Research Article: A Qualitative Exploration of the Help-Seeking Behaviors of Students Who Experience Psychological Distress Around Assessment at Medical School

Date Published: March 31, 2017

Publisher: Springer International Publishing

Author(s): Rachel I. Winter, Rakesh Patel, Robert I. Norman.


Medical students are at high risk of experiencing psychological distress at medical school and developing mental ill-health during professional practice. Despite efforts by faculty to raise awareness about this risk, many students choose to suffer in silence in the face of psychological distress. The aim of this study was to explore drivers that prompted help-seeking behavior and barriers that prevented individuals prioritizing their well-being around the time of high-stakes assessment at medical school.

Semi-structured interviews were conducted with fifty-seven students who failed high-stakes assessment at two UK medical schools, exploring their experience of academic difficulty and perceptions about causes. A thematic analysis of twenty transcripts that met inclusion criteria was completed to identify key factors that influenced participants’ decisions around seeking help for their psychological distress, and in some cases, mental health problems. Twenty participants who specifically described a deterioration in their mental health around the time of assessment were included in this study.

Barriers to seeking help in these instances included: normalization of symptoms or situation; failure to recognize a problem existed; fear of stigmatisation; overt symptoms of mental distress; and misconceptions about the true nature of the medical school, for example beliefs about a punitive response from the school if they failed. Drivers for seeking help appropriately included: building trust with someone in order to confide in them later on, and self-awareness about the need to maintain good mental health.

There are various drivers and barriers for students’ help seeking behaviors when experiencing psychological distress around the time of assessment, particularly self-awareness about the problem and prioritisation of well-being. Students who fail to recognize their own deteriorating mental health are at risk of academic failure and medical schools need to develop strategies to tackle this problem in order to protect these students from harm.

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Fifty-seven interviews were conducted between 2009 and 2014 across the two medical schools, and interviews from 20 participants met the inclusion criteria for this study (Fig. 1). The demographic details of participants are presented in Table 1.Table 1Demographics of participantsDemographicsNumberMale12Female8Primary or secondary in the UK prior to entry into medical school13International student7Graduate-entry student6n = 20

Failure to recognize a problem existed at the time

Participants’ help-seeking behavior was often slow and recognition for the need to seek help came as a last resort but there were specific drivers for accessing support.Recognition that mental health is important

There are a number of established factors that influence students’ help-seeking behavior at medical school such as a fear of stigmatization [1, 2, 13, 21–23], normalization of symptoms and situation [1, 2, 12, 24, 25] and various held perceptions by individuals of themselves, others and the medical school [1, 13, 23, 26]. The findings from this study confirm these factors as influencers on the decision-making process of students’ help-seeking behavior, with the denial of a mental health disorder [23, 24] being a key determinant on whether individuals actually seek help when in distress. In particular, this study suggests that students’ lack of awareness to their own mental health, as well as a lack of response to any awareness among those who retain it, is an important barrier to seeking help despite the support system in place to prevent or detect mental health problems among students at medical school.




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