A recent Annals study brings attention to medical school burnout, with 11 percent of students contemplating suicide in the past year. “The link was strong and independent of symptoms of depression,” says Tait D. Shanafelt, MD, director of the Mayo Clinic Dept. of Medicine Program on Physician Well-Being.
Scary.
Perhaps one reason is that, with a proportion of students getting a “C” grade or lower, it’s the first taste of failure for many students.
More schools are going with a strict “Pass/fail” grading system, which may reduce the pressure in the medical school cooker.
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Other reason: it is hideously expensive. If you discover medicine is really not your cup of tea after a couple of years, you are trapped in debt with no way out. Medical school debt is a financial tire spike, it can cripple you going either way.
We had a suicide in the class before mine. It had to do with grades, interestingly, from the his concern that the grades were disappointing his parents who had been used to him getting ‘all A’s’ his whole life…or at least that is what we think.
Shortly after this, the school implemented the ‘Number Scale’ so grades would be given as numbers, not traditional letters. But the scale remained 1-100. Their view was that it made things ‘less competitive.’ I’m not sure how they figured that one…our view was that now people would get A’s and still not be happy, they wanted the 100.
But, simply ‘Passing’ all of your classes was viewed as a concern because how could you get into a competitive residency program with all ‘passes’ when put up against someone from another school who had all A’s? Unless all schools went to pass/fail. As long as there is competition in the match – which there will be while there is an income disparity between the specialties.
Reforming the admissions process would be a good start, too, and not just because of suicide. As a medical student (and having worked in clinical healthcare prior to med school) I can’t tell you the number of times I have met both physicians and medical students who had absolutely no business being in the field. The admissions process so exclusively numbers-driven, often to the exclusion of other factors, abilities, and life experience. Obviously, these “intangibles” are much more difficult to assess and essentially impossible to quantify. Numbers, however, are fast, cheap, and easy. Or easier. Compare the hours upon hours that med school applicants spend preparing their applications to the 30 minutes or so that are allotted for each interview. How can anyone be expected to evaluate someone’s character, psychology, motivation, personality, etc. in an hour or less, particularly when pre-med students have access to a myriad of interview-prep resources. I would venture that anyone except the grossly unsuitable or profoundly mentally ill could rehearse and prepare enough to be convincing for 30 minutes. At my med school orientation, our class was lauded for having the highest XXXXXXXX of any entering class in the school’s history. Of course, nothing was said about how committed we were to medicine, how rigorous our scientific standards were, or how devoted we were to service.
Of course, Jason is absolutely right; once in med school, the pressure is enormous. We are all accustomed to getting “A’s” or at least doing well without much effort, which will not work in medical school. Everyone who applies to med school knows this, at least in the abstract, before applying, but the sheer volume of information is really inconceivable until you experience it first-hand. Even if you do master the study skills and time management strategies and can handle the volume, the quality of instruction is much more variable than in undergrad, if for no other reason than the number of different faculty involved. Also, the quality of the exams, or even of the questions within an exam, can vary widely as well. With so many different question writers, the quality of the test items can range from clear and well-conceived to jumbled, vague, and riddled with simple grammatical and spelling errors. The faculty can write test questions lacking complete sentences, but God forbid you should confuse your Toll-like receptors or some obscure MAP-kinase that you are likely never to see again in 40 years of practice (or can look up with the touch of a stylus if needed). On top of all that, if you are unlucky enough to be one of the vast majority of students who are just above passing, you are likely to be made to feel even more inadequate by being told that “XX% on the exam doesn’t really demonstrate a mastery of the material” despite the fact that the test average was XX% +/- 3%. If XX is not considered mastery, then raise the passing score!
Now that I think about it, I think the real surprise is that the suicide rate among medical students isn’t higher.
I’m in my 3rd year at med school we have a Pass/Fail/Honors system which is absolutely WONDERFUL!!! I struggled through my first two years, barely passing most classes (70% and higher). The top 20% in each subject get “Honors”. This system took away the stress and competition and our school strives to help each other out with schoolwork and studying.
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