June 2023


Today is the anniversary of the publication of Harry Potter and the Philosopher’s Stone, which, despite recent controversy surrounding its author, was a world-shattering publishing event and source material for countless educational activities since, both within the confines of medical education and beyond.

Two out of three of this week’s reviews relate to student mental health.  We hope that your students are  able to access the resources they need to learn and thrive.


Amit, Karen and Jon

Normalizing Mental Distress

Dru Brenner L, Wei H, Sakthivel M, et al. Breaking the Silence: A Mental Health Initiative to Reduce Stigma Among Medical StudentsAcademic Medicine 2023; Vol 98(4): 458-462. https://dx.doi.org/10.1097/ACM.0000000000005090

Reviewed by Khadijah Tiamiyu

What was the study question?
What is the impact of a mental health initiative on stigma and help-seeking behaviors among medical students?

How was it done?
Authors developed a 3-part mental health initiative (MHI) program at the Pritzker School of Medicine starting in 2015: (1) an annual first-year mental health panel where faculty and peers shared their stories of mental health; (2) an annual event named “Pritzker, I Screwed Up” where faculty and peers shared their experiences with failure; and (3) a social media platform called “Humans of Pritzker” that highlighted students’ posts on mental health experiences which were optionally anonymous. Student surveys assessed satisfaction with the program and the impact of the program on mental health stigma and help-seeking behaviors.

What were the results?
61% of students (261/403) completed surveys on the MHI program. Most agreed that they could speak about mental health without judgement from their peers (78%) and faculty (57%) and 41% utilized mental health services during medical school. Of those who sought mental health services, 41% agreed that the MHI program contributed to their decision to seek help. Almost all attendees of the 2021-2022 Mental Health Panel and the Pritzker, I Screwed Up session agreed that both events destigmatized mental illness (99%) and making mistakes (96%). Lastly, medical student utilization of Student Counseling Services increased from 8% in 2014-2015 to 19% in 2018-2019 to 33% in 2020-2021.

How can I apply this to my work in education?
Mental health conditions are common among medical students, but some students do not seek care due to factors including stigma that persists in the medical profession. This study highlights a formal and longitudinal program that was successfully implemented to reduce mental health stigma and increase health-seeking behaviors among medical students. Results from this study indicate that long-term mental health programming in a medical school curriculum is feasible and effective at addressing students’ mental health needs. This program may serve as a guide to other medical schools interested in employing similar initiatives to promote the well-being of their students.

Editor’s note: Several years back, I attended a COMSEP annual meeting workshop on storytelling. When reading this study, I was reminded of this workshop, and of the power of storytelling: “The shortest distance between two people is a story.” It is not surprising that integration of real stories, from peers and faculty members, contributed to this innovative program’s success. (KFo)

Shame in Medical School Applicants

Bynum WE, Jackson JA, Varpio L, Teunissen PW.  Shame at the Gates of Medicine: A Hermeneutic Exploration of Premedical Students’ Experiences of Shame.  Academic Medicine 2023;98(6):709-716.

Reviewed by Karen Forbes

What was the study question?
As they attempt to gain entrance into medical school and the medical profession, how do premedical students experience shame?

How was it done?
Hermeneutic phenomenology was used, a qualitative methodology that seeks to convey the nature and meaning of a phenomenon and the contextual factors that shape it. Twelve students from a Master of Medical Sciences program were recruited: these students all sought admission to medical school. A 2-hour, 3-phase data collection process was undertaken: (1) participants were asked to draw a rich picture of a shame experience during their premedical training, (2) semi-structured interview deeply exploring their shame experience, (3) debrief session to assess for distress and provide support resources. Qualitative analysis was based on hermeneutic principles: immersion, understanding, abstraction, synthesis, illumination, and integration.

What were the results?
Participants reported feelings of shame during their efforts to prove themselves worthy and make themselves competitive to “pass through the gates” of medical school. This shame was found to potentially have a significant impact on participants’ self-concepts (includes both self-esteem and identity). Further, shame experiences appeared to manifest under the influence of external forces and within a confluence of present, past, and future self-concepts. Shame experiences could significantly destabilize participants’ present self-concept, because of events related to the application process (e.g., not being granted an interview), interpersonal interactions (e.g., being belittled for testing accommodations, interactions with premedical advisors), and objective performance measures (e.g., MCAT scores, repeated MCAT attempts). Restabilization of self-concept could occur through participants efforts to recover from shame.

How can I apply this to my work in education?
Shame experiences in medical learners may occur even before entry into medical school, with multiple factors contributing to a destabilized self-concept. There is seemingly a disconnect between the value placed on certain “standards” for admission and the characteristics an individual needs to be successful in the profession. Is there an opportunity to re-envision the “why” and the “how” of these performance-based measures to mitigate negative consequences on self-esteem and self-concept? Further, as clinical educators, we should recognize learners’ potential past traumas, and focus on creating safe learning environments that foster self-esteem.

Editor’s Note: This is an interesting study that shows the injury to self-worth begins before we even enter medical school. This may mean that premedical programs may need to invest in ensuring the mental health of these students (AKP).

Effectiveness of Team-Based Learning Sessions for Developing Clinical Reasoning Skills

Forbes, KL, & Foulds, JL.. A team-based learning approach during pediatric clerkship to promote clinical reasoning. Academic Pediatrics. 2023; https://dx.doi.org/10.1016/j.acap.2023.04.002

Reviewed by Fatimah Roble and Hosanna Au

What was the study question?

Are team-based learning sessions (TBL) using Key Feature Questions (KFQ) effective in improving clinical reasoning skills in medical students?

How was the study done?

Over two years, 278 3rd year medical students at the University of Alberta in their mandatory clinical pediatrics rotation were engaged in a 2-hour team-based facilitated learning session using clinical scenarios and KFQ.

The students were assigned to groups of four or five to work through six unique clinical presentations representing 20 key features using a Team-Based Model: (i) individually, through an Individual Readiness Assurance Test (IRAT) and (ii) collectively, through a Group Readiness Assurance Test (GRAT).  Pediatric educators facilitated large group discussions of the responses.

Student performance on the IRAT and GRAT were scored and aggregated. Internal reliability was calculated using Cronbach's alpha. The relationship between KFQ and end-of-rotation multiple-choice question (MCQ) exam and the Observed Structured Clinical Exam (OSCE) were measured using Pearson's correlation coefficient.

What were the results?

Student GRAT scores were higher than IRAT scores for all cohorts, with minimal variability between cohorts. The IRAT scores were moderately correlated to the OSCE (r = 0.51)  and weakly correlated to performance on the MCQ exam (r = 0.29). Students appreciated the opportunity to discuss clinical decision-making with peers, commit to decisions, and practice clinical decision-making before high-stakes examinations.

How can I apply this to my work in education?

Active learning methods such as TBL, with formative assessment can be used to encourage the development of clinical reasoning, rather than relying solely on clinical encounters and passive learning for skill development.

Editor’s Note:   This study combines an evidence-based active learning strategy (TBL) with an evidence-based clinical reasoning assessment strategy (KFQ) with promising results.  The authors might have benefitted from the fact that the Medical Council of Canada (MCC) qualifying exam already uses KFQ’s, so the students had external reasons to master this strategy.  It would be interesting to see if the results were similar in a U.S. cohort of similar students. (JG)

View a PDF of the Journal Club