Mental health differences in medical students based on curriculum and gender

Abstract

Background: The prevalence of mental health struggles among students in medical school is widely reported; however, little is known about how it is impacted by the medical school curriculum. This study aimed to evaluate differences in anxiety, depression, and emotional exhaustion in medical students based on gender, class year, and curriculum.

Methods: An anonymous online survey consisting of questions from established, validated questionnaires about demographics, anxiety, depression, emotional exhaustion, and personal health behaviors was sent to 817 medical students who attended Rowan-Virtua School of Osteopathic Medicine during the Spring of 2021. When applying to this school, each of these students had the option to choose either the problem-based learning (PBL) or lecture-based learning (LBL) curriculum track.

Results: The survey was completed by 222 students. Females experienced higher levels of anxiety, depression, and emotional exhaustion than males. Students in the PBL had lower levels of emotional exhaustion than their peers in the LBL. Increase in emotional exhaustion was most pronounced between 1st and 2nd year students. Emotional exhaustion was inversely correlated with sleep and exercise.

Conclusions: On average, students who were either male or in the PBL curriculum experienced less mental distress in the form of anxiety, depression, and emotional exhaustion than their peers. While gender continues to be an established factor in how mental distress is experienced, the reduced levels of emotional exhaustion in PBL students is a novel finding that can potentially shed light on how to better optimize medical education. Despite the inherent selection bias and lower number of PBL students, to our knowledge, this is the first study comparing two different curricula within a single institution. This finding along with a focus on good sleep and exercise habits may provide a path for improving mental health in medical students.

Keywords: Anxiety; Curriculum; Depression; Emotional exhaustion; LBL; Medical students; PBL.

Fig. 1

Mood disorder among all students. Frequency of PHQ-4 composite scores

Fig. 2

Comparison of mood disorder between pre-clinical and clinical cohorts. Frequency of PHQ-4 composite scores

Fig. 3

Comparison of anxiety and depression by gender. a Average anxiety subscale scores. b Average depression subscale scores

Fig. 4

Comparison of mood disorder by gender. Frequency of PHQ-4 composite scores

Fig. 5

Comparison of anxiety and depression by curriculum. a Average PHQ-4 composite scores. b Average anxiety subscale scores. c Average depression subscale scores

Fig. 6

Comparison of mood disorder by curriculum and gender. a Frequency of PHQ-4 composite scores among females in PBL and LBL. b Frequency of PHQ-4 composite scores among males in PBL and LBL.

Fig. 7

Comparison of emotional exhaustion (EE). a Average EE scores by class year. b Average EE scores by gender. c Average EE scores by curriculum

Fig. 8

Emotional exhaustion (EE) and personal health habits. a Average EE scores and sleep duration per night. Linear trend p < 0.0001. b Average EE scores and exercise days (of at least 30 consecutive minutes) per week. Linear trend p = 0.0071