Medical students' evolving perspectives on their personal health care: Clinical and educational implications of a longitudinal study

The mental and physical health care issues of medical students are increasi ngly recognized as both prevalent and complex. Emotional distress, symptoms of mental illness, and maladaptive substance use are widespread and may of ten be driven by training-related stressors, The data suggest that nearly a ll medical students identify physical health concerns as well. The care of medical students as patients is complex because of problems associated with the stigma of various illnesses and the dual role of trainee and patient i n medical school. A written confidential survey assessed students longitudi nally near the end of their first and third years of training regarding the ir perceived health care needs, health concerns, attitudes toward care, acc ess to services, and care-seeking practices (161 items). A subset of studen ts (n = 33) were reassessed 1 month after the second survey to measure reli ability. McNemar's chi-square (chi(2)) tests, repeated-measures multivariat e analysis of variance (MANOVA), and kappa and Pearson correlations were us ed to evaluate outcomes. Almost all students reported health care needs dur ing both training phases, and their mental and physical health concerns wer e stable over time. However, the preference for obtaining health care at a site other than their training institution and concerns about confidentiali ty increased, although students were marginally more likely to obtain care at their medical school during clinical versus preclinical training. The st udents' tendency to seek informal care from colleagues remained consistent, as did their high level of concern about professional jeopardy relating to personal health issues. Their tendency to accept the dual patient-student role depended on the particular health care issue; they expressed a strong tendency to protect other students' confidentiality, even in cases of poten tial significant impairment. Responses were reliable across a 1-month retes t interval. We conclude that medical students' perspectives on their mental and physical health care across the transition from preclinical to clinica l training reveal the importance of pursuing, not neglecting, a number of c linical and educational initiatives. Through their specialized expertise, p sychiatrists may help to ensure sound mental and physical health care for t he more than 69,000 medical students in training in this country. Copyright (C) 2000 by W.B. Saunders Company.