Why 1 in 5 medical students consider dropping out

By Stephen Beech

One in five UK medical students has considered dropping out - with mental health issues a key contributor.

Researchers found that around 20% ponder abandoning medicine and mental well-being problems are rife among medical students.

The observational study, published in BMJ Open, involved students at nine medical schools in England, Scotland, Wales and Northern Ireland.

Students from all study years were invited to fill in an online survey between November 2020 and February 2021, and those who responded were invited to complete the questionnaire again three months later.

Of the 1,113 medical students who agreed to take part in the study, 71% filled in the initial questionnaire and just over half completed the follow-up survey.

The questionnaire included questions about medical students’ intention to drop out in the recent past and the extent and frequency of various aspects of their mental health.

These included emotional exhaustion; insomnia; hazardous drinking; anxiety or depression; obsessive compulsive disorder (OCD); paranoia; and bipolar disorder.

Researchers found that the prevalence of mental ill health among all the respondents was "high" - with a "substantial" number of medical students met screening criteria for mental ill health.

Six in every 10 were drinking hazardously and over half reported symptoms of insomnia (54%).

More than half (52%) reported a medium to very high number of stomach or bowel symptoms while 52% had OCD symptoms. Nearly half had anorectic tendencies (45%).

More than a third were emotionally exhausted (36%) while 38% had symptoms of anxiety or depression.

Around one in five had symptoms of paranoia (19.5%) and 3% had bipolar symptoms.

Just under a fifth of medical students (19.5%) said they had considered dropping out of medical school in the previous four weeks.

Study author Dr. Milou Silkens, of Erasmus University in The Netherlands, said: "With the exception of hazardous drinking and bipolar disorder, all the other aspects of mental ill health were associated with an intention to abandon their studies."

She said students who were more emotionally exhausted and had any of higher symptoms of anxiety or depression, insomnia, somatisation, paranoia, or anorectic tendencies expressed "significantly stronger" intentions to drop out of medical school than those at the lower end of the scale.

Dr Silken said the percentage of those who said they were considering dropping out is higher than the actual estimated percentage of 5%.

She said: “Students who complete medical school while doubting their career trajectory may be more inclined to drop out of postgraduate training.

“The number of doctors who pause their training after completing Foundation training has doubled from 34% in 2011/2012 to 70% in 2020/2021.

“Dropping out of medical school can have significant personal, financial and psychological consequences for the individual.

"There is also the financial cost to the taxpayer, and the time and effort wasted by educators."

Dr. Silken says plans to shorten the curriculum to four years from five may only make matters worse.

She said: “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.

“The various mental health symptoms that have been found to predict dropout are particularly difficult to recognize in medical students, due to the ‘toxic’ and competitive work culture of medical school normalizing the idea of individuals experiencing them."

The research team says medical schools need to do more to improve the learning environment for students and encourage them to seek help to reduce the stigma of mental health symptoms.

Dr. Silken said: “This can be through educating students on warning signs of mental decline through workshops or courses, and signposting clearly where they can go for help.

"Medical schools should also actively clarify that seeking help will not jeopardize their careers, but rather improve their chances of completing their degree.

“There should be no discrimination against individuals with these diagnoses, as with appropriate interventions and more supportive learning environments many students can flourish."

The research team also pointed out that medical schools need to help prospective applicants better understand the demands of their chosen careers.

Dr. Silken 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."

Se added: “It may be useful for medical schools to have systems in place that can help new applicants - and existing medical students - consider whether medical training is for them by setting realistic expectations of the demands of medical training."

The study comes amid a worldwide shortage of doctors, with the current shortfall estimated to be around 6.5 million.