Far too often in medicine, medical students feel as if they're blowing in the wind. Many struggle with finding their place and identity as budding physicians. On top of the of learning thousands upon thousands of medical facts, they must also learn to navigate intense competition. There's even a term for when colleagues degrade their fellow medical cohort for the sake of their own interests: . There's also a common phenomenon of feeling inadequate known as . Even for the most academically adept, the incredible amount of weighs heavily on students.
Suffice to say, medical school is often far less about learning facts and more about navigating the minefield of social dynamics constantly at play.
These academic rigors and social interactions foster a darker side of training. Medical students and residents experience of , , and when compared to their age-matched peers not in medical training; the rates of physicians with depression are also higher than their age-matched peers. While some institutions have tried "" and others acknowledge , few are adequately addressing students' mental health needs.
But what if there was a way to help medical students feel supported while those in power fix the upstream issues with medical education? What if there was an established method to help medical students? That's where peer support programs come into play.
What is Peer Support?
To combat feelings of inadequacy, anxiety, social isolation, and burnout, some medical schools are beginning to draw upon the of near-peer support services frequently utilized in other educational communities. For decades, have contributed to a growing body of evidence on the of peer support by providing peer counseling and peer education services. Harvard College, for example, has students serve as general and holds specialized peer-led programs for and students struggling with alcohol use problems, , and sexual assault.
These programs are easy to implement and require few resources – yet, it wasn't until 2015 that medical schools began to create to expand wellness services beyond licensed mental health counselors. The benefits of peer support have already been demonstrated in a variety of types of , from to .
Peer support in medical schools seeks to foster a culture in which students take an active role in the well‐being of their classmates and combat the pervasive feelings of competition. Older physicians will tell you how their classmates would rip pages out of books, one-up each other by showing up earlier and earlier to rounds, or refuse to share study guides. Peer support strives to create a campus community where students come together, collaborate, and treat one another with kindness and empathy.
These programs vary in size and structure. Generally, second- through fourth-year students are selected and trained to serve as ambassadors of wellness to provide an umbrella of non‐clinical support. On many medical campuses, peer supporters provide their classmates access to , same‐day support in the form of walk‐in office hours to provide a listening ear. At other institutions, peer supporters also host events – such as , sleep, , gratitude-writing, and – to alleviate stress, promote wellness, and destigmatize mental health.
Peer support can help students facing a range of challenges from to upsetting clinical experiences to to relationship issues. In , medical students were trained to deliver a peer support workshop aimed at recognizing peers in need of support, initiating a conversation, creating a mental health‐promoting plan of action, practicing self‐care, and using trauma‐informed care principles; students reported increased understanding of trauma‐informed care, comfort in addressing suicidal ideation, and awareness of community mental health resources after serving as peer supporters. In another paper, peer support was demonstrated to surrounding stress and psychological distress.
One of the students use peer support is or concerns like . As such, utilization of peer support fluctuates with common medical school milestones. This is because anxiety and depression have a higher prevalence rate in medical students . Peer support services or wellness campaigns at this time .
Medical students worry that showing signs of will make them deemed unfit by peers or professors. Peer support programs normalize feelings of , and help students realize they aren't alone. Moreover, they are an to to reach out for help. In one study, 75% of students reported that having peer support available created a , even if they did not personally plan on using the program.
Given the higher rates of among medical students, peer support is critical to encouraging students to seek support and streamlining referrals to counseling services. Students often don't feel as comfortable turning to faculty, and are ideally situated to recognize warning signs in a classmate. Peer support also helps account for the reality that sometimes medical students face issues that . Students benefit from "" and having a student "."
In short, peer support is one safety net we need to catch students when they are about to fall.
Peer Supporters Benefit Too
Those providing the peer support also benefit. Being a peer supporter allows students to develop empathy and increased self-efficacy addressing difficult mental health topics. Peer supporters reported they gained confidence providing mental health support and in making their campuses more welcoming. Peer supporters not only recommend self‐care and wellness strategies to others but end up into their daily lives. This incorporation could lead to finally breaking the legacy of abuse too often perpetuated in medicine.
Limitations of Peer Support
Peer support presents a low‐cost, sustainable modality to promote student well-being. However, there are some barriers. Firstly, a one size fits all approach is not effective for all students. In particular, medical schools may not have enough students from marginalized backgrounds to address every contributor to distress or others may not have adequate infrastructure to match students with supporters. Schools should recognize different forms of support needed for students of different identities, especially marginalized identities or .
Another limitation is intrinsic to the culture of medicine: students who would serve as peer supporters are sometimes themselves stressed, tired, and overworked, or have compassion fatigue. Structural changes to improve the culture of medicine need to come from the upper echelons -- students should not be expected to shoulder the burden of making such changes.
Finally, medical schools are small communities and and distrust run rampant due to the competitive environment. Peer support programs need to ensure they properly respect and incorporate all aspects of identity for sexual, gender, and racial minorities in medical school.
Peer support is an important step in the process of making medical students feel supported, and fostering community and empathy among medical students.
After all, we're kind to our patients, why not each other?
is a third-year medical student at the University of Central Florida in Orlando. , is a fellow in child and adolescent psychiatry at the University of California San Francisco.