Historically, medical students, residents, and physicians experience higher rates of stress—such as anxiety, depression, and related mental illness that affects quality of life, productivity, and patient care—but lower rates of seeking support.
And because mental health and self-regard are linked, there is also the stigma of seeking support.
Seeking to destigmatize this cultural dynamic, the Geisel School of Medicine Counseling Service launched Healthy Students, Healthy Physicians in 2019—a free comprehensive mental health and wellness program aimed to make help-seeking a lifelong habit.
The program is a confidential mental health resource for non-crisis counseling available to Geisel students, including those in medical, health science, and graduate programs. Supported primarily by a philanthropic endowment covering most of its annual budget—insulating it from the year-to-year budget pressures—it exists alongside other resources available to students, including Dartmouth College Health Service and a tele-therapy option that has proven particularly valuable for students on away rotations in other states.
What began as a pilot initiative specific to Geisel medical students within Dartmouth’s wellbeing landscape has grown into a well-established, reliable resource for all Geisel students.
“Many of our students find that life or school-related stressors can be better managed with supportive coaching,” Matthew Duncan MED’01, assistant professor of psychiatry says. “We intentionally set out to create positive experience with counseling to help shift the culture to one where in medicine help-seeking is accessible to all medical students, encouraged, and normalized as a sign of strength rather than weakness.
“If a medical student has a positive experience engaging with mental health services early in training—if they learn that asking for help makes them more effective rather than less—that lesson is more likely to travel with them through residency, fellowship, and practice.”
Medical school stressors are not random. They follow a predictable pattern which the counseling program has carefully mapped, phase by phase.
For medical students in the preclinical years, dominant themes cluster around several experiences that can catch even high-achieving students off guard. Academic failure is perhaps the most disorienting. Many students arrive at medical school as high achievers who may not have experienced academic failure and failing a quiz can feel discouraging and identity threatening.
They also find themselves in clinical situations they may not feel fully prepared to face. Still forming their professional identity, they are learning how to communicate and conduct themselves in clinical and academic settings, a need amplified by social media and the complex interpersonal dynamics that introduces.
Other common stressors include moral distress, imposter syndrome, evaluation culture, fear of making mistakes, sleep deprivation, financial struggles, and for new students, a disconnection from home that is particularly acute for international students who are adjusting to life in rural New England.
As medical students move into clinical training, the landscape shifts. The USMLE national licensing examinations loom large requiring sustained, solitary study periods. Self-regulation, long-range planning, and the ability to maintain focus without a formal structure are not the same skills that got students through their preclinical coursework.
Throughout the arc of their education at Geisel, counselors are available to help students develop a relationship with difficulty that does not unravel their sense of self. In the past year alone, students across all four years of the MD program and MPH and MS programs participated in approximately 1,500 counseling sessions, including follow-up visits indicating continuity of care. Monthly visits average 38 to 61 students, consistent with the academic calendar with preclinical students representing the largest share of users, aligning with known academic and clinical transition stress points.
The Geisel Counseling Service’s success is rooted in the depth of clinical expertise specifically matched to the medical school experience with counselors who have been carefully selected not as generalists but as providers who already understand the rhythms and pressures of medical training, so students need not spend the first several sessions explaining what that feels like.
Changing the cultural stigma against help-seeking in the medical profession is slow, but it can happen one student at a time, in individual sessions with someone who has spent their life succeeding but learns to sit with the discomfort of seeking support and realizes they are stronger for it.