Many medical students encounter academic, personal, and social stress during their educational experience. Most students cope successfully with the demands of medical school and the interpersonal experiences that go along with it, but for some students these difficulties can become overpowering and unmanageable.
Faculty and staff are frequently in the most direct position to identify students in distress. Moreover, staff and faculty are often perceived by students as the first point of contact in obtaining advice and support. Your expression of interest and concern may be critical in helping a student reestablish the emotional equilibrium necessary for academic success.
This guide is designed to assist you in working with students in distress. Medical Student Counseling Center (MSCC) staff members are available to offer further consultation.
Recognizing Distressed Students
A referral for counseling can be made when you believe a student’s problems go beyond your experience and expertise, or when you feel uncomfortable helping a student with an issue. A referral may be made either because of the way the student’s problems are interfering with academics or with your teaching, or because observation of the student’s personal behavior raises concerns apart from academic work.
At one time or another, everyone feels upset. However, when some of the following are present, the student is probably in distress:
- Noticeable decline in quality of work or writing and class participation; increased absences, or failure to turn in work
- Prolonged appearance of depression (e.g., sad expression, apathy, tearfulness, distractibility, weight loss)
- Nervousness, agitation, irritability, aggressiveness, non-stop talking
- Bizarre behavior or speech
- Extreme dependency on faculty or staff, including spending much time visiting during office hours or other times
- Marked change in personal hygiene
- Talk of suicide, either directly or indirectly (e.g., "I won’t be around to take that exam anyway." or "I’m not worried about getting a job, I won’t need one.")
- Comments in a student’s paper that arouse concern
Any one of the above signs present in a student does not absolutely indicate the student is in serious distress. Many disturbances during medical school are relatively transient. However, you may become alarmed by changes which are extreme or by significant changes that last longer than is typical. If there is doubt about the seriousness of the problem, consult a Medical Student Counseling Center staff member about evaluating the situation and taking the most appropriate steps.
What Can You Do?
The options you choose depend upon the urgency of the situation. For students who are having difficulty but seem able to cope, you may choose not to intervene, to limit your interaction to the academic issue, or to deal with it on a more personal level. If you judge a situation to be more urgent, you might decide that more active and timely involvement on your part is appropriate.
How Do You Make a Referral?
When you have decided a student might benefit from counseling, it is usually best to express your recommendation in a private and matter-of-fact manner. Make it clear that this represents your best judgment based on your observations of the student. Be specific regarding the behavior that has raised your concerns and avoid diagnostic labels or attributing anything negative to the individual's character.
Except in an emergency, the option must be left open for the student to accept or refuse counseling. If the student is reluctant for any reason, simply express your acceptance of those feelings so that your relationship with the student is not jeopardized. Give the student room to consider alternatives by suggesting that maybe you can talk after the student has had some time to think it over.
Once the student has agreed that counseling might be useful, there are several possible steps to take, depending on the urgency of the situation and how committed the student is to following through on the referral. You can give the student information about the Medical Student Counseling Center and urge the student to call for an appointment. Another option is to accompany the student yourself. The MSCC staff would appreciate your calling ahead if a student is being brought over or sent directly in an emergency, so that plans can be made to have a counselor available.
In emergency situations involving students who are unwilling or unable to seek help on their own, staff and faculty members may call the MSCC at 335-8056. For any referral, whether the student accepts it or not, follow up with him or her later to show your continuing interest.
What Happens at the MSCC?
Once the student contacts the MSCC, an appointment is made for an initial interview. This is usually within a few days from the time of contact, but can often even happen the same day. Depending on counselor availability, students are able to walk-in and speak with a counselor immediately. In an emergency, the MSCC will make arrangements for the student to be seen that day.
During the first meeting, a counselor assesses the student's needs and the ways the MSCC may be able to help. Options the counselor considers include individual counseling, tutoring groups or workshops, or referral to private or community counseling services. Some students may leave the initial appointment feeling able to handle their concerns without further assistance.
Counseling services provided at the MSCC for students are free and confidential. Information is released only with a student's written permission. This means that a counselor cannot discuss the student's situation with anyone unless the student provides written permission. Exceptions to confidentiality may occur if there is clear danger to self or others or in the case of court-ordered subpoenas.
Consultation Is Available to You...
- ...if you have concerns and questions about a student, staff members at the MSCC are available to help you assess the situation, its seriousness, and potential referral.
- ...to learn about resources, both on- and off-campus, so you can suggest the most appropriate help when talking with the student.
- ...to learn the best way to make a referral if appropriate.
- ...to clarify your own feelings about the student and consider the ways you can be most effective.
Other Important Information
The Medical Student Counseling Center is staffed by two licensed mental health professionals. Our office is open from 8:00 a.m. to 5:00 p.m. (including over the noon hour), Monday through Friday. Our phone number is 335-8056.
If an emergency occurs after hours, you are encouraged to call the:
- Iowa City/Johnson County Crisis Center at 351-0140;
- UI Department of Public Safety at 335-5022;
- UIHC Emergency Treatment Center at 356-2233
If you have concerns about another staff or faculty member, contact the UI Employee Assistance Program at 335-2085.