Asking future doctors: what support options do medical students want to cope with medical school?

The aim of this survey is to find out which support should be given to medical students to support them and their mental health according to students’ own perspectives. Results from the included Beck Depression Inventory II (BDI-II) will be correlated to the desire for support options.

This was a cross-sectional, comprehensive classroom survey of medical students at a German University.

Medical School of the Martin-Luther University Halle-Wittenberg.

From January 2018 to November 2018, students were examined cross-sectionally from all 5 years of the medical school of the Martin-Luther University before the second state exam. The sixth year was not evaluated since students from the sixth year complete the last part of their education in different facilities in Saxony-Anhalt and throughout Germany making a classroom survey impossible. The survey was performed as a classroom survey.

Courses with mandatory attendance were chosen in order to reach a high response rate. Students could also choose to take home the questionnaire and return it to a secure collection box in order to maintain students’ privacy. Participants remained anonymous as no personal identifiers were collected. Non-participants could not be identified individually. This study emanated from a working group project that focused on different aspects of medical students’ health.

For this study, a questionnaire was created in cooperation with the Clinic of Psychiatry, Psychosomatics, and Psychotherapy that collected statistical and biometric data, including age, gender, state of origin, education, family and social background, history of personal and family illnesses, as well as substance intake, including consumption of alcohol (Terebessy et al. 2016). The Beck Depression Inventory II (BDI-II) was used to assess for depressive symptoms. Support strategies that had been assessed in other studies concluded the survey and represent the underlying data of this manuscript. Items (N = 22) were extracted to evaluate support options such as accessible counselors (Brennan et al. 2016) or changing the grading system into a pass/fail system (Wasson et al. 2016). The leading question was, “In order to better deal with my study-related stress, I would use the following services/wish the following services were offered.” Students ranked each program on a Likert scale from 1 (entirely applicable) to 7 (does not apply at all).

The Ethical Committee of the Martin-Luther University Halle-Wittenberg approved of the survey protocol on January 18, 2018 (2017–138).

Whereas medical students of the local University favor a clear study structure and applicable measures such as a timetable that accommodates sports programs, options such as communication groups are considered less helpful.

Medical students form a heterogeneous group coming from various regions, with different social situations and with a varying level of previous work experience, which makes it difficult to identify the necessary support options (Karay et al. 2018).

Studies examining directly the needs and desires of medical students to support their state of health are rare (Williams et al. 2015). A national survey in the US determined that medical schools implement a variety of approaches to support medical student well-being, but proper analysis and evaluation of the diverse options are required (Dyrbye et al. 2019). According to our knowledge, no other survey has been published listing different options as rated by students. Normally, studies either consist of meta-analyses (Schmidt and Hansson 2018) or the assessment of a direct intervention (Brennan et al. 2016). Qualitative collections of student suggestions exist, where a relatively small number of participants indicated options they preferred (Kötter et al. 2015). However, no further evaluation of the proposals with a larger number of students has been initiated.

Students prefer a timetable leaving time for physical exercise but are less likely to accept options where they have to present themselves in person to talk about difficulties (see Fig. 1). The support option that was viewed as the most applicable to enhance the state of health was the establishment of a clear study structure. Changing the curriculum from a teacher-centered traditional setting to a student-centered approach proved appealing to medical students and effective in diminishing depressive symptoms, especially in female students (AlFaris et al. 2014). Hence, this is an option that should be explored further at medical schools.

The results from the included BDI-II depict a distribution related to other studies among students with some students presenting symptoms of severe depression (Rotenstein et al. 2016). Various studies evaluate additional ways of treating depression and mental health issues apart from the pharmacological approach (Kvam et al. 2016; Prathikanti et al. 2017). Exercise compared to no treatment evoked a significant improvement in the well-being of the participants (Kvam et al. 2016). In our survey, a sports program that accommodates a full student schedule ranked third best, meaning that the awareness of the impact of physical exercise among students is present. Also, generally, a higher BDI-II correlated significantly with a higher level of application to many of the proposed support options. Hence, this is one big factor on which future support programs should be based.

A meta-analysis of the treatment of burnout among medical doctors indicates that supportive working conditions strengthen mental health even more than just individual therapy (Panagioti et al. 2017). Several factors prevent medical students from seeking mental health support, among them are the stigma surrounding it and the lack of time (Rodriguez et al. 2017). Still, surveys show that students report major improvements in their stress levels and coping abilities when they participate in an elective subject on coping strategies (Pereira et al. 2015).

The options proposed in the questionnaire only partly matched this survey population. A significant correlation with a specific option was the use of exercise/sports classes and relaxation techniques frequented by female students, which could be explained through the fact that female students tend to have stronger stress reactions (Pradhan et al. 2014). The frequency of diagnoses of mental problems is also higher among females (Picco et al. 2017).

One benefit of this survey is the fact that all students of the first 5 years of a medical school were assessed. The last (sixth) year is missing because students attend the practical year at various teaching hospitals outside the surveyed school. Still, surveys of such dimensions are rarely implemented (van Dijk et al. 2017).

Mostly, studies try to assess a pre-clinical year and a clinical year and then compare the results of these two years (Riemenschneider et al. 2016). Although this survey was carried out at one German medical school, it has to be stated that students are assigned to universities following a central selection process for all German medical schools. A strong selection bias can, therefore, not be assumed for the assessed students. This is also supported by the heterogeneity of the survey population (see Table 1).

What is also a clear advantage is not only the large population compared to other surveys, but also the objective approach to assessing students’ opinions. Other surveys applied more subjective techniques (Kötter et al. 2015). We chose courses where a high response rate could be achieved. This resulted in varying survey dates throughout the semester. Students in their exam session might be under more stress and be more receptive toward a support program (Metzger et al. 2017). Nonetheless, this helped to achieve this large sample size of participating medical students.

According to this survey, only a few students would participate and take advantage of each option proposed. A large group of students ranked the support options between 3 and 5. This represents the target group of undecided students that might respond to implemented support. Further research should identify other options. One possibility could be to include fewer choices, which might result in clearer preferences.

Students tend to underestimate the effect of group treatment and overestimate their own ability to change lifestyle habits (Kendal and Diug 2017). Hence, it is also crucial to increase knowledge and awareness about coping strategies and support options. This results in encouraging medical students to seek assistance in order to strengthen their health before severe damage to their mental state has been done (Puthran et al. 2016; Hayes et al. 2017).

Surveys could be carried out at other German universities as well as universities outside of Germany to enhance the validity of the data from the University X for medical students (Lucchetti et al. 2018). This should also include students from other fields apart from medicine. In addition, cooperation between schools may be initiated in order to establish partnerships between students from different University departments. This would support medical students to widen their circle of study friends to include students from different subjects (van Ark and Wijnen-Meijer 2018). Qualitative research commenced in the form of interviews to identify support options named by the students themselves should be further pursued (Kötter et al. 2015).