From Medical Student to Medical Resident: Graduate Medical Education and Mental Health in the United States

From Medical Student to Medical Resident: Graduate Medical Education and Mental Health in the United States

Warren G. McDonald (Methoodist University, USA), Matt Martin (Southern Regional Area Health Education Center, USA) and Lenard D. Salzberg (Southern Regional Area Health Education Center, USA)
DOI: 10.4018/978-1-5225-2811-1.ch006
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Abstract

The transition from medical school to board-certified medical practice includes a period of intense, practical training known as medical residency. Medical residents are at risk for greater mental health distress than the general population. Interns, which are first year residents, are most at risk for, at worst, depression and suicidal ideation, and, at best, negative outlooks on the medical profession. Risk factors include role transition, decreased sleep, relocation, isolation, stigma toward mental health problems and treatment, and health care industry changes. Untreated mental health problems can lead to burnout later during a physician's career. Residents thrive on social and organisational support which can include systematic screening and treatment of mental health problems. Although research regarding best practices for addressing mental health problems during residency is limited, we offer four core strategies for preventing and addressing mental health problems in medical residents: education, screening, treatment, and support.
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Background

Residency selection is a long and cost-intensive process. During the fourth year of medical school in the United States, students apply to multiple residency programmes devoting significant money and time. Concurrently, residency directors and coordinators spend substantial resources recruiting and interviewing students for a limited number of slots. After interviews conclude, faculty members meet and rank all applicants according to programme fit and quality. Osteopathic students match to their respective residency programmes at the beginning of February while allopathic student match in the middle of March. Residency selection is a long and arduous process for both sides. New residents report to their programmes in June or July, complete orientation, and begin their first rotations.

First-year residents (interns) hit the ground running. Even during orientation, interns are signing medical orders and patients charts. They assume responsibility of continuity patients from recently graduated residents and make treatment decisions at the hospital. With a limited patient panel and under the watchful supervision of attending physicians, interns act like fully-functioning physicians. During the first three months of residency, incidences of depression can increase from 4% to 27% while suicidal ideation can increased nearly 400% (Sen et al., 2010).

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