1st Year Med Student Suicide

[Punkinhead]

This happened yesterday to a schoolmate and friend of mine. It was beyond imaginable and so sad. We all found out after our final final (biochem). I was just wondering what you all thought med schools could do to try to help with this kind of thing. or how prevalent it is? What did your med school do after it happened, if you've gone through this? Any thoughts on how to avoid a friend getting this far in such a high stress and competitive, isolating really, place as med school. And it's the holidays too...

---

Members don't see this ad.

 

[Law2Doc]

And it's the holidays too...

People get most depressed around the holidays.
All schools can do is have good and well advertised counseling services. I know someone who committed suicide in my prior schooling and often there are no tell tale signs friends could have picked up on, even in retrospect.

 

[Eric Lindros]

People get most depressed around the holidays.
All schools can do is have good and well advertised counseling services. I know someone who committed suicide in my prior schooling and often there are no tell tale signs friends could have picked up on, even in retrospect.

This is actually sort of a myth. December suicide rates are generally the lowest of the year.

http://health.yahoo.com/depression-2006/depression/2199/holiday-blues?cin=19

 

[Law2Doc]

This is actually sort of a myth. December suicide rates are generally the lowest of the year.

http://health.yahoo.com/depression-2006/depression/2199/holiday-blues?cin=19

If you read my post I spoke of depression, not suicide, around the holidays. People do get depressed around the holidays. See eg: http://www.medicalmoment.org/_content/risks/dec03/188214.asp
http://www.selfcounseling.com/help/depression/holidaydepression.html

 

[crazy_cavalier]

Oh man, that is so horrible! Sorry for the loss, this is always a very sad thing and unfortunately it still persists in med schools

 

[Eric Lindros]

If you read my post I spoke of depression, not suicide, around the holidays. People do get depressed around the holidays. See eg: http://www.medicalmoment.org/_content/risks/dec03/188214.asp
http://www.selfcounseling.com/help/depression/holidaydepression.html

The fact that the thread is about suicide and the first thing you mentioned was people get more depressed around the holidays generally leads one to believe that you are linking the holidays with this suicide (which very well may be the case, but the findings are that suicides are actually among the lowest levels around this time of year) Yes, I read the post but I wasn't exactly looking for loopholes in your wording. I am also aware that Holiday blues do exist, its just misleading to think that suicide increases around the Holidays - it doesn't.

 

[Law2Doc]

The fact that the thread is about suicide and the first thing you mentioned was people get more depressed around the holidays generally leads one to believe that you are linking the holidays with this suicide (which very well may be the case, but the findings are that suicides are actually among the lowest levels around this time of year) Yes, I read the post but I wasn't exactly looking for loopholes in your wording. I am also aware that Holiday blues do exist, its just misleading to think that suicide increases around the Holidays - it doesn't.

The OP's post mentioned the holidays. I didn't start that line of discussion. Chill.

 

[OHMAN0125]

I know my school offers crisis hotlines and confidential counseling sessions. But the problem is that most depressed ppl prolly won't go to them. I think friends and family should keep a look out for signs and help those that seem to be down.

 

[lilnoelle]

Thats terrible. I don't know how med schools should handle this type of thing. As previously mentioned, they have counseling offered.
As a first year med student in the brunt of it, I find it a bit difficult to understand why one could blame med school on a students suicide. Yes it is stressful, but it seems that a student must have other stuff going on in their life and/or are already psychologically unstable. I don't think that med school in itself causes suicide.
I'm guessing (if the above is true) that med schools try to weed out individuals who are unstable.

 

[Eric Lindros]

Thats terrible. I don't know how med schools should handle this type of thing. As previously mentioned, they have counseling offered.
As a first year med student in the brunt of it, I find it a bit difficult to understand why one could blame med school on a students suicide. Yes it is stressful, but it seems that a student must have other stuff going on in their life and/or are already psychologically unstable. I don't think that med school in itself causes suicide.
I'm guessing (if the above is true) that med schools try to weed out individuals who are unstable.

I wonder how medical school suicide rates compare to those in undergrad. We had a suicide in our dorm freshman year. It was one of the most shocking/sad times in my life because I had just recently become friends with this student.

I agree that this shouldn't be blamed on the school. I believe people who have thoughts of suicide have major problems psychologically, which sort of explains the unpredictable nature of it.

 

[PoorMD]

This happened yesterday to a schoolmate and friend of mine. It was beyond imaginable and so sad. We all found out after our final final (biochem). I was just wondering what you all thought med schools could do to try to help with this kind of thing. or how prevalent it is? What did your med school do after it happened, if you've gone through this? Any thoughts on how to avoid a friend getting this far in such a high stress and competitive, isolating really, place as med school. And it's the holidays too...

thats a real tragedy, im sorry for that students' family irregardless of the holiday season. It's a depressing time of year for a lot of people, especially those who are alone in the world or are suffering from disease whether it be mental or physical. I think the first two years of med school have been the worst 2 years of my life so far.. and I say that because it has been such a non stop stress and competition just to pass... and like the OP said its very isolating.. you can't open up to people.. it's like high school the way people talk.. i can see why someone would get suicidal, but sadly I can't see why they would carry it out. god bless the poor soul who felt it was so awful they had to take their own life.

 

[lilnoelle]

I believe people who have thoughts of suicide have major problems psychologically, which sort of explains the unpredictable nature of it.

Do you think so? I may be contradicting my previous post, but I'm guessing most individuals contemplate suicide at least once in their life. I'm not talking about seriously considering it, or planning it, but thinking about it in passing...

As far as what an individual (friend, family member) can do to prevent someone from taking that step...
I've had friends who I would describe as possibly suicidal at different times in their lives. They had serious problems with depression and other various things. I was very aware of their issues and tried to do as much as possible to help them. I found it very difficult and frustrating to try to help them with their psychological issues. In the years that I've tried, it seems that I have done very little other than prevent them from doing something drastic (such as suicide). I had a college roomate who I devoted a huge amount of time to, and truth be told, she's no better off today than when I met her 8 years ago.
However, I think a person can be very helpful in preventing someone from hurting themself by being a constant encourager. Try to lift the individual up all the time and definitely tell them how important they are to their friends and society.

 

[78222]

That sucks

 

[FenderHM]

rough times, I'm really sorry.... makes me want to email my class and make sure nobody's freaking out about our exams Mon and Tues

 

[tulane06]

This happened yesterday to a schoolmate and friend of mine. It was beyond imaginable and so sad. We all found out after our final final (biochem). I was just wondering what you all thought med schools could do to try to help with this kind of thing. or how prevalent it is? What did your med school do after it happened, if you've gone through this? Any thoughts on how to avoid a friend getting this far in such a high stress and competitive, isolating really, place as med school. And it's the holidays too...

 

[Hurricane95]

Wow, what a tragedy...that is really sad. My condolences to you and your classmates. After a while the class becomes almost like a second family...after all you see each other so much every day. I wonder how much of the depression can be attributed to personal factors? I know med school is stressful, but that couldn't have been it alone. There must have been other things in his/her life that contributed. That's terrible.

 

[NonTradMed]

That sucks that someone who was so bright and had so much promise killed himself. But given how stressful med school is, all it takes is something else to push people who may already be predisposed (or battling) depression to want to kill themselves.

Most med students are not new to the school gig, and many have lived by themselves. Since we are adults, I dont' think the administrators can do anything other than offer counseling to students who want it. Our school has offered that during orientation week and I have heard a friend using it to expell some steam.

 

[Ypo.]

This happened yesterday to a schoolmate and friend of mine. It was beyond imaginable and so sad. We all found out after our final final (biochem). I was just wondering what you all thought med schools could do to try to help with this kind of thing. or how prevalent it is? What did your med school do after it happened, if you've gone through this? Any thoughts on how to avoid a friend getting this far in such a high stress and competitive, isolating really, place as med school. And it's the holidays too...

We had a similar tragedy happen this past Thanksgiving. One of our classmates was killed in a car accident. It's been really hard on the entire class.

We all went to the funeral, cancelled classes for a day, put up a memorial, held class meetings to talk about it, donated money to an education fund for his niece. It would probably be nice if your school did something similar after the break, to show your respect for your classmate. And just having the school acknowledge the stress and offer counselling, etc...can help.

Sorry for your loss.

 

[OncoCaP]

This happened yesterday to a schoolmate and friend of mine. It was beyond imaginable and so sad. We all found out after our final final (biochem). I was just wondering what you all thought med schools could do to try to help with this kind of thing. or how prevalent it is? What did your med school do after it happened, if you've gone through this? Any thoughts on how to avoid a friend getting this far in such a high stress and competitive, isolating really, place as med school. And it's the holidays too...

Really sorry to hear about that. That sucks.

Suicides among U.S. medical students are about three times (3X) greater than for the college population as a whole, which already has a high rate to begin with. I don't think anyone is wondering why med student rates are higher (extreme pressure in a non-ideal environment puts some people over the edge). From the stats below and extrapolating a little, it looks like around 4 medical students per year commit suicide at the 126 U.S. medical schools that have around 16,000 students in 1995 (around the time of the study) or about 24 suicides per year per 100000 medical students (6 years worth).

Medical student suicide, 1989-1994.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8599405&dopt=Abstract
"Responses were obtained from 101 (80%) of the 126 U.S. medical schools. Responding schools reported 15 suicides by medical students from August 1989 through May 1994. Fourteen were by men. Six suicides were committed during the third year of medical school, and four occurred during the fourth year. Six students left notes, and nine of 13 had psychiatric histories. "

http://nearwestgazette.com/Archive/1006/newsstory1006k.htm
"College campuses grapple with escalating suicide rates"
"... the number of college suicides {not just med schools} is not insignificant, estimated at 7.5 per 100,000 students"
"College students face challenges that can become potential suicide risks, such as being away from home and family, juggling responsibilities such as classes and a job, and, for international students, getting used to a new culture. Jeff Lanfear, PsyD, director of University Counseling Services at DePaul University, said stress also comes from increased competition, isolation from greater dependence on technology, post-9/11 fear, and financial hardship due to government cutbacks of financial assistance.

Suicide warning signs include withdrawal from others, reckless behavior, mood changes, agitation, problems controlling anger, alcohol use, taking drugs, and family history of suicide. In addition, local surges in suicide can become contagious, influencing those already at risk to attempt taking their lives.

Myths surrounding suicide hinder prevention, such as the belief that suicide is a random act or results from stress alone. Also, some people fear that asking others if they have suicidal thoughts could plant the idea in their minds, even if they had not been considering it, according to Maria Devens, PhD, of UIC's Dept. of Family Medicine. Devens advised not to fear asking such a question if someone they know is at risk and to be persistent if they see a friend is suffering.

"Any expression of suicidal thoughts needs to be taken seriously" as well as any kind of self-mutilation, such as cutting, Devens said.

**********

IMO there are plenty of things that schools could do to prevent suicides, starting with reducing the pressure. However, I'm not sure that many schools are willing to do that ... I guess many schools want stress-hardened graduates or think that students should just learn to deal with it. I personally think this is wrong. In my opinion, the extreme stress should be eliminated, but that's just my opinion. It's worth noting that there are noticeable differences among the med schools with respect to stress level among the students.

 

[78222]

IMO there are plenty of things that schools could do to prevent suicides, starting with reducing the pressure. However, I'm not sure that many schools are willing to do that ... I guess many schools want stress-hardened graduates or think that students should just learn to deal with it. I personally think this is wrong. In my opinion, the extreme stress should be eliminated, but that's just my opinion. It's worth noting that there are noticeable differences among the med schools with respect to stress level among the students.

While I do think medschool is fairly stressful (probably more so or less so depending on your propensity towards stressing out), I don't think making it "less stressful" is really an option. This is a fairly high stress career choice we've made, better to build it up incrementally than throw people into their internship expecting flowers and sunshine. Stress is part of being a physician, what are you going to do when you are confronted with reality?

 

[OncoCaP]

While I do think medschool is fairly stressful (probably more so or less so depending on your propensity towards stressing out), I don't think making it "less stressful" is really an option. This is a fairly high stress career choice we've made, better to build it up incrementally than throw people into their internship expecting flowers and sunshine. Stress is part of being a physician, what are you going to do when you are confronted with reality?

Perhaps the stress level could build up from 1st to 4th year, instead of shocking the daylight out of you in year 1 and barely generating a pulse elevation by year 4. Some schools seem to do this already. I'm not sure that the best way to prepare people for a high stress career is by stressing them out all the time. Perhaps there could be periods of stress that are well-organized into a program that recognizes the high-stress nature of the job and prepares people as much as possible over a period of time. Also, the stress should be a job-realistic as possible (clinical) instead of classroom stress recognizing difference between responsibility & medical-work stress and stress in competing against classmates and dealing with tough profs. Longer-term improvements in the quality of life in the medical profession would also be a good thing as well....

 

[RxnMan]

...IMO there are plenty of things that schools could do to prevent suicides, starting with reducing the pressure. However, I'm not sure that many schools are willing to do that...

Some schools may see reducing stress as equivalent to reducing the volume of material taught.

A number of suicides and "student deaths" occurred at my ugrad campus while I was there (one year we had 6 in a student population of ~3000). My ugrad is famous for it's rigorous curriculum, and historically 2/3 of a freshman class would quit before making it to graduation. What did the administration they do? They did have a very active student counseling service and anti-stress activities every finals week - one was essentially a huge playroom with brainless activities. I think they had a stress seminar for incoming freshman, some of which was recognizing suicidal tendencies in classmates. That is basically all the administration could do. They couldn't monitor all 3000 of us 24/7.

You can educate students and hold seminars, but you really can't do much more to stop these are tragic and horrible events

 

[OncoCaP]

Some schools may see reducing stress as equivalent to reducing the volume of material taught.

A number of suicides and "student deaths" occurred at my ugrad campus while I was there (one year we had 6 in a student population of ~3000). My ugrad is famous for it's rigorous curriculum, and historically 2/3 of a freshman class would quit before making it to graduation. What did the administration they do? They did have a very active student counseling service and anti-stress activities every finals week - one was essentially a huge playroom with brainless activities. I think they had a stress seminar for incoming freshman, some of which was recognizing suicidal tendencies in classmates. That is basically all the administration could do. They couldn't monitor all 3000 of us 24/7.

You can educate students and hold seminars, but you really can't do much more to stop these are tragic and horrible events

I'm not sure that I share your fatalistic attitude. Also the measures that you describe that your school took, while perhaps helpful, don't appear to be effective based on what you are saying. Just saying, "well we had a seminar, that's all we can do..." sounds really sub-standard to me. Perhaps they could make the admission standards more rigorous, look for students who have had more challenging experiences, etc. The key is to find something that actually works; otherwise, it's a waste of time.

There is much that can be done, although a school may be unwilling to make the changes. For example, perhaps your school could have admitted fewer students and put more effort into teaching and coaching the ones who were admitted. Also, looking at what other schools that have less of a suicide problem are doing would be helpful. Another key fact is that one suicide can produce more, so it's really important to prevent even small numbers of suicides. When we start sacrificing actual lives at the altar of knowledge, I'll object every single time. In my mind it's a question of what value do you put on human life. If a few more people die so that most people are a little smarter and more stress-resilient when they graduate, is it worth it? I would say no. The attitude you describe reminds me of the idol worship of primitive civilizations that believed that cutting someone's heart out would produce a better harvest or whatever. Granted there is a big difference between murder and producing stress that leads to suicide, but there is a similiarity in that both lead to death.

I realize that some people have issues that have nothing to do with the curriculum (e.g., drug abuse or relationship issues), but whatever the purpose of having a program that leads to 27X the average suicide rate (if the six suicides / 3000 isn't a gross outlier) ... I'm not sure it's worth it (at least for me).

 

[Law2Doc]

You can educate students and hold seminars, but you really can't do much more to stop these are tragic and horrible events

One thought. You might make personality screens/tests part of the admissions process (the way law enforcement does). You could screen out, or at least identify people of concern. I don't know if this would be a good idea or not, though. Just a thought.

 

[78222]

Perhaps the stress level could build up from 1st to 4th year, instead of shocking the daylight out of you in year 1 and barely generating a pulse elevation by year 4. Some schools seem to do this already. I'm not sure that the best way to prepare people for a high stress career is by stressing them out all the time. Perhaps there could be periods of stress that are well-organized into a program that recognizes the high-stress nature of the job and prepares people as much as possible over a period of time. Also, the stress should be a job-realistic as possible (clinical) instead of classroom stress recognizing difference between responsibility & medical-work stress and stress in competing against classmates and dealing with tough profs. Longer-term improvements in the quality of life in the medical profession would also be a good thing as well....

You aren't in medschool yet right? If not, how do you know the progression of stress? I think it is pretty stressful at first simply because you arent used to that much work. The work load increases but it doesn't seem as bad because you figure out how to study (hopefully). I know the first block was terrible for me, I just wasn't prepared for the volume of work and I was used to thinking of school as school instead of a job. Now, 4 months later, I treat medschool like a job and I don't find it that bad. My grades are pretty good (could be better of course) and I have found a good mix of outside life and school. Personally, I don't mind medschool anymore and don't feel stressed at all.

I think the highly stressed individuals have probably always been stressed. I knew people who freaked out taking organic chemistry, whereas I never really worried that much. Hell, I've seen people freak out in general chemistry classes. The same is probably true with suicidal people as well. I don't believe, and the fact tht a good number of the suicides quoted had prior histories of mental problems supports it, that medschool itself will make you suicidal. If you have the inclination towards depression anyway, it will probably be amplified by medschool, but medschool itself wont make you wnt to kill yourself (Just other people).

 

[78222]

I personally really dislike this "destressing" medschool nonsense. Medschool isn't supposed to be easy, and having peoples lives in your hands should not be a stress free experience. This is not beauty school, if you aren't prepared for a little stress, you should have chose another profession.

 

[OncoCaP]

One thought. You might make personality screens/tests part of the admissions process (the way law enforcement does). You could screen out, or at least identify people of concern. I don't know if this would be a good idea or not, though. Just a thought.

I'm not sure that personality tests would be my first choice. Perhaps some kind of stress coping test ... maybe Federal Interrogators could see how much and for how long an applicant can endure "non-torture" before giving up a fact that the applicant was told to keep secret?

 

[OncoCaP]

I personally really dislike this "destressing" medschool nonsense. Medschool isn't supposed to be easy, and having peoples lives in your hands should not be a stress free experience. This is not beauty school, if you aren't prepared for a little stress, you should have chose another profession.

I'm 100% in agreement that med school should not be stress free. It is imperative that med schools prepare med students for a potentially stressful career (although, ironically, several doctors described their education as more stressful than their current job). I'm convinced that there must be a way to vet and educate students that doesn't increase the suicide rate 3X.

 

[Law2Doc]

I personally really dislike this "destressing" medschool nonsense. Medschool isn't supposed to be easy, and having peoples lives in your hands should not be a stress free experience. This is not beauty school, if you aren't prepared for a little stress, you should have chose another profession.

I tend to agree. The stress in med school is nothing compared to the stress you will face in residency when people's lives are at stake and totally in your hands, so "gearing down" med school is not the answer. Getting people help who need it is the answer. The trick is how to identify them in time.

 

[OncoCaP]

You aren't in medschool yet right? If not, how do you know the progression of stress? I think it is pretty stressful at first simply because you arent used to that much work. The work load increases but it doesn't seem as bad because you figure out how to study (hopefully). I know the first block was terrible for me, I just wasn't prepared for the volume of work and I was used to thinking of school as school instead of a job. Now, 4 months later, I treat medschool like a job and I don't find it that bad. My grades are pretty good (could be better of course) and I have found a good mix of outside life and school. Personally, I don't mind medschool anymore and don't feel stressed at all.

I think the highly stressed individuals have probably always been stressed. I knew people who freaked out taking organic chemistry, whereas I never really worried that much. Hell, I've seen people freak out in general chemistry classes. The same is probably true with suicidal people as well. I don't believe, and the fact tht a good number of the suicides quoted had prior histories of mental problems supports it, that medschool itself will make you suicidal. If you have the inclination towards depression anyway, it will probably be amplified by medschool, but medschool itself wont make you wnt to kill yourself (Just other people).

Yes, it's true I'm not there. However, you are there and describe exactly what I'm talking about, which, incidentally is backed up by numerous accounts I have heard and is more relevant than my personal experience ... maybe I'm really laid back and nothing ever stresses me .... I'm actually older (38) and already well established in life, so I know that failing out of med school is far far far from the end of the world, and never worth killing oneself for --- if it's not working out, find one of the many great alternatives. Maybe stressing that one fact alone could save a few lives. My experience is going to be somewhat different from most because of my previous, rather lengthy experience in dealing with stress.

Maybe there needs to be psychiatric screening (in terms of if you have a certain kind of depression history, then maybe that should be an admissions red flag). There would also be cause for this intrusion into privacy if it could be shown that certain psychiatric issues make students more succeptible to suicide. However, it may not be legally feasible. I'm not suggesting implementing all kinds of oppressive requirements. I am suggesting that because the med school suicide rate is 3X that of college in general (with a similar population), this issue should be evaluated for possible solutions and giving up ... thowing up the arms and saying there is really nothing we can do is really not impressing me at all. The idea that there is really nothing that can be done when the problem hasn't even really been studied carefully (as far as I can tell) is just wrong. Let's at least look at the problem and potentially solutions before we give up.

Another possiblity is that there be certain "stress" periods during an otherwise less stressful first year could be used to evaluate students who cannot cope and would be sent home. I'm not sure. My point is that investing in the death of a few med students so that perhaps fewer patients could die down the road is a very sick trade-off if you ask me.

 

[RxnMan]

I'm not sure that I share your fatalistic attitude. Also the measures that you describe that your school took, while perhaps helpful, don't appear to be effective based on what you are saying...

I'm not fatalistic, I just realize that while you can lead a horse to water, you can't make it drink - you can't force the kids who are having trouble to get help. In fact, that's part of the problem - folks who are suicidal are withdrawn.

...Perhaps they could make the admission standards more rigorous, look for students who have had more challenging experiences, etc...

I agree with respect to my ugrad - they definitely admit people who have no business being there. But I don't believe in only admitting people who have already had more challenging experiences. I don't mean to pick a fight by saying this, but to do so would in effect be picking students who have already gone through a sort of "selection process."

...There is much that can be done, although a school may be unwilling to make the changes. For example, perhaps your school could have admitted fewer students and put more effort into teaching and coaching the ones who were admitted. Also, looking at what other schools that have less of a suicide problem are doing would be helpful. Another key fact is that one suicide can produce more, so it's really important to prevent even small numbers of suicides.

I agree with you on every point here, but later...

...If a few more people die so that most people are a little smarter and more stress-resilient when they graduate, is it worth it? I would say no. The attitude you describe reminds me of the idol worship of primitive civilizations that believed that cutting someone's heart out would produce a better harvest or whatever...

...you're getting a little deep for me. I don't know how one person dying makes another smarter, and I didn't mean to imply that my school sacrificed students in any way.

The only reasonable suggestion I've seen here is Law's: administering some sort of personality test with emphasis on ID'ing persons vulnerable to suicidal ideations/behaviors. It'd have to be confidential, but I don't see how you could do that in small med school classes (<200 students). You'd have to have people meet their counselors outside of class and outside of any place where students would do their clinicals.

 

[medicomel]

i can see how someone could view failing out of medical school as a devastating embarassment and, in their estimation, the end of their world. a lot of us are type A personalities who put an overwhelming amount of pressure on ourselves, nevermind pressure coming at us from the school and parents. it's almost mocking at my school, when professors smile at us and say, "welcome to medical school" whenever they pile on another 3" of notes.

i'm not saying it's okay, and i wish the student would have reached out and gotten tutoring or maybe taken some time off to evaluate the situation, get some therapy, get on a 5-year decelerated program if it's available. something.

 

[OncoCaP]

...
I agree with respect to my ugrad - they definitely admit people who have no business being there. But I don't believe in only admitting people who have already had more challenging experiences. I don't mean to pick a fight by saying this, but to do so would in effect be picking students who have already gone through a sort of "selection process."

Hmmm. Not sure I understand. What's wrong with picking students who have already gone through a sort of "selection process"? The point is to pick the applicants so that when you send them through flaming hoops they have the greatest chance of success and the least chance to be looking for a bottle of sleeping pills when things get rough.

I don't know how one person dying makes another smarter, and I didn't mean to imply that my school sacrificed students in any way.

The relatively stressful program at your ugrad school hopefully pushes people to learn more ... albeit at the expense of more suicides (up to 27X the national average). If there is no benefit (in "making people smarter") then it's really a problem with no justification whatsoever.

The only reasonable suggestion I've seen here is Law's: administering some sort of personality test with emphasis on ID'ing persons vulnerable to suicidal ideations/behaviors. It'd have to be confidential, but I don't see how you could do that in small med school classes (<200 students). You'd have to have people meet their counselors outside of class and outside of any place where students would do their clinicals.

Seems like a reasonable suggestion to me as well. The issue is worth a careful look.

 

[78222]

Another possiblity is that there be certain "stress" periods during an otherwise less stressful first year could be used to evaluate students who cannot cope and would be sent home. I'm not sure. My point is that investing in the death of a few med students so that perhaps fewer patients could die down the road is a very sick trade-off if you ask me.

So you are suggesting that they charge us a years tuition and then decided we are too stressed out to handle it, despite passing, and kick us out? I think that would certainly make someone suicidal. And how exactly is the school supposed to know what is going on in everyones life? I don't want anybody sticking their nose in my business and I sure as hell don't need the school to hold my hand. I am an adult, as are all medstudents, most of us can take care of ourselves.

I say offer students help if they need it and lookout obvious warning signs of potentially suicidal students - but don't go beyond that. In the end we have to live our lives ourselves, we don't need nannies at this stage in our development (as you are suggesting).

 

[Law2Doc]

Another possiblity is that there be certain "stress" periods during an otherwise less stressful first year ...

You seem to be focusing on the first year of med school as the problem. Actually, the first year isn't really the worst of it. It is actually the lightest load you will have in med school until 4th year -- it just doesn't seem that way at the time. It is stressful for reasons more related to adjustment than from the curriculum. For many it is the first time students find themselves not getting the A's. The level of competition is simply much greater. It is the first time for many that they actually have to spend multiple weekends studying for an exam. You have to find what works in terms of studying, often having to cast out old study systems for new ones. Less stable relationships break up frequently. And it is a time when you are exposed to death, elbow deep, in anatomy lab.

However guess what, second year covers more material and goes much faster. So it's not like first year is the worst, curriculum-wise and that the stress level doesn't already increase over the subsequent years. Second year is harder than the first in terms of quantity, but you are hopefully better prepared for it. Third year is more time intensive than second year due to serious hours in the hospital, but more fun because you are getting to play doctor. And fourth year your focus is in matching.

So I disagree that curriculum is the problem, or that first year should somehow be changed to ease you into it, because frankly that already is the way it is set up -- it just doesn't feel like it at the time because college does a pretty lame job of getting you up to the speed you need to be at to merge onto this educational highway.

Identifying people at risk is the only place you can fix this.

 

[OncoCaP]

So you are suggesting that they charge us a years tuition and then decided we are too stressed out to handle it, despite passing, and kick us out? I think that would certainly make someone suicidal. And how exactly is the school supposed to know what is going on in everyones life? I don't want anybody sticking their nose in my business and I sure as hell don't need the school to hold my hand. I am an adult, as are all medstudents, most of us can take care of ourselves.

I say offer students help if they need it and lookout obvious warning signs of potentially suicidal students - but don't go beyond that. In the end we have to live our lives ourselves, we don't need nannies at this stage in our development (as you are suggesting).

What I'm suggesting is that the powers in charge look at what the options are and then consciously decide what to do in some manner that recognizes that we are dealing with more people potentially dying if they choose a sub-optimal approach. It may be that the current system reflects the values of the people in charge of the medical school system or maybe not and should be changed. If it turns out that lives could be saved by the administration sticking their nose into your business, then that's an option that should be considered.

Another option might be to change the way that med students are taught to deal with stress. For example, I'm unconvinced that stressing students out with classroom stuff vets the best physicians. Maybe stress in clinical rotations could be retained while stress in classes could be reduced. Again, I consider this a serious problem that needs serious solutions.

I'm not suggesting that I have any relevant answers. What I am telling you is that I find a 3X suicide rate increase unacceptable. You might not, and we're all entitled to our opinion. I think I can see where you are coming from, but I don't agree.

It also may be that this problem is concentrated at certain medical schools and that your med school already has a very good approach to teaching students to deal with stress while not driving up the suicide rate. As I pointed out above, not all schools are equal when it comes to this stuff, and I'm also not convinced that this is a totally random phenomenon.

 

[DropkickMurphy]

Guess that means there's a spot open for a transfer student.....

 

[RxnMan]

...The relatively stressful program at your school hopefully pushes people to learn more ... albeit at the expense of more suicides (up to 27X the national average)...

From the "harvest" comment I thought you meant there was a direct link between a student dying and another getting smarter, which made no sense. I understand you now.

...What's wrong with picking students who have already gone through a sort of "selection process"?...

To put it another way, how one could define a stressful experience that you could use as an admission standard? You would essentially ask the prospective student experience stress similar to med school before school, effectively shifting the risk to the student. More than the logistical difficulties of such an admissions standard, it would be unethical and cruel.

Thinking about it another way, I don't believe that one stressful (or many,) experiences make you resistant to self-destructive behavior. I've seen people who get very stressed out by exams, but work through anatomy lab like it's a walk in the park. Each situation will provoke different reactions in the same person. Similarly, one person will handle the same stress differently than their classmates.

 

[OncoCaP]

Identifying people at risk is the only place you can fix this.

I realize this is an informal forum, and I enjoy that.

At the same time, let's take a look at the science behind what we talking about (or, perhaps the lack of it). Can you point to any careful study of this issue? From a quick look, I don't get the impression that this has been given the attention it deserves. Yes, there are a few studies, but I haven't found anything that anyone would claim really exposes the root causes and potential solutions and their relative benefit.

I'm much more hestiant than you to say that something is a solution without any data to back that up. I agree that you have a good idea. I'm just surpised at your level of confidence. Maybe you have some data that you haven't shared. If your solution is based on your intuitive sense, your intuition may be correct, but I would find it more convincing if you had something besides your intuition to back it up.

 

[78222]

What I'm suggesting is that the powers in charge look at what the options are and then consciously decide what to do in some manner that recognizes that we are dealing with more people potentially dying if they choose a sub-optimal approach. It may be that the current system reflects the values of the people in charge of the medical school system or maybe not and should be changed. If it turns out that lives could be saved by the administration sticking their nose into your business, then that's an option that should be considered.

I think the system we currently have, while not perfect, isn't that bad and definitely not in need of radical change.

Another option might be to change the way that med students are taught to deal with stress. For example, I'm unconvinced that stressing students out with classroom stuff vets the best physicians. Maybe stress in clinical rotations could be retained while stress in classes could be reduced. Again, I consider this a serious problem that needs serious solutions.

You are going to teach medstudents how to deal with stress? Give me a break, there isn't a chance in hell I'd show up to such a ridiculous class. Like it or not, being a physician means you need to know a lot of ****. I don't see this changing. Without our background in the basic sciences we are just PAs.

I'm not suggesting that I have any relevant answers. What I am telling you is that I find a 3X suicide rate increase unacceptable. You might not, and we're all entitled to our opinion. I think I can see where you are coming from, but I don't agree.

I don't see any reason the suicide rate wouldn't be 3X higher. Undergraduate is a joke! I partied my ass off all the time in ugrad, played sports, and generally had tons and tons of freetime. I bet the suicide rate of having a real job is also higher.

 

[OncoCaP]

To put it another way, how one could define a stressful experience that you could use as an admission standard? You would essentially ask the prospective student experience stress similar to med school before school, effectively shifting the risk to the student. More than the logistical difficulties of such an admissions standard, it would be unethical and cruel.

Thinking about it another way, I don't believe that one stressful (or many,) experiences make you resistant to self-destructive behavior. I've seen people who get very stressed out by exams, but work through anatomy lab like it's a walk in the park. Each situation will provoke different reactions in the same person. Similarly, one person will handle the same stress differently than their classmates.

In that particular idea of looking at stressful experiences in an applicant's history, there are many options. An obvious one might be if the student was a marine with 24 months of combat duty in Anbar province ... that would be an obvious (an highly life threatening) one. I'm not suggesting anyone should enlist prior to going to medical school, but an applicant who dealt successfully as possible with their buddies dying as well ask putting their own tail on the line should clearly be considered as resilient when it comes to stress. Closer to home, maybe the student taught at an inner city junior high schools where there were occasional fights that had to be broken up could be considered "stress-experienced." Another possibilty is someone who was a paramedic. On the less glamorous side, maybe just working at a fast-food restaurant as an order-taker at a very busy restaurant could count for something.

As I've pointed out several times, I don't know enough to really suggest solutions (and I'm concerned that there really isn't enough known about this issue by anyone and how to best improve it). However, I do find it an interesting and worthwhile point of discussion.

 

[Law2Doc]

I realize this is an informal forum, and I enjoy that.

At the same time, let's take a look at the science behind what we talking about (or, perhaps the lack of it). Can you point to any careful study of this issue? From a quick look, I don't get the impression that this has been given the attention it deserves. Yes, there are a few studies, but I haven't found anything that anyone would claim really exposes the root causes and potential solutions and their relative benefit.

I'm much more hestiant than you to say that something is a solution without any data to back that up. I agree that you have a good idea. I'm just surpised at your level of confidence. Maybe you have some data that you haven't shared. If your solution is based on your intuitive sense, your intuition may be correct, but I would find it more convincing if you had something besides your intuition to back it up.

You don't scrap a system that works well for 99.9% of all students. You identify that 0.1%. It is not just my idea -- see eg.

Johns Hopkins Med J. 1976 May;138(5):185-95. Links
What becomes of medical students: the dark side.
Thomas CB.

"These findings underscore the need for learning to identify and help medical students who are especially vulnerable to stress. Such insights would contribute to the prevention of premature disease and death, not only from mental illness but from other disorders." PMID: 940252

Also, you are assuming that because the rates of suicide are so high in medical school that medical school is a causitive factor. How do you know that folks with these kind of instabilities don't gravitate toward this profession? That is certainly one other inference that can be drawn from your numbers.

 

[OncoCaP]

I don't see any reason the suicide rate wouldn't be 3X higher. Undergraduate is a joke! I partied my ass off all the time in ugrad, played sports, and generally had tons and tons of freetime. I bet the suicide rate of having a real job is also higher.

From what I've heard, residency is more stressful than most jobs that physicians have....

 

[78222]

From what I've heard, residency is more stressful than most jobs that physicians have....

I have little doubt that it is. At least the internship year... I don't see what that has to do with anything. Imagine going to residency without first being buffered by medschool.

 

[RxnMan]

...maybe the student taught at an inner city junior high schools where there were occasional fights that had to be broken up could be considered "stress-experienced." Another possibilty is someone who was a paramedic. On the less glamorous side, maybe just working at a fast-food restaurant as an order-taker at a very busy restaurant could count for something...

Ok, you're starting to hit on what I'm talking about. How could you compare a paramedic to a fast-food order-taker to a inner-city teacher? Would growing up in an inner-city school be treated as equal to teaching in one? Would an ADCOM only consider stressful ECs valid when the applicant was in a position of responsibility (as they will be as a doc)? Would one have to work 5 years as a teacher in an inner-city school to equal a tour of in Anbar?

...An obvious one might be if the student was a marine with 24 months of combat duty in Anbar province...I'm not suggesting anyone should enlist prior to going to medical school,...

I'm taking some liberties with your quote, but you hit on another problem. With requiring a stressful experience, people would look for the most stressful experience because it would make them more competitive - it's the nature of the pre-med game.

Again, I very much doubt the protective or predictive effect of prior stressful experiences. Each situation is different, and each student will handle ot differently. From my own experience, I've seen people die in horrible ways. I've seen operations and once had a gun held to my chest. But the other day I was in anatomy lab and I saw a classmate pull out some random wad of tissue out of the cadaver's groin. I didn't know what it was (some stuffing used in the embalming process,) but I nearly threw up. Am I not stress-experienced? I think I am, but each situation is different, and this one threw me for a loop.

 

[OncoCaP]

You don't scrap a system that works well for 99.9% of all students. You identify that 0.1%. It is not just my idea -- see eg.

Johns Hopkins Med J. 1976 May;138(5):185-95. Links
What becomes of medical students: the dark side.
Thomas CB.

This goes back to my sacrifice analogy ... we work with a system that leads to 3 more students committing suicide every year ... the sacrifice for the better harvest. I'm not sure the sacrifice leads to a better harvest any more than fraternity hazing leads to better fraternity members.

I'm not suggesting we scrap the system. My first suggestion is that we find out what is leading to the 3 additional suicides per year. I suspect you are in the majority and that I'm in the minority opinion on this ... most people wouldn't give a hoot about 3 additional med students dying per year.

Even with 24 suicide deaths per 100000, going to med school isn't as hazardous as being, say, a fisherman:

http://money.cnn.com/2006/08/16/pf/2005_most_dangerous_jobs/index.htm
Fishermen It was another tough year for fishermen in 2005; 48 died, up from 38 the year before. That made it the nation's most dangerous occupation in 2005, with a fatality rate of 118.4 per 100,000 - nearly 30 times higher than the rate of the average worker.

However, apparently the risk of suicide in med school on a per-person basis is greater than dying in a construction accident:

The most dangerous industry in terms of total killed was construction, where 1,186 workers died. The rate of 11.0 per 100,000, however, trailed the agricultural segment (32.5 per 100,000), which included fishing and logging; mining (25.6 per 100,000); and transportation and warehousing (17.6 per 100,000), where many drivers died in traffic accidents.

Thus, the suicide fatality rate of med school students puts it among some of the more dangerous professions in terms of potentially fatality. I do understand the important difference between getting run over by steam roller and taking one's own life, but the end result is the same, and still serious in my opinion.

In any case, I don't like med students dying and think it's worth a look. It may be that most of the suicides are concentrated at relatively few schools and that could ease the path to a solution. There are probably similar arguments about helmet laws, seat belts, air bags, etc.

Now on your reference: Am I reading this right ... you are quoting a paper from 1976? 30 years old? That paper refers to classes of 1948 through 1964. Something tells me a few things have changed in med school since then. I wish there was something more recent.

"These findings underscore the need for learning to identify and help medical students who are especially vulnerable to stress. Such insights would contribute to the prevention of premature disease and death, not only from mental illness but from other disorders." PMID: 940252

I'm under the impression that schools have done something about the issue (added counseling). However, given the stats, I would question whether they have addressed the problem effectively.

Also, you are assuming that because the rates of suicide are so high in medical school that medical school is a causitive factor. How do you know that folks with these kind of instabilities don't gravitate toward this profession? That is certainly one other inference that can be drawn from your numbers.

If it's that people with a suicidal predisposition are attracted to medical schoool ... maybe there is more truth in that than we are willing to admit ... then maybe screening becomes that much more important ... perhaps even the screening that surebreC objects to.

I suspect there are effective solutions. Your quoting a study from 1976 makes my point that there has not been much effort on this (at least I haven't found it).

 

[OncoCaP]

Ok, you're starting to hit on what I'm talking about. How could you compare a paramedic to a fast-food order-taker to a inner-city teacher? ...

How can you compare two med school applicants in the first place? There is an important subjective element. Even subjecting students to the MCAT is subjecting them to stressful experience in and of itself. The evaluator would need to look at the application an make a judgment about how well prepared the student was to deal with the stress.

With requiring a stressful experience, people would look for the most stressful experience because it would make them more competitive - it's the nature of the pre-med game.

If this works in providing more qualified applicants (who make better doctors) and reduces the suicide rate ... then I say ... take a look at it.

Again, I very much doubt the protective or predictive effect of prior stressful experiences. Each situation is different, and each student will handle ot differently.

With that attitude, you could question the entire med school admissions process. At the end of the day, however, one can look for correlations and make the best decision humanly possibly ... and possibly save the lives of three medical school students per year.

From my own experience, I've seen people die in horrible ways. I've seen operations and once had a gun held to my chest. But the other day I was in anatomy lab and I saw a classmate pull out some random wad of tissue out of the cadaver's groin. I didn't know what it was (some stuffing used in the embalming process,) but I nearly threw up. Am I not stress-experienced? I think I am, but each situation is different, and this one threw me for a loop.

True. It may be that, as you say, previous experience with stress is almost irrelevant to whether someone will commit suicide in medical school. What I'm suggesting is that we look at (a) what leads to med student suicides, (b) if there are differences in individual med school suicide rates and what that suggests about the potential effect of certain features of curriculum etc, and (c) Attempting various controlled changes to reduce suicide rates and studying their effect, if any.

I'm also not suggesting that this should be the top priority of med schools. For example, there may be that something else med students are doing could be improved that would cut the deaths and injury to patients that should have priority. Based on the stats, I see med student suicides as an issue worth spending some money on, precious as cash is to the schools.

 

[OncoCaP]

I have little doubt that it is. At least the internship year... I don't see what that has to do with anything. Imagine going to residency without first being buffered by medschool.

What it has to do with anything is that maybe the stress in med school and residency is higher than it needs to be. For example, perhaps the stress of residency should be brought into line with (reduced to) the typical stress level experienced by physicians and perhaps this would justify reducing the level of stress in med school (at least in the classes, perhaps).

Consider this: Imagine the classes in med school being less stressful and the clinical rotations being similar in stress to what they are now. Would the quality of the graduating med school students in terms of being able to deal with stress and do an effective job be less? Maybe, but maybe not. It's worth a look in my opinion.

I'm not saying this because I want to be a slacker in the classes. I'm saying it because I don't think me learning more is worth 3 more students per year losing their lives.

Again, I'm really most interested in finding out what the best approach is ... whether it's doing nothing different, increasing prerequisites, psych screenings, more counseling, seminars, etc. I have no joy from my idea being implemented versus someone else's as long as the lives of the "sacrificed" med students are getting more respect than they do now.

 

[78222]

My god man, I just can't talk to you without feeling like your pussification is rubbing off on me.

 

[OncoCaP]

My god man, I just can't talk to you without feeling like your pussification is rubbing off on me.

Man, I've been where you are (in terms of attitude anyway). I used to think people should just suck it up and get the job done. I ran a company for about 10 years and that helped me figure out (the hard way) that beating people more and harder doesn't produce better people or better results. This experience really turned me into a "*****" in some ways.

My attitude now is to define what actually is required to get the job done and get the "right" people to do it ... things actually work out pretty well. The "right" people will push themselves in a healthy way. If the medical profession improved the med school experience and quality of life of doctors and perhaps vetted people more appropriately (smarter is not always better -- especially if the smarter applicant can't deal with stress), we might actually be able to attract some hard-core talent that is choosing other options right now ... and save lives.

I used to think that if you impose enough coaching or stress or whatever on the "wrong" people that they would turn into the "right" people over time (or at least "medium-right"). I was proved wrong many times, and finally changed my philosophy about this.

I'm convinced that everyone has something to offer, but not everyone who wants to become a medical doctor is necessarily making the right choice. There are plenty of other ways to make a great living and to make a difference. Sometimes not letting someone in or kicking someone out is the only way to make them happy ... and anything is better than them jumping off a building or downing a bottle of sleeping pills. Maybe counseling or seminar would help, but I would like to see some data to support such a plan with an eye toward to what kind of counseling and seminars and when ... work best. On the other hand, some situations have stupid stressful features that should simply be eliminated because they are less than worthless (and perhaps ridiculously difficult exams are one such "feature").

As a small example as a potential improvement, we make not getting in or dropping out of medical school as something that is a better fit out to be a "failure." Just changing that attitude alone might save lives. There is a balance here. We want people to do their best, but not at any cost.