It’s no secret that many physicians are suffering from burnout. But at St. Louis University’s medical school, the director of curriculum wondered whether the trend could be traced back to medical school, where many students are depressed and anxious. And if so, how could he root out the problem to nurture happier students, possibly leading to happier physicians? “Are we kind of sowing the seeds for this in med school?” Dr. Stuart Slavin asked. The question arose six years ago when Slavin thought about national statistics that show medical students have higher rates of depression and anxiety than their age group in the general population. “I didn’t see it in our students,” he said. They appeared energetic and positive, especially if he looked at the national graduation survey. SLU medical students reported high levels of satisfaction with their administration and overall education. But quality education doesn’t mean there’s less pressure. So in 2008, Slavin surveyed his students on their wellness. What he discovered was that at the end of the academic year, 57 percent of first-year medical students had moderate to high symptoms of anxiety, and 27 percent experienced moderate to severe symptoms of depression. “I still remember the day I saw the results,” Slavin said. “It was devastating. ... In some ways, I felt kind of personally responsible.” Other schools have addressed this problem with their students, Slavin said. Sometimes they take a reactive approach that tackles the already existing anxiety or depression. Or, they use a supplementary and preventive method, which attempts to balance the negative experience with positive ones, such as wellness programs and social activities. But Slavin wanted to target what caused the harm and eliminate it before the damage was done. So when students cited their stressors as competition for grades and heavy class material, Slavin began making changes to the curriculum. The biggest changes for first- and second-year students were a 10 percent reduction in the required course-load and a switch in the grading system. A simple pass/fail system replaced the honors/near honors/pass/fail. For Courtney Karr, who has just finished her first year at SLU’s medical school, the changes have made all the difference. Medical students, she pointed out, have always been high achievers who are accustomed to being at the top of their class. So when they’re thrown into the same pool, the competition becomes cutthroat. But with a simpler grading system, “Everybody sort of wants to work together now,” Karr said. “It’s not, ‘I have to do better than you.’ It’s, ‘Let’s do this together. We’re all going to get through this together.’” SLU isn’t the first school to implement a pass/fail system in its medical school. The University of Missouri-Columbia and Washington University in St. Louis both use this method for their first-year students, although neither does it for second year. Dr. Lisa Moscoso, associate dean for student affairs at Washinton U.’s medical school, said implementing this in the first year helps students with diverse backgrounds begin on a level playing field. But one aspect concerns her. “Are you postponing the stress that they’re going to feel at some point by making it a pass/fail (for) now?” One positive outcome Slavin noted is that students haven’t lost their sense of motivation just because the grading system is simpler. Not only have class exam scores remained stable, but scores rose on the U.S. Medical Licensing Exam for second-year students. The school also incorporated learning communities for faculty and students to connect, and a required resilience class to teach ways to reduce stress. These classes incorporate positive psychology to help students change their mindset and outlook on situations. The hope, Slavin said, is that teaching students to have a more positive attitude will stick with them in their careers. Physician burnout happens when people allow the demands of the practice to overwhelm them, he said. “It’s easy as a physician to start feeling like a helpless victim in the system,” Slavin said. “I think physicians really need to find out how to find meaning in their work.” Vanessa Voss, who just finished her second year of med school at SLU, said the resilience classes have been good for her. They taught her how to keep from jumping to conclusions. She’s also learned to better reflect and be more present and aware of her daily experiences. Slavin “portrayed it as a way to be even better as a student or as a doctor, and I think it’s really true,” she said. Because if she’s feeling stressed or isolated, she said, she won’t be able to connect with patients as well. For many of the students, the changes seem to be making a difference. While 55 percent of students who expected to graduate in 2011 had moderate to severe anxiety by the end of their first academic year, and 27 percent had depression, now, 31 percent of first-year students who expect to graduate in 2015 have anxiety, and 11 percent have depression. And reaching these lower levels “cost virtually nothing to do,” Slavin said. Next, he plans to tackle the curriculum for third-year students. He’s just sad it wasn’t done sooner. Source
