Grace Buechel,Medical College of Wisconsin-Central Wisconsin, Class of 2026
It represents everything I’ve worked for thus far, as well as the support I’ve had along the way. Family, friends, and mentors have pushed me, cheered me on, and held out their arms during the lows. As I enter one of the most challenging periods of my life, I depend on that same support. Unfortunately, it can be difficult to discuss this experience with people from our support system, but who are not in medical school. Reasonably, it may be easier to confide in fellow medical students. So, what if an institution could build on this? What if medical students could build a foundation to support one another? What if students could create the open, safe atmosphere necessary to cultivate vulnerability, awareness, and connection?
With the passion of Medical College of Wisconsin-Central Wisconsin students, our school has turned these “what ifs” into a reality. The rural medical school campus has continued to develop and promote its Seeking Peer Outreach* (SPO*) program with the help of numerous students aspiring to create and maintain such an environment.
WHAT?
Seeking Peer Outreach* (SPO*) at MCW-Central Wisconsin is an integrated, tiered approach to address stigma and isolation in healthcare education. By being integrated, it incorporates a gatekeeper training program with a peer-support program. Being tiered means it is based on the public health model of prevention, striving to reach the broadest spectrum of our MCW population by preventing suicide attempts, deaths by suicide, and reducing suicide risk factors. With these goals, SPO* makes great efforts to educate students, raise awareness for mental health struggles during the medical school journey, and create a safe space for discussion surrounding these struggles.
WHY?
Medical students are exposed to a large set of stressors. These may include academic workload, competition with peers, conflicts in work-life balance, financial difficulties, family demands, and exposure to emotionally-taxing experiences. When compared to the general population, medical students show higher rates of depression, suicidal ideation, and stigmatization around mental health. In addition, medical students are less likely to seek support.1 A 2021 assessment found that over two-thirds of surveyed medical students reported worsened mental health since the onset of the COVID-19 pandemic, as well as one or more symptoms of anxiety and depression.2 Additional research shows residency trends in death by suicide, with more occurring during early years of residency.3 In past years, suicide has been a leading cause of death among male residents and the second leading cause of death among female residents.4 Previous research demonstrates the need to highlight mental illness in medical school to increase awareness, normalize conversation surrounding common struggles, and address stigma as a significant barrier to seeking support.
HOW?
The tiered system of SPO* encourages all students to participate, beginning with the first tier. Tier 1 includes the entire MCW community—students, house staff, and faculty. At this tier, individuals take on the role of primary prevention by acknowledging and understanding the impact of mental health on physicians. They begin creating a support network within the community, and initiate conversations about mental health. Tier 2 representatives consist of peer supporters who have completed additional training, representing secondary prevention. These individuals have been identified by their peers as trustworthy and empathetic, and thus are recruited for further development in providing a non-judgmental, confidential, and safe space for their peers. Training equips these individuals with deeper knowledge to handle crisis and asks them to be accountable for others’ well-being. Finally, Tier 3 includes third party healthcare professionals. This tertiary prevention aims to improve quality of life and reduce symptoms for those referred for behavioral health care. Tier 3 goals are to reduce barriers to treatment including availability, access, and stigma.
Seeking Peer Outreach* offers students at the Medical College of Wisconsin-Central Wisconsin campus a way to find support. With increasing awareness surrounding mental health, I hope this article will inspire the development of similar programs and conversations among other institutions.
Grace Buechel is a rising 3rd year medical student at the Medical College of Wisconsin-Central Wisconsin. In her pursuit of Psychiatry, she has become a lead for the SPO* program and continues to advocate for mental health awareness and provision of accessible support for rural medical students.
Special acknowledgments to the founder of the program, Dr. Margaret Lieb, MD. Also, student-leads Marissa O'Hair, Casey Balson, Justin York, and Erin Gruber. Lastly, staff and faculty Dr. David Cipriano, MS, PhD; Dr. Jeffery Fritz, PhD; Dr. Sara Kohlbeck, PhD, MPH; and Christopher Knight, MA.
References:
- Fischbein R, Bonfine N. Pharmacy and Medical Students' Mental Health Symptoms, Experiences, Attitudes and Help-Seeking Behaviors. Am J Pharm Educ. 2019; 83(10):7558. doi:10.5688/ajpe7558
- Christophers B, Nieblas-Bedolla E, Gordon-Elliott JS, Kang Y, Holcomb K, Frey MK. Mental health of us medical students during the covid-19 pandemic. J Gen Intern Med. 2021;36(10):3295-3297. doi:10.1007/s11606-021-07059-y
- Yaghmour NA, Brigham TP, Richter T, et. al. Causes of death of residents in ACGME-accredited programs 2000 through 2014: implications for the learning environment. Acad Med. 2017;92(7):976-983. doi:10.1097/ACM.0000000000001736
- Goebert, D., Thompson, D., Takesh*ta, J., Beach, C., Bryson, P., Ephgrave, K., & Tate, J. (2009). Depressive symptoms in medical students and residents: a multischool study. Academic Medicine, 84(2), 236-241. doi:10.1097/ACM.0b013e31819391bb
