What Changes Are Needed?

Researchers have also been studying what undergraduate medical education learning environment interventions may be associated with improved emotional well-being among medical students. They found it may be time for program reforms when it comes to mental health programs, wellness programs, and mentoring programs. Data also appear to support a preclinical pass/fail grading system.3

“The main changes needed in medical education are primarily structural with pass/fail grading and reduction in class time and amount of information being taught,” said Dr Slavin.


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He noted that there is a strong link between depression and burnout in physicians and quality of care, with increases in medical errors and declines in empathy and altruistic behavior.  

“My personal feeling is that we should be routinely, and perhaps annually, anonymously or confidentially assess students, residents, and physicians for depression and burnout. I feel like action will only occur when we are willing to measure and track mental health outcomes of our students and employees in the healthcare setting,” Dr Slavin told Endocrinology Advisor.

Addressing Issues of Disabilities

Researchers recently assessed the prevalence of all disabilities and the accommodations in use at allopathic medical schools in the United States. They sent an electronic, web-based survey between December 2014 and February 2016 to 145 institutions. Among the 133 schools deemed eligible, 91 completed the survey (68.4%).4 The respondents identified 1547 students with disabilities (43.3% men) and represented 2.7% of the total enrollment.4 The survey found that 97.7% received accommodations.4 The most common disabilities were attention-deficit/hyperactivity disorder (ADHD; 33.7%), learning disabilities (21.5%), and psychological disabilities (20.0%).4

“So many individuals with disabilities are being dissuaded from medicine and incorrectly counseled that accommodations are not available in medical school or in the clinical years. We wanted to highlight just how many students with disabilities are in medical school. It was also critical to try to capture the entire spectrum of disability as previous studies only included subsets of disability like sensory or physical disabilities,” said study author Lisa Meeks, PhD, director of Medical Student Disability Services and assistant professor of medicine at the University of California, San Francisco. 

Physicians with disabilities add a rich dimension to their care of patients, according to Dr Meeks. She said physicians with disabilities have the potential to increase patient compliance and satisfaction through patient-physician concordance, similar to the effects shown with other marginalized populations. One in five Americans has a disability, so it is certain that future physicians will care for people with disabilities. However, she said providers with disabilities remain an underrepresented minority in the healthcare workforce, with the numbers being disproportionate (2.7%) to the magnitude of disabled people in the general population (20%).

“Medical schools around the country would benefit from learning more about how to support students with disabilities in keeping with the spirit of the Americans with Disabilities Act,” Dr Meeks told Endocrinology Advisor. “I think now that we know the prevalence, we need to work toward standardizing the process by which they receive accommodations.”

She said students at any allopathic or osteopathic program should expect the same objective, confidential, and supportive analysis of their accommodation needs by a qualified disability provider who does not play an evaluative role in their education.

References

  1. Slavin SJ. Medical student mental health culture, environment, and the need for change. JAMA. 2016;316(21):2195-2196.
  2. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214-2236.
  3. Wasson LT, Cusmano A, Meli, L, et al. Association between learning environment interventions and medical student well-being: a systematic review. JAMA.  2016;316(21):2237-2252.
  4. Meeks LM, Herzer KR. Prevalence of self-disclosed disability among medical students in US allopathic medical schools. JAMA. 2016; 316(21):2271-2272. 

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This article originally appeared on Clinical Pain Advisor