To build a 'more humane' medical school, Saint Louis University looks to its students
During her first year of medical school, Katherine Hu struggled with the feeling that she didn’t measure up.
“You end up becoming, actually, pretty cynical. I’d be sitting in class, the professor’s speaking a million miles an hour, and I don’t know what’s going on,” Hu said. “It just becomes heavier and heavier … kind of hopeless sometimes.”
Hu grew up in Cupertino, California, and decided to go to medical school after a stint at a health care startup. During her first Midwestern winter, she realized that the anxiety she felt wasn’t normal.
“I opened up and addressed these problems and I’ve been a lot happier since then,” Hu said. “Instead of thinking about negatives, I started keeping a journal of three positive things a day and opening up more to my family.”
Hu, 26, is now a third-year student at Saint Louis University’s School of Medicine. She just finished a series of 12-hour, overnight shifts and sat on surgeries at a children’s hospital at the time of this interview. As she walked to the library for a few precious hours of study time, she said that the stress is still intense. But now, she knows how to manage it.
“Anything medical just bears that weight of, 'I’m going to be helping someone and if I don’t know what I’m doing I could be hurting them,' or 'I could be inadvertently causing harm to other people around me,'” Hu said.
When administrators at SLU's medical school found that more than half of their students reported symptoms of anxiety or depression eight years ago, they overhauled their program to reduce student stress.
“I felt like I’d been kicked in the stomach,” said Dr. Stuart Slavin, the school’s association dean of curriculum. “We had evidence that when students started here, they looked like the general public. So, as associate dean for curriculum, it was like … we are doing this to them. And I am kind of responsible.”
In that initial survey in 2008, more than a quarter of students reported moderate to severe symptoms of depression after their first year of medical school. Fifty-seven percent reported symptoms of anxiety. These rates are particularly high when compared with numbers of the general population. The Centers for Disease Control and Prevention estimates that 7.4 percent of young adults live with depression and 15 percent experience anxiety in their lifetime.
Over the last few years, with counsel from the students themselves, SLU established a series of changes to reduce student stress and anxiety. All classes for first- and second-year medical students are graded on a pass or fail basis, which students say encourages collaboration. Everyone takes a seminar in mental well-being and resilience, taught by Slavin. Anatomy — the course where all medical students dissect a human cadaver for the first time — is no longer the first class medical students ever take.
When Slavin distributes those surveys today, the number of students reporting severe symptoms of mental illness is much lower. When Hu’s class was surveyed at the end of its first year, 4 percent of students reported depression and 14 percent reported anxiety. At the same time, average scores on first-year board exams have increased from 222 to 229, he said.
“People think that by backing off our medical students aren’t going to be as well prepared. There’s evidence they’re actually better prepared, despite making life easier for them,” Slavin said.
In practice, Slavin’s model of giving medical students some breathing room can manifest in interesting ways.
Take, for example, a crew of second-year students who started a band that practices in the school’s basement.
Drums can be heard from the hallway as “The Palpations” prepare for a show at the Archive Music House this weekend to welcome first-year students at the end of their Orientation Week.
Hyun Lee, a shy, 22-year-old who hopes to become a cardiothoracic surgeon, is the band’s drummer. Practices are a welcome release, he said.
“I came into med school with the mentality of, ‘I’m going to study 24-7. For four years, I’m going to pretend like my life is over and just do it,'” Lee said. “But that’s not possible. You just need a place where you can go and do something.”
The name of the band is a joke that stuck — a palpation is the act of touching or feeling a patient’s body or organs, generally for diagnostic purposes. “Under the Counter” and “Ravi and the Dermatomes” were also considered.
Lead singer Ravi Patel, 23, and guitarist Tony Zunica, 24, regularly play acoustic covers of songs to share on the band’s Facebook page, taking requests when classmates need a study break or a birthday shout-out.
In Patel’s opinion, keeping a band running wouldn’t be possible at a program that didn’t place such an emphasis on students having free time.
“Honestly, I feel like the more things you do outside the hard sciences, you grow as a person, you become a more complete person, and you can talk to your patients,” Patel said. “You can be a complete physician, and that means relating to them on other things outside of medicine.”
To guitarist Vincent Le, 25, knowing how to balance classwork and the band is simply practice for life as a doctor.
“When I get out there, I want to be a doctor but I also want to have a life. I want to have a family. So making time for my hobbies and things I love, and not letting go of those, is really important to me,” said Le.
SLU isn’t alone in trying to make medical school more manageable, but the process isn’t always easy.
Missouri legislators tried this year to pass a measure that would make it easier for student and professional organizations to conduct mental health assessments in Missouri medical schools. The measure would set up a research project committee to help coordinate efforts statewide and identify ‘best practices’ to reduce stress and the risk of depression and suicide among medical students. The “Show-Me Compassionate Medical Education Act” passed the House but not the Senate.
On a national level, there is also a shift — but it’s slow going, said Geoffrey Young, the senior director of student affairs at the Association of American Medical Colleges.
“Change can be difficult. Medical school curricula, although they’ve been changing over the years, they’ve fundamentally remained the same,” said Young, who previously worked as a psychologist for medical students.
That "same” curriculum consists of two years of intensive, science-based class work. Then two years where students are introduced to the clinical setting. After medical school, newly minted doctors go through a highly competitive match process to be placed into residency programs. Even if a school makes an effort to improve mental health, it can be hard for a student who has to seek help.
“They work very hard to get to this point in their career. And they’re worried about issues of stigma," Young said. "For example, 'What if I were to acknowledge that I’m having some difficulty, how would that be viewed by my peers, my colleagues and, ultimately, the leadership of the medical school?'”
As for Hu, the third-year medical student at SLU, she credits the school with creating a culture that felt comfortable asking for help, and where mental well-being is a priority.
“If you take care of yourself, and establish these good habits early, you’ll be more successful as a physician and you’ll be more successful to take care of patients,” Hu said.
Follow Durrie on Twitter: @durrieB.