Stress takes toll on med students

Juan Velazquez was just one year into medical school when a patient suffering from a heart attack came into the clinic. The office had just opened its doors and with the physician not yet checked in, Velazquez knew he didn’t have time to think. He needed to act. “I did my job and I didn’t really stress out about it,” he said. “Afterwards, my legs were shaking because I realized what I had dealt with. I said ‘You know what, I freak out every day right now in school and if I freak out now, who’s going to keep their head?’”

For Velazquez, 26, the stressors he must face as a second-year student in MSU’s College of Osteopathic Medicine can only make him stronger. But new challenges of balancing his roles as a husband and father with friends and an increased workload heavy on memorization have forced Velazquez to deal with life under pressure.

This lifestyle can send many medical school students spiraling toward burnout — and not all of them are willing to talk about it.

Reaching out

Each year, MSU’s College of Osteopathic Medicine ushers in about 200 new students.

In a September edition of the medical journal Annals of Internal Medicine, a study examining U.S. medical student burnout and suicidal ideation showed 50 percent of more than 2,000 medical students surveyed at seven medical schools reported burnout.

Eleven percent of those students said they considered suicide within the past year.

Within the last 10 years, one student in the College of Osteopathic Medicine committed suicide. There have been no suicides reported in the College of Human Medicine in that same span of time, said Judith Brady, the college’s director of student counseling and wellness.

“Far too long the attitude has been that training is supposed to be stressful and that the degree of stress brought about by training is OK,” said Tait Shanafelt, a senior investigator in the study and faculty member at the Mayo Clinic in Rochester, Minn.

The study, “Burnout and suicidal ideation among U.S. medical students,” offered hope to the student participants feeling the burn from continuous studying. More than 25 percent of students who met criteria for burnout recovered by the following year.

Despite the large number of medical school students who report depression and burnout, few will seek help.

“Do we have to press students? Yes,” said Celia Guro, director of the College of Osteopathic Medicine’s personal counseling and professional development.

“In the past, there’s been such a stigma to go for mental health,” Guro said. “We always say in our college it’s a stigma if you don’t go for mental health.”

Starting early

New pressures come with a student’s acceptance into a medical program and problems once easily suppressed can quickly surface as the strain of medical school begins to set in.

“One thing I always say to them, and this is what they remember, is if they haven’t looked at their issues or resolved their issues before they get to the college, often medical school will bring them out,” Guro said.

Eric Rueff asked many medical students and pre-professionals about medical school before he applied to MSU’s College of Osteopathic Medicine, but he said no response could prepare him for the high volumes of required material.

Rueff, a second-year student in the college, graduated from MSU in 2007.

His immediate jump to medical school following graduation delayed his feelings of burnout until he reached the halfway mark in his first year.

“It affects everybody at some point,” he said.

“It just depends on how you respond to it. If you feel a little burnt out, you have to take a little break, but you have to realize no one’s going to get you up and do the things you need to do.”

Although he never sat down with Guro, Rueff said time management and study skills workshops offered by the college helped him adapt to his work load.

“Coming in, the hardest thing to adjust to was just kind of setting myself up for the fact that this is now the career path I’m choosing,” he said.

“Unlike undergraduate, where you can get by without knowing the stuff or fully understanding it … I need to know the material to treat the patient.”

Weathering the storm

Velazquez spends most of the 14 hours he is awake each day studying, with an occasional interruption to eat or change a dirty diaper.

“Usually around 7 or 8 (p.m.) I try to stop studying to spend time with my wife and hang out with her for an hour or two,” Velazquez said.

He begins his day at 7 a.m. to watch class lectures online, punctuated with short breaks to prepare lunch and care for his son. For Velazquez, going to classes isn’t practical.

“I personally don’t have time to go to class because I’ll waste a half-hour parking and walking to class,” he said.

Today’s students must memorize more information than ever before due to new technology opening the doors to new scientific research. This demand on students can become a source of stress for many, said Scott Becker, associate director of the MSU Counseling Center.

“The field is more complex than it’s ever been and it changes faster,” Becker said. “What you learn this year might not be applicable next year. It’s learning how to learn.”

Although depression sets in when his family leaves for vacation and Velazquez is left with his books and an empty apartment, he said the depression will recede eventually.

“Medical school is a lot of storms,” Velazquez said.

“Some little thing will make everything disappear, whether coming home and seeing your baby smile or just having a little bit of time with your wife or that grateful patient says something wonderful to you. You really start appreciating the little things in life when you’re under this much stress.”