Institute of Medical Education, Cardiff University; Prepare to Share; College of Medicine, Swansea University; Independent Researcher; University of Exeter Medical School

BackgroundThe GMC commissioned research to inform the development of guidance for medical schools (n=32) on how they can best support students with mental health concerns.[1]

Adopting a mixed method approach e-survey (n=24), telephone interviews (n=15) and site visits (n=5) helped to explore areas of good and innovative practice.

Seven focus groups were held with students across five medical schools and biographical narrative interviews were conducted with 11 current students who had experienced, usually serious, mental health problems. References

The seven focus groups were designed to ask students (n=40) about their perception of attitudes towards mental health problems among medical students and the medical profession (Table 1).

Data collection

Table 1: Focus Group statements

Statement 1: Socio-cultural pressures to which medical students are subjected render them more susceptible to mental illness and, through fear of stigma and adverse Fitness to Practise procedures less likely to seek the help they need when they do develop mental illness

Statement 2: Medical schools face a dilemma of care. They must care for their students, who have an increased risk of developing mental health problems, and they must care for the public, who could potentially be exposed to considerable risk from doctors who have unresolved mental health issues.

Belief Mediating Processes Imagined consequences

1.Mental ill health is a weakness that wont be tolerated2.Doctors dont get sick/should be superhuman

3. Mental illness can be hidden/self-treated

1. Scare/War stories from senior clinicians 2.Presenteeism as a cultural norm/Barriers to seeking treatment e.g. time off3.Experience

1. Being expelled/leave of absence 2. Personal reputation/Being seen as a slacker

3. Fuels fear of being found out but many succeed

1.The system seeks to weed people out rather than support them2.Fitness to practise covers every aspect of your life unreasonable expectation of perfection

1.Distrust of staff/Confusion between performance and pastoral roles2.Messages that medical students are different/grey areas about conduct

1.Being expelled/Judgement rather than support on my record2. Expulsion/Damage to personal reputation/being caught out for something you didnt know was wrong

1.Medicine is the only career option2.Other options are failure

3. Being average isnt good enough

1.Investment from an early stage2.Structure of the profession/Options are rarely discussed except as a negative consequence3.Intense inter-student competition

1.Being expelled/Leave of absence2.Failure/letting parents down

3. Losing respect of peer groupIncidence of student FtP cases 30,000 medical students in the UK Medical Schools 375 cases per annum = 1.3% About of cases are health related = 125

Far from supporting the commonly held imagined consequence that getting kicked off the course is common (Table 2), the MSAR data supports the view that such occurrences are extremely rare.

ConclusionOutcomes of student FtP hearings involving health in the two year period 2011-2013 1 student was expelled for reason of health 7 students were expelled for reason of a combination of health and behaviour 23 withdrew or were temporarily suspended A far more common outcome was the provision of some kind of support or a lesser penalty such as a warning.

Medical Schools Council Annual Return 2011 & 2012 (MSAR) [2]

[1] Grant, A., Rix, A., Mattick, K., Jones, D., Winter, P. (2013). Identifying good practice among medical schools in the support of students with mental health issues A report for the General Medical Council (GMC)[2] Medical School Annual Return (MSAR) (2012) - a report by the Medical Schools Council

Peter Winter, Andrew Rix, Andrew Grant, Debbie Jones,

Karen MattickWhat medical students are frightened of and why?Secondary analysis of medical student focus group data

Table 2: What focus group students believe

Primary Analysis Focus group transcripts containing responses to the two statements were analysed thematically during primary analysis of the data [1]

It emerged that the majority of students commonly accepted that disclosure of a mental health problem would be a Fitness to Practise (FtP) issue and automatically lead to their immediate withdrawal from their course.

Despite the consistency of this message students were incapable of giving tangible examples of who had been excluded from medical school as a result of mental health issues. This prompted secondary analysis of what students had to say regarding their beliefs about FtP.

Content Analysis facilitated:

(1) The exploration of students fears of adverse consequences of disclosure of a mental illness (RQ 1: What do students fear?) (2) What was said in the context of FtP? (RQ 2: What confirms or denies these fears?)

The synthesis of key terms relating to causes of fear across transcripts comprised a systematic search for contextual data regarding students fears: Fear; Weak; Scared; Mistake; Excluded; Pressure; Career; Criminal; Error; Trust; Sued; Fitness to Practise.

Contextual excerpts were then coded into 3 Fears (Table 2)

Secondary Analysis