When Erin Kim, a fourth-year medical student at the University of Michigan Medical School, and Tasha Hughes, M.D., M.P.H., a surgical oncologist at Michigan Medicine, crossed paths, they connected over a mutual passion for mental health advocacy work.
Kim spent years as a peer support advocate in college and medical school, and as a suicide hotline volunteer. As Vice Chair of Health and Wellbeing for the department, Hughes is invested in supporting surgeon mental health through training and beyond.
Kim was interested in how Hughes’ research linked to her work as Vice Chair. Hughes had done some work with the Intern Health Study (IHS), an existing ongoing prospective cohort study assessing multiple factors that impact mental health in first-year residents. (The study is led by U-M’s Eisenberg Family Depression Center director, Srijan Sen, M.D., Ph.D.) Hughes had used IHS data in a previous paper, which found that surgical trainees are a higher-risk group for depression, and she was interested in data that looked at well-being factors for practicing physicians. The more she and Kim talked, a partnership blossomed, along with a question that needed answers.
“We were curious about looking at what the long-term effects of new-onset depression symptoms during intern year was,” Kim said. They took a look at the data and now their findings are being published in JAMA Network Open, with Kim as the first author.
Digging into the data
Using existing data collected by IHS, they explored this question. In total, their data set included 858 residents representing 105 programs across the country who took a depression screening survey quarterly in their intern year with annual followup surveys for ten years after that.
What did the data reveal? “There looks to be a three or four time higher rate of depression when there’s depression as an intern,” says Hughes. Those who didn’t screen positive for depression during that first year of training were less likely to have more severe or persistent symptoms.
Another finding from the entire study group was that while average rates of depression declined over time, they remained higher than the initial survey score before participants started their intern year. Everyone was affected to different degrees by their training experience.
This data follows participants through training and early into their practice, so it suggests that even when they’ve completed training, those depression symptoms may still be around in their early career as practicing physicians.
A case for long-term thinking
“This paper brought to the surface that those training years have lasting impacts on you, and you can’t keep running from them,” said Kim. It’s good evidence of a need for proactive measures, like institutional support, mentorship and other systems in place to support mental health early on.
For example, the University of Michigan Medical School is instituting an opt-out mental health program for its students. The default is that you’re provided services unless you say you don’t want to partake. Kim and Hughes have talked about how they could expand an initiative like this to residents and faculty, and this data could be good evidence to leverage for it.
“For me, this also gets at how I like to frame health and wellbeing, which is as a workforce sustainability issue,” says Hughes. She thinks the findings of this study show that there’s value in addressing well-being early, because it could help combat issues like physician burnout and loss of people in the field.
Hughes thinks that Michigan Medicine has made good progress with its commitment to building a healthy workplace culture. However, she points out that there’s a lot of individual difficulty that can’t be addressed by the environment alone.
With the help of research like this, she wants to find ways to build infrastructure to support individual needs. This could go a long way in helping surgeons and other physicians have a happier, more sustained career.
Spreading the word
Carrie Cunningham, M.D., M.P.H., who’s a co-author on this paper, made headlines last year after her presidential address to the Academic Surgical Congress, where she talked frankly about her own mental health struggles. It sparked much-needed conversation about discussing these challenges in the field more openly.
Similarly, Kim and Hughes were interested in using their findings to keep that conversation going. Aside from publishing their work in a journal, how could they get this data out there and seen by a different audience?
Kim ended up submitting an abstract version of their findings to a data competition for medical students held by the Association for Women Surgeons.
She won. Twice. Her first win at the Great Lakes regional competition advanced her to the national one, where she won first place again.
She admits that she was a bit unsure initially about how their study would be received by a panel of judges from all over the country with a variety of perspectives. “It was further validation for myself and Dr. Hughes that this is important work and that people will listen once we can go back to the data and prove it. Hopefully this will start changing culture not just here, but everywhere else,” Kim said.
Another part of that experience she’ll never forget for the rest of her career? The fact that Hughes took time out of her personal life on a weekend to show up and support her for, as Kim puts it, “a random medical student research competition.” It was an example of how committed Hughes is to cultivating a healthy, supportive workplace culture, and it made her very proud to be her mentee.
When she was asked to provide a photo of herself after she won, she found Hughes and they took a picture together.
Looking to the future
With these findings, Kim and Hughes are thinking about future projects. It’s in the early stages now, but they’re interested in looking at other factors that could influence work status, like work-family conflict and gender.
As a future M.D. interested in pursuing surgery, Kim will be applying to residency programs next year. One might think that her work with this study would dissuade her from this field, but she thinks of her participation more like preventative healthcare. For her, that looks like investing in healthy coping skills for herself and her loved ones now.
She’s also grateful to those who’ve worked hard to foster a good culture here at Michigan Medicine, and to the residents and attendings who’ve been candid about their career paths and supportive of the next generation. Their example, along with this research, has made her think about what successful programs do to support physician mental health and ways she can advocate for it in the future for herself and her community as a future resident and practicing surgeon.
“She has a lot of initiative, that one,” says Hughes. “She’s very unique.”
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By Gillian Golden