Essentials for Education and Training for Tomorrow's Physicians

Education and training of medical students and postgraduate residents must undergo a critical review in light of the changing times and attitudes. The demands of life in general are enough to provide significant stressors for today's students in addition to coping with pressures of balancing passing exams with meeting the expectations of family and instructors. This chapter will highlight the realities of the effect of the pressures of study on the students' mental health and well-being. It will then describe several changes that can be made to the way medical students are trained which then shifts the focus to personal growth and development and away from the traditional goals of knowledge, skills and competencies for the goal of passing the exams. In the end, this chapter will challenge readers and institutions to pause and reconsider the current approach to training of medical students.

From Medical Student to Medical Resident

The transition from medical school to board-certified medical practice includes a period of intense, practical training known as medical residency. Medical residents are at risk for greater mental health distress than the general population. Interns, which are first year residents, are most at risk for, at worst, depression and suicidal ideation, and, at best, negative outlooks on the medical profession. Risk factors include role transition, decreased sleep, relocation, isolation, stigma toward mental health problems and treatment, and health care industry changes. Untreated mental health problems can lead to burnout later during a physician's career. Residents thrive on social and organisational support which can include systematic screening and treatment of mental health problems. Although research regarding best practices for addressing mental health problems during residency is limited, we offer four core strategies for preventing and addressing mental health problems in medical residents: education, screening, treatment, and support.

Perfectionism

Perfectionism is the refusal to accept any standard short of perfect. Perfectionist students might strive for ‘faultless performance, meticulous attention to detail and high levels of competency' (Humphris & Kaney, 1998). In a field as complex and advanced as medicine, faultless performance is unrealistically expected. This chapter will discuss how the rigours of medical school promote perfectionistic behaviours in students. What is perfectionism? How does perfectionism in medical school affect students? How can educators and administrators identify perfectionism, provide psychoeducation, or address maladaptive perfectionism? How can students address perfectionism? It is essential to recognise perfectionism in medical students as research has shown that maladaptive perfectionism has been correlated to physician suicide (Scutti, 2014). The chapter concludes with recommendations on how students and medical educators can employ strategies to promote sound mental health and wellbeing during medical school.

Medical School Wellness Initiatives

In this chapter, wellness, and the importance of balance among wellness dimensions for medical students will be defined based on information found in relevant peer-reviewed and/or professional literature. Practical, evidence-based examples of wellness programme and initiatives within medical schools will be discussed. Benefits and challenges of the wellness program examples will be presented; limitations to programme results will be provided. Health education models and/or theory applicable to the needs assessment, development, implementation, and evaluation of medical school wellness programmes will be explored. Recommendations and best practices will be suggested to facilitate the practical implementation of wellness initiatives. A discussion of emerging trends will also be presented for future consideration.

Resident Physician and Medical Academic Faculty Burnout

Physician burnout finds its roots in both undergraduate and graduate medical education and has emerged as an important cause of academic faculty turnover. Recognition of the need for resiliency training has led to the development and implementation of wellness programmes throughout the country and world. This chapter examines the causes and potential solutions of combating resident physician and academic faculty burnout in medical education. The authors reviewed current literature on wellness programmes in medical education, including both traditional and curricular approaches and provide a template for creating a well-rounded wellness programme to promote resident physician and academic faculty wellness.

Developing a Comprehensive Wellness Program for Medical Students

This chapter addresses the various components that go into the development of a comprehensive wellness programme. Medical school can be a difficult time for students and some will experience an increase in burnout, stress, and anxiety that can lead to less empathetic physicians, decline in professionalism, and ultimately impact the quality of healthcare. Increased stress, burnout, and anxiety can lead to less empathetic doctors, decline in professionalism, and ultimately impact the quality of healthcare. One way to address these issues is through the development of a comprehensive wellness programme that addresses both academic and non-academic contributing factors. Prior to the development of a comprehensive wellness programme one must identify key stakeholders and assess the factors that are contributing to medical student well-being. Equal consideration must be given to both academic and non-academic factors that contribute to overall student well-being and incorporated into the design of a comprehensive wellness programme.

Medical Students' Quest Towards the Long White Coat

Every year across the globe, thousands of students begin the quest towards becoming a medical doctor and donning a long white coat. Global research indicates that after beginning medical education, medical students' mental health and well-being dramatically declines. The loss of well-being continues into the residency and practice of medicine. The aim of this chapter is to broadly examine the pressures unique to medical students within the context of medical education training, higher education, and the general population. A call for medical education to adopt innovative policy, plans, and administrative and curricular changes designed to foster a culture conducive to the long-term positive mental health and well-being of medical students during training and into the internship and long-term practice of medicine concludes the chapter.

Deliberate Self-Harm and Suicide Ideology in Medical Students

The risk of deliberate self-harm (DSH) and suicide ideology in medical students is a pertinent issue that has received a surge in attention over recent years. Medical students are at risk of normalisation of DSH and suicide ideology despite their mental health literacy levels and are still susceptible to the stigma of help-seeking for their mental wellbeing. This chapter will explore assessment, preventative and management strategies to improve education, awareness and ultimately reduce the rates of DSH and suicide risk. A comprehensive review of practices and techniques that medical training community and their family members could utilise to aid medical students to adequately and safety manage DSH and suicide ideology. This will assist in identifying crucial areas for future research to aid students, professionals, family and friends in supporting medical student health to optimise mental health overall wellbeing of medical students.

Medical Students' Perceived Stigma in Seeking Care

This chapter discusses the stigma and the barriers, which hinder medical students from seeking help for both physical and mental health conditions. Stigma will also be explored from a cultural perspective; the authors will demonstrate how it is embedded in help seeking behaviour. The authors will explore the existing literature to highlight these issues, and demonstrate how negative help seeking behaviour contributes to the poor academic performance of the students, as well produces chronic mental and physical health conditions. Solutions and interventions to address this perceived stigma will also be discussed. The authors will emphasise the importance of educators and staff of medical schools taking a more proactive role, in providing the necessary environment to facilitate such change in behaviour, by implementing some of these interventions.

Medical Student Burnout

Medical students' mental health is a topic of great interest as it has implications not only for medical students but also for the patients of these future doctors. Medical students face many academic pressures and burnout is one possible consequence of these stressors with some studies suggesting that burnout affects up to 50% of medical students. Our own study of American students in a medical programme located outside of the U.S. showed that student perceptions of the medical learning environment were linked with burnout suggesting that reducing burnout requires a pedagogical approach that addresses academically related stress factors. This chapter contends that one institutional strategy to prevent problems such as burnout is to adopt a theory-based approach to instructional design that addresses the causes of medical student stress and burnout from the instructional side.