While getting into a residency program can be an exciting next step toward your medical aspirations, it is not without its own hardships. Throughout the 21st century, research finds that many medical residents struggle with clinical depression and poor mental health at some point in their residency.
From a 2018 study by the University of Michigan and Medical University of South Carolina, roughly 33% of residents exemplified thoughts, feelings, or behaviors that were linked to symptoms of depression. But what causes these symptoms, and what can be done to counteract these difficulties with mental health?
Factors Contributing to Depression
Stress of Residency
Unsurprisingly, a significant factor, found to aggravate these depressive symptoms is the difficult nature of a residency program. Career burnout brought forth by high-stress hospital environments, medical errors, and the time-consuming nature of a residency exacerbated depressive levels in residents. Unfortunately, many of these structures can be cyclical. Long work hours lead to sleep deprivation. This lack of sleep directly correlates to a higher risk for mistakes and a poor residency performance, which in turn worsens these depressive symptoms.
Along with this, many first-year residents begin residency mere weeks after graduating from medical school. While most medical school graduations occur in early to mid-May, the average residency program starts in mid to late June. Only weeks after completing a rigorous four years of education, many graduates must then begin an equally hectic life as a resident. This quick turnaround with little room to rest and reset can intensify these factors.
Additionally, poor faculty and patient engagement were noted to increase depression in residents, as this lack of interaction created a sense of isolation. For example, programs more focused on research rather than facetime with patients consistently had greater amounts of depressed residents. There are similar findings regarding resident/mentor relations. Residents who felt they did not have a sufficient relationship with mentors and teachers of their program showcased higher symptoms of depression.
In a 2018 study, Internal Medicine had the highest rates of depression-related symptoms in residents. Coincidentally, this specialty sports some of the longest working hours, least helpful faculty feedback, and least valuable in-patient training rotations. The rigorous schedule and somewhat lonely experience of a residency can have a significant impact on one’s mental health.
Beyond workplace loneliness, the logistics of attending a residency program can also cause social isolation. Once again, a major factor this stems from is the hectic hours required of all residency programs. This, mixed with life changes such as moving to a new city, state, or even country for your residency program, can put residents in an extremely lonely position.
With the time commitment that a residency program demands, it can be challenging to find any room to pursue a social life or make community connections. A 2006 study published in the National Library of Medicine found that international medical graduates (IMGs) experienced higher levels of depression on average than their domestic counterparts. While some programs are beginning to prioritize assistance for international residents to get more acquainted with their new environments, many far away residents find themselves alone in these pursuits. With a lack of time to invest in their private life, residents find their nonexistent social lives negatively impact their mental health.
Close Ties to Community Based Trauma
For many residents, the first time fully working in a hospital is their residency. Close contact with medical emergencies and struggling patients are essential experiences each resident must go through on their medical journey. This new perspective can be harrowing, as residents now find themselves at the front lines of community-based trauma. These traumas will greatly vary depending on the location of one’s residency. Some instances, such as the ongoing COVID-19 pandemic, have been felt globally. Other traumatic situations could include more regionally based drug epidemics or medical hardships that emerge in the wake of sudden disaster. For residents experiencing hospital life at large for the first time, these situations can be traumatizing to witness and assist in. Especially for those living in a new location, these community-based traumas can be some of the main ways residents interact with their community.
There have not yet been great efforts in the education field to aid residents in the mental strain that the medical frontlines can cause. Many doctors must individually find assistance for dealing with any potential depression or mental illness that may form because of close access to community-based trauma. With an overwhelming lack of free time, it can be difficult for residents to find safe and healthy spaces to process this reality. The inevitable nature of these difficult situations can add to residents’ depression and poor mental health.
Finding the Right Path
The application process for residency is stressful and arduous. It is essential to invest your time preparing yourself as a strong candidate for consideration. Ideally, though, residents would also be able to vet the residency programs to find the best fit. Ultimately, getting a bad match could be detrimental for your own self. The right program will not just professionally fulfill you but will hopefully allow you to flourish wholly in life. Aspects such as in-patient care versus solitary research are important to consider. When looking into residency programs to apply to, ask about the quality of faculty feedback and what a typical work schedule looks like. To truly understand these factors, it can be best to reach out and speak with actual residents of the program, whose experiences will more closely mirror what yours would be.
However, although these are good aspects to look out for, many hopeful residents, particularly IMGs, can’t afford to be picky when selecting programs they are interested in. Due to unfair biases and the struggles of applying to programs internationally, IMGs are often overlooked in favor of their American counterparts, not allowing them the grace to find the programs best suited to their strengths. IMGs will not be given a true opportunity to thrive in their residency until these unfair disadvantages are adequately discussed and abolished.
Finding the Right Location
Along with residency research to better understand the social conditions of the program, it can be incredibly helpful to investigate the location and culture of the program as well. Through some thoughtful reading, you can gain better insight into what broader struggles and trauma impact the surrounding community of the specific residency program and hospital. This better helps you understand and be prepared for the unique cultural aspects each residency program will have. Additionally, this can help you feel better integrated within whatever new communities you may be a part of once you begin your residency.
For IMGs, it can be helpful to have a close eye on what programs and locations will be most accommodating and acclimating for international students. By committing to programs that have consistently bolstered and supported demographics similar to yourself, holistic success can more easily be found. A thorough understanding of the community and culture surrounding your program, both professionally and socially, can greatly assist your mental health and well-being.
While there are specific steps you can take as an individual to combat depressive symptoms, many researchers who have studied this phenomenon find that there is ample room for residency programs to grow and change their ways. Experts in this research call for reworked hours for residency programs such as those exhibited by the University of Alabama’s Huntsville Regional Medical Campus. There, each resident is given a full weekend off every other weekend, rather than the typical scattered two days most residents receive. This longer break allows for residents to rest and reset themselves properly and has thus far garnered positive performance results in residents.
Additionally, depression’s disproportionate effect on IMGs cannot go unrecognized. Residency programs must lose their unfair biases and create a level playing field for IMGs to truly pursue the opportunities they are best suited for.
Pursuing your residency is hard. No student pursues the field of medicine expecting low stress and an easy job. However, there is room for hospitals to better situate and run their residency programs to allow residents an easier path to flourishing. When residents can rest, socialize, and receive proper faculty feedback, they not only exhibit better mental health but also generate better performance results. Residency programs must reshape their environments to fight this history of depression and pave steps toward a brighter, healthier future to create the best field for future medical practitioners.