UP CLOSE | A class of its own: How medical students balance mental health and career aspirations

UP CLOSE | A class of its own

How medical students balance mental health and career aspirations

Published on April 19, 2023

Julia Schaffer MED ’25 said she grapples with how much of her life should revolve around her identity as a physician. 

While on rotations with medical residents at the hospital who work 80 hours a week, Schaffer described how it can “seem like that’s their whole life and their whole person.”

“It’s this ideal that I have to be a doctor as a person,” Schaffer said. “That’s always there and something to be struggled with. Do I have to be doctor-like outside the hospital? Is it some quality inside me that needs to be stable no matter where I am? … Does my whole life need to revolve around the centerpiece that is being a physician?” 

Schaffer is a part of the peer advocate program, a student wellness resource at Yale School of Medicine. Founded in 2000, the program consists of medical students nominated and selected by their peers in their first year to be a 24/7 resource that other students can reach out to if they need to discuss any personal, academic or professional struggles they may be facing. 

The advocates discuss problem-solving strategies and point students toward other resources if need be, as the focus of the program is to discuss more acute mental health issues, explained Schaffer. Once selected, peer advocates hold this position throughout their time at YSM.

All students receive a contact card with the numbers of every advocate. If contacted, the advocates respond within 24 hours. 

Student stories

Samiksha Chopra MED ’29, another peer advocate, said that she has enjoyed each step of the medical school process more than the last. However, Chopra acknowledged that there are unique stressors on medical students that can be damaging to their mental health — particularly regarding what students have to see in the hospital.

Chopra’s interest in medicine began at a young age. Her grandfather was a doctor in India, and while he never got the chance to practice medicine in the United States, he passed down what he knew to his granddaughter. Chopra has memories from when she was young of her grandfather teaching her how to use a stethoscope and take blood pressure. 

When her grandfather had a stroke, Chopra decided she wanted to specialize in neurology. At University of California Los Angeles, Chopra studied neuroscience with the hope of someday going into pediatric neurology. 

In coming to YSM, Chopra said she was tasked with finding a new community far from Los Angeles, where she had always lived. Chopra said it was important to her to make connections with others, and she was humbled to be selected as a mental health peer advocate.

“I’ve been really big … on wanting to make connections with a lot of people in my class,” Chopra said. “Coming from LA, I had all my family there… so I’ve been used to having these huge networks of people that no matter what I could depend on … My first year here was really, really spent trying to foster that family for myself.”

Chopra explained that people come to her as a peer advocate for a wide variety of issues.

She outlined that these issues tend to fall into one of three buckets: academic stressors, struggles with personal life and what students see in the hospital.

“A lot of times we, as medical students, think that [what we see in the hospital] is part of being a student.” Chopra said. “But I think it’s actually just a really unique part of being a healthcare provider. I think that’s something that no one can really prepare you for. What happens when you walk into a patient’s room and feel like, ‘this could be my family?’ or ‘this could be me?’”

Chopra explained that she personally has had to grapple with this issue over this past year. According to her, YSM has amazing resources for academic stressors, but less help to support students with regards to what they see in the hospital. 

Samiksha Chopra grappled with seeing a patient that reminded her of her late aunt. (Tim Tai, Photo Editor)

Last year, Chopra’s aunt passed away from cancer. Her first year in medical school was full of trips back home to Los Angeles and to India to be with family. During the second half of a medical student’s first year at Yale, they are given a Medical Coach Experience, or MCE, to prepare them for exams and clinical rotations in their second year. 

For her MCE, Chopra was placed on the oncology floor a week after her aunt passed away. She recalled meeting a patient who was around the same age as her aunt and had children about the same age as her cousins.

“I remember just not knowing what to say, not knowing what to do,” Chopra said. “It was one of those things where I didn’t realize how hard her death had hit me until I saw that patient. I can’t even put into words how I felt at that moment, but that was really the moment where I realized something is wrong and I need to talk to someone about this.”

Chopra explained that it can be challenging to find support for this type of experience, since it is so specific to being a healthcare provider and can affect individuals differently. 

Social stressors are another component affecting medical student mental health, Chopra said. She explained that during this time period of life — typically mid-twenties —students experience social pressure to find long-term romantic relationships. This can also be especially stressful because when matched with residency programs at the end of their time in medical school, a student could be placed anywhere in the country and separated from their partner. 

Chopra said that within her medical school cohort, everyone is very supportive of each other’s goals. She explained that student affinity groups at YSM are a great way to make connections with other students. Chopra herself is involved in SAMoSA, the South Asian Medically-oriented Students Association.

Ilhan Gokhan MED ’27 is slightly farther down his path toward the MD-PhD than Chopra — he has completed two years of his MD and is currently working on the second year of his doctorate in Biomedical engineering. 

Gokhan always planned on getting a doctorate and going into industry work, but at the last minute of his undergraduate career at Duke, he decided to add the MD component for the human connection that comes with working with patients. 

Ilhan Gokhan said that clerkship is an environment you are never completely prepared for. (Tim Tai, Photo Editor)

So far, Gokhan said that his favorite aspect of working on the MD part of his degree was getting to know patients. He enjoyed hearing their stories beyond their illness and was interested in supporting them beyond just medical care.

While working on clerkships during the second year of his MD, Gokhan said he appreciated being the most junior person on a patient’s care team because he could learn from those around him. 

However, Gokhan explained that there is also a level of imposter syndrome that comes with being the least experienced, which can be “very hard and stressful” and lead to burnout. 

“It’s an environment you’re never totally prepared for because, for the first year and a half, you’re just in class learning all the physiology and pathophysiology,” Gokhan said. “And then you come to the wards, and it’s totally different. You may feel like you don’t belong or don’t know anything, and you kind of have to drink from a firehose while you’re taking care of patients.”

Completing a clerkship not only teaches students medical knowledge, but also how to effectively communicate good and bad news with patients. Gokhan said there are a lot of difficult conversations that have to happen every day as a medical provider, which can be taxing on mental health. 

Julia Schaffer said that although medical students are allowed to take time off for mental health concerns, the academic workload and cultural environment dissuades them from doing so. (Tim Tai, Photo Editor)

Schaffer’s interest in medicine grew throughout her time as an undergraduate at Cornell, where she studied chemistry. Originally from Stamford, Schaffer returned to Connecticut to attend medical school at Yale. 

She explained that the transition from undergraduate to medical school is the first time she grappled with the identity component of being a doctor.

“I feel like the year you are applying [to medical school,] you are selling yourself to all these schools by saying … ‘I want to be a doctor, that’s the person I want to be,’” Schaffer said. “In that time, my whole identity was kind of conflated into my identity as someone who is going to be in medicine. And then when you’re [at medical school]  you’re like, ‘Okay, I’m here, but how do I be doctor-like?’”

Medical school is the first time students are completely surrounded by their future, seeing their goals reflected in the doctors around them. Schaffer described that it is thorough exposure to what one’s life might be like after all their years of education.

This exposure can be intimidating at times, Schaffer noted. Clinical rotations, which are the short stints in different areas of medicine that all medical students participate in, place students alongside struggling residents working long shifts and night hours. 

“On rotations, every day you’re being evaluated … so you’re showing up every day and … you feel like you need to prove yourself,” Schaffer said. “So I think that it is kind of constantly swirling in your head like ‘Oh, did what I do seem confident enough? Did that seem appropriate?’” 

This high-stakes, high-pace culture also impacts the acceptability of taking time for mental health-related appointments and struggles. 

Schaffer explained that the YSM administration views mental health concerns as a form of chronic illness, and also makes it clear that students can take time off academically if needed. 

However, cultural permission, which Schaffer describes as “pressures that are felt but not always told,” may not be as easily granted. Additionally, Schaffer explained that taking time for oneself to do things you enjoy is not normalized in the cultural environment and structure of being a medical student.

“The onus tends to be on the student, in that we hear ‘You should be doing other things besides studying,’ ‘We want you to enjoy your life,’ ‘We want you to have fun,’ but the workload doesn’t change,” Schaffer said. “So, what am I supposed to do, fail? I think that a lot of times the message cannot be well represented in the culture, or the structure.”

Schaffer does acknowledge that there are excellent student, resident and faculty leaders working hard to shift this cultural climate. 

However, beyond cultural pressures, Scaffer explained that, as a medical student, there can also be internal pressure to feel like you must “love medicine all the time to justify all of the all that you have sacrificed.” Schaffer went on to describe that the sacrifices, hard work and debt that come with studying medicine can lead to an inner dialogue about being “in too deep,” and the impossibility of abandoning the medical career path.  

A deeper look into burnout

Benjamin Doolittle, professor of medicine at YSM, studies wellness and burnout. Doolittle defines burnout as a work-related syndrome with three components: emotional exhaustion, depersonalization and lack of accomplishment. 

Burnout can happen in any interpersonal space, but those working in medicine are especially susceptible, said Doolittle. Medical students, for example, are having many intense experiences that are novel to them. 

Furthermore, medical students are constantly stepping into new microcultures — such as clerkships — in order to learn different components of medicine, which Doolittle explained can make it difficult to form long-lasting bonds. 

“It’s a perfect setup for burnout in that sense because [medical students] are rapid cycling through all these different experiences, and [they are] on this very steep learning curve,” Doolittle said.

Despite this, Doolittle emphasized that the medical school experience can affect different individuals in very unique ways. The collaboration and shared purpose that come with working on a medical team is one reason some people thrive, he explained.  

According to Doolittle, based on previous studies, burnout affects about 50 percent of doctors and medical students, and this figure has remained relatively stable over time. In a recent study conducted by Doolittle, residents and doctors were interviewed to determine what leads to life satisfaction when working in medicine. 

In this study, five dimensions were found to be associated with thriving physicians: love for the work, enjoyment from being with patients, social connectedness and value-based commitments to medicine and autonomy. 

The final component of autonomy relates to having control over one’s schedule but does not encompass work-life balance. Doolittle explained that doctors who are not suffering from burnout do not necessarily have work-life balance, but do have a career of richness — meaning it is composed of many components that bring the doctor joy. Some examples include teaching and working on a committee.

“I wonder if work-life balance is a false dichotomy,” Doolittle said. “In other words, when we set that up, it makes it sound like you have your life, and that’s good, and that your work is not good. But guess what, most of our waking hours are spent working, so wouldn’t it be nice if our work environment was a rich, thoughtful, stimulating time?”

To counteract burnout, students should strive to achieve those five components. Interestingly, in Doolittle’s study, it was found that residents tended to value good leadership over autonomy, and Doolittle explained that this may be the same case for students. 

YSM programming

YSM recently launched a pilot Student Mental Health & Wellness Program with the goal of increasing the accessibility of mental health services for medical students. Short-term mental health consultation and intervention are provided through the program, and students will be directed to other resources if long-term treatment is needed. 

The program is facilitated by Kathlene Tracy, a clinical psychologist, Sundari Birdsall, a wellness counselor and Lisa Ho, a social worker who also manages the program.

“When medical students develop positive wellness habits during their training years, they tend to stick with them when entering the field which can help prevent and reduce burnout and impairment in their careers,” wrote Tracy, Birdsall and Ho in a joint statement to the News. 

The program is designed to be especially accessible to student schedules. The meeting hours of Tracy, Birdsall and Ho extend into the evenings and weekends. Since the program is embedded within the medical school itself, it is designed to be approachable for students who may not have received mental health treatment in the past. 

Tracy, Birdsall and Ho also shared that 75 percent of students that signed up for one-on-one clinical sessions were students of color. 

“The data reflects that the students of color who used the program last year had a specific need that was possibly unaddressed in years prior,” wrote Ho. “Research suggests that due to their intersecting identities, medical students of color must navigate additional stressors.”

Students often approach the program with stressors surrounding transitions, such as going into medical school or clerkship. Struggles they have raised also include facets mentioned by Schaffer, Chopra and Gokhan, such as self-confidence and imposter syndrome. 

The statement explained that programs specific to medical student wellness are important because medical students face unique stressors. 

“One unique way the program approaches thinking about medical students’ mental health is to conceptualize these students as having unique ‘occupational hazards’ that accompany their work, such as the risk of needle sticks and blood-borne pathogens,” wrote Tracy, Birdsall and Ho in the statement. “These factors along with the exposure to human suffering and death, high patient workloads/shift work, among other factors, put medical students’ physical health at risk, and affect students’ mental health.”

The School of Medicine recently launched a pilot Student Mental Health & Wellness Program. (Tim Tai, Photo Editor)

Tracy, Birdsall and Ho employ different techniques to engage and treat students. 

Tracy developed the 30-day Wellness Challenge for students at YSM after seeking input from medical students on the Committee on Wellbeing of Students. 

The Committee on Well-Being of Students, which Schaffer is a part of, is a resource that focuses primarily on wider-reaching initiatives in comparison to the peer advocate program, such as well-being events and student mental health advocacy.

“Sometimes students want to bounce ideas around or have support in processing and other times they need help addressing more chronic issues managing psychiatric Conditions,” Tracy wrote.

Birdsall often suggests that students use apps for wellness because these apps can easily be implemented into busy schedules. Ho uses a value-based approach to help students suffering from anxiety and stress consider why medicine is meaningful to them as individuals. 

Ho also mentioned that the program includes easy-to-access events — such as yoga and meditation classes led by Birdsall — so students who might feel a stigma about engaging with mental health services can “dip their toe in wellness.”

Chopra addressed this stigma as well, explaining that there is a lot of work to be done in shifting attitudes regarding seeking out mental health resources. 

“We hear stories of medical students who were discriminated against during residency application cycles for disclosing that they have sought out mental health care,” wrote Chopra. “Other stories of residents being forced against their preference to go on extended leave (years +) for mental health crises further perpetuate our fears … the threat of retaliation is enough for many students to go through great lengths to either hide or forgo their need for care.”

Chopra emphasized that those who seek out help should not be seen as weak, but rather strong and resilient for acknowledging their limits in a field plagued by burnout.  

Furthermore, Chopra noted that medical schools are in a unique position to encourage this shift in outlook, as students build the foundation for their future careers.

“We are responsible for learning so much in a short period of time that we skip over the equally important skill of learning how to care for oneself,” wrote Chopra.

She emphasized that YSM is working to better provide mental health resources and support. However, she still hopes to see a resource or space specifically catered towards the trauma and concerns triggered by exposure to patients with stories that mirror the students’ own experiences.

Chopra said that this could be accomplished by providing peer support sessions tailored towards the topic, or grief counseling sessions specific to healthcare providers.

“Our vision is to enhance Yale School of Medicine’s positive learning environment by augmenting ease of access to mental health services and bolstering available student wellness support,” wrote John Francis, YSM associate dean for student affairs. “We will continue to utilize creative ways of increasing regular awareness of the program thereby growing utilization.” 

Gokhan said that it is difficult to express what changes he hopes to see more specifically than “more programs, more diverse providers, more access,” because the challenges facing the mental health of students and healthcare workers are emblematic of the entire United States healthcare system. 

Schaffer explained that a major barrier to student utilization of the resources is the culture of medicine itself, which encourages complete devotion to the field even in the face of great personal challenges.

This culture can model to students that in order to be a better doctor, more sacrifices must be made, according to Schaffer. If the choice is between studying or going to therapy, Schaffer said that students will feel pressure to choose to study. 

“The more that those above us in the hierarchy of medical training applaud – rather than look down upon – trainees’ efforts to maintain wellbeing, the more likely students may be to seek support, even if it means they have to sacrifice an hour of studying per week,” Schaffer wrote.

The Yale School of Medicine was founded in 1810. 


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