College and graduate students are seeking mental health treatment in record numbers, yet schools often struggle to keep up with demand and provide sufficient care, especially for the unique needs of medical students.
A 2016 study in the Journal of the American Medical Association found that approximately 27% of medical students reported experiencing depression or depressive symptoms. Additionally, 11% of medical students reported suicidal ideation during their medical school years.
Medical students are particularly susceptible to stress during their graduate studies, internship, and residency, facing both everyday challenges and the heavy pressures of their demanding training. This vulnerability stems from a combination of factors, including long hours, sleep deprivation, and the weight of real-world patient care.
Many institutions are increasing resources for mental health services, but they still face challenges in addressing the rising tide of student needs.
In this issue of the UICDR newsletter we explore how the rigorous and highly competitive nature of medical school can take a toll on medical students’ mental health, which has powerful implications for Chicago's medical landscape, from the care and treatment that patients receive, to the physician shortages that currently exist in the city and across the nation.
Mental Health Risks for Medical Students
Medical students are often portrayed as intensely disciplined, invincible individuals who are seemingly impervious to - or even thrive on - the pressures they face and the long hours logged in the classroom, library, or clinic. Increasingly, however, the mental health risks and psychological distress experienced by medical students are being recognized. Research indicates that nearly a third of all medical students report symptoms of depression, and medical students are more than three times more likely to die by suicide than same-aged peers in the general population. Media attention to death by suicide among physicians-in-training serves as powerful, sobering reminders that our future physicians are vulnerable, too.
Yet, despite being ensconced in a healthcare environment, medical students are in fact less likely than the general population to receive appropriate treatment and report high levels of barriers to mental health treatment. Many of these barriers are unique to their position in the healthcare system, such as concerns that seeking treatment will affect their ability to obtain licensure or gain future employment. The implications of untreated mental health difficulties among physician trainees extend beyond the individual and are associated with poor quality patient care, burnout, and a decline in the physician workforce.
Medical Student Well-Being and Resiliency
Protecting the health and success of medical students is not only vital to their own wellbeing – but also the health of our nation. In a 2024 report published by the Association of American Medical Colleges (AAMC), projections indicate a physician shortage of 86,000 physicians in the United States by 2036. These shortages will particularly impact rural areas where healthcare disparities are most prevalent. It is noteworthy that these estimates are based on current utilization rates; the reality is that much of our country is vastly underserved by the current health care system. More than 200,000 more physicians are needed to truly address disparities in health care access and utilization.
The call is clear: we must invest in the training of new physicians to meet our future health care needs. This means investing in the whole person in impactful ways – strengthening their mental and cognitive health alongside their medical knowledge. But how is this complex and multifactorial task accomplished? Promoting mental health and wellbeing goes beyond treating the symptoms of depression and anxiety; strengthening protective factors such as resilience and executive functioning is crucial to promoting success during this vulnerable period.
Executive function (EF) includes a set of cognitive processes and mental skills that allow individuals to plan, monitor, and achieve goals. These include self-regulation, decision-making, managing emotions, and adapting to challenging or changing circumstances. Research shows that EF skills contribute to higher self-efficacy and better academic and behavioral outcomes. Deficits in EF are associated with increased mental health problems, including ADHD, anxiety, and depression.
Medical school places significant demands on students' executive function due to its rigorous academic and clinical requirements. Medical students typically face 12 hour-plus days comprised of class, studying, and clinical requirements, which often bleeds into the weekend. Success in this environment thus requires the ability to manage time effectively, balance school and life, and sustain focus through long hours of study and clinical work. However, not all students enter medical school with well-developed EF skills. Students from under-resourced or underprivileged backgrounds often face additional challenges in these areas, as they may not have had the same opportunities to develop effective study habits or self-regulation strategies. Neurodiverse students, including those with ADHD, can also experience additional difficulties. Providing meaningful assistance in building EF skills is thus essential for building a diverse and representative healthcare workforce, which is needed to advance health equity.
Moving beyond traditional mental health treatment approaches, EF coaching programs hold promise for building the resilience and cognitive skills necessary to not only be successful during medical school, but also to prevent the development of mental health difficulties. These programs are behavioral, skills-based interventions that aim to increase cognitive skills through various formats (computerized, group, or in one-on-one coaching sessions with a therapist), with favorable effects for improving EF skills and mental health symptoms among vulnerable populations such as individuals with depression and schizophrenia.
Saving Lives, and Careers through Innovative Solutions
The utility and value of EF coaching to enhance medical students’ EF skills and mental health was recently realized at the Resiliency Center at the University of Illinois Chicago (UIC) College of Medicine.
The Resiliency Center represents a novel concept and approach to providing mental health support to medical students, through digital/technology-based treatments and in-person counseling designed to promote healing and integrative wellness, providing a safe and supportive healing environment for medical and graduate students.
For EF coaching, the Resiliency Center developed a novel 5-week pilot program, combining group and individual coaching sessions with an individualized digital intervention, targeting the development of EF skills such as planning, task initiation, and cognitive flexibility. Demonstrating success not only for EF deficits but also for improving anxiety, depression, and stress, the UIC Resiliency Center EF Coaching Program is paving the way for investing in medical student wellness. As one student remarked, “I did not know how hard coping with med school would be before starting, and I think that if I had these skills initially, it would've been a lot easier to emotionally regulate throughout the whole time. I wish that this course was a part of our mandatory wellness curriculum!”
Such positive outcomes highlight the potential for EF coaching programs targeting medical students to move the needle in developing a healthy and diverse physician workforce for the future – saving lives, and careers.