Mental health challenges significantly influence students’ decisions to quit medical studies in the UK.
A new observational study indicates that approximately 1 in 5 UK medical students are contemplating leaving medical school, with mental health challenges significantly influencing their decision.
The researchers emphasise the urgent problem of the global shortage of doctors – currently estimated at 6.5 million – which affects patient care.
The heightened workload and stress on doctors create a vicious cycle that worsens recruitment and retention challenges.
Recognising the potential consequences of student dropout on an already burdened healthcare workforce, researchers aimed to explore the relationship between mental health and academic outcomes in medical education.
They aim to develop strategies that prevent students from abandoning their training.
The study included nine medical schools in England, Scotland, Wales and Northern Ireland, each differing in size and curriculum.
Regardless of their year, all medical students were invited to participate in an online survey conducted between November 2020 and February 2021.
Those who responded were asked to complete a follow-up questionnaire three months later.
Of the 1,113 students who initially agreed to participate, 792 (71%) completed the first survey, while 407 (51.5%) followed up in the second round.
The questionnaire assessed students’ recent thoughts about dropping out and measured various aspects of their mental health, including:
• Emotional exhaustion
• Insomnia
• Somatic symptoms (e.g., stomach or bowel issues)
• Hazardous drinking
• Anxiety and depression
• Anorectic tendencies
• Obsessive-compulsive disorder (OCD)
• Paranoia
• Bipolar disorder
A striking number of participants met the screening criteria for mental health difficulties:
• 60% engaged in hazardous drinking
• 54% reported symptoms of insomnia
• 52% experienced somatic symptoms
• 52% exhibited signs of OCD
• 45% had anorectic tendencies
• 36% reported emotional exhaustion
• 38% showed symptoms of anxiety or depression
• 19.5% experienced paranoia
• 3% had symptoms of bipolar disorder.
Nearly 1 in 5 students (19.5%) considered dropping out of medical school within the past four weeks.
Except for hazardous drinking and bipolar disorder, all other mental health symptoms were associated with students contemplating leaving medical school.
Those experiencing high levels of emotional exhaustion, anxiety/depression, insomnia, somatic symptoms, paranoia, or anorectic tendencies were significantly more likely to express intentions to drop out.
While this is an observational study – meaning it cannot prove causation – the researchers note that the proportion of students thinking about leaving (19.5%) is higher than the estimated dropout rate of 5%.
They caution that: ‘Students who complete medical school while doubting their career trajectory may be more inclined to drop out of postgraduate training’, adding that ‘the number of doctors who pause their training after completing Foundation training has doubled from 34% in 2011/2012 to 70% in 2020/2021’.
The impact of dropping out is substantial, both personally and financially. For individuals, it can lead to psychological distress and wasted years of effort.
Proposals to shorten medical school curricula to four years may further exacerbate these issues. The researchers suggest: ‘The findings of this study suggest that medical students’ mental health is an important contributor to students dropping out and reinforces the importance of supporting students at medical school.’
They also highlight that mental health issues in medical students can be challenging to recognise due to the field’s ‘toxic’ and competitive work culture, which normalises distress and discourages help-seeking.
To support students more effectively, medical schools must work to foster a healthier learning environment and reduce the stigma around mental health. The researchers suggest:
• Raising awareness through workshops on mental health warning signs
• Clearer signposting to mental health resources
• Reassuring students that seeking help will not jeopardise their careers
• Ensuring zero discrimination against students with mental health conditions
• Beyond supporting current students, medical schools must also help prospective applicants understand the realities of a medical career.
The researchers said: ‘While medical schools can take action to improve their environment, it is important to acknowledge that medical school is not for everyone, and to provide resources for those medical students who are deciding whether to continue and those who choose to leave.’
Ria Bansal and Akshata Valsangkar, welfare deputy chairs of the BMA medical students committee, said: ‘These worrying findings line up with what we hear from our fellow medical students every day. No one should feel so stressed and under such great pressure from studying to be a doctor that they experience serious symptoms of poor mental health.
‘These astonishing and unmanageable pressures we’re putting medical students under are completely unnecessary. With straightforward changes to medical student funding, and with more psychological support from medical schools, we could turn this situation on its head and give medical students the breathing room to focus on becoming the best doctors they can be.’
