Suicide in Medical Trainees: Lack of Data Hurts Prevention

Marcia Frellick

Disclosures

August 22, 2019

How can a problem be solved when much of that problem remains a mystery?

Unlike the scope of physician suicide, which has been well documented, the precise number of medical trainees who die by suicide each year is unknown. No national database for student and resident suicides exists. Medical schools are not required to keep such statistics. Coroners are not required to inform medical schools when the cause of death is suicide. And families may not want the information shared, especially when the cause of death is unclear.

The sparse data that are available about suicides among medical trainees vary widely. For instance, the American Medical Student Association reports that medical students die by suicide at a rate three times higher than that of their peers in the general population. Yet conversely, a study published earlier this year in Academic Medicine , led by Caren J. Blacker, BMBCh, MA, found that medical students kill themselves less often than their general-population peers.

As Blacker told Medscape, when it comes to medical trainees, "Worldwide, there have only ever been 12 papers that have looked at actual suicide, whether suicide numbers or suicide rates. There is no comprehensive data collection on actual suicides among medical students." In fact, she said that when it comes to questions about the scope of these suicides, the only answer is, "We just don't know."

No Agreement on Who Should Collect Data

In an invited commentary published online in April in Academic Medicine , Benjamin M. Laitman, MD, PhD and David Muller, MD, from the Icahn School of Medicine at Mount Sinai in New York City, explain the need for research and transparency. Research should help determine whether medical student suicides have any significant link to variables such as demographics, region, private or public education, or average student debt, they write.

The authors call on medical school leaders to support reporting student suicides to a central, secure database managed by a combination of the Association of American Medical Colleges, the American Council for Graduate Medical Education, and the Liaison Committee on Medical Education (LCME). If that does not happen, the authors predict that medical students will eventually start a grassroots open-access, social media–based reporting system. That "would not be an effective way to gather and report valid data, but it would certainly spur the medical education community into action if the community fails to act in a timely fashion," they write.

The subject of suicide was also a critical topic at the annual meeting of the American Medical Association (AMA) in Chicago in June 2019. Delegates adopted a report that included a call to explore reliability and cost-effectiveness of collecting National Death Index data and keeping a confidential database of information on manner of death for physicians, residents, and medical students listed as deceased in the AMA Physician Masterfile for long-term studies. The National Death Index is a centralized database of death record information established by the National Center for Health Statistics.

According to a news report released by the AMA, the delegates directed the AMA to "request that the LCME and the [American Council for Graduate Medical Education] collect data on medical student, resident, and fellow suicides to identify patterns that could predict such events."

However, Veronica M. Catanese, MD, MBA, co-secretary of the LCME, told Medscape that collecting such data is not in the purview of an accrediting board, such as the LCME. Even if the data could be collected, it would be misguided for an accreditor to do so because that would "make schools feel as though there is a direct correlation in any kind of unfortunate student outcome and the medical education program itself, when there are so many other factors involved," she said.

"There may be a need to collect this information, but certainly it should not be collected by an accrediting body." Catanese added that the LCME does make sure the schools are meeting the bars for duty hours and are readily available for personal counseling and student well-being programs. These are all part of strategies to reduce stress that can lead to suicide.

The Association of American Medical Colleges (AAMC) also does not currently offer data on trainee suicides and has not publicly indicated any specific plans to participate in future collection. However, Geoffrey Young, PhD, senior director of student affairs and programs for the AAMC, told Medscape that the organization is "engaged in several national efforts to improve clinician and student well-being across academic medicine."

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