Supporting the Next Generation of Providers: Pandemic's Impact on Student Mental Health

It has been over two years since the United States saw its first case of COVID-19. Recent and ongoing research has shed light on how the pandemic impacted the mental health of populations across the country.

In this interview, Dr Rebekah Layton shares findings from her recent study on mental health deterioration in graduate and medical students in 2020. She also discusses interventions that may support students, not only in completing their studies during a crisis, but also in maintaining their well-being as they enter health systems as full-time clinicians.

What inspired your research into the impact of COVID-19 on medical students?

We looked at the crisis in mental health across training populations, especially given the added stressors during COVID-19, particularly for students from historically underrepresented and excluded populations. We were concerned there may be mental health impacts that we were not catching.

The groups we wanted to focus on were our students who identify as Black, Indigenous, and people of color (BIPOC); Latinx trainees; LGBTQIA-identifying trainees; and folks who identify as women, who may have different experiences than male trainees.

There is not a lot of evidence-based research looking at graduate and medical student populations to figure out how to better support them. Part of our motivation was to contribute to that genre of research.

Can you briefly describe your study’s design and any findings that stood out?

Our design is a cross-sectional approach, which I always warn everyone to interpret with a grain of salt because this is a snapshot of a particular population. But I do think the lessons from our study can help inform future studies and expand knowledge around graduate and medical students’ mental health.

We were curious what shifts in mental health occurred between 2019 and 2020. We saw decrements on depression and anxiety indices for historically excluded groups based on race, ethnicity, gender, and sexual orientation. That was concerning, particularly because the numbers were extremely high for both medical and graduate trainees. Between one-quarter and one-half, sometimes up to two-thirds of the population, reported significant impacts on anxiety and depression. That is a systemic problem we need to be paying attention to, knowing in the general population the number is typically under 10%.

We thought the political turmoil at that time may be impacting students as well. We examined media sources in 2020 for our Latinx and BIPOC students, as well as our students of Asian descent. The mental health of these populations deteriorated during that time. Further research needs to examine how those impacts can be mitigated and what specific factors contributed to them.

Interestingly, our medical students showed an improvement from year 2019 to 2020, which was somewhat unexpected as we thought they may be experiencing negative detriments similar to those of our graduate students.

We think this impact on mental health may be buffered and mitigated for our medical student population because there was an intervention during COVID-19. This intervention was intended to increase community, share support, create virtual engagement, and help medical students through the COVID-19 transition.

At the same time, our graduate biomedical students were increasingly siloed. They were working off hours to reduce population density in research areas, or working off campus completely. Any delays they experienced slowed down their progress in completing their degrees. This contrasted with our medical students, where training and education shifted to a virtual training environment. They were able to pull students out of the clinic temporarily while personal protective equipment was unavailable and build this training environment around them.

One message to take from this is, if that intervention worked, even though it was for this one specific point in time, are there other ways we can transform graduate and medical education to better support trainees? Future research needs to look at what aspects were successful and what parts we need to replicate, but this initial research suggests medical and graduate training environments can be changed to better support students going through unexpected turmoil during a time of crisis.

Another message is the environment around students does seem to make a big difference. We must think about broadly transforming graduate and medical education, not one simple fix done in this one semester during this crisis. This can be done by creating proactive opportunities for them to engage in well-being and mental health training, talking about mental health more, providing additional mental health practitioners internally and externally, and thinking about what barriers might prevent students from accessing mental health support and how we can reduce those.

This is not an all-encompassing list but some suggestions that might be good to start with to support students’ mental health.

Thank you. My next question is about how you think mental health efforts can be improved as we move out of the pandemic. Did you want to add anything about this?

Revisiting curricular structures to reduce stressors and increasing mental health and well-being resources within each training program are important. We should not wait until we are in crisis and see that students are struggling, but rather be proactive in providing resources before it gets to that point.

As these students graduate from their programs and move into the workforce, how do you think health systems can use findings like this to support the next generation of providers?

Our evidence suggests there are ways to better support clinicians during training. We saw medical students’ mental health and well-being improved even during a time of crisis. This is hopeful. We must understand what interventions are effective to create longitudinal systems that will support trainees over time.

In our medical education intervention, we noted that focusing on COVID-19, specifically how trainees were directly impacting human health, could be motivating and provide a buffering effect. How do we help clinicians see the actual impact of their work in real time? How can we help biomedical trainees understand the impact of what they are doing, which may happen years down the road after developing a novel intervention or pharmaceutical drug?

Burnout is not just something that happens in medical school. The whole profession is struggling with retaining clinicians and inspiring people to go into clinical practice in the first place after seeing the burnout that medical professionals are experiencing.

Helping people build health and well-being during training is going to serve them in maintaining their health during clinical practice, residency, and a long-term career that will support their personal life.

Being on call as a caregiver for others can take a lot out of you. If you do not fill your own cup, it is very hard to fill others’ cups. We can do that for both medical and biomedical students early on by building health and well-being into their professional development and curriculum. The more places we can drive home that message to take care of themselves, the better.

We know these clinicians and scientists are going to enter the world, make life-changing discoveries, and provide support that will be life and death decisions for people. As an academic training system, we must prioritize our trainees, because they are the future. They will impact not just themselves and the future of medicine, but the health and wellness of individuals across the world and nation. If we are not supporting the future of our country and medicine, who will? It has to start with us.

Is there anything else you would like to add today?

I think accreditation bodies have helped create visibility for medical education. I would love to see that extend beyond medical education, into biomedical graduate training and other areas of academia. The more we measure and talk about it and the more these standards are enforced, the better we can implement systemic change.

Since our research was conducted, we have tried some novel approaches. It is to be determined if these approaches are working better and what the long-term impact will be. One example is having a diverse array of practitioners. Students can now choose if they want to see someone who matches a social identity of theirs. Now they can sign up with a practitioner they are most comfortable with that can support them in many of their personal identities. This could help people in managing their own mental health, without having to explain from baseline the microaggressions or systemic barriers they have experienced.

We have also been expanding on-campus mental health access. In the past we had part-time staff whose time was split between graduate and medical education, and now there will be full-time staff for each program. We know more must be done, but gathering evidence like this that shows a positive impact can help us advocate for systemic and institutional change.

Peer-led groups are also evolving on our campus. People say, well, we cannot afford additional support. The consequence of not affording it is that you have students experiencing a mental health crisis, which is not acceptable. There have been several peer-led wellness and mental health groups, where students can reach out to other students to support each other.

These are some promising practices we can continued to investigate as we move into the future.

About Dr Layton

Rebekah Layton, PhD, CMC, PCC, is the director of professional development programs at the University of North Carolina Chapel Hill. Dr Layton develops and directs innovative professional development programs for 1000+ biomedical graduate students and postdoctoral trainees; provides individual career coaching and leadership mentoring; develops curricula and oversees academic certificates; and is an active scholar in education research.

Dr Layton serves as the PI for a jointly funded NIGMS/NSF SCISIPBIO Award examining biomedical workforce development, training, and education, and is a collaborator on national research projects in graduate biomedical education, including four multi-institution NIH Broadening Experience in Science Training (NIH BEST) research teams. Dr Layton’s contributions to the field are represented through multiple peer-reviewed publications and book chapters on biomedical workforce development, training, and education, and she is a regular contributor to Inside Higher Ed’s Carpe Careers advice column.

Dr Layton earned her PhD and MA at the University at Albany, State University of New York, and completed postdoctoral training at UNC School of Medicine. She is passionate about improving the academic training environment for medical and biomedical graduate trainees using evidence-based research and data-driven solutions.