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Identifying good practice among medical schools in the support of students with mental health concerns / Andrew, Grant

Swansea University Author: Andrew, Grant

Abstract

Medical students are more prone to mental health issues than their university contemporaries by reason of predisposition and situation. The literature shows that medical students who do develop mental health problems are less likely to access the help that they need.The General Medical Council (GMC)...

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Published: London General Medical Council 2013
URI: https://cronfa.swan.ac.uk/Record/cronfa15889
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Abstract: Medical students are more prone to mental health issues than their university contemporaries by reason of predisposition and situation. The literature shows that medical students who do develop mental health problems are less likely to access the help that they need.The General Medical Council (GMC), as the body responsible for the registration and regulation of doctors, and, as the result of a working group set up under the chairmanship of Mr Stephen Whittle wishes to provide guidance to medical schools on how to improve access to support. This is to ensure that medical students can complete their studies and have successful careers whilst minimising any potential risk to the public.Research was commissioned to inform the development of guidance for medical schools on how they can best support students with mental health concerns. A systematic review was undertaken along with a mapping exercise of current practice, and an exploration of interventions which have the potential to work well. All 32 medical schools in the UK were given the opportunity to take part in the research through an e-survey (24 responded), a programme of structured telephone interviews (n= 15) and visits by the research team to five medical school sites to explore areas of good and innovative practice. Seven focus groups were held with students across five medical schools and biographical narrative interviews were conducted with 11 current students who had experienced, usually serious, mental health problems.The research confirmed the extent to which students are reluctant to acknowledge and reticent to seek help about their mental health issues. The report concluded that, while there were many examples of excellent support processes, medical schools are failing to respond to the big issue of the stigma that attaches to mental illness, which directly impacts on students’ reluctance to seek help. While attempts have been made, with varying degrees of success, to use Fitness to Practise (FtP) procedures as a way to support students this has to been seen in the context of a culture which encourages fierce competition, where illness, and particularly mental illness, is seen as a weakness, where work and study schedules are relatively inflexible (compared with other undergraduate programmes). Many of the successful role models students are exposed to, particularly in hospitals, espouse values that encourage students to hide rather than seek help with problems. The tendency for medical schools to take a clinical interest in their students illnesses, while laudable in its intention and its ability to treat each case individually, may have the undesired consequence of further positioning mental health issues as something outside routine expectations of student life – a ‘secret’ and certainly not a topic openly discussed.The researchers conclude that there are a number of practical steps that medical schools can take to improve the support on offer including better performance monitoring, the development of the role of personal tutor and greater transparency in medical school procedures based on occupational health models. However these are of little value if the underlying issue of stigma is not addressed via concerted efforts to normalise mental health through the use of role models, everyday dialog, and integration of services at institutional level.An important finding is the extent to which peer support is used and valued and the opportunities this provides, not just to address immediate needs of fellow students, but to provide an important skill which will serve tomorrow’s doctors, and society, well. The report proposes training that will enable students to perform this role at a basic level, recognising that signposting is an appropriate outcome in many cases.The report contains: a summary of the systematic review, a discussion on why medical schools and medicine are ‘different’ and how that has moulded provision, an overview of current practice and suggested changes, where possible indicating the strength of supporting evidence. The report also contains summary case studies, derived from biographical narrative interviews, of medical students who have suffered serious mental health problems and examples of good practice from UK medical schools.Most importantly it calls for clarification of policies in respect of mental health and careers in medicine, and the need to provide protection for students as a means to bring about change.6th March 2013
Keywords: medical students, mental health, mindfulness, peer-support,
College: Swansea University Medical School