I was sitting in a presentation at the 2016 conference of the American Association of Colleges of Osteopathic Medicine in Washington, D.C., when the student presenters shared the data that they had collected from osteopathic medical students nationwide. And I almost fell out of my chair.
Ten thousand medical students responded to the Council of Osteopathic Student Government Presidents (COSGP) survey designed to measure levels of depression and anxiety. The conclusion they had reached was that, nationwide, 54 percent of osteopathic medical students self-reported being clinically depressed and/or anxious at some point during their four years in medical school. Fifty-four percent.
Recent studies, such as Rotenstine, Ramos, Torre, et al. (JAMA. 2016;316(21):2214–2236), had provided conclusions that 20 to 27 percent of medical students nationwide were clinically depressed at some point during their medical school years. My own professional experience working with medical students on a daily basis led me to believe it was somewhat higher than 25 percent, a number already substantially above the general population. But when you begin to consider that over half of our medical students are depressed and/or anxious, that is an overwhelming number.
If we as medical professionals and educators were confronted with over half of our patient population having the flu or meningitis, for example, we would label it an epidemic, declare a public health crisis, and begin emergency procedures to treat and care for the sick.
Yet, historically, medical educators have accepted that being burned out, unhappy and even depressed is just part and parcel of the gauntlet that is medical school and medical training. And in many cases, medical educators have even actively encouraged systems, traditions and practices designed to frustrate future physicians to, in essence, “toughen them up.”
Four years ago, we began a discussion at KCU about how we could place student wellness at the heart of our Student Services philosophy. We began planning for how we could systematically address burnout, stress levels, depression, suicidality and general wellness.
There is a clear need to do this in a way that is different from the status quo at most medical schools. National research is unequivocal in demonstrating that the medical educational philosophies of the 1960s and 1970s simply don’t work with this current generation of students. And achieving these changes is possible without breaking the bank. The following is how KCU set about focusing on student wellness.
Systematic Changes to Student Services
Five years ago, Student Services at KCU was a diffuse group of administrative offices that had individualized missions, visions, and goals. We changed that by bringing all student-related services — Admissions, Financial Aid, Registrar, and Student Affairs — under one department, run by a single vice provost.
This approach allows us to work toward a single mission and a single set of common goals for all four offices and provides for more collaboration in how we offers programs and services to our students, in both our College of Osteopathic Medicine (COM) and our College of Biosciences (COB).
Secondarily, we place our singular focus on making sure we’re positively enhancing students’ experiences on a day-to-day basis. Customer service has become a natural priority, and in a couple of our offices, we have changed cultures that previously were focused on saying only “no” to students, to a culture that now emphasizes saying, “Let me see how I can help you solve your problem…”
Activities such as yoga, held here as a sunrise session during a Wellness Week, bring students together to release the stresses of academic rigor.
These cultural changes allow us to more clearly and effectively emphasize the osteopathic foundation of insuring that our students’ minds, bodies and spirits are cared for on a daily basis.
Enhancing Counseling Services
One of the major additions we made to Student Services was creating an on-campus, full-time Office of Counseling Services. Prior to this decision, students were referred off-campus to clinicians through the University’s employee assistance program (EAP).
We added two full-time, doctorate-level licensed psychologists to begin meeting with our students. The effects of this change were felt immediately. Students quickly filled the new 70 hours per week of counseling sessions that were available. And for student crisis situations, Student Affairs added two new staff who are available to assess potentially suicidal students on-campus, just a short walk away. This saves time and provides immediate care for our students in crisis.
In addition to the new on-campus resources, we kept our EAP contract in place, primarily so that we would have a nationwide network of providers for our third-and fourth-year rotating students. This provides them with mental health care and support while outside of the Kansas City metro area, via an easily accessible website and a 1–800 hotline.
Lastly, our Office of Counseling Services sponsors a year-long series of seminars focused on emotional intelligence. These seminars, available to our medical students, are shaped to provide both information on personal wellness and professional balance. Some of the topics of the seminars have included: “Emotional Wellness and Bioethics,” “Emotional Wellness and Being a Trauma Surgeon,” “Emotional Wellness on Clerkships,” “Emotional Wellness in the Operating Room,” “Emotional Wellness in the Emergency Room” and “Emotional Wellness in Internal Medicine,” to name a few. These seminars are taught by our own faculty and some of our KCU alumni.
Changes in Student Activity Programming
Each year, when the Office of Student Affairs is considering its budget requests for the upcoming fiscal year, the conversations around the table are no longer about “fun stuff” we can do for students. Rather, the conversations have focused on “What fun things can we do for students that emphasize personal wellness?”
As we have planned these events for students, we really have focused on how we can impact the whole student. Examples of programming include:
Mind
Meditation and mindfulness classes taught by one of KCU’s Buddhist faculty members
Emotional intelligence workshops
Motivational speakers such as Dayton Moore, general manager of the World Series Champion Kansas City Royals
Regular interaction with certified therapy dogs that are brought to campus during stressful weeks
Body
On-campus yoga classes
Group runs around and near campus
Core workouts
Chair massages, on-campus, by certified massage therapists
Spirit
Faith-based celebrations such as Ramadan, Christmas, and Hanukkah
Support from student-organized and student-run religious organizations, such as our Muslim student organization
Student access to a university chapel for daily prayer and reflection
Peer encouragement programs, which tap students to identify and communicate positive reflections with their medical student and master’s degree peers
Consistent and Ongoing Student Well-Checks
As a proactive step to identify at-risk students as early as possible and apply effective interventions with those students, KCU has begun administering the Maslach Burnout Inventory (MBI) to our medical students and master’s-level students. This nationally recognized tool allows the University to gauge each student’s personal level of burnout, which is often predictive of levels of depression and anxiety.
The MBI is sent to students at the midpoint of each of the fall and spring semesters. All students are required to take the MBI. Once individual results are available, students are then placed in three separate categories based upon their inventory scores: 1) a high-risk category, identifying students who need immediate intervention; 2) a moderate-risk category, identifying students who need follow-up, but not immediately; and 3) a low-risk category, including students who do not need any follow-up at the time. Each of the students in categories one and two is assigned to a Student Affairs staff member for personal follow-up.
Interventions with students may include a visit to Counseling Services, a referral to an off-campus psychiatrist, and/or an appointment with one of our Learning Specialists to assist the student with academic problems. Each intervention is specifically tailored to the individual student’s needs.
Development of Student Wellness Council
KCU has formed a Student Wellness Council, which fosters a culture of advocacy, promoting students’ personal growth, wellness and resilience.
Our Wellness Council meets once a month and consists of students from each of our COM classes, as well as representatives from our COB class. Each meeting is student-driven and focuses on: programming for students outside of class; our curriculum and ways we can improve student wellness from an academic perspective; and the opportunity to talk about University systems, policies and procedures.
As administrators working with the Wellness Council, we take student concerns and ideas to other administrators and faculty and serve as a bridge between the Council and the University administration. So far, we are seeing positive results.
Intentionality
“Wellness” has become one of those trendy words within higher education and especially within medical education during the last year. Ultimately, the success of any program designed to ensure students’ health and happiness should not be based upon trendy words. The success of any program should be based upon intentional effort, every day, to promote student well-being through the University’s mission, vision, values, goals, decisions, planning and actions.
Remember that nationally, 54 percent of our medical students are telling us that they are clinically depressed because of the educational experience we are providing for them. This should be a call to action for all medical educators to no longer continue the status quo. If we are able to change this paradigm now, what we will find in the future are healthier students, healthier residents and healthier physicians in our communities. And each of them will be modeling to their patients how to find wellness in their own lives.
Biography
Richard Winslow, PhD, is Vice Provost of Student and Enrollment Services, Kansas City University of Medicine and Biosciences.
Contact: RWinslow@kcumb.edu
