Utilization of counseling services at one medical school.

OBJECTIVES: The purpose of this study was to assess the usage of mental health counseling services by medical students. Medical students experience high rates of burnout, depression, and suicidal ideation. Our medical school (Baylor) provides free professional counseling services. METHODS: The authors administered a survey that included a burnout scale; a depression screen; and questions about demographics, usage of counseling services, and helpful coping mechanisms for 526 first-through third-year students (336 respondents) at one school. RESULTS: Approximately 24% of students with high rates of burnout and 24% of students with depressive symptoms took advantage of counseling services at least once. Of the students who had not used counseling services, approximately 49% were found to have high rates of burnout in the domain of emotional exhaustion. Similarly, of the students who had not accessed counseling services, 56% had depressive symptoms. CONCLUSIONS: A large percentage of medical students across three classes did not use mental health counseling services provided by the school. Students should be clearly informed about the availability of counseling services and their potential utility. In addition, specific barriers to attendance should be identified and reduced.

A systematic review of stress-management programs for medical students.

OBJECTIVE: Because medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions. METHOD: The authors searched the published English-language articles on PsycINFO and PubMed, using a combination of the following search terms: stress-management, distress, burnout, coping, medical student, wellness. Both randomized, controlled trials and controlled, non-randomized trials of stress-management programs were selected and critically appraised. RESULTS: A total of 13 randomized, controlled trials or controlled, non-randomized trials were identified. Interventions included self-hypnosis, meditation, mindfulness-based stress-reduction, feedback on various health habits, educational discussion, changes in the length and type of curriculum, and changes in the grading system. Only one study was identified to be of very high quality, although several had described group differences at baseline, used blinding, had good follow-up, and used validated assessment tools. There was a wide heterogeneity of outcome measures used. Interventions that were supported by a reduction in stress and anxiety in medical students included mindfulness-based stress-reduction or meditation techniques, self-hypnosis, and pass/fail grading. CONCLUSIONS: Significant opportunities to advance educational research in this field exist by developing more high-quality studies with particular attention to randomization techniques and standardizing outcome measures.

Survey of the prevalence of burnout, stress, depression, and the use of supports by medical students at one school.

OBJECTIVE: The authors determined the prevalence of stress, depression, and burnout in medical students and the resources used by students in one school to alleviate psychological distress. METHODS: A survey was administered to 526 students in the first 3 years of medical school (336 responders; response rate: 70%) at one institution, using a modified Maslach Burnout Inventory Human Services Survey (MBI-HSS), the two-question PRIME-MD depression screening survey, the Perceived Medical School Stress Scale, along with questions on demographics and helpful programs to cope with stress. RESULTS: The percentage of respondents scoring in the High Burnout range was approximately 55% for all three subscales. Depressive symptoms were reported by 60% of respondents. The most helpful coping mechanisms reported were social support from peers and faculty, counseling services, and extracurricular activities. CONCLUSIONS: The prevalences of burnout, depression, and stress were higher in this sample of first- through third-year medical students when compared with other medical student groups previously studied. Important limitations of this research included the fact that it was cross-sectional in design and that the PRIME-MD tool is simply a screening tool and does not diagnose major depression. Medical educators, deans, and administrators should appreciate the possibility of higher levels of psychological distress among their own students than those previously reported.

Students versus faculty members as admissions interviewers: comparisons of ratings data and admissions decisions.

PURPOSE: To explore variations both in interview ratings data and in medical school admissions decisions when current medical students do and do not participate in interviewing applicants. METHOD: The research team conducted this randomized controlled trial by performing identical analyses for each of six independent cohorts of applicants (n = 3,868) to Baylor College of Medicine for the academic years 2005-2006 through 2010-2011. A pair of randomly selected interviewers--either two faculty members or a faculty member and a student--interviewed each applicant in a one-on-one interview. RESULTS: Interviewer pairs randomly structured to include either two faculty members (n = 1,523) or one faculty member and one student (n = 2,345) produced ratings of similar means as well as homogeneity across ratings. The structure of the rater pairs, as expected, was not predictive of the final admissions decisions after the authors took into account Medical College Admission Test scores and grade point average. CONCLUSIONS: These results, showing that student involvement does not compromise the ratings of interviewed applicants, support the continued involvement of students in medical school admissions interviews.

Crossing the patient-centered divide: transforming health care quality through enhanced faculty development.

In the report "Crossing the Quality Chasm," the Institute of Medicine asserted that patient-centered care is one of the six domains of quality. In this article, the authors consider how the patient- and relationship-centered components of quality can be achieved in all aspects of medical care. They suggest that faculty development in three key areas-mindful practice, formation, and training in communication skills-is necessary to achieve patient- and relationship-centeredness.The authors first review the philosophical and scientific foundations of patient-centered and relationship-centered care. They next describe and provide concrete examples to illustrate the underlying theory and practices associated with each of the three faculty development areas. They then propose five key areas for faculty development in patient- and relationship-centered care: (1) making it a central competency in all health care interactions, (2) developing a national curriculum framework, (3) requiring performance metrics for professional development, (4) partnering with national health care organizations to disseminate the curriculum framework, and (5) preserving face-to-face educational methods for delivering key elements of the curriculum. Finally, the authors consider the issues faced in faculty development today in light of the medical education issues Abraham Flexner identified more than a century ago.

Teaching development in undergraduate and graduate medical education.

Faculty members from three different institutions, each with long-standing experience teaching development, present strategies for teaching normal development in undergraduate and graduate medical education. This article provides an overview of licensing body requirements, teaching methodology, audiovisual and textbook resources, goals and objectives (knowledge, skills, and attitudes), and sample curricula for teaching human development to medical students, general psychiatry residents, and child and adolescent psychiatry residents. The challenges of teaching development to various groups of trainees with different required course lengths and expected levels of competency, using lifespan and topical approaches, are reviewed.