Bruce Bassi#FuturePsychiatryPodcast discusses novel technology and new ideas in the field of mental health. New episodes are released every Monday on YouTube, Apple Podcasts, etc.
Summary
Sean Woodward is the PsychSIGN (Psychiatry Student Interest Group) national President and Medical Student at Northwestern University Feinberg School of Medicine. Sean and I discussed medical student stigma and factors that prevent students from seeking help. Dr. Bassi cited a study that gave examples of how to promote medical student mental health OTHER than simply encouraging more mindfulness. Another study gave suggestions to faculty to how to support medical students.
Chapters / Key Moments
00:00 Preview
08:09 What is PsychSIGN
12:24 Differences in med student experiences
16:16 Changes to psychiatry curriculum
21:34 Stigma against psychiatry as a career path
26:18 Should everyone have a therapist
27:58 Learning from patients
30:09 Stigma of medical students
32:46 Should medical students disclose mental health history to psychiatry residencies?
36:12 What else, other than mindfulness promotes med student mental health?
39:13 Suggestions for faculty to encourage med student mental health
Transcript
Sean Woodward (guest): Because the question came up, “Should I disclose my history of mental health in my application to psychiatry residency?” And one of our program directors said, “I would love it if I could say yes. I would love it if you could disclose your mental health status as a way of describing your interest in psychiatry.” But she said, “don’t do it it.” And she brought up a paper, and they found that on average, the students who disclosed mental health issues performed more poorly in the match.
Bruce Bassi, MD (host): Hello, and welcome to the Future Psychiatry podcast, where we explore novel technology and new innovations in mental health. I’m your host, Dr. Bassi, an addiction physician and biomedical engineer. If you are joining for the first time, I would greatly appreciate if you subscribe and share it with your friend network on social media. Additional resources, a full transcript and group discussion form can be found on our website telesychhealth.com. Then click podcast in the top right corner. Thank you so much for joining us, and I hope you enjoy the discussion today. All right, today we have Sean Woodward, a third year medical student at Northwestern and national president of PsychSIGN, a medical student organization for those interested in psychiatry. Sean, I appreciate you joining me today to discuss some interesting topics related to medical student mental health and curriculum.
Woodward: Thank you, Bruce. I’m very happy to be here and to get the opportunity to speak about these topics, which kind of really happens.
Bassi: Yeah, I have to disclose I got two flu shots yesterday, one covered booster and a regular flu shot in the same arm. So my brain is a little bit slow today. And I know you came off surgery right. So your brain is probably a little slow for other reasons.
Woodward: Hopefully we are perfectly synchronized.
Bassi: Yeah, totally.
Woodward: No fever or anything, at least, right?
Bassi: No fever, just kind of pretty sore. But I think it’s good for the long run. That’s how I’m trying to reframe it. Short term pain, long term gain.
Woodward: Investment in the future.
Bassi: How was your surgery rotation? Before we get into more other mental health related topics. I feel like when I was on surgery, if you told them what you’re going into, there is a little bit of judgment about your personality off the bat.
Woodward: Yeah. I had an interesting interaction with one very well known plastic surgeon. I won’t name him, but he was finishing up a breast surgery I was in. Oftentimes plastics will come in to finish up those surgeries. And he’s known for developing a particular type of suture, and he’s also known for asking a lot of questions about this type of suture, kind of selling it across the hospital. He kind of tries to lead people into kind of the design of the suture and its necessity.
Bassi: Humble bragging.
Woodward: Yeah, humble bragging. A little bit of that. So he was standing next to me in the surgery doing his work and looked at me and asked me if I was a medical student. I said yes and started asking me these questions about the history of the suture, where it originated. Turns out to be Agent Egypt, what are the things a suture is good for? Cutting cheese. And a few other questions along these lines. And surprisingly, I’m not sure what happened inside my head, but I was able to answer all these questions correctly. Where you put that? Yeah. He he was very, very surprised and impressed. He looked at his fellow, his plastic surgery fellow, and asked him if he had, like, preps me for this to kind of punk him or whatever the phrase would be, said, no. And he kind of nodded, finished the surgery, and just at the end said, you should consider plastics, and left the room. His fellow was was still in there and began talking with me, showing me his technique and everything. And the fellow asked me, what do I want to go into? And I said psychiatry. Or maybe anesthesia and the look on that fellow’s face after I said that was a bit priceless. There was a sigh, and he kind of looked down and got quiet, the anesthesiologist on the other side of the curtain yelled, yes and put her hand up, her arm up.
Bassi: Yeah. There’s, like, a sense that I’ve gotten once, but they feel that, like, talent is wasted if it’s not going into surgery.
Woodward: Yeah. It’s almost as though the pinnacle of human achievement is surgery.
Bassi: I’ve had that experience once where I just out of good fortune and luck, I read the right chapter right before a particular chief complaint that we were rounding on that day, and then you’re just, like, nailing it right in a row. And it’s such a good feeling in the converse of getting pimped and totally not getting it.
Woodward: Yeah. There’s an addictive— where surgery is known for for that pimping. And it’s an addictive environment when you play by the rules or you satisfy the surgeons and you get a little bit of affection and love because it’s so limited, I guess, in the operating room, that sort of affirmation that you feel very special when it’s given to you in that environment.
Bassi: I was brushing up on some articles on med student mental health, and I came across an article on pimping, actually, and the authors said that people who are more likely to pimp were younger faculty, male participants, specialists, and those reporting a lower quality of life. And I wonder if authors put that in there to swipe people away from pimping. If this gets out that the more people are pimping, there maybe could be judged as being kind of onerous and disgruntled. Then maybe they’ll stop doing it.
Woodward: Yeah. Pretty interesting. Why does that happen psychologically? That’s interesting. Yeah. I imagine it serves some sort of purpose for them, the pimping. Maybe it’s a way of getting entertainment that they don’t get elsewhere or the sense of authority that they don’t get elsewhere or something. I was talking with another student once about the culture of pimping and everything, and I never found his article, but he cited this article saying that as we become older, we need more and more pain or maybe sub acute trauma to learn. I’m not sure if you know anything about this, but the idea is that we learn better when there’s a little bit of pain.
Bassi: I can attest to that, with watching my son grow up. I mean, pain is probably the most highly correlated variable to getting him to learn that certain things are hazardous or that are very dangerous to him. And even though they can’t communicate under one, they definitely remember very traumatizing falls or devices that had pinched them or whatnot. And so I do think there’s truth to that, I mean, sadly, but hopefully it’s not being applied directly to med students.
Woodward: Yeah, you would hope there’s a better way. A neurosurgeon once described to me how he learned, and he said, becoming a neurosurgeon is just a series of traumatic experiences.
Bassi: It’s a sad statement, I think.
Woodward: Yeah, it is sad.
Bassi: Yeah. Let’s talk about PsychSIGN and what their mission is and how you found it helpful to be engaged in this as a president.
Woodward: Yeah. So PsychSIGN the whole name is Psychiatric Student Interest Group Network, which I think describes its function pretty well. So we’re a national group affiliated with the APA, the American Psychiatric Association, and our purpose is to really unite all of the individual student interest groups at medical schools around the country. So your average medical school will have a psychiatrist and interest group and will create events specific to that school, but oftentimes will not get the opportunity to collaborate in larger scale events. So one main function that PsychSIGN serves is to have all these regional chairs, each of whom will kind of interact frequently with the medical schools in their region. And they’ll also host regional specific events. They’ll host kind of mixers or opportunities for the leadership at individual school student interest groups to meet each other and to collaborate. And then the region chairs will all come together under our national president elect, and together they’ll try to create more events specific to the regions or maybe to the country at large.
Bassi: Does PsychSIGN monitor medical student interest and how it’s grown over the past five years? I don’t know where I thought I heard this, but I thought psychiatry was becoming more and more popular and competitive. And I looked at the data from the I guess the ERAS data over the past five years, and I looked at the number of total potential applicants and then the number of applicants to psychiatry specifically. And over the past five years, it hovered, I think, around 15% to 17% or so of all total applicants. And so I was kind of surprising. I was a little disappointed in that.
Woodward: I don’t know if psychSIGN has any sort of metrics that you guys trend over the last few years or not. We have noticed that we do have some numbers as far as our membership over the years. We haven’t done the work to see if that correlates well with the total applications. It’d be a good question to ask. We do have a sense, very qualitatively, of how competitive each application cycle is and who’s applying. And we do see much more competitiveness in the psychiatry match. We see that the match rate has been going down, and I think that’s another way it’s been reflected. So I was just looking at the number. I think it was in the high 80% match rate a year or two ago, and that’s very low, actually. Consider something like vascular surgery is 80, 83%. Psychiatry was just a few points higher than that. So it does seem to be becoming more competitive. Most of the seats are filled. There are more medical students applying more medical schools, which is a factor. International medical schools too. And every year there are international students applying to psychiatry residency programs. And it used to be a kind of a safe bet for international students. Not a safe bet, but within arm’s reach. And we are seeing as becoming more and more difficult for them to match, suggesting that there are more US. Medical students applying for these seats than there were before. Unfortunately, I don’t have the numbers handy.
Bassi: I always found it interesting when I was an M1, M2, M3. You’re kind of looking at the match data from your school, and I don’t know if it could be attributed to just chance alone and randomness, but there will be certain classes that will have eight people go into nerve surgery, and then there will be one or zero, like the next class. And there’s like this ebb and flow. And I wonder if there’s some element about the way a course was portrayed or a mentor who was particularly on one year when people were trying to make their decisions. And it got me to thinking about how even within the same med school or even the same class, you might have a totally different experience depending on what rotation you were assigned to, like on surgery or psychiatry. I just remember there being a high degree of variability among different rotations and the expectations, schedules, how fun they were and things like that.
Woodward: Yeah, for sure. I’ve talked about this with other students, with residents and faculty too. At the end of the day, there’s really not enough information for medical students to choose a specialty because there is so much noise. A single positive mentor is the difference between applying to a specialty and never even considering it as a valid option. For example, my school is known for producing many urologists per capita, and it’s surprising until you kind of get to know the urology department here. The urology department is an extremely positive place. Amazing mentors. When a student says they’re applying for urology, everyone from the department chair to the residency director will stand behind the student and vouch for them. And yeah, when once you get to yeah, like I was saying, once you kind of start to see these dynamics, it’s not so surprising that that urology is such a popular field. I was in urology for part of my surgery rotation, and everyone was fantastic.
Bassi: And I’ve heard of certain scenarios where somebody had a really strong mentor in a particular field, and that kind of skewed their whole perception of the field itself. They go into the field thinking that they really like it because they really like this one mentor and felt like it was kind of skewed their whole perception of the field itself because that person was so strong and guiding them into that.
Woodward: Yeah, it’d be interesting if there was a way to take– I guess there was a way for programs to take advantage of that. Just recruit good, positive people that students interface with, produce good mentors or hire good mentors. I guess that’s easier said than done, though, right?
Bassi: Yeah. I wanted to talk about med school curriculum briefly after med school. I can’t tell you how many times I’ve heard “we don’t cover this enough” in med school. There’s that slogan all the time, and it’s impossible to cover everything. So to some extent you can say that about something. You could find a way that points to a certain topic being covered in lesser percentage than it should be just because of the fact that we have a finite amount of time in med school, like nutrition or the billing aspects of being a physician, how to manage burnout, quality improvement and patient safety, healthcare policy, transgender health. Just broadly speaking, before we kind of hone in on psychiatry, are there any recent changes to Northwestern curriculum that you’re aware of and kind of the impetus behind those?
Woodward: Yeah, so I think one significant change that just began when I was there was the addition of a data science thread. So they are not actually they are teaching a little bit of programming. I was going to say they’re not teaching programming, but they are teaching a little bit. But while they’re not really getting into the weeds of data science tech, they are making students familiarize themselves with some higher level data science tools like Orange. I think there’s a little bit of Python programming, not much. And most importantly, they’re making students just aware that data science exists and kind of what you can do with it, specifically what machine learning is and what you can do with it. I think that’s been an important change. Another thing, we do have some business courses that we get in our first two years, I wouldn’t say business so much as lectures on the healthcare system. We had talks on Affordable Health Care Act about the general framework of insurance companies, this sort of thing. So we are getting some exposure to that as well. I’m trying to think there were there is try a push to do more outreach at least at Northwestern. So for instance, we have a program called ECMH which is a longitudinal clinical experience that we do throughout our four years. We’ll tend to connect maybe once every two weeks or so where we might see the same patients do primary care. So we are creating or Feinberg is creating some new threads to work that ECMH program into outreach in the community. So we have quality improvement projects where we try to consider where our patients come from as far as socio demographics and other issues or other circumstances and tailor care to them connecting with communities around Northwestern to try to give them preventative care options. So for instance, something I worked a little bit on was wellness: we are starting a project to give wellness training to the surrounding community that will follow up on during clinic.
Bassi: So I totally get med school is about understanding the basics and fundamentals of psychiatry. But as an outpatient clinician, much of the day kind of spent with telehealth, talking about psychedelics technology, talking about those things and maybe I’m a little biased too my perspective. So I don’t necessarily think it’s a plausible argument to just look at a pie chart of how attending spends their time and say that a med school or med student should mimic the exact pie chart because they need to be exposed to all the basics and the highest pathology, more acute pathology. But if you wanted to do additional learning and how telehealth works like is that incorporated? I imagine with COVID there’s probably got to be some sort of exposure to that.
Woodward: We get some telehealth experience in certain clinics that are more that are staying remote. So I personally got it a little bit in epilepsy clinic and sleep clinic and REI reproductive endocrinology clinic. As far as psychiatry goes, I didn’t really get any telehealth experience, mainly because our experience is primarily inpatient so outpatient where you get most of the telehealth involvement wasn’t something that we experienced.
Bassi: What is the general interest level among your peers? You probably talk to more people who are maybe interested in psychiatry than average student in your class, but is it a pretty popular field to go into among your peers?
Woodward: It’s not particularly popular at my school. I think there is increased interest just based on actually an upcoming meeting on the application process for psychiatry. Based on the enrollment though, I hear from members of PsychSIGN, from leadership in PsychSIGN that around the country there’s a very strong interest in psychiatry. I hear that psychiatric interest groups can be as large as 20 people if not more so. I think at the national level at least, there’s increasing interest in psychiatry, and I think there are a lot of things contributing to that. I think one thing that historically has impeded students interest in psychiatry is, one the stigma. I think a lot of students carry stigma that their parents do about psychiatry and just don’t considering it, don’t consider it a viable option.
Bassi: Like, basically a psychiatrist is not a real doctor?
Woodward: Essentially something to that effect, yeah, psychiatrist is not a real doctor. And just even just stigma around general mental health, I think, is a factor. And the idea that psychiatric medication shouldn’t be used, period, I think that affects a lot of people’s decisions. I know students here who don’t believe in psychiatric medications, so I think that’s significant.
Bassi: Yes, it’s partially a fear of the unknown and also questioning whether or not there’s some sort of financial conflict of interest behind the psychiatric medications because it is more difficult than medicine that’s geared towards diabetes to determine how well it’s working. A lot of the studies look at six weeks, ten week studies of outcomes, and the pharmaceutical industry profits immensely off of a lot of these medications are very popular in the country. So I think that probably adds to stigma against psychiatry.
Woodward: Yeah, for sure. I think another factor that I’ve heard is that psychiatry is kind of covering up problems in our society that would be better solved with large scale societal changes and restructuring. There are so many social determinants of health that lead people to anxiety, to depression, needing to work multiple jobs to make ends, meeting to work in one job 12 hours a day to make ends meet in the culture associated with that. And I think there’s a feeling that we would need fewer antidepressant meds, for instance, and fewer SSRIs if we just kind of resolve these issues with society. And I agree it would be great to resolve these issues. I don’t think it would be realistic to do so. And I think that we do need to have mercy on the people who do find themselves in these situations, but they shouldn’t be made to suffer until their circumstances change. That’s something else that I’ve heard cited that turns people away from psychiatry.
Bassi: There was a podcast that I was listening to recently that went into a lot of depth about contextual errors and how we need to pay more attention to that. Because if you’re looking at a retrospective chart review whether or not you did a good job treating a patient, and you just look at whether or not the treatment was given doesn’t necessarily illustrate whether or not the patient actually engaged with that treatment, took the medications, were able to afford them, or if it had other sort of secondary consequences on their life. So I think that’s a really important factor. Seems like what you’re kind of describing. I think there’s a level of appreciation too, from the patients. When you’re not quick to prescribe right away, you get to know them. You have a longer visit, you talk about other things going on in their life, and you kind of basically include the person in the treatment decision. Making process and kind of talk out loud about what you’re thinking, what could help them and maybe some other aspects of their life that they can focus on to improve, meaning, satisfaction in their life rather than just giving them a medication which is just an overlay on top of some other maladaptive behaviors that are going on. In particular, I often see patients who are unemployed, recently unemployed or underemployed, come to me for depression. It’s like, do you give an antidepressant when 99% of the issue comes down to the fact that they have no income right now and they’re very stressed financially?
Woodward: Yeah. There is a lot of growing appreciation, especially in the context of COVID in our society for therapy, medication society. I think a lot of people are valuing therapy more and more. I’ve heard it said by many people, just didn’t around me, not in medicine, that everyone should have a therapist. Usually they don’t say everyone should have a psychiatrist, but everyone should have a therapist. Right. And in fact, there’s this movie on Netflix right now called Stutz. It’s interesting the way they frame the relationship between Stutz and Jonah Hill is a bit artsy. It’s just kind of who’s interviewing questions about there are questions about who’s interviewing you, where the perspective of the audience is between them. So there are a lot of artistic considerations in the filming of the filming of the documentary. But at the heart, I feel it’s kind of interesting story about who Stutz is, what brought him to psychiatry, and specifically psychotherapy, and what his method is about. And essentially he practices a form of therapy that I would describe as being somewhere between CBT and old school psychoanalysis. I won’t share any more details, but I think that film has become so popular because of just the emphasis on therapy and on positive therapy and simple techniques you can use in the moment and long term to reframe your thinking without pharmaceuticals.
Bassi: It’s interesting what you said about it’s hard to tell who’s interviewing who. And it kind of reminded me of one thing that I often remind myself of my career path is that I feel like as a student, med student, I felt like I was in this role to teach. I thought being a doctor meant that you have to teach them what’s right. And then as I progressed further along, I started to realize that there’s so much untapped knowledge that the patient knows, and especially in the world of addiction psychiatry, that I can learn from and start to speak the language for the next patient about what they’ve taught me. And I think that’s really important. And it kind of goes back to what we were discussing in understanding contextual errors in our treatment plan and planning and how important it is to kind of understand their life and their situation before making a recommendation.
Woodward: Yeah, that is something that I think is becoming more emphasized in medical school, at least in my medical school, which is reassuring. We’re taught, speaking to what you were mentioning before about kind of eliciting the patient’s own knowledge. We’re taught to use motivational interviewing to kind of lead our patient towards changes they can make and towards things that we can better do to help them, and more specifically, to potential errors. We’re taught to really dig into what is preventing people from taking their medications, from coming to the physician’s office, et cetera. Whereas maybe the old school method of dealing with medication nonadherence would be to just try to bully the patient into taking the medication, saying, “hey, you really need to take this. What are you doing?” Now we are trained to ask more questions about what’s preventing the health care habits that we’re looking for, we could talk a little bit about stigma of medical students themselves seeking treatment.
Bassi: And it almost makes sense to me that there will be stigma, because if there’s stigma about the field of psychiatry in general, that’s not even involving any self disclosure, of course there’s going to be even more stigma about potentially opening up, about going through a difficult time. Remember when I was a medical student, there was maybe some talk about, like, ADHD treatment and being on an SSRI, but nothing really that specific. I think out of fear of being judged or fear of whatever, I’m thinking of you. You are constantly wanting to portray this external outward perception of competence and stability towards your peers and your mentors and whatnot. So to disclose about one’s mental health struggles is kind of antithetical to those underlying goals of what students have. And what are your thoughts about stigma within the medical school and student community about receiving mental health treatment?
Woodward: Yeah, so there’s a lot of reluctance for medical students to disclose. I’m thinking a couple of years back, my school has a wellness committee that tries to run different school oriented events to promote wellness. And at one point, we were discussing having a panel of students with a diagnosed psychiatric psychological conditions speak to the student body about their struggles. We ended up finding needing to find some residents. So that the problem was we all thought it was a good idea to have this in theory, but we had significant difficulties recruiting anyone willing to speak up. We had one fourth year medical student who was very openly interested in psychiatry, going to psychiatry, who was happy to do it, and that was essentially it among medical students. Otherwise, I think we found a couple of residents and maybe a young attending to participate, but there was a lot of fear among students to participate. You could tell, there’s a fear that this will hurt not only hurt the student’s image among their classmates, but hurt their application chances. And speaking to that within PsychSign or as a member of PsychSign, I hosted one residency director panel for students applying to psychiatry. That’s particularly memorable because the question came up, should I disclose my history of mental health in my application to psychiatry residency? And one of our program directors said, I would love it if I could say yes. I would love it if you could disclose your mental health status as a way of describing your interest in psychiatry. But she said, don’t do it. And she brought up a paper written about students applying to residency. It wasn’t specific to psychiatry. Students applying to residency with both disclosure and nondisclosure of their mental health conditions. And they controlled for other variables like scores and grades and what have you. And they found that on average, the students who disclosed mental health issues performed more poorly in the match.
Bassi: That makes sense to me. As a clinician who does a lot of hiring, I’ve probably reviewed over 1500 resumes for non clinical and clinical positions. And it’s very commonplace for people to describe why they’re interested in our company, to say that they were interested in mental health because of their own struggles in mental health. And reading it over and over and again, it feels like not really that well thought out. It’s almost so kind of stereotypical. And I want a person who’s kind of fleshed it out more than just having had a few good experiences from their perspective. I want to know that they’re actually like it as a career path in addition to just having personal experiences, because we have personal experiences that are good. And I have personal experiences a lot of restaurants, but it doesn’t make me want to become a chef.
Woodward: Yeah, that’s interesting. That’s something that I haven’t thought of before. But I know all specialties deal with their run of the mill personal statements that they get sick of reading in surgery. I’ve heard it said, we don’t want another personal statement talking about how good you are with your hands.
Bassi: Yeah, just another eye roll for them, probably. Here we go again.
Woodward: In anesthesia they don’t want another application about how calm you are under pressure or about how anesthesia is like something else that is not like fishing, it seems. For radiology, I’ve heard it said that they don’t want the radiology application talking about how you like scavenger hunts or like solving puzzles. Yeah, it’s probably getting harder and harder to write a fairly moving personal statement these days then. Yeah, I can see why these topics are so popular for students to talk about. It’s probably hard to impress someone who reads hundreds, thousands of applications every year.
Bassi: In preparing for this talk with you, I came across an article by Neufeld in 2020 that basically was saying that. while, yes, people who are well practiced with mindfulness and resilience, it does help reduce stress. And whatnot, what is also important for them is to have their psychological needs met and they define those by having strong levels of autonomy, competence and relatedness. So as a student, kind of like what we’re talking about, like layering a bandaid over something, yeah, you can put mindfulness on top of a really stressful environment, but that doesn’t necessarily change the stressful environment. But in order to make them feel like they’re enjoying themselves in their life and they have a purpose in med school. Give them a sense of autonomy. Make them feel that they’re independent thinkers. Promote a sense of competence. Where they feel like they can achieve these challenging goals that are set in front of them and then promote relatedness where they’re feeling that they belong to a community of other people who are like minded. I thought that was an interesting article and I’ll reference it in the resources section on my website. What are your thoughts on that?
Woodward: I agree completely and that those three experiences, for lack of a better word, are important to someone’s pride, to their competence. And I also think that it’s very hard to achieve them as medical students. Competency and autonomy are two things that medical students are known for not having. We’re switched between rotations every four weeks, every four to eight weeks, and even within those rotations, we’re switched between services every week eventually. And so the idea that we can never feel competent in what we’re doing is kind of absurd.
Bassi: Almost the exact opposite, because the staff around you at the new service know you know nothing about their service and the way it runs. And then there’s going to be this massive time sink of their efforts to train you for a week and then you leave and then they have to do it all over again. Speaking of that repetitive stereotypical nature, I can kind of understand where they’re coming from. There’s really no good way to fix it, though. If you want to expose a med student to a lot of different services, by definition you need to be moving around a lot in that four year period of time.
Woodward: I agree. I know some schools are moving to a system where only the first year rather than the first two years of school preclinical or pure book learning, which should open up time to do more clerkships and specifically longer clerkships where there’s less of that movement. But even so, like you said, this is the nature of the beast. We’re going to be switching fast, maybe a little bit slower, depending. But still, one week in a service isn’t that much different than two weeks.
Bassi: In wrapping up the stigma topic for medical students, there was an article I came across that was more geared towards advice and suggestions for the faculty rather than what the students need to be doing differently because God knows we put enough on students already. And this was an article by Hodgson in 2020, and they came up with, I think it was like 13 tips, and I jotted down a few that I felt like were particularly salient.
1) Arranging and maintaining formal communication points throughout the academic year and laying a foundation of open communication encouraging self reflection, self care
2) providing opportunities for support seeking with open door periods during the week where appointments are not needed.
3) Responding promptly and briefly to emails from distressed students and giving them opportunity to meet with those faculty members
4) giving adequate time for appointments and reinforcing the message that it’s okay to not be okay and to try to partially normalize what their experience is in dealing with personal stressors that are ongoing and just will continue to go on.
And medical school itself just keeps chugging along and you can’t stop it from going on to the next rotation and feeling the sense that you’re stuck in this process of med school, but you can’t really take a break because that’s going to affect your cycle for residency applications and whatnot. Yeah. So I like this idea, this article, where it was providing a little bit more suggestions for the faculty members about how to support a student who is going through a difficult time.
Woodward: It’s hard. Yeah, I think a difficult scenario because the student is going to be naturally reluctant to lean on faculty, I think, when they’re undergoing difficult times because inevitably they’re going to be wondering whether their vulnerability will be used against them. Kind of in the same way we were talking about before about disclosing mental health status, something that I think a lot of students appreciate understanding and less like draconian ruling in medical school makes a big difference. But I think something that medical students appreciate in particular is just having kind of time to recharge, which I think many medical students don’t or many medical schools don’t offer to the extent that they could. I know that medical schools are trying to increase the dimensions of teaching that they offer. For instance, giving students experience with QI projects, giving them experience with data science, with business and medicine, but kind of including all these different threads comes at the expense of giving students time for themselves. And students are very aware that what they’re being judged on at the end of the day, as far as getting into residency, are certain tangibles or tangibles, but certain specific items like shelf score, like step score, like clinical evaluations. And I think it’s easy for students to view anything else as kind of fluff that’s just kind of inhibiting them from feeling well.
Bassi: Yeah, 100% agree. So you mentioned that you were interested in natural language processing as it applies to mental illness detection, I should say. Tell me a little bit about how your interest in that evolved and where you see yourself jumping in in the future.
Woodward: Yeah. So my background is in acoustics, and I worked a little bit with dolphin sounds. Not to take us on a big tangent, but that’s my research background. In entering medical school, I kind of had this particular view of language being closely connected to behavior. And it’s a perspective that seems to be somewhat new in medicine, at least in a formalized sense, at least in a machine learning sense. There are research groups kind of just beginning to kind of probe the depths of the interaction between language and behavior. And I was interested in getting on board that my impression, and the impression of people in the field is in the tech field, is that there’s a lot of low hanging brew to be had connecting language and behavior. So, for instance, Agatha Christie, very famous author, she was prolific in her works, and she got dementia. It was noted that the vocabulary of her books continued to diminish, and it was very casually observed that that was probably an indicator of her dementia. And so you can imagine a system that would just count the richness of a vocabulary as one part of a system for predicting dementia. Of course, as a very simple example, people are also looking at schizophrenia at the characteristic disorganized language associated with that and predicting that no, there’s a lot of really good use applications.
Bassi I found an article recently published in nature, April 2022 this year by Tianlin Zhang, and it was a very good review article, basically, of natural language processing and all of its different types of protocols that people have utilized. And there’s a lot it very quickly goes kind of a little bit over my head, which scares me a little bit, because I feel like I’m pretty educated individual and have an interest in this and engineering background. But I think you need to have a complicated solution for a complicated problem, because a lot of this is difficult even for a human to understand based on tone, voice, how to analyze somebody’s sentiment and emotions based on what they’re saying. And if a human can’t do it, then the machine learning algorithm needs to take that data and use it to encode its process, its model, in order to kind of give you accurate results. This article definitely covered a lot of it very well. They talked about social media messages on social media platforms, transcripts of interviews and clinical notes. So those are the main things that they were looking at. They were looking at mainly language that was transcribed into text. So they weren’t actually looking at the waveforms themselves of the of the speech patterns, but they were looking at twitter. That was like 30% of the data sources that they looked at. I think there’s the advantage of looking at twitter is that these text snippets that are short, that was another point that they brought up, that there’s not really that many public databases to feed into the algorithm for learning purposes, training the algorithm.
Woodward: I know some companies which offer psychological services such as telehealth therapy are starting to collect data that they’re trying to do research with. In fact, even company like Facebook Meta is constantly doing analysis along these lines using the data that people give to them freely.
Bassi: Yes, the field obviously is moving very quickly, and machine learning is already incorporated into our day to day activities with Google’s filtering out spam, malware, your bank, identifying fraudulent credit card transactions, potentially Alexa and Siri using these algorithms to understand what you need based on prior search actions and orders that you’ve placed. So I think it’s important to as mental health clinicians to stay abreast of these topics so that we’re still involved in them and talk about and we continue to talk about the ethical concerns and considerations and how to appropriately apply these to mental health issues. It’s interesting that in a way, industry, these companies, like these social media companies, are actively trying to hack the psychology of patients, of consumers, and in some ways creating new psychological traps that psychiatrists and psychologists need to address.
Woodward: I know that some people in mental health are focusing specifically in social media addiction right now. I think for that reason, or just that reflects that psychology isn’t stagnant or the areas people need counseling with aren’t fixed, that they will change as technology changes, as new forms of addiction are created.
Bassi: They’ve become so good at making content and apps so engaging that it created a new problem. Now they have to make a new solution to the problem they just created by now, letting you know what your screen time is and providing reminders to put your phone down and disconnect and do something else. I feel like that’s pretty funny the way things have evolved. Originally they were trying to grow the platforms and get people to be totally entertained and keep using them as much as possible for their advertising revenue, probably most likely. And now they have a different problem on their hands where there’s this social discontent and awareness now that a lot of their metrics and strategies have become so good that it really got out of hand.
Woodward: Hopefully that there is some shame there, and some real efforts to reduce screen time. I think maybe Apple’s incentive is a bit different than the incentives of some of the people who design their apps, unfortunately. So hopefully there’s a battle and wellness wins out.
Bassi: Well, Sean, it was really nice talking to you. I appreciate your insights. You’re very astute and wise for your years and appreciate you getting to tell our audience about struggles of mental health these days within the medical school community and what things are being done to address it. And I think that’s really important because the better the health of our students, the better the health of the clinicians down the road who treat patients so it’s obviously very important and that’s why I invited you on today.
Woodward: So thank you so much. Thank you, Bruce. It’s been a pleasure.
Bassi: As a reminder, if you’d like to support the show, one way you can help us is by subscribing to the channel on YouTube and leave a comment if you’d like. It also mean the world to me if you can share it with your social media network. Maybe there’s somebody out there who might be interested in the podcast. Hope to see you next week. Next Monday. New episodes are released every Monday morning. Thanks a lot. Take care.
Resources
Adam Neufeld: Basic psychological needs, more than mindfulness and resilience, relate to medical student stress: A case for shifting the focus of wellness curricula
https://pubmed.ncbi.nlm.nih.gov/33016810/
Jessica Hodgson: Twelve tips for novice academic staff supporting medical students in distress
https://www.tandfonline.com/doi/abs/10.1080/0142159X.2020.1831464
Natural language processing applied to mental illness detection: a narrative review
https://www.nature.com/articles/s41746-022-00589-7
Contextualizing Care Organization w/ Dr. Saul Weiner
https://www.contextualizingcare.org/
