"Medical students" burn out – need of student mentor and support groups and emotional resilience skills training to be a part of medical school curriculum

Dear editor

We would like to applaud the authors of the article “Potential predictors of psychological distress and well-being in medical students: a cross-sectional pilot study” for conducting a cross-sectional pilot study to understand the predictors of psychological distress and well-being and for assessing their extent using latest scales that have not been extensively used for this purpose before.¹ We would like to add some views in its support.

There is a social stigma prevailing in our society that we judge and be harsh toward the students who are generally not performing well in studies despite having adequate resources. We would like to elaborate that such performance declines can be simply mental exhaustion, particularly among medical students, as overtime leads to an increased prevalence of stress-related disorders, depression and, sadly, suicide.^2,3

Lack of concentration, inability to focus, difficulty in retaining information, experiencing recurrent headaches, lack of sleep, feeling fatigued and helpless, not putting up the best efforts, and experiencing unknown hesitation – these are simply burnout symptoms due to academic stressors and performance anxiety. Multiple surveys have shown significantly increased incidence of stress-related disorders among medical students as soon as they enter medical college.⁴ Medical students quite often suffer from depression and anxiety disorders all over the world. A study by Association of American Medical Colleges revealed that about 13.6% of medical students were suffering from major depression, and about 6% of them had suicidal ideations.⁵

A lot of medical students usually experience self-doubt and fear of failing exams, and thoughts of not doing well in their studies and managing relationships, home, and social life further impacts their distress, leading to panic attacks, and thus a vicious cycle begins from this point onward when they believe they are not able to justify anything in their lives. Although, there is enough burden in the form of extensive curriculum, with the increasing competition globally, the desire to perform well in every semester/exam along with excelling in research work and the need of elective rotations to improvise curriculum vitae are further compounding academic stressors. In various cross-sectional studies, higher levels of stress are found among Pakistani medical students, particularly in the female population, which leads to development of depression over time.⁶ To add to academic issues, there are multiple other issues prevalent in our country such as transport issues, electricity, and finances to amplify psychosocial stressors.³

Internationally, medical students employ various stress-management skills to cope up, and it is high time for us to take some initiative and help our medical students cope well, multitask, and perform. What is required is to identify such stressed students and try to create student support groups that work to help them cope with their stressors and other issues that limit their progress. Emphasis on group learning and examination techniques, introduction of strategies to increase focus, controlling of panic attacks, and suppression of distracting thoughts are the major factors behind worrying so much. Stress-management skills are also beneficial for students who find it difficult to deal with exam anxiety and experience bad performance despite good internal evaluations.⁷ Students with very serious concentration issues should be given proper psychiatric/psychologist consults and be treated with therapies and tranquilizers. Extracurricular activities, physical training, or social activities can be helpful; yoga has been proven to be associated with improvement in mood symptoms and causing students to feel better and confident about themselves, and so medical schools can benefit from having exercise and yoga instructors and gym and recreational facilities for students.^8,2

Also, there should also be an evaluation of our examination system to test if it is burdening at any stage (so as to stress out students). The issue will fade away in future if we work upon the precipitating events by introducing student support groups, provide professional mentors, and arrange for psychological support rather than judging or negatively evaluating those students who really need psychological help.

Disclosure

The authors report no conflicts of interest in this communication.

References

1.		Bore M, Kelly B, Nair B. Potential predictors of psychological distress and well-being in medical students: a cross-sectional pilot study. Adv Med Educ Pract. 2016;7:125–135.
2.		Kaiser BN, Haroz EE, Kohrt BA, Bolton PA, Bass JK, Hinton DE. “Thinking too much”: a systematic review of a common idiom of distress. Soc Sci Med. 2015;147:170–183.
3.		Osama M, Islam MY, Hussain SA, et al. Suicidal ideation among medical students of Pakistan: a cross-sectional study. J Forensic Legal Med. 2014;27: 65–68.
4.		Wolf TM, Von Almen TK, Faucett JM, Randall HM, Franklin FA. Psychosocial changes during first year of medical school. Med Educ. 1991;25:174–181.
5.		Goebert D, Thompson D, Takeshita J, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009;84:236–241.
6.		Shah M, Hasan S, Malik S, Sreeramareddy CT. Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani Medical School. BMC Med Educ. 2010;10:2.
7.		Malathi A, Damodaran A. Stress due to exams in medical students – role of yoga. Indian J Physiol Pharmacol. 1999;43:218–224.
8.		Redwood SK, Pollak MH. Student-led stress management program for first-year medical students. Teach Learn Med. 2007;19:42–46.
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