When Dr. Stuart Slavin started his administrative duties at the St. Louis University Medical School, the mental health of medical students was not one of his concerns.

About nine years ago Slavin, the associate dean of curriculum, came across material about a problem of depression and anxiety among med students. He almost dismissed it, thinking that the problem didn't exist at SLU. "They seemed happy," Slavin said of his students. "I knew some students were suffering because medical school is demanding, but overall I thought our students were doing well."

He went ahead with a survey of students, and the results startled him. "We got the initial results and they were just devastating. We were just like any other medical school," the physician said.

He took it personal. "I felt responsible ultimately. It was clear medical school was doing this to them."

Jesuit education entails caring for the whole person — mind, body and spirit. Slavin brought that to the forefront when suggesting reforms at the medical school.

Without sacrificing critical components, SLU changed its curriculum to remove unnecessary stressors, a big shift from seeing stress as an inevitable part of the path of becoming a doctor. Added was a required class that teaches strategies to de-stress. "We created an environment where students don't suffer unnecessarily," Slavin said of the changes that began in 2009. "It's about making reasonable demands on students whenever possible, treating them with the respect they deserve and giving them a voice in how decisions are made."

That was a start for Slavin, and since he's become more immersed in the topic. He's written on it in various national medical publications.

In a commentary in the September issue of Academic Medicine, Slavin stated that a multipronged approach that improved mental health among St. Louis University students during their first year of medical school could serve as a model for reducing stress and depression later in their training. The mental health of the most recent first-year classes of SLU medical students was better after they completed the year than before they started classes.

Survey results for the class of 2018 showed 5 percent said they had symptoms of depression and 21 percent had anxiety symptoms before classes began. By comparison, 4 percent had symptoms of depression and 14 percent had symptoms of anxiety at the end of their first year of medical school.

Depression and anxiety rates for second-year students in the classes after the curricular changes were lower than for those in medical school before the changes. However, rates began to go up as students prepared to take their first standardized test that helps determine where they will be admitted for residencies, which is the education step after medical school when doctors study the specialty field of their choice.

External stressors in the third and fourth years of medical school, when students began rotations through multiple hospitals and interacted with patients and hundreds of residents and physicians, take a further toll on the mental health of medical students during their clinical years.

Slavin used an editorial in the December issue of the Journal of the American Medical Association to call for change. He countered the idea that if students are not strong enough to handle the stress they probably should seek another profession — noting that when changes are implemented, students report not only improved quality of life and mental health but also improved academic performance.

Students today have increased pressures, he said, beginning in high school or sooner. The pressure isn't to just succeed in academics but to excel in a pursuit of prestige and income, a notion that Pope Francis and other Church leaders have warned about as well. Secular medical schools can learn from Jesuit schools and their concern for educating the whole person and an emphasis on social justice issues, Slavin said.

He sees a growing resolve for change. "We've charted a path forward in some ways, at least in a model that can be used in various environments. The bottom line is that there's tremendous interest in what we're doing." 

>> Changes

St. Louis University attacked anxiety and depression among medical students on several fronts by:

• Changing the system to remove unnecessary stress. SLU tweaked its curriculum, which included cutting class time by 10 percent, freeing up time for longitudinal electives, and implementing a pass-fail system during the first two years of medical school before clinical years of training, a practice shared now by about 80 other schools;

• Offering ways to ground students in the meaning of what they were learning. Students choose between multiple electives and learning communities to kindle their passion and explore their specific interests, such as conducting basic science research, advocating for those who have no voice or volunteering in a health clinic;

• Teaching resilience training and coping skills, which are critical strategies to help students deal with adversity throughout their careers and lives.