Medical Student Suicide: How Far We’ve Come

When my roommate killed himself in 1962, there was silence. I made the announcement to my class (I can still feel my wobbly knees and hear my quivering voice), and then we never spoke about Bill again. We buried ourselves in our studies, easy to do in medical school. No one from the Dean’s office or faculty spoke to us. Critical incident debriefing or counseling services for medical students did not exist then. You carried on.

I’ve just returned from a half-day workshop at the Association of American Medical Colleges (AAMC) in Washington, DC on medical student suicide. I was invited to give a presentation to medical school student services administrators and staff about what we know about this tragic subject. What a dedicated and committed group of professionals! But before coming to that, I want to make some comments about the structure of the meeting.

Dr. Geoffrey Young, Senior Director, Student Affairs and Programs, AAMC, set the tone for the afternoon with a heartfelt testimonial of losing a medical student to suicide at the UMDNJ-Robert Wood Johnson Medical School when he was Assistant Dean for Student Affairs. He rightly not only described how the student’s death affected him personally but mentioned the wide arc of people in an institution who are touched by this kind of loss. His words validated what has been known for some time in the world of suicidology, that suicide impacts a lot of people—and in distinctive and unexpected ways.

MORE: The Intimacy of Tragedy 

We then heard from Dr. Robert Campbell, Assistant Dean for Student Affairs, Florida State University College of Medicine, who shared the very recent loss of one of his medical students. With the consent of the young man’s parents, he brought him to life. He gave a very detailed and moving account of the student’s background as an EMT, his passion for medicine, his academic struggles and eventual demise. He also walked us through the step-by-step journey of “One School’s Experience”, especially noting what seemed to work well and what didn’t.

My presentation was next. I began with a bit of history, my response to the AAMC’s 1984 document “Physicians for the 21^st Century: General Professional Education of the Physician” and my recommendations¹. These were: identifying the vulnerable student, allocating funds for program development and research, teaching didactic material on stress and the physician, recruiting women into academia, developing various types of support groups, and providing psychiatric services for symptomatic students. I then summarized advances in the decades since. After a brief review of what we know about predisposing factors leading to suicide in medical students, I gave an analysis of the suicide deaths of 3 medical students whose stories have been published—Kathryn Stascavage², Kaitlyn Elkins³ and Anthony Halperin⁴. My goal was to highlight how elusive—and dangerous—depression (and other illnesses) can be in highly achieving and normally resilient students as they advance through training. I showed the 4-minute DVD “Make the Difference: Preventing Medical Trainee Suicide”⁵ and also alerted those in attendance to a resource for responding to suicide “After a Suicide: A Toolkit for Residency/Fellowship Programs”⁶. Both are excellent and have been coproduced by the American Foundation for Suicide Prevention and the Mayo Clinic.

MORE: Physician Suicide: Lessons Learned From Those Left Behind 

The remainder of the afternoon was all interactive, both in plenary and workshop form. In the first part, many spoke about their own experience with losing a student to suicide in their particular medical school. I think we all learned a lot from each other’s stories and different ways of moving through the loss. In the second part, small groups tackled 1 of 3 case scenarios, all of which dealt with the subject matter: 1) what to say to a beleaguered medical student who may be suicidal 2) what to say to a student returning from medical leave after a suicide attempt and 3) dealing with the sudden news of a student killing himself at home after a weekend away. Sharing reactions, frustrations, insights, plans of action, and more from each of the working groups was enlightening.

Returning home to New York City on Amtrak that evening, I was exhausted. But it was a good fatigue. As I reflected on the afternoon and recalled the sad and powerful stories of the many workshop participants I was filled with hope and purpose. It is gratifying to know that so much is being done at a national level to understand and prevent suicide in the doctors of tomorrow. How far we’ve come!

References

1. Myers MF. The medical students of 1985: toward meeting their personal needs. Journal of the American Medical Women’s Association. 1985;40(5):141-144.
2. Muller D. Kathryn. The New England Journal of Medicine. 2017;376(12):1101-1103.
3. Elkins R. My Bright Shining Star: A Mother’s True Story of Brilliance, Love & Suicide. Cambridge, England: Perfect Publishers Ltd; 2014.
4. Halperin A. My brother’s life, unraveled. Salon. March 12, 2013.
5. Make the Difference: Preventing Medical Trainee Suicide. American Foundation for Suicide Prevention Web site. https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention/. Accessed August 8, 2017.
6. After a Suicide: A Toolkit for Residency/Fellowship Programs. American Foundation for Suicide Prevention Web site. https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention/ - section0. Accessed August 8, 2017.

Dr. Myers is Professor of Clinical Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, NY. He is the author of 8 books, the most recent of which are "Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared" and “The Physician as Patient: A Clinical Handbook for Mental Health Professionals” (with Glen Gabbard, MD). He is a specialist in physician health and has written extensively on that subject. Currently, Dr. Myers serves on the Advisory Board to the Committee for Physician Health of the Medical Society of the State of New York. He is a recent past president (and emeritus board member) of the New York City Chapter of the American Foundation for Suicide Prevention.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.