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.

Unrelenting pressure

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.

Ethicon Announces Strategic Collaboration With Touch Surgery To Evolve Medical Education

SOMERVILLE, N.J., Aug. 24, 2016 /PRNewswire-USNewswire/ -- Ethicon, Inc., part of the Johnson & Johnson Medical Devices Companies, announces a strategic collaboration with Touch Surgery to help improve patient outcomes by delivering simulated surgical training based on the safe and efficacious use of Ethicon products in a free mobile app that can reach medical professionals in even remote regions of the world.   

Ethicon's more than 60-year history in educating surgeons and deep expertise with surgical products, combined with Touch Surgery's technology platform and unique 3D simulations, will provide digital content that aids surgeons and students in training anytime, anywhere.

A report on global surgery, commissioned in 2015 by The Lancet, found nearly one-third of the global burden of disease can be treated surgically and that five billion people lack access to safe and affordable surgical care.1

"We're looking to improve the standards of surgical care and treatment around the world, accelerating our pace of innovation and aiding the training of more physicians through collaborations such as this agreement with Touch Surgery," says Michael del Prado, Company Group Chairman, Ethicon.  "It reflects our broad-based approach to innovation and is another important step toward developing a trusted education ecosystem that improves patient outcomes."

The Touch Surgery platform empowers and connects the global surgery community by enabling virtual surgical training on procedures in 3-D operating room simulations that are unlike other available solutions. The app currently has one million users and helps enable surgeons and other healthcare providers to practice more than 75 procedures of varying surgical specialties.

Ethicon and Johnson & Johnson Medical Device Companies are committed to expanding access to surgical procedures around the world, especially in developing countries where access to the latest training practices can be limited. The collaboration with Touch Surgery will help bolster the library of procedures to create leading educational content across a broad range of surgical specialties, helping to expand resident education and standardize procedures. 

Ethicon will begin by addressing training needs in General Surgery and will look at potential opportunities to expand over time to include other Johnson & Johnson Medical Device Companies businesses and specialties, such as orthopaedics and cardiovascular.

About Ethicon
From creating the first sutures, to revolutionizing surgery with minimally invasive procedures, Ethicon has made significant contributions to surgery for more than 60 years. Through Ethicon's surgical technologies and solutions including sutures, staplers, energy devices, trocars and hemostats and our commitment to treating serious medical conditions like obesity and cancer worldwide, we deliver innovation to make a life-changing impact. Learn more at, and follow us on Twitter @Ethicon. Ethicon represents the products and services of Ethicon, Inc. (the signing party) and certain of their affiliates.

About Johnson & Johnson Medical Devices
Having made significant contributions to surgery for more than a century, the Johnson & Johnson Medical Devices Companies are in the business of reaching more patients and restoring more lives. The group represents the most comprehensive surgical technology and specialty solutions business in the world, offering an unparalleled breadth of products, services, programs and research and development capabilities directed at advancing patient care while delivering clinical and economic value to health care systems worldwide.

1The Lancet Commission on Global Surgery, 2015,

Cautions Concerning Forward-Looking Statements
This press release contains "forward-looking statements" as defined in the Private Securities Litigation Reform Act of 1995 related to a new collaboration to expand access to digital training in surgical procedures. The reader is cautioned not to rely on these forward-looking statements. These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or known or unknown risks or uncertainties materialize, actual results could vary materially from the expectations and projections of Ethicon, Inc., any of the other Johnson & Johnson Medical Devices Companies and/or Johnson & Johnson. Risks and uncertainties include, but are not limited to: the potential that the expected benefits and opportunities related to the collaboration may not be realized or may take longer to realize than expected; uncertainty of success and continued use of the app; competition, including technological advances, new products and patents attained by competitors; changes in behavior and spending patterns of purchasers of health care products and services; and global health care reforms and trends toward health care cost containment. A further list and description of these risks, uncertainties and other factors can be found in Johnson & Johnson's Annual Report on Form 10-K for the fiscal year ended January 3, 2016, including in Exhibit 99 thereto, and the company's subsequent filings with the Securities and Exchange Commission. Copies of these filings are available online at, or on request from Johnson & Johnson. None of the Johnson & Johnson Medical Devices Companies or Johnson & Johnson undertakes to update any forward-looking statement as a result of new information or future events or developments.

Peggy Ballman
Mobile: 908-310-7721
This email address is being protected from spambots. You need JavaScript enabled to view it.

SOURCE Ethicon

How India can be a world leader in medical education

(HT File Photo) How India can be a world leader in Medical Education

The Lok Sabha on Tuesday passed two bills aimed at putting in place a single common examination for medical and dental courses that will bring even private colleges under its ambit.

“The bill will give statutory status to the NEET. This will make the examination system fair and transparent and students won’t face multiplicity of exams. It will also stop the exploitation of students in the name of capitation fees,” health minister JP Nadda said while replying to the debate.

The National Eligibility and Entrance Test (NEET) was brought in for the first time by the Medical Council of India (MCI) in 2012 to hold a centralised examination for admissions to undergraduate and postgraduate courses in medicine. This would ensure merit-based admissions in a transparent manner and check the irregular admission processes prevalent in some of the private medical colleges.

However, NEET was set aside by the Supreme Court on petitions filed by private medical colleges. While the decision of the apex court was a setback, the court agreed to reconsider its split-decision. A few weeks ago, the court recalled its order of 2013, by which NEET had been set aside, and directed that NEET be conducted for the year 2016.

This was a welcome step. For an equal representation from states, the Government of India decided to promulgate an Ordinance, allowing the states to conduct their own medical entrance examination for the undergraduate course for this year. The Ordinance does not allow private colleges to conduct their own examinations.

NEET is urgently required in India as it will foster a sense of confidence in the admission process, and help in attracting the brightest talent to the medical profession. Moreover, students will be relieved of the burden of appearing in and paying for a number of entrance tests. However, there is criticism of NEET due to the divergence in its course content and standards. The syllabus for NEET was first based on the 10+2 level CBSE and other state boards’ course content. Issues from various quarters were examined by an expert group before finalising the course content and separate merit lists for each state were contemplated. Thus students from a particular state would compete with peers from their own state with no question of any urban-rural divide.

The ordinance does not affect NEET for postgraduate courses, which will be held in December this year. Of course, the timing of the exam could be revisited. Currently, the NEET for postgraduate courses is held at the end of the internship period. This results in students preparing for an entrance test during their internship, thereby compromising on the clinical training period. This adversely impacts the training of graduate doctors. In my view, the internship period should be properly utilised and the entrance process for postgraduate courses should include testing the students’ clinical skills.

Therefore, NEET is only the beginning. The next step should be to have a common exit examination, to ensure uniform standard of evaluation across the country. Presently the deemed or private universities conduct their own exit examinations. There have been murmurs regarding irregularities and the unfair means used in these exit examinations.

Other reform measures can include an increase in the number of postgraduate seats, adoption of a new undergraduate curriculum and adjunct faculty from basic science institutes and eminent clinicians from private hospitals. It is also necessary to review the minimum requirements required for setting up medical colleges. This would incentivise entrepreneurs whose prime interest is to create institutions of excellence providing quality education and training. Such reforms when met with the wealth of clinical material available can make India a world leader in medical education and healthcare.

First clinical study for Zika vaccine to begin in Canada

Université Laval's Infectious Disease Research Centre (IDRC) and Centre de recherche du CHU de Québec-Université Laval (CHU) are proud to announce that the first clinical study for a Zika vaccine in Canada is set to begin in Quebec City.

"We're very proud to be part of the first international team in the world to complete all of the steps in the regulatory process and to be authorized by the Food and Drug Administration (FDA) and Health Canada to develop a Zika vaccine," said Gary Kobinger, doctor of microbiology, professor in Université Laval's Faculty of Medicine, researcher with Centre de recherche du CHU, director of IDRC, and a global authority on vaccine research.

The Zika virus is transmitted primarily by mosquitoes. Although most cases are relatively mild, women who are infected while pregnant are at risk of miscarrying or giving birth to children with abnormally small heads -- a condition known as microcephaly.

"There is no existing treatment or vaccine for Zika. The vaccine currently being developed will be administered to humans for the first time as part of the clinical study. CHU de Québec-Université Laval is one of the three leading research centres involved in the vaccine study and we're very proud of that," said Gertrude Bourdon, president and CEO of CHU.

"This study under Professor Gary Kobinger's supervision is further proof of our institution's global leadership in the field of infectious disease research," said Rénald Bergeron, dean of Université Laval's Faculty of Medicine.


Université Laval

Foreign NHS workers must be assured they are still 'welcome' after Brexit vote, Simon Stevens says

Foreign NHS workers must be given “reassurance” by the Government that they are still “welcome in this country”, Simon Stevens says today.

Writing in The Daily Telegraph, the NHS chief executive calls on Theresa May’s new Government to protect the rights of all international employees in the wake of the vote to leave the European Union.

Mr Stevens says that Britain’s NHS relies on “committed health professionals from other countries”.

Setting out a post-Brexit blueprint for the health service, Mr Stevens also says that money should be diverted from hospitals to GP surgeries to help save the NHS.

He calls on Mrs May to use the EU referendum as an opportunity for “radical change” in the health service.

Urging the Government to focus resources on GPs rather than hospitals he says that “headlines about hospital deficits obscure the fact that over the past decade their share of funding has grown rapidly at the expense of primary care”.

And he warns that GP surgeries and hospitals across the country are “overcrowded and clapped-out” and calls on Mrs May to set up new infrastructure fund to replace buildings “buildings in need of a makeover if not a bulldozer”.

Following the Brexit vote, there have been repeated calls for the Government to guarantee the rights of EU citizens already living in the UK.

However, ministers have so far refused to do so unless there is a reciprocal guarantee to protect British citizens living on the continent.");" class="js-video-player__image-container video-player__image-container"> Simon Stevens: Economic tailspin from Brexit 'severe concern' for NHS Play! 00:30

Mr Stevens calls on Mrs May’s Government to give assurances “every international NHS employee”.

NHS figures for 2014 suggest 25 per cent of doctors are non-British, and 13.5 per cent of nurses – statistics which are still among the highest in Europe.

“As the largest employer in Europe, the health service needs to do a better job training and looking after our own staff,” he writes.

“New apprenticeships and ladders of opportunity for committed young people can help many of the left-behind communities most alienated from modern Britain. 

“Even then we're still going to need committed health professionals from other countries. Australian-style immigration points systems all give thumbs-up to nurses, doctors and other skilled health professionals. So it should be completely uncontroversial to provide early reassurance to every international NHS employee about their continued welcome in this country.”");" class="js-video-player__image-container video-player__image-container"> Farage: I can't guarantee EU money will go on the NHS Play! 01:19

In his article, Mr Stevens also says that Mrs May’s new Government must “urgently” set out a child obesity strategy.

He writes: “Piling on the pounds around our children's waistlines is piling on billions of pounds in future NHS costs. We're now spending more as a nation on obesity than on the police and fire service combined. So we urgently need an activist child obesity strategy, including comprehensive action on food reformulation, promotions and advertising.”

He also says that ministers should expand the “triple lock” on the state pension to take in the cost of elderly care to ensure that A&E services are no longer “overwhelmed” by older patients.

The “triple lock” ensures that the state pension rises in line with whatever is highest out of wages increases, inflation or 2.5 per cent.

Mr Stevens urges Mrs May and Jeremy Hunt, the Health Secretary, to focus on improving GP care in the years ahead.

“How NHS care is provided needs a major overhaul,” Mr Stevens says. “Access to GPs was a repeated public concern during the referendum campaign, alongside pressure on primary school places and affordable housing. We make 300 million visits to our GP practices each year, compared to fewer than 25 million A&E attendances.

“So if GP services fail the NHS fails. Yet headlines about hospital deficits obscure the fact that over the past decade their share of funding has grown rapidly at the expense of primary care, and hospital consultant numbers have expanded three times faster than GPs.”

He says that a new NHS infrastructure fund would “create optimism across the NHS, unleash major efficiencies, turbocharge the construction industry, and be welcomed in constituencies and communities right across the country”.

He writes: “Many patients arrive each day for their GP or hospital appointment in what are - can we speak frankly? – overcrowded and clapped-out buildings in need of a makeover, if not a bulldozer.");" class="js-video-player__image-container video-player__image-container"> Farage: I can't guarantee EU money will go on the NHS Play! 01:19

“Yet to help balance the books, the NHS is currently switching billions of pounds of capital investment into needed day-to-day running costs.”

A Government spokesman said: “NHS staff make a huge contribution to our country and Government has been clear that it fully expect the legal rights of EU nationals already in the UK will be properly protected.”

It came as the Government was accused of issuing "misleading" figures over its pledge to increase NHS funding.

MPs on the Commons Health Committee said the Government's claim that the NHS would receive £8.4 billion by 2020/21 actually translates into £4.5 billion because ministers used a different calculation compared with previous years.

They concluded that health spending "will not increase by as much as expected from official pronouncements", and the financial challenge faced by the health service is "colossal". @2014