Why mental health of medical students is a concern

A dentist who received his degree from a dental college in Uttarakhand in 2017 claimed, “I experienced a mental collapse after arriving at the college.” She gave alleged “ragging and favouritism” as her explanation. She succeeded, but issues with students studying to become doctors’ mental health continue. At least 15 recorded cases of medical student suicides have occurred since March in various sections of the nation.

125 medical students and 105 resident doctors, or postgraduate students, were reported to have died by suicide between 2010 and 2019, according to a study published in the International Journal of Social Psychiatry titled “Suicide deaths among medical students, residents, and physicians in India spanning a decade (2010-2019): An exploratory study using on-line news portals and Google database.” The mental health crisis among this group of students was attributed to a wide range of factors by both students and psychiatrists. The process of enrolling in the MBBScourse itself came first among them. Intense rivalry to get a seat is followed by academic pressure, challenging work environments made worse by the Covid-19 pandemic, and ultimately another round of preparation for a postgraduate seat for those who succeed. Plus, ragging can push students over the edge; attempts to stamp it out have been inadequate, doctors pointed out.

NEET competition

It starts with the test. According to information provided by the ministry of health and family welfare in Lok Sabha, more than 15 lakh students—more than 18 lakh in 2022—take the National Eligibility cum Entrance Test (NEET) each year, competing for a total of 612 medical institutions’ 19,927 available MBBS seats. The only national-level entrance test for enrollment in all medical and associated programmes is the NEET. While a variety of other courses can be entered through it, the main objective for the majority of students is to perform well enough to get a subsidised place at a public medical college. Suicides have been reported from the coaching stage itself due to the hard training required for it, which is frequently conducted in coaching centres like Kota, and Rajasthan.

Ikshita Nagar, a medical intern at Chhatrapati Shivaji Subharti Hospital in Meerut, Uttar Pradesh, and the director of memberships and development for Asian Medical Students Association India, stated that medical students “give tests nearly all the time in their careers.” “The stress continues even after the course is over. Even though we frequently witness trauma in hospitals, not everyone can obtain care, and not everyone feels confident enough to ask for assistance when they are struggling with a mental health condition.

Medical students must put in a lot of effort because there are so few places available and there is fierce rivalry, both at the undergraduate and postgraduate levels, according to Basir Sheikh Abdul, a consultant psychiatrist in Delhi who has taught and practised for more than three decades. The strain of relentless cramming affects a young person’s life in numerous ways. The parents of a boy who had gone to Abdul for help with his NEET preparation “proudly” declared that their son had no friends.

Medical College: NEET UG, PG, seats

According to Abdul, stress is greatly exacerbated by the extremely difficult exams that each medical student must take at key points in their academic careers. He emphasised that there are only 322 publicly supported medical colleges in India. “Since these institutions are affordable, every medical student aspires to enrol in one. While every student cannot afford the thousands of dollars in tuition at private medical colleges, he claimed. Financial strain may also be experienced by students who attend private institutions on a full scholarship. The National Medical Commission (NMC), which oversees medical education, frequently modifies its policies, which is not helpful. “Something changes every other day, whether it’s the postgraduate or undergraduate course entrance date. Hence, appearing in the entrance exams is quite torturous and further to be able to qualify, is a big stress,” said Abdul.

What awaits students who graduate the next year is currently unclear, including whether they will be required to take the NEET PG or the new National Exit Test (NExT), which is intended to replace it. “Students are uncertain as to whether they will be able to take the test or not. “With all the delay, it’s hard to tell what’s coming,” continued Nagar. “Students are determining when the exam will take place and what the syllabus will be.” For students enrolled in MBBS, the following stage – postgraduate medicine – is considerably harder, according to Prabhu Malhotra, a resident at the Critical Care Department, Sri Ram Murti Smarak Institute of Medical Sciences, Bareilly, and national coordinator, All India Medical Student Association. The pressure to prepare for life after graduation is significantly greater, he claimed.

The pandemic effect, long hours

Only interns and final-year medical students were permitted in the hospitals during the horrific second wave of the Covid-19 pandemic in 2021. They got first-hand experience dealing with trauma and death on a pandemic scale, along with graduate medical students preparing for the PG. “It was quite traumatic. Many people like me couldn’t travel home to our family for months as we began our last year. At that point, we all experienced a mental breakdown, said, Nagar. Even in the best of circumstances, internships and residencies are challenging. According to Malhotra, students work 12- to 13-hour shifts in hospitals.

According to Kaustav, a senior resident at Sion Municipal Hospital in Mumbai and MD in community medicine graduate of King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College in Mumbai, “a great amount of workload and sleepless nights are inhuman by any standards.” His last name is absent. Young doctors who have just graduated from medical school must work shifts for 48 hours straight in hospitals. This occurs repeatedly for at least two to three years, not just once or twice, he stated. Many senior physicians would laugh at junior physicians who complained of being sleep deprived. The young doctors who receive this type of care have their self-esteem damaged, and they then make every effort to demonstrate their stress tolerance.  It also deters them from seeking help.

According to Abdul, ragging is still a significant problem. “Juniors and seniors face significant discrimination in medical colleges. Juniors are asked to behave in a certain manner by seniors, which causes peer humiliation in front of others. Minority and caste also have a significant impact, Abdul continued.

Seek help

It is past time for medical students to accept asking for assistance as the norm. Nagar advised telling folks if you’re not feeling well. “Students must be made aware that they don’t have to face every challenge alone. They are unable to inform their parents about their circumstances because they reside in hostels, far from their families. And most parents still don’t comprehend what depression is. Malhotra argued in favour of having on-campus clinical psychologists. Some already do, such as the Christian Medical College (CMC) Vellore. Every student at CMC Vellore has a mentor they can talk to about their career and other issues with.

Sonia Bhatt, a dentist, countered that the kid would have no one to turn to if the staff participated in the racial and gender discrimination. The medical commission should look at any situations where a procedure for anonymously filing complaints by medical students has to be established. Additionally, a review committee needs to investigate these situations from the commission,” the speaker added. Seniors and juniors should encourage one other to engage in healthier activities, particularly on campus, continued Kaustav. “In general, the medical community needs to be more understanding of one another.”

If you, or anyone you know, needs help, AASRA has a list of resources here: http://www.aasra.info/helpline.html. They can be contacted at 91-9820466726, 24 hours, all days of the week, and counselling is in English and Hindi.