LAUSR

To the Editor: “How to Cope with the Challenges of Medical Education? Stress, Depression, and Coping in Undergraduate Medical Students” [1] provides crucial insights into the challenges of medical education in terms of its detrimental effects on mental health and evaluates the various coping strategies that students utilize. The pressure to perform at a high standard can often lead to burnout and depression, which stems from a competitive nature among students, who are generally eager to surpass their peers. Furthermore, the vast amount of content that is required to be covered and the long contact hours and travel time to clinical teaching sites can drain students, leaving little time for sleep and other social activities that may help with mental well-being. As medical students, we appreciated the authors’ use of evidence-based clinical survey models to identify stress and depression in their medical student cohort. The Stress and Coping Inventory (SCI) [2] and the Center for Epidemiological Studies Depression Scale (CES-D) [3] have been proven to be reliable in detecting mental health issues and are used frequently in general practice and primary care settings. The authors’ finding that second-year medical students presented with higher stress and depression levels than their colleagues in their sixth and final year of training was interesting to note. This finding perhaps could be attributed to the development of resilience and becomingmore accustomed to a “hectic” and “stressful” lifestyle after many more years of training, while second-year students have not yet developed appropriate coping mechanisms to deal with these pressures [4]. Caution must be taken when interpreting these results, however, owing to the disproportionately smaller sample size of the year 6 medical students and a potential confounder that students who are less resilient tend to drop out early on, thus resulting in a cohort that has a greater proportion of mentally strong individuals at the end of the course. Given that students in their final years face a lot of responsibility and new challenges, this is indeed something that needs to be investigated. This paper also highlighted females displaying higher levels of stress and depression than their male colleagues, and it would be interesting for the authors to come up with possible explanations that support this disparity. It was discovered that positive thinking was the only coping method which improved stress and depression scores. We concur that a positive mindset and optimistic thinking during stressful periods can shape mental health substantially and alter outlooks on life. Previous studies have established negative thinking to often be counter-productive to recovery and can lead to worse long-term outcomes [5]. Furthermore, while it seemed logical to us that seeking social support was the most commonly utilized coping method, we found it peculiar that it did not seem to alleviate student stress or depression. We often find that speaking to family or close friends is a positive experience and can help to lift some of the burden that we may face. What was surprising to see was that religion was associated with higher stress scores and had no effect on depression. Placing trust in higher places can often cultivate a sense of hope, and the support offered by religious communities can aid individuals during difficult times. Being a doctor is stressful and it is therefore crucial to develop healthy coping methods early on. Students should be encouraged to self-reflect and promote positive mindsets. This could be achieved through improved accessibility to counseling services and various workshops that offer resilience training, mindfulness, open dialog with colleagues in similar positions, and advice on exam technique and worklife balance. Frustratingly, universities are often lacking in welfare services such as counseling, and students may often face waiting times of weeks before they can speak to a * Sophie Rainbow [email protected]