What I am reading: Why is 1st year of medical school hard?
“It’s like drinking through a fire hose” is a common refrain heard in reference to the first year of medical school.
AAMC data indicates that the attrition rate for US medical schools is relatively low. Over the 20 years between 1993 and 2013, the attrition rate averaged 3.3%. Combined MD-MBA programs had the lowest overall attrition rates at 0.8%, and students in combined bachelor’s-MD programs had the highest overall attrition rate. The data also reflects that more medical students leave medical school for nonacademic than for academic reasons.
A publication in BMC Medical Education, "Why do students struggle in their first year of medical school? A qualitative study of student voices” conducted unstructured open-ended exit interviews with first-year students at the University of Birmingham (UK) who opted to leave or were required to withdraw. They had a small response rate (15/52 students who left the program), and the UK medical education system is different than the US, however, this can still give us qualitative insights into some of the stressors in medical training. In comparison, the UK attrition rate averages 11%. The structure of the program evaluated in this article is a 5-year program entered into after high school.
Ultimately, they identified a six group typology of students:
wrong degree choice: “I was applying because I didn’t know what else to do and it seemed like a good idea.”
mental health problems: “What if (acknowledging a mental health problem) affects my medical career later?”
acute crisis: physical or mental health crisis, death of a family member, parental divorce, family crisis.
at capacity: academic struggles and inability to meet the demands of an increased workload., and difficulty adapting to self directed learning.
slow starter: Slow to adapt to university living and never catching up.
family rock: students with significant family responsibilities.
Mental health and acute crises were the most common issues. Several students had multi-factorial problems. Many students did not access resources available to them.
“You’re expected to cope- you’re doing medicine, you should be smart, you should be able to cope with the pressure.”
Medical school is a high-stakes proposition, financially and emotionally. The real question is can schools do anything to help with early and healthy professional identity formation to help support at-risk students. When medical students start school their general wellbeing is equivalent to the general population, however, the literature suggests that it often decreased over the course of medical training. In the UK the first year of medical school is also an adjustment to the first year of university so these themes are more transferable to US pre-medical students on college campuses than to US first-year medical students.
Most upsetting is the persistent theme that surfaced that students are still reluctant to seek mental health treatment still exists due to fear of punitive response or stigmatization, particularly so early in training. Several medical school programs have worked to integrate mentoring and wellness initiatives, but perhaps this needs to start earlier in undergraduate education.
Picton A, Greenfield S, and Parry J. Why do students struggle in their first year of medical school? A qualitative study of student voices. BMC Medical Education (2022) 22:100.
