February 23, 2021 by
Christopher Veal, Larner Class of 2021 medical student (Courtesy photo)
In a commentary in the journal Academic Medicine, titled “We Burn Out, We Break, We Die: Medical Schools Must Change Their Culture to Preserve Medical Student Mental Health,” fourth-year Larner medical student Christopher Veal reveals his personal experiences as a Black man dealing with depression and suicide ideation and calls on the medical education community to change its culture to support the mental health of its learners.
Veal writes, ". . . from my own experience with depression and candid conversations with classmates about their personal struggles, I know that each of us had our own unique situation, and each of us reached a breaking point at which we had limited support from the medical school. Support is critical — self-advocacy in the midst of depression is almost impossible."
To change the culture and preserve students' mental health, Veal implores medical school leaders to recognize the incredible pressure that an investment in medical school puts on the student and make it clear that their institution will do everything in its power to ensure successful completion of medical school, by providing supportive academic and wellness services, among other resources.
In support of Veal’s call to action, Dean Richard L. Page, M.D., in a message to the Larner College of Medicine community, affirmed “the commitment of our College to each of you in promoting an environment of unwavering support for mental health.” Dean Page aligned this commitment with the tenets of the Larner Statement on Professionalism, which emphasize cultural humility, kindness, and respect, along with compassion and accountability.
In his commentary, Veal cites several reports, including one from 2019 by the American Medical Association’s Council on Medical Education, which states that "medical students are three times more likely to commit suicide than the rest of the general population in their age range in other educational settings.” In his message, Dean Page acknowledged this disproportionate trend in the field, the compounding impact of academic pressures and expectations for success, and the greater degree to which this stress can impact students from underrepresented groups.
“Our culture must normalize students’ requests and need for academic and psychological support,” Dean Page wrote.
As Veal notes, getting access to these supports proved transformational: “Although I failed the Step 1 exam on my first attempt, the coping skills I learned through CBT helped me prepare to retake and pass the exam just a few months later. I learned that failure is an option, and it can be used as an agent for growth and change. I embraced my need for a tutor and a therapist. Taken together, these changes allowed me to do more than just pass the Step 1 exam—they helped me get my life back. Through my third-year clerkships and into the start of my final year, I began to feel I was becoming the physician I was destined to be.”
Dean Page shared the following list of affirmations in his message to the Larner community as expressions of his commitment to fostering an environment of wellness:
- Our community shall embrace the fact that we are all vulnerable and must give a priority to self-care and wellness.
- We shall work to eliminate any stigma associated with mental illness or the need for psychological assistance.
- We aspire to provide equitable academic and personal support for each student.
- We shall offer tools for members of our community to help recognize and assist in the setting of psychological crisis, including the risk for suicide.
- We shall assure that each student is provided information regarding the confidential mental health services that are available.
Veal’s call to action prompted Dean Page to task the Office of Medical Student Education, Wellness Committee, and Office of Diversity, Equity and Inclusion with developing a working group to assess current services and identify ways to optimize effectiveness, and to initiate a collaboration between the College, the UVM Graduate Medical Education office, UVM Health Network Medical Group, UVM Medical Center leadership, and UVM Staff Council to “align our priorities regarding wellness, resilience, mental illness, burnout and suicide prevention.”
Veal's commentary will appear in printed form in the May 2021 issue of Academic Medicine.