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      Taking care of our future doctors: a service evaluation of a medical student mental health service

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          Abstract

          Background

          Studies suggest medical students experience high levels of mental distress during training but are less likely, than other students, to access care due to stigma and concerns regarding career progression. In response, The School of Clinical Medicine, University of Cambridge supported the development of the ‘Clinical Student Mental Health Service’ to provide specialist input for this vulnerable group. This study evaluates the efficiency and effectiveness of this service.

          Methods

          Using mixed-methods, cross-sectional analysis of validated psychiatric rating scales and qualitative feedback, 89 responses were analysed from 143 clinical students referred, between 2015 and 2019. The care pathway included initial review by a psychiatrist, who triaged students to psychologists delivering therapies including: Cognitive Behavioural Therapy, Interpersonal Therapy, Eye Movement Desensitization Reprocessing Therapy or Cognitive Analytic Therapy.

          Efficiency was assessed by waiting times for psychiatry and psychology interventions, and number of sessions. Academic outcomes included school intermission and graduation. Clinical effectiveness was analysed by measuring global distress, depression, anxiety, functioning and suicidal risk. Pre/post intervention changes were captured using t-test and McNemar test with thematic analysis of qualitative feedback.

          Results

          Referral rates increased from 3.93% (22/560) in 2015 to 6.74% (45/668) in 2018. Median waiting times for initial psychiatric assessment and start of therapy was 26 and 33 days, respectively. All graduating students moved on to work as junior doctors.

          Levels of distress, (t = 7.73, p < 0.001, df = 31), depression (t = 7.26, p < 0.001, df = 34) anxiety (Z = − 4.63, p < 0.001) and suicide risk (Z = − 3.89, p < 0.001) were significantly reduced. Participant’s functioning was significantly improved (p < 0.001, 99.5% CI 4.55 to 14.62). Feedback indicated high satisfaction with the rapid access and flexibility of the service and the team clinicians.

          Conclusions

          A significant proportion of medical students attending the service scored highly on validated rating scales measuring emotional distress, suicidality and mental illness. Reassuringly they benefitted from timely specialist mental health input, showing improvements in mental well-being and improved functioning. The development and design of this service might serve as an exemplar for medical schools developing similar support for their students.

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          Most cited references10

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          Interventions to reduce stress in university students: a review and meta-analysis.

          Recent research has revealed concerning rates of anxiety and depression among university students. Nevertheless, only a small percentage of these students receive treatment from university health services. Universities are thus challenged with instituting preventative programs that address student stress and reduce resultant anxiety and depression. A systematic review of the literature and meta-analysis was conducted to examine the effectiveness of interventions aimed at reducing stress in university students. Studies were eligible for inclusion if the assignment of study participants to experimental or control groups was by random allocation or parallel cohort design. Retrieved studies represented a variety of intervention approaches with students in a broad range of programs and disciplines. Twenty-four studies, involving 1431 students were included in the meta-analysis. Cognitive, behavioral and mindfulness interventions were associated with decreased symptoms of anxiety. Secondary outcomes included lower levels of depression and cortisol. Included studies were limited to those published in peer reviewed journals. These studies over-represent interventions with female students in Western countries. Studies on some types of interventions such as psycho-educational and arts based interventions did not have sufficient data for inclusion in the meta-analysis. This review provides evidence that cognitive, behavioral, and mindfulness interventions are effective in reducing stress in university students. Universities are encouraged to make such programs widely available to students. In addition however, future work should focus on developing stress reduction programs that attract male students and address their needs. Copyright © 2012 Elsevier B.V. All rights reserved.
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            Distress among matriculating medical students relative to the general population.

            Many medical students experience distress during medical school. If matriculating medical students (MMSs) begin training with similar or better mental health than age-similar controls, this would support existing concerns about the negative impact of training on student well-being. The authors compared mental health indicators of MMSs versus those of a probability-based sample of the general U.S. population.
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              The mental health of university students in the United Kingdom

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                Author and article information

                Contributors
                Rebecca.Jacob@cpft.nhs.uk
                sharon.lity@gmail.com
                Zoe.Martin@cpft.nhs.uk
                Amanda.Burren@cpft.nhs.uk
                Peter.Watson@mrc-cbu.cam.ac.uk
                Rhian.Kant@cpft.nhs.uk
                rgd25@medschl.cam.ac.uk
                dfw23@medschl.cam.ac.uk
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                29 May 2020
                29 May 2020
                2020
                : 20
                : 172
                Affiliations
                [1 ]GRID grid.450563.1, ISNI 0000 0004 0412 9303, Dept of Liaison Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, ; Cambridge, UK
                [2 ]GRID grid.120073.7, ISNI 0000 0004 0622 5016, Dept of Liaison Psychiatry, Addenbrookes Hospital, ; Hills Road, Cambridge, CB2 0QQ UK
                [3 ]GRID grid.5335.0, ISNI 0000000121885934, MRC Cognition & Brain Sciences Unit, , University of Cambridge, ; Cambridge, UK
                [4 ]GRID grid.5335.0, ISNI 0000000121885934, School of Clinical Medicine, , University of Cambridge, ; Cambridge, UK
                Author information
                http://orcid.org/0000-0002-2152-1847
                Article
                2075
                10.1186/s12909-020-02075-8
                7257172
                32471406
                8e9f2745-081a-4235-8492-40160e0b7bc1
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 16 October 2019
                : 12 May 2020
                Funding
                Funded by: NIHR ARC East of ENGLAND
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Education
                higher education,medical student,mental disorders,fitness to practice,service evaluation
                Education
                higher education, medical student, mental disorders, fitness to practice, service evaluation

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