Resilience: From Personal Challenge to Public Health Solutions

28 January 2021

We start the year with a very topical blog written by Heather McAdam, President of the Edinburgh Medical School Psychiatry Society about resilience and being a medical student during the pandemic.

We have always been warned that it was almost inevitable for another global health crisis to hit. As an adolescent, it was dramatically portrayed through dramas such as Black Mirror or I, robot. Once we became ‘responsible’ doctors in training, the focus moved more towards the awareness of antibiotic resistance and hospital superbugs. A perhaps selfish part of me always assumed, whenever this mysterious outbreak would occur, it wouldn’t really impact me. From what I was taught and observed, the ones facing the brunt of a pandemic would be the specialists healing the infected and the infected individuals themselves.

Obviously, such beliefs did not age well.

The unique perspective, or should I say opportunity, of being a healthcare student in 2020, is that we simultaneously are given the experience of being a key worker whilst also inexperienced enough to feel as if we should be in the shoes of the general public. It is a catch-22 of representing responsibility and ambassadorship for the NHS whilst also empathising the fear of the unknown and general sense of fed-up-ness that the rest of the general population feel. This creates unique pressures, concerns and lack of belonging to this small minority of students.

There is a fair chance this can go one of two ways. Firstly, this belief of feeling lost, perhaps even hopeless, along with a pressure to perform whilst simultaneously being restricted in how they can help, can push students to becoming frustrated, anxious and demotivated. In extreme levels, this can push individuals, already studying high pressure degrees in ‘normal’ times, to breaking point and wanting to give up. Not only can this mean a potential loss of talent for our future healthcare workforce, but it means this should also be seen as a very real and imminent challenge for mental health.

Such reactions from students of all disciplines are understandable, as shown through seeing the extreme reactions of society in the past seven months; even the most high-profile and influential figures have been shown to flex the rules or showing signs of cracks starting to form. After all, we are innately a social species, driven by the need to do more.

To limit support for students wanting to help, particularly when entering a career that in itself which is riddled with ‘Imposter Syndrome’ and competitive workaholism, can be doubly harmful for mental health. Inclusion and support is therefore more important than ever, especially to the healthcare students on the edge of it all. That does not necessarily mean we should encourage the unhealthy work ethic amongst many health professionals, but rather we should avoid creating the additional barrier for students of expecting them to work in a similar way then not allowing them to do so.

This led to me thinking, is there a solution which could solve multiple of these challenges? To allow students to feel incorporated, to do so in a healthy manner, whilst also supporting the strain our healthcare system is facing?

Perhaps from a fresh perspective, instead of viewing various population groups as separate domains with individual challenges and therefore solutions, why don’t we encourage something which brings these groups together through a multifaceted strategy? How do we ensure our patients’ quality of not only physical, but mental, care and wellbeing are preserved and protected? How do we make students feel engaged in the crisis? How do we use the difficulties, and unique perspectives they have, and flip them so they no longer question their motivations, but use it to help others?

A potential solution could answer such questions: talking. Taking two of the few groups which can physically meet and allowing them to talk.

It sounds obvious, and perhaps too simplistic, but bare with me for a moment.

Human interaction is something many of us have lacked this year and can greatly boost morale for all recipients of the conversation loneliness itself has been seen as a public health crisis in Covid-19’s most vulnerable, older age groups (Berg-Weger & Morley, 2020). Not only that, it has been shown to be an increasing crisis for the under 30s (Lee, Cardigan & Rhew, 2020), the most common age of medical students. It can be argued, that to lack conversation, is to lack meaningfulness. This can lead to loneliness, depression and a wide array of mental illnesses. These two groups are both exposed to hospital wards and often with time that is not available to others in healthcare. So let us use this as an opportunity to help each other; let us find calm within the storm to talk.

It is understandable for both students and medical schools to be worried about the lack of clinical exposure they will likely (or in this case, not) be getting this year. Fortunately, for many medical courses, a compromise has been made to increase the time on the ward, at the expense of the number of wards a student may see. However, this offers a gift that many of our previous colleagues (in particular the ones who have just graduated and are now on the frontline themselves), have never fully experienced before. As students, we can become integrated fully for the first time into the team and now have the power to do more than shadow or practice clinical skills; we have the power of talking.

I therefore encourage students to use their newfound rapport with their colleagues and patients to make your role very clear: you are there for them. You will be there for patients with no visitors, and colleagues likely very stressed and scared. Attempt not to use this as a reason to emulate this, but rather to be their friend, their listener and, from the unique and isolating nature this pandemic has created, their potential mental health saviour.

References

1. Berg-Weger, M. and Morley, J.E., 2020. Loneliness in old age: an unaddressed health problem.
2. Lee, C.M., Cadigan, J.M. and Rhew, I.C., 2020. Increases in loneliness among young adults during the COVID-19 pandemic and association with increases in mental health problems. Journal of Adolescent Health, 67(5), pp.714-717.