Medical school is an exciting time in an aspiring physician’s life, but a somber reality is looming. The health care community is increasingly aware of the poor mental health of medical students manifesting as significantly higher rates of sequelae such as depression and suicidal ideation. It is widely accepted that these problems are due to various stressors in medical school such as academic demand, emotional stress of interacting with distressed patients, standardized exams and financial burdens. Some medical schools have made calls to action, but the poor mental health of medical students may not be entirely constructed within medical school: This could be further explained by a compelling pre-existing condition. The mental health problems faced by medical students may be the byproducts of patterns and habits apparent before matriculation.
Most medical students were once on the pre-medical or “pre-med” track and are likely familiar with the culture and expectations surrounding the role. In a struggle to achieve academic excellence and a shiny list of extracurricular activities, pre-meds often equate competitiveness with success. This results in an unfortunate, toxic atmosphere of misplaced pride, superficial judgment and aversion to collaboration. Browsing online discussion boards like Reddit and Student Doctor Network reveals some of this behavior: The practice of telling other pre-meds that they do not have the dedication required for medical school on the basis of one post is not an uncommon occurrence. Though pre-meds carry this toxic reputation, digging past the unsavory image reveals poor wellness and questioned self-worth.
Many students start college with the mindset that they will become physicians due to personal dreams, love for health care or sometimes familial pressure. However, the mounting pressure to be academically perfect can make the goal of medical school seem out of reach, thus creating feelings of stress and hopelessness that may lead to poor mental health outcomes. According to one study, pre-meds were significantly more likely than their non-pre-med peers to have major depressive disorder. One possible cause identified distress related to qualifying for medical school.
According to a biology professor whom I personally interviewed at The College of New Jersey, the main difference seen between pre-med students and other students is anxiety over maintaining an excellent GPA and the feeling that there are no options other than medical school. After interviewing a few people who left the pre-med track, this professor noted the students’ fear of their decisions to change career trajectory until they learned of the many other options available.
Medical education communities should consider adding analysis of pre-med mental health to the discussion of medical student wellness, as that may lead to better wellness outcomes. Generally, studies attempting to grasp the causes of mental illness among medical students ignore events prior to matriculation because studies have shown the well-being of matriculants is actually better than that of the general population and only begins to decrease during medical school.
However, brand-new medical school matriculants are typically in a low-stress situation: They are no longer concerned with acquiring a seat in a medical school, yet have not begun the considerable workload that coincides with the onset of classes. Many medical students have followed the pre-med perfectionist ideology for years and maintain some of its detrimental habits. Therefore, one can still speculate that behaviors established pre-matriculation may affect mental health in medical school.
Several behaviors that cause poor medical student wellness appear to be reflections of the mindset and mental health habits that are geared towards the aforementioned toxic pre-med culture. Pre-meds who sacrificed personal well-being for academic success are likely to continue this habit in medical school. While this tactic may have worked for a time in the undergraduate setting, the denser material in medical school may demand a prolonged sacrifice of wellness that negatively affects students’ mental health. For example, undergraduate students who isolate themselves socially before an exam may find that, in medical school, the increasing number of exams completely erodes their support structure.
Furthermore, pre-med students may be especially susceptible to self-doubt upon receiving negative criticism, resulting in distress by worsened self-image. These are just a few reasons why pre-meds may experience worse mental health than others. This foundation of maladaptive behaviors continues to affect students once they reach medical school.
The competitive nature surrounding pre-meds also carries over to medical school. Students at the top of their undergraduate institutions may find themselves receiving only average grades in medical school, which could lead to self-doubt and eventual mental health challenges. Many medical schools have made the switch to pass/fail grading to eliminate this competitiveness, but feelings of inferiority can still occur when comparing oneself to classmates.
Another commonly cited reason behind the declining mental health in medical school is the perception that seeking professional help is a sign of being unfit to be a physician. This idea resonates with the commonly held pre-med ideology of perfectionism, being afraid to stain a spotless image even at the expense of harming one’s health. Pre-med culture changes the way that people see the world and themselves; it does not suddenly disappear after getting accepted to medical school. Likewise, its slew of mental health issues is glaringly apparent.
We may be able to prevent the poor mental health outcomes of pre-meds and medical students alike by targeting the roots of negative pre-med culture. This could be done by consistent effort on the part of undergraduate faculty as well as more experienced pre-meds to mentor newer pre-meds and improve their wellness. For example, faculty advisers could inform students of exciting opportunities outside of the medical school route, allowing pre-meds who feel there are no other options to find a fulfilling career trajectory. Also, pre-med student organizations could encourage students to not only care for their own wellbeing, but also to be cognizant of their peers’. With simple efforts like these, negative pre-med habits can be addressed to improve the mental health of potential medical students.
The mental health of medical students is a serious topic warranting considerable discussion and action. In addition to the efforts of medical schools, undergraduate programs too should take ownership of this pervasive problem. Focusing on a culture that embraces the open discussion of mental health and balances the merits of academic success alongside personal well-being may effectively prevent the development of another generation of distressed, depressed and anxious medical students.