Overall the teaching session seemed to be going well. There is a gentle buzz of activity but one of the students seems distracted. His attendance on this attachment has been poor and your attempts at engaging him with gentle, simple questions have been stonewalled. You speak to him after the session and it’s evident that he has been struggling for some time. His mood is low; he appears to be holding back and is clearly worried about confiding in you and the university. 

Our experience as educators would suggest that everyone involved in teaching will encounter a similar situation. Compared with non-medical teachers, healthcare professionals often feel an extra responsibility to students with health concerns. With mental health problems we can find ourselves caught in a maze of ethical and professional dilemmas. The reluctance of medical students to discuss mental health problems candidly is understandable. In the past, the response to students who are struggling has been variable. Attitudes of individual teachers and medical schools have differed considerably. The publication of the General Medical Council (GMC) guidance on supporting medical students with mental health conditions is therefore particularly welcome.¹

Although the report identifies some interesting themes, it is the qualitative research undertaken by the authors themselves that adds breadth and depth to the document. They conducted an online survey and structured telephone interviews with medical schools. In addition, they talked to educators and students. One of the most striking themes identified was the reluctance of students to seek help. When asked to choose available sources of support, just over half the students would prefer to seek help from a friend, a quarter would approach their family and 10% would try to help themselves. Only 10% would choose to approach their GP, medical school or university support services.

Although the narrative approach has its limitations, the shorter GMC report is essential reading for all those who come into contact with undergraduate medical students. There are three reasons for this conclusion. Firstly, it is clear that the document itself will be widely circulated and medical students will be encouraged to read it and refer to it. Therefore, students will reasonably expect to be treated in a manner consistent with the GMC advice.

Secondly, wide appreciation of the scale of the problem and application of a supportive, nurturing response to mental health problems should help to de-stigmatise mental health problems in the wider community. Doctors and medical schools have an opportunity to lead in this area.

Finally, it offers some clarity on our professional responsibilities to students with mental health problems. This includes practical advice about how and when fitness to practise procedures should be considered and how to manage transition from medical school to foundation training.

The stakes are high. The suicide rate in doctors as a group remains higher than that of the general population, and these problems seem to have their roots in medical school, with medical students reporting poorer mental health than age-matched controls. The problems experienced by such students are real and need to be dealt with. This should enhance resilience and reduce burnout throughout the medical community.

Reference

1. General Medical Council. Supporting medical students with mental health conditions. 2013 [www.gmc-uk.org/education/undergraduate/23289.asp]