Medical students notoriously have higher levels of stress and depression compared to other undergraduates. With countless contributory factors such as stress, sleep deprivation, academic rigour, traumatic clinical situations and debt, medical schools’ welfare support is crucial. 

Surprisingly – or not – the institutions which are meant to nurture the next generation of empathetic doctors fall short in caring for them. 

The BMA medical student wellbeing checklist was created in 2021 in response to declines in student mental health. The checklist aims to identify discrepancies in welfare provisions across UK medical schools. It also acts as guidance to medical schools about what measures they should provide their students. 

We surveyed students recently and received 534 responses from 43 UK medical schools between October 2023 and May 2024. The main findings are summarised here, but you can also read the full report.

Mental health support

Only 44% and 45% of students agreed their medical school offered voluntary wellbeing sessions and easily accessible psychological support, respectively. Despite such limited provisions, the implementation is poor and performative at best. 

Many students highlighted that wellbeing provision is a ‘tick box exercise rather than genuine care about students’ welfare’. Some universities had only one support officer for over 400 students while others did not even respond to emails. Although the number of counsellors may not correlate with better support, having a larger number means there may be more availability for appointments. 

These performative acts are combined with an unpleasant culture which dissuades students from seeking support. It is shocking and disheartening that students thought ‘people get kicked off if it seems like they are struggling with mental health to prevent more suicides’.

Numerous studies emphasise not just the provision of wellbeing sessions, but more importantly their impact and uptake by students. Poor provisions, poor support, poor culture – it needs to change. 

Feedback

On a positive note, 75% of students agreed they had a mechanism to give continuous feedback.

However, some were disincentivised due to inaction and the potential of punitive measures. Some students highlighted that they are labelled by senior staff as a ‘troublemaker and gaslit to feel the issue is their fault’ if they raise a complaint. This is unacceptable and equivalent to punitive measures on whistleblowing.

Organisation

Support should be constant in medical school. Two key times when support should be prioritised is when students begin and conclude their studies. These times of change can be difficult due to a new routine, workload and friendships. 

Medical schools should offer adequate transition provisions such as peer-to-peer mentorship schemes and assistantships/transition to FY1 programmes. While 71% of students agreed their school had a peer-to-peer mentorship programme, transition to FY1 support is sparser – student consensus is they ‘couldn’t feel less prepared’.

Similarly, some felt they were expected to act outside of their remit on placement (out-of-hours or excessive workload) despite being unpaid. The current medical student finance system is failing, with some having to pay out of pocket to travel to placement. With already excessive costs, insufficient funding and limited time to work, students should be reimbursed. 

Workload and burnout

Balancing a 9-to-5 placement and self-directed learning is challenging. Students felt ‘there is no time to learn content let alone live our lives’ and ‘no one really cares how much we do because apparently being burnt out is just part of being a med student.’ This fits with existing studies which found excessive workload can lead to high levels of medical student burnout.

30.71% of students agreed their medical school incorporated a period of designated weekly protected study time into the timetable. Students explained how no protected time means they are ‘forced to skip’ placement to find time to study. This is abhorrent. Self-directed learning is the foundation to build clinical knowledge on. When lacking, it leads to missed opportunities, stress and burnout.

Moving forward

Most medical schools meet criteria of having a peer-to-peer mentorship scheme and measures for students to provide continuous feedback. However, the rest were rarely met. 

It is disheartening to see the lack of psychological support and negative cultures surrounding seeking support in medical schools. This is especially concerning given the difficult climate students live in highlighted with the full report, which includes inadequate rest facilities, lack of protected mealtimes and insufficient funding. 

Such tangible measures should be easily implemented, and we hope that medical schools will use this feedback to do so. However, negative culture around seeking support should not be overlooked due to its often taboo nature. In fact, it may be one of the most important findings. 

To be able to study medicine, individuals should not just be able to look after others but also themselves. Medical schools should be catalysts to conversations about mental health and support, not adding fuel to the fire. 

Now armed with the knowledge of discrepancies in wellbeing provisions across medical schools in the UK, the medical students committee hopes to act on it. We plan to present this report to the Medical Schools Council and related stakeholders to advocate for change and improve the state of medical student welfare in the UK. 

Ria Bansal is a 4th year medical student at the University of Nottingham and the BMA medical students committee deputy chair for student welfare