick and dying patients, often for the first time. Immersing oneself in human suffering each day can leave its mark. Medical students spend days and nights with patients who die of cancer, who lose limbs to amputation, who depend on ventilators to breathe, who will never walk again.
Rather than receiving support in these situations, these students often suffer humiliation from senior clinicians. Doctors work in a hierarchy, with attending physicians above residents, who are above interns. At the bottom of the totem pole are medical students.
This hierarchy engenders a culture of bullying toward medical trainees. More than 80 percent of medical students report mistreatment from supervisors. I’ve seen classmates shouted at, cursed at and mocked in clinical settings. A surgeon referred to me as “Helen Keller” because I couldn’t suture fast enough.
Money can also weigh heavily on the minds of medical students, who shoulder astounding debts to finance college and medical school. According to 2015 data, 81 percent of medical students reported academic debt at graduation, with an average indebtedness of more than $180,000.
Amid these unrelenting pressures, many medical students descend into despair. Some turn to suicide.
No suicide is the same, just as the causes of depression and despair vary from individual to individual. But with medical students, the shared stressors of medical school are undoubtedly a common thread. In recent years, these schools have taken steps to tackle this issue.
Reducing competition in the classroom may help. The majority of medical schools have embraced pass-fail grading systems for the first one to two years when students take classes, reforms shown to enhance well-being among students without affecting academic outcomes.
Team-based learning is another emerging trend in medical education. By encouraging collaboration, educators hope to increase cohesiveness among classmates and decrease social isolation while better preparing future doctors for team-based patient care.
Universities and hospitals have sought to change the culture of medical education in other ways as well. Schools have introduced a variety of wellness programs, including counseling, group fitness activities, outdoor retreats and healthy eating seminars. Nationwide, the medical community has aimed to eradicate mistreatment of medical students in clinical settings.
But one part of medical school culture has been especially hard to overcome: the stigma of mental illness. When they need help most, medical students in anguish rarely reach out. Students attribute this reluctance to seek care to fear of stigmatization by peers and to concerns over professional ramifications, particularly during applications for residency and licensing.
Last spring, I wrote publicly about my own struggle with depression during medical school. The days leading up to the article’s publication were terrifying. I worried I might lose the residency slot I had matched into or forfeit the trust of future colleagues. Again and again, I checked the medical licensing requirements in California to make sure I wouldn’t lose the ability to care for patients.
Yet my fears have gone unfounded and, in the days that followed, I received nothing but support from colleagues and mentors. Fortunately, others are speaking up as well. In online magazines and on NPR, medical students who have lived through suicide attempts, depression and other mental-health issues are standing up against this stigma. Medical schools are now training faculty to recognize risk factors for suicide and assuring students that seeking help isn’t a sign of weakness.
Despite these efforts, too many medical students still take their lives, as the recent tragedy at Mount Sinai reminds us. In May, two physicians started a petition urging the governing bodies of medical education to do more to prevent suicide among medical trainees. As of this writing, the petition has garnered around 75,000 signatures.
Medical students spend their days learning how to help others. Can we learn to care for them, too?
Morris is a resident physician in psychiatry at the Stanford University School of Medicine.