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| LETTER TO THE EDITOR |
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| Year : 2015 | Volume
: 28
| Issue : 2 | Page : 150-151 |
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Medical students hanging by a thread
Sonal Pruthi1, Vineet Gupta2, Ashish Goel3
1 PGY-1, SUNY Upstate Medical University, Syracuse, New York, USA
2 Assistant Clinical Professor, Medicine, Division of Hospital Medicine, University of California San Diego, California, USA
3 Assistant Professor, Department of Medicine, University College of Medical Sciences, New Delhi, India
| Date of Web Publication | 21-Nov-2015 |
Correspondence Address:
Ashish Goel
Department of Medicine, University College of Medical Sciences, New Delhi - 110 095
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1357-6283.170129
How to cite this article:
Pruthi S, Gupta V, Goel A. Medical students hanging by a thread. Educ Health 2015;28:150-1 |
Dear Editor,
In his book, "Doctors," Erich Segal writes "Med schools provide perhaps the best substantiation for Charles Darwin's theory of natural selection. For here we see in its cruelest form the survival of the fittest to cope with the inhuman pressures, the demands made not only on the brain but on the psyche".[1]
A recent news report of a medical student committing suicide due to academic stress reminded me of this statement as memories of a similar tragic day came rushing back to me. It was one of those nights when I sat with a cup of steaming coffee trying to fend off approaching sleep and trying to cover the vast gap between what I knew and what the upcoming professional exams expected from me. It was then that a colleague brought the news that left me numb and shocked. One of our classmates had chosen to end his life by hanging himself on the ceiling fan. I suddenly realized that I had known him for two years and yet knew so little of him. The memory of those who witnessed that awful sight in the hostel that day never fails to send a chill down the spine.
Suicide is a tragic event with strong emotional repercussions for families and other survivors of its victims. Official figures from World Health Organization estimate that 1 million people commit suicide every year with an annual suicide rate of 16 per 100,000, or 1 suicide every 40 s.[2] Reports indicate that physicians are more likely than other professionals to commit suicide owing to the constant stress of their work and the need to juggle personal, family and financial problems.[3] Reports for the United States indicate nearly 400 physician suicides every year, yet statistics for American medical students are not readily available.[4] Suicides among Indian medical students have never been studied or reported, to our knowledge. In this letter we attempt to highlight medical students' suicides in India. Medical students in India compete successfully for 40,525 seats in 335 medical colleges from among over 500,000 desirous candidates, yet those who choose to end their lives in the middle of the academic program chose were evidently unable to cope with the academic stress.
| Methods | |  |
We searched the Google database and websites of five leading Indian dailies (Times of India, Hindustan Times, Indian Express, The Tribune and The Hindu) to identify incidents of suicide by medical students in India. We reviewed the detailed newspaper reports and other available information about the individual cases. We found reports of 16 medical student suicides over a four-year period (January 2010–March 2014). Nine students (56%) committed suicide citing professional reasons, mostly stress due to poor performance. The details of the 16 incidents are presented in [Table 1]. | Table 1: Incidents of suicide by medical students in India from January 2010 to March 2014
Click here to view |
| Discussion | | |
In a retrospective review of newspaper reports and internet search we were able to identify 16 medical student suicides over a four-year period, mostly men, most citing poor academic performance as a cause.
In our country, a large number of failed suicide attempts go unreported and unnoticed. Medical students are a vulnerable lot, with high rates of depression, burnout, mental illness, suicidal ideation and suicide.[4] Several authors have studied the occurrence of stress among students during medical education, reported at between 31% and 73% in different studies.[5],[6],[7],[8]
Failed personal relationships and family problems are often considered to be the culprits responsible for suicides among students. However, in the suicide reports we found most students cited inability to cope with academic stress as an inciting factor pushing them to take their extreme step. It is important to consider that these students who had competed successfully through extremely challenging entry level examinations to secure admission into medical programs found themselves unable to complete it. This suggests that either the selection process itself is flawed or there is a need to seriously revisit our medical under-graduate curriculum. Further, it is interesting to note that most of the suicides involved male students, indicating perhaps a particularly inadequate ability to handle stress among men.
The biggest setback, however, is that even though medical fraternity comprises one of the most learned members of the society, we are foolish enough not to recognize this illness among our colleagues and accept its truth. We shirk from talking about suicides in our community. We have found that discussing a colleague's suicide is taboo, something that is looked down upon, something that would tarnish the righteous, self-reliant image that we physicians carry for ourselves. Our curriculum ingrains in us a need to project an intellectual, unemotional, strong façade – more than what we truly feel. As a repercussion, we shirk from asking for help, even when we know that it is most needed and will result in dire consequences.
| Conclusion | | |
Remedies are needed. We suggest a pre-placement assessment of students' expectation from the course and regular counseling sessions throughout the course to create realistic expectations and help students better cope with stress. Also important for creating a friendly and supportive environment would be periodic stress management workshops, encouraging extracurricular activities, providing opportunities to relax, supporting open discussion forums, promoting medical humanities and improving individual mentoring. The first step to breaking students' long journey from stress to taking the leap of doom is to recognize that stress and suicide are real and something that needs to be fixed. We should not let the victims of suicide—our colleagues—die in secrecy and shame.
| References | | |
| 1. | Segal E. Doctors. Toronto: Bantam Books; 1988.  |
| 2. | Medical Student Commits Suicide in AIIMS. Hindustan Times; 4 March 2012. |
| 3. | Results and implications of the AMA-APA Physician mortality project. Stage II. Council on Scientific Affairs. JAMA 1987;257:2949-53. [ PUBMED] |
| 4. | Tyssen R, Vaglum P, Grønvold NT, Ekeberg O. Suicidal ideation among medical students and young physicians: A nationwide and prospective study of prevalence and predictors. J Affect Disord 2001;64:69-79. |
| 5. | Saipanish R. Stress among medical students in a Thai medical school. Med Teach 2003;25:502-6. |
| 6. | Sherina MS, Rampal L, Kaneson N. Psychological stress among undergraduate medical students. Med J Malaysia 2004;59:207-11. |
| 7. | Firth J. Levels and sources of stress in medical students. Br Med J (Clin Res Ed) 1986;292:1177-80. [ PUBMED] |
| 8. | Supe AN. A study of stress in medical students at Seth G.S. Medical College. J Postgrad Med 1998;44:1-6. |
[Table 1]
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