On an unusually chilly spring day, a fourth-year medical student in northern Missouri completed his mission with such surety that only dental records could identify his remains.
“He was going to get it right this time,” lamented his father, who declined to have the family identified. His son, who died from a self-inflicted gunshot wound, was weeks away from earning a DO.
More than 300 mourners were on hand for the premature burial of the 26-year-old, including state lawmakers attempting to push through legislation to deter the alarming rate of depressions and thoughts of suicide amid medical students in Missouri. Among them, Keith Frederick, DO, one of four doctors serving in the Missouri Legislature, and a state representative (R-Jefferson City) who proposed House Bill 867, the “Show-Me Compassionate Medical Education Act” in the 2015 regular legislative session.
By the time Frederick’s bill had churned through the legislative process and was awaiting a final look acknowledging the acceptance of a conference committee report, a Senate filibuster over a Right-to-Work vote killed it, along with a couple of dozen bills awaiting similar action during the volatile last week of session.
“This topic – a dirty little secret of medical education for decades – badly needs the light of day,” said Frederick. “One of the biggest problems is that medical schools say, ‘we’ve got this covered,’ but they don’t.”
Even though HB 867 nearly crossed the finish line, medical school deans balked early on. As originally drafted, the bill would have established an anonymous online survey to screen medical students for depression and provided for access to immediate help through an existing 24-hour hotline for students in crisis. It would have also required the state’s six medical schools – two public, four private – to conduct the screening. Results would have been made public after three years.
Strong opposition came from the Washington University School of Medicine (WUSM) in St. Louis, consistently ranked among the nation’s top medical schools by U.S. News & World Report, and world-renowned for its 124-year history of groundbreaking research.
“Washington University’s primary concern – voiced by all six Missouri medical schools – was a provision that would have required the State of Missouri to publish the rates of depression among MD students at each of the state’s medical schools,” said Lisa Moscoso, MD, PhD, associate dean for students affairs at WUSM. “In its earliest form, House Bill 867 would’ve required the Missouri Department of Mental Health to determine rates of depression using a state-mandated survey tool, though student participation in the survey would’ve been optional. We noted that a voluntary survey instrument would give schools an unreliable view of the scope of any mental health challenges. We also worried that a government-mandated survey and reporting process for what is unquestionably a sensitive matter would undermine the culture of trust each school strives to build with its student body.”
Frederick modified the bill while it was held for more than a month in the Social Services Committee, and then medical schools unofficially removed their opposition to the bill, which Frederick plans to pre-file this fall.
“The measure that was before the Senate in the final weeks of the session represented a reasonable approach to raise awareness about medical students’ mental health and to encourage Missouri medical schools to collaborate to identify best practices, particularly those efforts that are most effective at de-stigmatizing mental illness and encouraging students to seek support and services to cope with mental health issues,” said Moscoso.
Margaret Wilson, DO, dean of A.T. Still University’s Kirksville School of Osteopathic Medicine in Kirksville, Mo., expressed concern about “confidentiality and potential to cause stigma to students.” Since modifications have been made, “the bill meets with my school's support,” she said.
In its final form, HB 867 dropped the requirement that medical schools undertake this study, but protected medical students and medical student organizations from interference or retribution from the medical schools when planning or conducting screening for depression or other mental health issues among medical students.
Britani Kessler, MD, immediate past president of the American Medical Student Association (AMSA), traveled from Virginia to testify before the Social Services Committee that “mental wellness” is the organization’s most frequently clicked-on website link.
“The culture of the current medical education system is that you can’t show weakness,” said Kessler. “The rigors of medical school make you sometimes think this sustained high level of stress is normal.”
The AMSA Board of Trustees has expressed interest in launching a national pilot program to survey medical students anonymously at various intervals of their educational training. To Kessler’s knowledge, Missouri is the only state to have attempted to pass legislation relating to medical students’ mental well-being.
“The purpose of the AMSA is to help pre-med and medical students learn things they aren’t taught in traditional medical education,” said Kessler. “We’re very feisty about medical education reform and making sure the social determinants of health are included.”
Frederick said more changes are needed in medical education, like national award-winning modifications made to the four-year curriculum at Saint Louis University (SLU) School of Medicine in St. Louis, Mo., to reduce the damage rather than emphasize that medical students need to learn to cope with the existing medical education structure and harshness.
“As SLU’s groundbreaking study revealed, medical education can greatly reduce the harm inflicted on medical students,” he said, “without adversely affecting achievement and board scores.”
LINKS:
Missouri House Bill 867: http://openstates.org/mo/bills/2015/HB867/
A.T. Still University: http://www.atsu.edu/
Washington University School of Medicine: http://medicine.wustl.edu/