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Distress in Medical Students: is it a nurture or nature problem?

Brazeau Cet al. Distress among matriculating medical students relative to the general population. Academic Medicine 2014;89:1520-1525.

Reviewed by Jeanine Ronan

What was the study question?

When comparing mental health indicators, is there a difference between matriculating medical students (MMS) and a probability-based sample of the US general population?

How was the study done?

In 2012, all MMS at 6 medical students were invited to participate in a voluntary survey during orientation. These results were compared to other US 4-year college graduates of similar ages. The survey included items from validated instruments assessing burnout, depression symptoms, and mental, emotional, physical and quality of life (QOL).

What were the results?

546 MMS and 517 similar age college graduates were enrolled. MMS had lower rates of burnout (27.3 v. 37.3) and depression symptoms (26.2 v. 42.4) and higher QOL scores across all domains (overall mean 7.7 v 6.9).

What are the implications of these findings?

The results of this study are in stark contrast to previous studies demonstrating that medical students are more likely to suffer from fatigue and depression. Other studies have shown that almost 50% of medical students have reported burnout and 11% suicidal ideation. Matriculating medical students have relatively good mental health compared to the general population. Hence, the authors argue the learning environment must lead to higher rates of burnout and depression in future physicians.

The authors suggest ways to prevent the development of burnout and depression in medical students. Once enrolled students should participate in programs that further develop coping skills. Changes to the learning environment may also be beneficial. The authors stress the importance of student wellness programs, strong faculty mentorship and more faculty development programs.

Editor’s note: This well-written study is important because it shows that these medical students began their medical training with good mental health. That these same students may be “burnt out” by the end of their MD degree program is a reflection both of the students and of the learning environment they will experience. I am not convinced, though, that the age-matched control group in this study was a good control group. This study compares the mental well-being of individuals who have just been accepted into medical school (presumably a long-term goal of most of them) to students who have just graduated and are facing the challenges of finding a job, paying off debt, and transitioning into a new phase of their lives (SLB).

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