LAUSR

To the Editor: Medical students experience notable rates of depression (28%) and suicidal ideation (between 5.8 and 11.1%), and those with depression seek formal treatment at low rates— between 12.9 and 15.7% [1, 2]. Research suggests that young adults experiencing suicidal ideation are more willing to confide in their peers; one study of more than 26,000 undergraduate and graduate students found that of those who disclosed their suicidal ideation, two-thirds chose to tell a peer first [3]. Thus, it is essential to prepare medical trainees to recognize peers in distress, respond appropriately, and facilitate connections with professional mental health resources. This “peer-to-peer” approach to suicide prevention has been implemented in many communities, high schools, and colleges, with promising early results that prompted the dissemination of various peer-to-peer trainings at institutions across the country. Unfortunately, effective approaches for reducing the risk of suicide among medical trainees are not well described in the literature, despite increasing efforts to educate trainees about intervening on behalf of patients [4]. In May 2019, we conducted a small, 2-h pilot (N = 7) of a peer-to-peer suicide prevention training at the Oregon Health & Science University (OHSU) School of Medicine. Participation was voluntary and available to all first-year medical students. A pre-post survey, administered on paper immediately before and after the session, evaluated attitudes, perceived behavioral control (i.e., confidence), and intentions toward peer-to-peer suicide prevention behaviors on 5-point scales. The post-survey additionally evaluated the most and least useful components (free response) and overall utility of the training (binary). The study received ethics approval from the OHSU IRB. The training included a didactic session presented by a representative from the American Foundation for Suicide Prevention, an overview of local resources, a demonstration of intervention techniques, and role-play exercises, as suggested by prior findings that “experiential exercises” increase both self-efficacy and suicideand crisis-related knowledge [5]. Notably, the content was adapted for a medical student audience: several role-play scenarios included common crises faced by medical students, and the discussion of local resources considered options that would protect student confidentiality and ethical boundaries. Overall, 100% of participants believed that this training would help them to intervene if a peer was experiencing suicidal thoughts, and 100%would recommend this training program to other students. In their qualitative feedback, participants identified the role-play exercises and discussion of local resources as the most helpful aspects of the training, and some recommended that the information about statistics and scope of the problem be provided prior to the training as pre-course learning material to free up more time for role-plays. Of the ten 5-point survey items, participants demonstrated the largest gain in perceived knowledge of resources to get help for a peer (Mpre = 3.00, SD = 1.00; Mpost = 4.57, SD = 0.53), followed by confidence in asking about suicidal thoughts (Mpre = 3.00, SD = 1.00; Mpost = 4.00, SD = 0.58). The impact of the training on participants’ likelihood of intervening was less clear as the direction of responses varied among the three survey questions that assessed this outcome. Finally, both preand post-surveys indicated that participants did not strongly believe they could prevent someone from suicide (Mpre = 2.29, SD = 0.76; Mpost = 2.67, SD = 1.21). We offer three possible explanations for the lack of clear gains in the latter domain. First, participants were selfselecting and thus, compared with the average first-year medical student, may have held more deeply ingrained attitudes and beliefs toward suicide that were unlikely to shift during a * Alyssa Eldridge [email protected]