College of Medicine adds to its wellness emphasis
Doctors are a notoriously hard-working, perfectionist bunch. The flip side of that is they’re more prone to burnout, depression and even suicide. Those troubling trends are seen in medical school as well. A 2008 study in the Annals of Internal Medicine found that 50 percent of medical students experienced burnout and 10 percent had suicidal thoughts. That’s why the American Association of Medical Colleges has mandated that medical schools begin implementing programs on student well-being, said Myra Haney Singleton, Ed.D., associate dean for student affairs and student wellness in the College of Medicine.
The college has been working on student wellness for a couple of years now, but a new staff member focused on student wellness is bringing the issue to the forefront.
|Adrienne Edge, M.Ed.|
“Wellness is not about being happy all the time,” said Adrienne Edge, director of student support and wellness. “It’s about when life happens to you, how quickly can you bounce back? How resilient are you? And we want them to learn things are going to happen; the day is not always going to go the way you want it to. That test or exam may or may not be what you expect, but when things are going on, and it’s piling on top of you, how can you get through that?”
By teaching students how to care for themselves, educators hope students will continue to attend to wellness as they become residents and then practicing physicians.
It’s about cultivating a culture of wellness, Singleton said. That can sometimes go against the ingrained physician culture of long hours, and there was some resistance when the idea was first broached a couple years ago. But Dean Raymond DuBois, M.D., Ph.D., is fully supportive, she said.
“It’s slow, but the process has started,” Singleton said.
|Myra Haney Singleton, Ed.D.|
For the last several years the college has grouped students into “treehouses” — small groups of first-year students partnered with second-year mentors and faculty advisors. This year the student affairs group will use those small groups as the foundation for the wellness curriculum.
Students have a tendency to look to the future — what will happen with boards, what will happen in the match — instead of at the present. Emphasis on Now, or EoN, small groups will meet a couple of times each semester to discuss topics that aren’t part of the academic curriculum but might be affecting students’ studies — for example, a hurricane and its aftermath, which could affect how well students can concentrate on school.
The first EoN discussion will be in October and will focus on bias in medicine.
As an alternative to small-group discussions, there will also be panel sessions in which students can hear from faculty members about a topic. The students will reflect and journal on the topic after the panel discussion.
Also rolling out in October is an university-wide initiative for the student body called Exercise is Medicine.
Coordinated at MUSC by the Office of Health Promotion, Exercise is Medicine is a program of the American College of Sports Medicine.
|Susan Johnson, Ph.D.|
“The overarching goal is to connect clinicians with fitness professionals and to view physical activity as a vital sign,” said Susan Johnson, Ph.D., director of health promotion.
Students who go to Student Health or Counseling and Psychological Services (CAPS) will be asked how many days a week they exercise and for how long. Students who exercise less than 150 minutes per week — or half an hour for five days — will be referred to the Wellness Center for a meeting with an Exercise is Medicine-certified trainer. The voluntary 45-minute session will help students identify what’s keeping them from exercise and to come up with strategies to incorporate exercise into their day.
Responses from the annual student survey in April indicate about half the student body doesn’t meet the 150 minutes per week recommendation for exercise.
“We know the students are really challenged with their schedules, and a lot of times their personal health takes a back seat to academics,” Johnson said.
It’s easy to pick up bad habits that continue through residency and into professional practice. But studies have shown that doctors who exercise are more likely to counsel their patients about exercise, and their patients are more likely to listen to them.
Olivia Hesslein, who is studying for a master's degree in public health and will graduate in December, has been working to get the Exercise is Medicine program started. She said this initiative is something she’d like to see as a student.
“It’s giving them the tools and the resources to make it easier,” she said. “All the students at MUSC are intelligent people. They know what is going to make them healthier and keep them healthy, but it’s the barriers they face with time, money and resources and fitting everything into their day while not losing their academic edge.”
|Angela Dempsey, M.D.|
Time becomes even more of a precious commodity once students begin their clerkships. At that point, students begin to work a schedule similar to a “real” job and because of those hours, they might become more isolated from family and friends, said Angela Dempsey, M.D., College of Medicine associate dean for curriculum in the clinical sciences.
In addition, the clerkships are their first experiences with the emotional part of medicine — seeing a patient die, having to deliver bad news or just realizing how the health care system can fail patients, she said.
“We’re really aware that those are things that can impact their wellness,” Dempsey said. “Our goal in the wellness initiative in the clinical years is to begin to give them tools and insights they can use, not just in their time in medical school but as they go into their clinical careers.”
Because the demands of each clerkship are different, each one is crafting its own wellness initiative. In Medicine, for example, it’s an afternoon off so students can fit in their own doctor or dental appointments. Psychology will have a cognitive reflection group to teach the students how to work through patient experiences. Surgery is working on mindfulness and might do research to see how mindfulness training affects students.
|Students gather for a Step 1 study break in March.|
The dean’s office is also working to ensure students can request mental health services without judgment or stigma, Dempsey said.
Physician and medical student wellness wasn’t something that was much understood when she was in medical school, she said. Looking back, she can see the seeds of bad habits were planted in medical school, which is why she hopes that proactively working with students to develop good habits around nutrition, sleep, exercise and mentally working through the negative parts of the job will help them remain resilient. But, she said, the overall medical culture still has to catch up to what research has shown about physician wellness.
“It doesn’t do us much good to carve out a little utopia for them here while they’re in medical school if in two years when they enter residency they are not equipped with what they need to handle that stage,” she noted.
The college wants to ensure students leave here with a full toolbox of wellness elements they can draw from. “We know they’ll need it,” Dempsey said.
Students who’ve competed in, or just heard about, the COM Cup will be pleased to know that the college is continuing this event along with several other existing wellness initiatives.
The COM Cup debuted in March 2017 after Singleton suggested a field day event to the wellness council. The students took the idea and ran with it.
“They took a small concept and made it into a huge day-long event of activities and competitions that include the faculty, staff and the students,” she said.
The COM Cup also includes a cooking competition at the Urban Farm.
The day is fun — and a little goofy — but it’s also a means to get students outside into the sunshine and fresh air and to emphasize physical activity.
Student Affairs also provides healthy snacks during exam study times, encouraging students to take much-needed breaks. Those breaks are intentional, Edge said. It’s not just about providing granola bars; it’s about educating students on wellness, which includes proper nutrition, and preventing student burnout. Students put an enormous amount of pressure on themselves at exam time, particularly for the pivotal Step 1 exam.
“We can’t take that pressure away, but we can help them manage the stress and the pressure,” Edge said.
Many of the wellness activity ideas come from the student wellness leaders who are part of the Wellness Council.
The college also works with CAPS and other student services to help students who need intervention. The college doesn’t want students to isolate themselves or assume no one else is struggling.
“We’re building a culture where it’s OK to ask for help,” Edge said.