Medical Student Mental Health

Laura writes about the importance of protecting your wellbeing as a medical student.

- Laura

Research carried out by the BMA has shown that around a third of medical students are suffering from depression and around 1 in 10 experience suicidal thoughts. I am Laura; I am currently resitting my 4^th year of medicine at The University of Nottingham. I failed last year due to poor mental health. Here’s a brief summary of my experience of mental health in medical school, then I will be exploring why medical students (and therefore also doctors) are at such high risk.

My first 3 years of medical school were a continuous cycle of minor episodes of anxiety and depression combined with poor coping mechanisms. It went almost completely unnoticed by myself and everyone else because it was pretty much the norm. I would feel stressed constantly about workload, fitting in hobbies and social life and constantly feeling inadequate compared to my peers. This stress would build up and then around exam time come to a head. By the time it got to exams it was crossing over from stress to anxiety – the physical symptoms were there, I was struggling to sleep and could not switch my mind off from the constant whirring. I wasn’t just worrying about exams anymore; my mind was flying all over the place worrying about all kinds of things. Then after exams, I would go out and get hammered, and for the next month or so I would feel exhausted, empty, hollow. I would withdraw, struggle to motivate myself for anything and lose enjoyment for life. I didn’t know it at the time but I was depressed. It would clear and the cycle would start again.

I went into 4^th year tired already, 2 weeks off after the rollercoaster that was 3^rd year was not enough. I went in already having given in to failing. I had heard about the 20% fail rate and was already convinced it was going to be me. Having not enjoyed my first experience of clinical placements and constantly doubted if medicine was really for me, I made a pact with myself. If I didn’t enjoy my first placement of 4^th year, paediatrics, something I had always wanted to do, I planned to drop out and do postgrad teacher training. But I loved paediatrics, the supportive team atmosphere, working with kids, the positivity of it all and I decided to stick it out. Day in day out of 4^th year I enjoyed the placements but they were only a small part of it all.

Something I absolutely loved at uni and got me through some tough times was sport. In 3^rd and 4^th year I was on the uni cycling team and enjoyed training every day as an escape and the successes of racing. But in 4^th year, my attitude switched. I became obsessed with training. I really struggled to fit it around studies but forced myself to. What used to be an escape from stress became an additional stressor.

My performance on the bike suffered as my mental health started declining. I was behind on my studies. This was something I always found throughout medical school – the feeling of never being on top of studies, always somehow being a step behind was something I was very familiar with. But this time I was more than a step behind. I felt completely out of control. I tried to plan an intense schedule to fit in studies and training but it was too much. From February onwards, I was just studying and training day in day out. I didn’t really see my friends nor do anything else. I wasn’t enjoying life and felt constantly on edge.

Exams came round quickly. I felt unprepared and overwhelmed. In our OSCEs (practical exams, 10 minute stations with a simulated patient and examiner, no hiding) I panicked and messed up on things I should have been able to do. I finished my 2^nd OCSE and spent half an hour crying on my own. Picking myself back up to revise for our written knowledge exams was hard. But I did it and somehow passed those.

I got the results on holiday in New York. Having got my hopes up slightly that I may have scraped through, seeing the fail highlighted in the email was crushing. 2 weeks later and my mental health was in a bad way for the resits. It had gotten to the point where the achievement was getting through the exams without breaking down into tears.

After finding out I had failed, I then had a week to make the decision whether to retake the year or take a year out and sit the exams again after a year. I decided to retake the year and I’m glad I did but coming back was really hard.  I felt super anxious and upset on that first day but was grateful to have supportive housemates, family and everyone was really friendly and supportive.

I am now in recovery. I take antidepressants every day, I received CBT and have a more balanced life now. I still cycle but I am less obsessed (not perfect by any means), I make time to see my friends, I talk about things and I know the warning signs and when I need to slow down and take a step back to preserve my mental health.

So Why Is It That Medical Students Are Struggling?

The course. It’s always a joke at uni that if you complain about your course being difficult, a medical student will pipe up that theirs is harder. It’s a stereotype that I have to say I agree with. At Nottingham our first 2.5 years are squeezing in a 3 year degree. We learn the anatomy, physiology etc of the whole body and have to write a dissertation in that time. We have to learn a lot independently and are constantly pitted against each other. Whether it’s answering the quiz questions in anatomy or getting an email at the end of the year with our ranking against the whole year, there’s underlying tones of competition when we should all be supporting each other – as long as we pass we will all be doctors.

The clinical placement hits and suddenly you’re in placement 9-5 (or longer) every day at the same time as having to learn 1000s of objectives independently and somehow keep up some sort of life outside medicine. You encounter all sorts of problems unique to our course. How do I get through Burns theatre without fainting? How do I deal with my first death? Will I ever get a cannula in? Why is life so unfair? Day in day out you see life changing things; people who are suicidal, people with terminal cancer diagnoses, people who’ve had a hard lot in life, the list could go on. You are told to be a doctor you need to be empathetic but there is also such thing as too much empathy. The other day, after seeing a woman have a miscarriage I said that I probably have too many emotions to be a doctor! I was devastated for her and could not stop thinking about it for the rest of the day.

The type of person who does medicine. We are all high achievers, perfectionists, ambitious people. We don’t just want to excel at our course but we also want to play sport at a high level, or do extra research, or volunteer with homeless people. Medical students are some of the busiest people at university yet we also have the most contact hours. This perfectionism and ambition is good but it can lead to burn out. Trying to do sport at a high level alongside placement can really take its toll physically and mentally and due to the hard working and perfectionism it’s so easy to overtrain. The type of people we are means that if we’re not excelling we are exceptionally hard on ourselves. Self-doubt can creep in all too easily. Perfectionism and being a high achiever is a huge risk factor for eating disorder and other mental health problems.

We make the decision to do medicine at a really young age. I was 14 when I first said I wanted to be a doctor. At that age you don’t fully appreciate the sacrifices it involves and that it is frankly a lifestyle rather than a career. In 3^rd year you see friends graduating, getting jobs in London. These jobs are 9-5 Monday to Friday, pay better than doctors, give lots of holiday and mean living a balanced life is easy. At that point you have 2 years (or more!) left of medical school then foundation years then a minimum of 3 more years training. You face years of night shifts, exams, overtime and having to jump through lots of hoops. Everyone at medical school and beyond has the creeping doubts: “is it all really worth it?” we ask ourselves. Fear of dropping out and failure means people soldier on despite being convinced it’s not actually for them. Family pressures, coming from a family of doctors, is another thing people face.

When people are struggling with their mental health at medical school they are scared to speak up. They think they’ll be dismissed as being “just stressed” the same as everyone else. They fear the dreaded “you chose to do it”. They are scared to seek help from the medical school for fear of repercussions on continuing their degree or on their future careers. “Fitness to practice” is held over our heads like a threat. The idea that we need to be perfect professional mini doctors all the time. Fear culture.

What Can We Do?

Medical students need support. Because of long hours on placements, residential placements etc support needs to be offered out of hours, and over the phone or internet. People need to understand the toll it takes on everyone, even those without mental health difficulties. Words of kindness, support and understanding go a long way.

You can information and advice on looking after your wellbeing here 

My name's Laura, I’m a 4th year medical student, hoping to eventually become a children’s psychiatrist. Outside of med school I’m very keen on sports - triathlon, cycling and climbing mainly. I am really excited to be a student minds press ambassador this year to help share my story and raise awareness of the struggles students are facing.

For more support:

Support offered GMC

Doctor's Support Network