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Introduction
Depression and suicidal ideation are common among medical students, a group at higher risk for suicide completion than their age-normed peers. Medical students have health-seeking behaviors that are not commensurate with their mental health needs, a discrepancy likely related to stigma and to limited role-modeling provided by physician...
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Introduction
People with mental illness continue to face stigma, despite these illnesses being common. Previous studies have demonstrated reduced stigma in pharmacy students after various exposures and education, although results have been mixed. The primary objective of this study was to evaluate the effects of an advanced pharmacy practice experi...
Citations
... Another mechanism to reduce stigma is for senior doctors to openly disclose and share their experiences of mental ill-health. Medical students exposed to physicians who self-disclose a history of mental illhealth can lessen stigma towards mental illness and lead to more positive attitudes towards helpseeking [27,28]. ...
Background
High rates of burnout, anxiety, and depression in medical students are widespread, yet we have limited knowledge of the medical school experiences of students with mental health issues. The aim of the study is to understand the impact of mental health issues on students’ experience and training at medical school by adopting a qualitative approach.
Methods
Qualitative study using in-depth semi-structured interviews with 20 students with mental health issues from eight UK medical schools of varying size and location. Students were purposefully sampled to gain variety in the type of mental health issue experienced and demographic characteristics. Reflexive thematic analysis was employed using NVivo software.
Results
Three themes were identified. 1) Culture of medicine: medical culture contributed to causing mental ill-health through study demands, competitiveness with peers, a ‘suck it up’ mentality where the expectation is that medical school is tough and medical students must push through, and stigma towards mental ill-health. 2) Help-seeking: students feared others discovering their difficulties and thus initially tried to cope alone, hiding symptoms until they were severe. There were multiple barriers to help-seeking including stigma and fear of damage to their career. 3) Impact on academic life: mental health issues had a detrimental impact on academic commitments, with students’ unable to keep up with their studies and some needing to take time out from medical school.
Conclusion
This study provides insight into how medical culture contributes both to the cause of mental health difficulties and the reluctance of medical students to seek help. Mental health issues had a considerable negative impact on medical students’ ability to learn and progress through their degree. Addressing the medical culture factors that contribute to the cause of mental health issues and the barriers to help-seeking must be a priority to ensure a healthier medical workforce.
... Stigma to oneself, also known as self-stigma or internalized stigma, can contribute to a loss of self-efficacy and learned helplessness [5,9]. In a recent study of stigma amongst medical learners, stigma against seeking help was counterbalanced by the ideal of heroic disclosure which was perceived as difficult within a system that upholds cultural norms of perfectionism and invulnerability that are further perpetuated by the hidden curriculum [10,11]. ...
... Current knowledge on self-disclosure in medical education is limited. Existing literature includes a few studies that highlight the value of faculty self-disclosure [11,18]; and evidence that medical graduates who disclose are less likely to receive a residency interview invitation [19]. While studies have been conducted to explore attitudes on the topic [20,21], these included little to no empirical investigation of the process of learner self-disclosure, including information about how disclosure relates to self-stigma, learners' social identities, and the barriers or enablers for the process of disclosure within broader social and structural contexts within medical education. ...
... The process of facilitating disclosure was varied but ultimately shaped by all actors and influences, highlighting the importance of everyone's role in medical learners' sphere of influence in addressing stigma [11]. Some participants disclosed to peers, others to preceptors, and some to their institution itself. ...
Introduction: Mental illness stigma remains rooted within medical education and healthcare. We sought to measure perceptions toward mental illness and explore perceptions of self-disclosure of mental illness in medical learners. Method: In a mixed-methods, sequential design, authors recruited medical learners from across Canada. Quantitative data included the Opening Minds Scale for Healthcare providers (OMS-HC), the Self Stigma of Mental Illness Scale (SSMIS), and a wellbeing measure. Qualitative data included semi-structured interviews, which were collected and analyzed using a phenomenological approach. Results: N = 125 medical learners (n = 67 medical students, n = 58 resident physicians) responded to our survey, and N = 13 participants who identified as having a mental illness participated in interviews (n = 10 medical students, n = 3 resident physicians). OMS-HC scores showed resident physicians had more negative attitudes towards mental illness and disclosure (47.7 vs. 44.3, P = 0.02). Self-disclosure was modulated by the degree of intersectional vulnerability of the learner’s identity. When looking at self-disclosure, people who identified as men had more negative attitudes than people who identified as women (17.8 vs 16.1, P = 0.01) on the OMS-HC. Racially minoritized learners scored higher on self-stigma on the SSMIS (Geometric mean: 11.0 vs 8.8, P = 0.03). Interview data suggested that disclosure was fraught with tensions but perceived as having a positive outcome. Discussion: Mental illness stigma and the individual process of disclosure are complex issues in medical education. Disclosure appeared to become more challenging over time due to the internalization of negative attitudes about mental illness.
... [14][15][16][17][18] In education, most discussions of physician self-disclosure to date have centered on mental health. A randomized clinical trial by Martin et al 19 found that medical students who attended a panel session on physicians disclosing experiences of mental illness and treatment had more favorable attitudes toward seeking help. Similarly, Vaa Stelling and West 20 found that faculty disclosures of mental health history lowered resident perceptions of stigma. ...
... 18,[22][23][24] Furthermore, the way learners understand and process preceptors' stories of illness, the impact on their learning and development, and the potential of these narratives in medical education remain unclear. 19,20,25 We therefore aimed to explore undergraduate medical student perspectives on physician illness discussions of both physical and mental illness, including perceptions of their use as a pedagogical tool. ...
... Our findings suggest a role for self-disclosure in smaller, informal learning settings in addition to the large-group panels previously characterized. 19,20 This finding reveals an additional potential avenue for countering issues of professional disconnection in learners and merits further exploration. ...
Purpose: The notion of physician invulnerability to illness contributes to the ongoing marginalization of physicians with personal experiences of illness and complicates professional identity development in medical learners. As such, physician self-disclosure of lived experiences as patients has seen an increasing role in medical education. Existing literature, centered on mental health, has characterized the positive effect of physician discussion of experience with mental illness on medical students and residents. However, the ways learners process and understand physician illness stories beyond this context and their use in education remains unclear. This study aimed to explore undergraduate medical students' perspectives on physician illness discussions of both physical and mental illness, including their perceptions of its use as a pedagogical tool.
Method: This qualitative study followed an interpretive descriptive design using activity theory as a sensitizing concept. Semistructured interviews with medical students were conducted between January and April 2022 at McMaster University in Hamilton, Ontario, Canada. The authors analyzed transcripts using reflexive thematic analysis.
Results: Twenty-one medical students participated in interviews. Although rare, self-disclosure conversations occurred across varied settings and addressed diverse aspects of illness experiences. Discussions involved teaching of pathophysiology, career advice, and wellness guidance. Five themes were developed: the opposition of physicianhood, patienthood, and situating the learner identity; invisibility and stigmatization of physician illness; impact of preceptor stories on learners' relationship with medicine; challenging the "rules" of physicianhood; and situating self-disclosure in medical education.
Conclusions: Students strongly appreciated physician self-disclosure conversations. Self-disclosure can act as an effective pedagogical tool by fostering expansive learning among medical students. Further research is necessary to explore physician perspectives and supports for self-disclosure in education.
... With time, I am realizing the gravity of her statement and how much the medical profession demands of us, at times stretching us to our limits. Exposure to physicians who had the courage to discuss their mental health and lived experiences may benefit those pursuing medical training and improve mental health attitudes [3,4]. As my program director says, "it takes a village to raise a resident." ...
... These findings suggest that more significant efforts are needed to destigmatize mental illness in work and improve support for doctors. Similarly, Martin et al. [61] showed that medical students could benefit from exposure to physicians with self-disclosed histories of coming mental illnesses. Winstanley (2018) [62] developed a web-based intervention to support doctors and medical students in their decision to disclose their mental illness. ...
Background:
Physicians suffering from burnout are more likely to develop depression, substance dependence, and cardiovascular diseases, which can affect their practices. Stigmatization is a barrier to seeking treatment. This study aimed to understand the complex links between burnout among medical doctors and the perceived stigma.
Methods and findings:
Online questionnaires were sent to medical doctors working in five different departments of the Geneva University Hospital. The Maslach Burnout Inventory (MBI) was used to assess burnout. The Stigma of Occupational Stress Scale in Doctors (SOSS-D) was used to measure the three stigma dimensions. Three hundred and eight physicians participated in the survey (response rate: 34%). Physicians with burnout (47%) were more likely to hold stigmatized views. Emotional exhaustion was moderately correlated with perceived structural stigma (r = 0.37, P < .001) and weakly correlated with perceived stigma (r = 0.25, P = 0.011). Depersonalization was weakly correlated with personal stigma (r = 0.23, P = 0.04) and perceived other stigma (r = 0.25, P = 0.018).
Conclusion:
These results suggest the need to adjust for existing burnout and stigma management. Further research needs to be conducted on how high burnout and stigmatization impact collective burnout, stigmatization, and treatment delay.
... Research has also begun to focus on practical ways to reduce stigma and increase openness to consider therapy. One such study revealed that when experienced physicians engaged in self-disclosure regarding their history of mental health issues and treatment, it had a positive impact on medical students' view of psychiatry and individuals with mental illness [17]. To date, there have been efforts to establish anti-stigma curricula through various methodologies and a majority of approaches studied have resulted in an improvement with stigma and mental health literacy [18]. ...
The study explored if willingness to seek psychotherapy or refer patients to therapy is predicted by either perception of its usefulness or stigma (public and self-stigma), and if there are any differences based on specific psychological disorders for this population. A cross-sectional study was conducted surveying medical students enrolled at a southeastern university during spring 2022. These medical students completed the Mental Help Seeking Attitudes Scale (MHSAS), revised Self-Stigma of Seeking Help Scale (SSOSH-7), Stigma Scale for Receiving Psychological Help (SSRPH), in addition to vignette-based items assessing the likelihood they would seek therapy treatment and refer a patient for therapy based on two specific psychological disorders. The survey was completed by 106 medical students out of 495 current students (21.4% response rate). The data reveal that the greater the public stigma endorsed, the less likely medical students would be willing to seek therapy for panic disorder; however, the greater the self-stigma, the less likely they would seek therapy for depression. This study found differences in willingness to utilize therapy based on stigma-related attitudes and specific disorders, but not for referring patients.
... Additional key elements of effective contact-based learning include facilitators with first-person experiences, contradiction of stereotypes, and teaching communication and behavioral skills for future patient interactions [11]. In health professional students, contact with more senior providers sharing personal experiences of MI may be particularly salient for stigma reduction [13][14][15]. ...
... Changing the nature of the interpersonal context from a shared physical space to a shared virtual space may alter its impact in meaningful ways that could facilitate or inhibit influential factors such as engagement and psychological safety [20,21]. There is initial evidence that stigma reduction benefits are maintained when changing an in-person contactbased program to a virtual format [13,14]. However, studies that explicitly compare the exact same set of multidimensional outcome measures across inperson and virtual formats and include longitudinal analyses of effects are lacking [18]. ...
Purpose
Contact-based education, offering meaningful contact with individuals living in recovery with mental illness, reduces stigma. This study evaluated the effectiveness of the National Alliance on Mental Illness Provider Education Program (NAMI PEP) when implemented as a curricular requirement across two cohorts of third-year osteopathic medical students, comparing traditional, passive learning and active, online delivery formats.
Materials and Methods
Participants were two cohorts of third-year medical students (Cohort 1 n = 186; Cohort 2 n = 139; overall N = 325) who completed questionnaires measuring affect, beliefs, and behaviors toward patients with mental illness at pre-program, 1-week follow-up, and 6-month follow-up. For Cohort 1, the existing community-based NAMI PEP was implemented. For Cohort 2, the program was adapted to an online, active learning format tailored to medical students, and an additional 3-month follow-up assessment was added to better identify intermediate-term effects.
Results
The NAMI PEP was associated with longitudinal improvements in target outcomes, with enhanced effects with the adapted curriculum in Cohort 2. At 6-month follow-up, students reported less stigma, fewer stereotyping negative attitudes, and lower anxiety treating patients with mental illness. They also reported increased confidence integrating psychiatry into routine care and increased competence in principles of collaborative mental health treatment.
Conclusions
This study demonstrates the longitudinal effectiveness of the NAMI PEP across two cohorts of medical students, with strengthened effects observed when the program is tailored to contemporary medical education.
... Medical students and physicians have historically under-disclosed mental illness, which discourages care-seeking [30,31]. To address this, educators have called for promotion of vulnerability, personal disclosure from faculty, and cultivation of a professional culture that values wellbeing [32]. One student's disclosure of mental illness in the written exercise suggests that the course was able to foster a safe learning environment in which students could express vulnerability. ...
Background
Professional identity formation is an important aspect of medical education that can be difficult to translate into formal curricula. The role of arts and humanities programs in fostering professional identity formation remains understudied. Analyzing learners’ written reflections, we explore the relationship between an arts-based course and themes of professional identity formation.
Materials and methods
Two cohorts of learners participated in a 5-day online course featuring visual arts-based group activities. Both cohorts responded to a prompt with written reflections at the beginning and end of the course. Using a thematic analysis method, we qualitatively analyzed one set of reflections from each cohort.
Results
Themes included the nature of the good life; fulfilling, purposeful work; entering the physician role; exploration of emotional experience; and personal growth. Reflections written at the end of the course engaged significantly with art – including literature, poetry, lyrics, and film. One student disclosed a mental illness in their reflection.
Conclusions
Our qualitative analysis of reflections written during a visual arts-based course found several themes related to professional identity formation. Such arts-based courses can also enrich learners’ reflections and provide a space for learners to be vulnerable.
Practice Points
(five short bullets conveying the main points) Arts-based courses can support learners’ professional identity formation
Reflection themes related to professional identity formation included entering the physician role, fulfilling clinical work, and personal growth
At the end of the course, learners’ reflections included significant engagement with art
Reflective writing in small, arts-based learning communities can provide space for learners to be vulnerable
The Role of Arts-Based Curricula in Professional Identity Formation: Results of A Qualitative Analysis of Learner’s Written Reflections
... A large study involving more than three thousand medical students in 12 countries reported burnout prevalence exceeding 75% . The stress experienced by this group of students is reported to be higher than students of other academic majors (Dunn et al., 2008;Martin et al., 2020;Simpson et al., 2019). As known consequence of burnout in medical students, is that they can become less engaged and losing some of their initial commitment to studying medicine (IsHak et al., 2009). ...
Background
Medical students are under high pressure to perform academically and also face the impact of the COVID-19 pandemic, putting them at risk of developing burnout.
Aims
This study aims to evaluate the prevalence and degree of burnout among medical students in Indonesia during 1 month of the COVID-19 pandemic.
Methods
From April to May 2021, we conducted an online survey of Indonesian medical students to assess burnout (using Maslach Burnout Inventory-Student Survey, MBI-SS).
Results
A total of 1,947 students from 27 universities participated in the study. About 35.5% had burnout, 41.7% with a moderate to high level of emotional exhaustion, 45% had moderate to high level of depersonalization and 66.7% had a low level of personal accomplishment.
Conclusion
A total of 35.5% of medical students in our sample experienced burnout. We suggest further research to explore and identify factors related to these findings and the need for potential interventions at global and national level to enhance the well-being of medical students.
... Battling the stigma that is associated with mental health concerns should be a priority. Structural efforts to combat it should include interventions to raise awareness and mental health literacy [87,88], as well as changing professional guidelines related to licensure to remove the sanctions associated with the reporting of mental health problems. ...
The paper begins by reviewing the literature on oncology healthcare professionals’ (HCP) mental health. We summarize and present the current data on HCP mental health in order to understand the baseline state of oncology HCPs’ mental health status prior to the COVID-19 pandemic. At each juncture, we will discuss the implications of these mental health variables on the personal lives of HCPs, the healthcare system, and patient care. We follow by reviewing the literature on these parameters during the COVID-19 pandemic in order to better understand the impact of COVID-19 on the overall mental health of HCPs working in oncology. By reviewing and summarizing the data before and after the start of the pandemic, we will get a fuller picture of the pre-existing stressors facing oncology HCPs and the added burden caused by pandemic-related stresses. The second part of this review paper will discuss the implications for the oncology workforce and offer recommendations based on the research literature in order to improve the lives of HCPs, and in the process, improve patient care.
