For this week’s article, I’ve asked Renee Fitzpatrick, Director of Student Affairs, to write to us about a topic of critical importance. Indeed, the issue of student wellness and risk should be a major concern of both individuals and institutions engage in the education and development of young people. As she points out, our efforts in this regard need to be ongoing, and she introduces a recent initiative taken up jointly by the Canadian Undergraduate Deans and Student Affairs leaders to consolidate and strengthen our approach to this problem.
In April 2016, Laura Taylor, a third year medical student at UBC, died just days before her 34th birthday. Her parents, devastated by the loss of their kind, loving, brilliant, athletic daughter shared that the bipolar disorder that she had struggled with for more than half of her life, became too much. She had worked tirelessly to reduce the stigma of mental illness.
Her photograph shows a girl with a full smile, the kind that would inspire confidence in any patient, a smile that is referred to repeatedly in her book of condolence, a hockey helmet, reflecting her passion for hockey and a stethoscope, the signature of the medical profession.
The tributes speak to her energy, her athletic ability, her generosity in volunteering, her openness about her mental illness, her academic brilliance, her wit, her courage and her humility.
Any medical school in the country would have been proud to have Laura as a student, and UBC was particularly proud of her. She had all the attributes that we have identified as important to sustain a career in medicine. She also had a serious mental illness, one that she had prior to medical school, which she actively tried to manage.
Just days before Laura’s death, at this year’s CCME, the Canadian Federation of Medical Students, presented results of a mental health survey of medical students across Canada, results that challenged us to take action. The report described increased rates of anxiety, depression, suicidal ideation and burnout, compared to the general population, replicating results from other countries. The Undergraduate Deans committed to a review of suicide risk factors in medical students in an attempt to understand what factors are associated with the conversion of suicidal ideation, a sign of distress to suicide.
Over the last few decades there has been increasing emphasis on the need to identify and treat mental illness in medical students, residents and physicians. Accreditation requirements include a need to demonstrate that there is access to help for mental health issues. However, there is still stigma about seeking help, with concerns ranging from impact on license to fear of judgment. The ACGME Council of Review Committee Residents made suggestions to identify ways to improve resident wellness and resiliency following the death by suicide of 2 resident physicians in New York in August 2014. These were. (1) increasing awareness of the risk of depression during training and destigmatizing it; (2) building systems to confidentially identify and treat depression in trainees; (3) establishing a more formal system of peer and faculty mentoring; (4) promoting a supportive culture during training; and (5) fostering efforts to learn more about resident wellness.
We had made some strides in the last few years to increase wellness initiatives, promote resilience and reduce burnout. The CFMS survey indicates that we have no reason to be complacent. It is crucial to identify the risk factors that convert ideation to suicide. We must reflect on the degree of perfectionism that we require to achieve one of the coveted spots in our medical schools. We must ask how students survive our scrutiny as we demand competent collaborators, communicators, managers, experts, leaders and advocates. Is the perfection that we demand reasonable? Is the environment conducive to negotiating the developmental tasks of early adulthood in addition to training as physicians?
I do not suggest for one moment that we reduce our standards or dilute the fact that medicine is demanding and that we need to be able to tolerate uncertainty, failures, distress and pain. I believe that this is achievable in an environment that promotes and facilitates the growth of healthy physicians. The leadership and support of the Undergraduate Deans is crucial in enhancing the health and resilience of the next generation of physicians, who have taken a courageous step in identifying the issues.
Our Undergraduate Deans have made a commitment that deserves all of our support and challenges us also to become healthy physicians.