December 22, 2011, 12:01 AM

A Medical School More Like Hogwarts

By PAULINE W. CHEN, M.D.

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  Dr. Michael Pilla

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  Dr. Michael Pilla

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  Dr. Michael Pilla

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  Dr. Michael Pilla

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  Dr. Michael Pilla

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  Dr. Michael Pilla

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  Dr. Michael Pilla

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  Dr. Michael Pilla

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  Dr. Scott Rodgers

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  Enoch Sizto

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  Enoch Sizto

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Students and faculty from Vanderbilt School of Medicine compete in the Spirit Showdown against other colleges for the College Cup, an Olympic-style competition spanning two days in the fall semester. (From left: Jacob Ark, Beau Kelly, Megan Culler, Conrad Myler and Allison Martin.)

It’s been clear for several years now that while aspiring doctors may start medical school as happy and as healthy as their non-doctoring peers, four years later they aren’t.

More than 20 percent end up with depression, more than half suffer from burnout, and in any given year, as many as 11 percent contemplate suicide. All of these statistics, of course, bode poorly for patients. Doctors who are burned out are more likely to make errors and to lose sight of the altruism that led them to go into medicine in the first place.

Fortunately, the subtext of this growing body of data — that there is something toxic about the medical education process — has not been lost on the educators who run this country’s medical schools. Some have hired mental health experts for their institutions, created counseling centers and set up confidential Web sites and hot lines; others have developed elective courses in meditation and mindfulness, switched from letter grades to pass-fail systems and revamped class schedules to foster better work-life balance.

Despite the good intentions, their efforts continue to be stymied by one thing: Students aren’t participating. As one educator recently told me, “I keep seeing the same 10 students at all these events, and I’m not even sure they’re the ones we need to be reaching.”

But one medical school, Vanderbilt, in Nashville, appears to be succeeding, with a Student Wellness Program that includes activities like yoga classes, community service events, healthy cooking classes, forums on nutrition and sleep, and a mentoring program that pairs senior students with newer ones. The key to its success? Empowering and partnering with those who have the most at stake — the medical students themselves.

Aside from an annual daylong retreat and a weekly medical humanities course, “most of the ideas are generated by the students themselves,” said Dr. Scott M. Rodgers, the associate dean of medical student affairs, who started the program with a group of students six years ago and continues to be its guiding force. “We just try to come up with any necessary money.”

One example of this unique collaboration is the program’s college system, which assigns students to one of four “colleges,” each with its own set of faculty advisers. Instituted nearly five years ago and intended simply as an improvement over a traditional but more random advising program, the new system was also set up in a way that allowed Vanderbilt students to introduce innovations.

They ran with it. Drawing on cultural cues that resonated with their peers — in this case the Harry Potter stories — they took an active role in naming the colleges after former medical school deans and imbued each with a particular personality. Completing the picture were artfully designed crests, designated college colors and devised mottos in Latin that range from the more noble (“Primus Inter Pares,” or “First Among Equals”) to the tongue-in-cheek put-down (“Commodum Habitus Es,” or “You Have Just Been Owned”).

As college loyalties began to develop, students organized friendly competitions that promoted healthy habits and community service. These events culminated four years ago in the first College Cup, a now annual weekend affair where pride runs deep. Amid bagpipes and a marching band, colleges vie to outdo one another in events like a 5-K run, an “Iron Chef”-style cooking competition and a trivia contest.

“These programs keep you from putting your whole self-worth on the next exam,” said Kathleen Weber, a first-year student who was also quick to point out the superiority of her own college, Batson.

There are critics, however, who charge that with so much to learn in so little time, medical students — and their future patients — would be better served if they expended more, not less, effort on studies. Others have voiced concern that students end up feeling a “reverse pressure” to choose extracurricular activities over studying.

But proponents are quick to counter that medical students in general aren’t people who must be persuaded to study. What they need is encouragement to balance academic dedication with the self-care that will sustain them in the long run. “You can’t keep running on fumes,” said Dr. Johanna N. Riesel, a former medical student at Vanderbilt now in her second year of surgical training at Massachusetts General Hospital in Boston. “You have to learn how to maintain some sense of equilibrium and sanity in a relatively insane process.”

While no one yet knows the long-term effect of Vanderbilt’s innovations – or, for that matter, of any programs designed to promote “wellness” — Dr. Rodgers and his colleagues and students at Vanderbilt remain committed to their initiatives. For them, the implications of medical student depression and burnout are simply too important to ignore.

“It’s a challenge for anyone to stay healthy and happy,” Dr. Rodgers said. “But when doctors are able to stay healthy and happy, that means patients get physicians who are more compassionate and selfless. They end up with doctors who really have the energy to invest time in them.”

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The Goldilocks Principle of Stress: Too Little Is Almost As Bad as Too Much

STRESS

Stress isn't all bad. You need just the right amount of adversity in life to learn to cope with the troubles ahead.

By MAIA SZALAVITZ | @maiasz | December 20, 2011 | 3

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ANTHONY LEE / GETTY IMAGES

A life free of stress and adversity sounds blissful. But, in fact, the happiest and healthiest people are those who have had at least some early exposure to negative experiences, according to a new research review.

Despite the popular notion, stress isn’t all bad. In fact, low to moderate amounts of stress are necessary for healthy growth. What’s harmful is large doses of uncontrollable stress — experiencing a natural disaster, for instance, or living in extreme poverty — particularly in early life. Also harmful, it turns out, is having experienced no stress at all.

The new review adds weight to a growing body of evidence that most brain systems function like muscles: they are strengthened through exposure to gradually increasing loads at the appropriate stages of development, but they will wither without exercise and get injured if they are suddenly overloaded without prior training. The stress system is a prime example.

MORE: Why American Presidents (and Some Oscar Winners) Live Longer

In one study included in the review, researchers interviewed 2,000 adults about their lifetime experiences with 37 negative events — things like serious illness or injury, parental divorce, death of a family member, natural disasters and physical and sexual abuse. Participants also provided information about how old they were when the various events occurred.

In addition, the participants were asked about their current levels of distress, their functioning at work and in their relationships, their symptoms of post-traumatic stress and overall life satisfaction. Participants were followed for two years.

Not surprisingly, the more negative experiences people had suffered in the past, the more distress, impairment and post-traumatic stress they reported, along with less satisfaction with life. However, the relationship wasn’t linear. “A history of some prior adversity was associated with better outcomes over time than not only a history of high prior adversity but also a history of no prior adversity,” the authors wrote.

In other words, there’s a sweet spot of stress: too much stress overloads the system and makes life difficult, but having had too little stress causes similar problems. It may be that people who have been through just enough hardship are best able to develop their abilities to cope — and have a more firmly established network of social support — making it easier for them to handle tough experiences later on.

MORE: Study: How Chronic Stress Can Lead to Depression

Another study looked at people with chronic back pain. Again, those who had either no previous adversity or high levels of it had worse function and used more medical services than back-pain sufferers who had experienced some life stress. Indeed, having had an adversity-free life was almost as bad as having had high levels of trauma in terms of disability and prescription pain medication use.

In another study, researchers gauged students’ experience of physical pain. The students were asked to submerge one hand in a bucket of freezing water and report how much pain they felt. Afterward, they were interviewed about their emotional experience during the task.

The researchers wanted to know whether the participants were “catastrophizing” the pain task. Catastrophizing involves thinking that the pain will be unbearable and overwhelming — which in turn heightens the perception of pain.

In this study, too, the researchers found that those who had had moderate exposure to adverse experiences were less likely to catastrophize and felt less pain and less associated negative emotion, compared with those with histories of high or no adversity. Catastrophizing itself, in fact, accounted for some of the increase in pain intensity and negative emotion seen in people on both ends of the spectrum.

That makes psychological sense: if you’ve experienced many disasters, it’s not surprising that you’d expect the worst, while if you’ve had a stress-free life, the novelty of pain itself may provoke intensified fear. In contrast, if your past experiences of stress have been manageable, new ones are less worrisome.

MORE: Viewpoint: Why Tough-Love Rehab Won’t Die

So, does this mean you should deliberately expose your children to stressful experience to toughen them up? Mark Seery, assistant professor of psychology at the State University of New York at Buffalo, the author of the study, thinks not.

“Bad things are still bad things,” Seery writes, noting that the findings should not be taken to minimize the negative consequences of adversity. “This work does, however, suggest that experiencing adversity may have an upside — a silver lining — in that it may help foster resilience.”

For most people, life naturally includes enough stress that there’s absolutely no reason for parents to create more for their children. In fact, studies of “tough-love” programs aimed at promoting behavior change find that this is either ineffective or outright harmful.

For babies in particular, the research finds that responsive care — especially soothing them when they cry — is the best way to “educate” their stress systems. Infants first require nurture from caregivers in order to develop the ability to self-soothe. As they grow, however, they will require gradually increasing challenges — not too much, not too little. When it comes to stress, the Goldilocks principle seems to apply.

Read more: http://healthland.time.com/2011/12/20/the-goldilocks-principle-of-stress-too-little-is-almost-as-bad-as-too-much/#ixzz1hZw5Mkgj

Arguing with Mom Helps Teens Fend Off Peer Pressure

PARENTING

Note to all control-freaky parents out there: sometimes being a good parent means giving in.

By ANNE HARDING/HEALTH.COM | December 22, 2011 | 1

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GETTY IMAGES

Parents of teens beware: It may not be a good thing if you always gain the upper hand in arguments with your son or daughter.

New research shows that adolescents who quickly backed down during an argument with their mother had a harder time resisting peer pressure to use drugs and alcohol than teens who were able to calmly, persuasively, and persistently argue their point with Mom.

Although the findings don’t mean parents should let their kids win arguments, they do underscore that parent-child relationships are an important training ground for how children will handle peer relationships as they grow up, says Joanna Marie Chango, a study coauthor and a graduate student in clinical psychology at the University of Virginia, in Charlottesville.

“They have to learn somewhere [how to] stand up for themselves, and what they learn at home we think they take largely into their interactions with peers,” Chango says.

MORE: Health.com: How to Have a Healthy Argument

It may seem easier to parents just to demand compliance from their kids, but doing so can create unintended consequences down the road, says Stephen Hayes, a professor of psychology at the University of Nevada, in Reno, who was not involved in the study. “There’s a message inside ‘do what I say’ parenting,” he says. “It’s ‘do what other people say.’”

The study, which was published in the journal Child Development, included an ethnically and socioeconomically diverse group of 157 adolescents. When the kids were 13, Chango and her colleagues observed them in two conversations with their mother. (The researchers focused on mothers because they tend to spend the most time with a child, but the findings would likely apply to fathers as well, Chango says.)

LIST: Health.com: 8 Reasons to Make Time for Family Dinner

In one conversation, mother and child talked about a contentious issue of the child’s choice (such as grades or household rules), and the researchers noted how often the children backed down without appearing to have truly been won over. In the second conversation, the children asked their mother for advice with a problem and the researchers rated the mother’s warmth, positivity, and support.

At ages 15 and 16, the teens were more likely to be influenced by the drug and alcohol use of their friends (whom the researchers surveyed independently) if they’d received less support from their mother and backed down more easily in the conversations. Teens who argued with their mothers less effectively also were found to be more susceptible to peer pressure in a series of hypothetical situations posed by the researchers.

MORE: Health.com: Teen Dating May Spread Teen Drinking

The key quality that appears to link household arguing and resisting peer pressure is a child’s “ability to persuade and be assertive through calm reasoning,” rather than resorting to whining or yelling, Chango says. “We found over and over again that the right kinds of arguments are linked to better outcomes for teens.”

These interpersonal skills may be especially important today, Hayes says, since social networking and other technology has made peer pressure much more subtle and diffuse than the age-old scenario of, say, one teen urging another to try cigarettes.

“You almost don’t know who your kids are touching, and who are their heroes and who are their networks now, because they’re so extended now with internet messaging and all the rest,” Hayes says. “You better teach kids who can have a strong spine and a sense of values and know that they’re cared for.”

MORE: Kids Sexting May Not Be as Big a Problem as Thought

Dennis Embry, president of the PAXIS Institute, in Tucson, Ariz., which designs programs for preventing substance abuse and violence among young people, says a good way for parents to foster better communication with teens is to ask them open-ended questions that, for instance, encourage them to explain what they want to do and why.

“What you want is to shift the conversation away from control toward exploration about how they can become self-reliant human beings,” Embry says.

Teaching self-reliance without losing control over a teen’s behavior is a “balancing act for parents,” Hayes says. Giving teens autonomy can be “uncomfortable,” he says, “because it means you’re losing a bit of that role, but of course that’s the point: You’re training yourself out of the job.”

Read more: http://healthland.time.com/2011/12/22/arguing-with-mom-helps-teens-fend-off-peer-pressure/#ixzz1hZv9kuD2