The curriculum in medical school aims to train students to have the knowledge, expertise. However, some aspects of training can impact impaired to the mental health of medical students. The study found that the mental health becomes worse after students began going to medical school and still continues to worsen in the training process. The medical students getting depression proportion range from 21% to 56%, depending on their country and their school [39]. Considering the degree of personal influence, healthy problems can push students to abuse stimulants, disorientate occupation, and seriously, to suicide. On a professional level, the study found that students with problems of mental health affect the care, treatment, the ability to work and break the moral medicinal values [18].
The change in the learning environment: Medical students need to learn a large amount of knowledge. However, the knowledge gained is not sufficient to work, but only for the exams, causing feelings of depression [39].
Moreover, academic workload and pressure of academic achievement lead to depression. Trying to master a large work volume also puts pressure on medical students. These challenges are increasing in preclinical academic year due to the pressure to pass exams. During the school year clinical students must become familiar with the new learning environment that is at the hospital, facing the patient has different symptoms. It requires students to mastes the knowledge learned in the preclinical year and skills to apply knowledge. Students are exposed to the patient's pain, so it changes the mental students.
There is a conflict between theory and practice. The medical profession requires high moral both in training and working. During studying at the hospital, the morality is misleading. In a study about the student in the 3rd and the 4th grade, 98% of student responded that they saw doctors insulting patients. 60% of students had seen a physician violating professional moral. More two thirds of the students had a feeling they did not complete their responsibilities for patients and for their future [18].
Learning environment exposes to the suffering and the death. Medical students in the clinical years regularly face with death. But the curriculum usually focuses on diagnosis and treatment, less interest in palliative care in the final stages of life. The medical students often learn lessons about the theoretical exposure of patients and relative’s patients in critical cases, but not trained in skills of patient care in the final stages of life. So students feel frightened, nervous, confused, sad, vulnerable and hesitant when they see the patients died.
The personal life event of students. Students face with the medical training program, experience much stressful personal life, as well. In a study of more 1000 medical students, many students witness a member of their family died (15%), besides, they are ill or injury (25%), changing in the health
(42%), in addition, they are engaged or get married and have children. In 1995, the Association of American Medical Colleges surveyed graduated medical student, 30% of those was married, and 14% was engaged or had a child. Married was less stressful than the single [18].
Marriage is common among medical students, students have children before graduation accounted for 10% [18], and therefore, it will greatly affect the lives of students. In fact, based on one study of medical students second year, female students were more likely to be depressed if they had children [18].
1.3.2. The consequences of depression for medical students
Poor academic performance: Stress, anxiety and academic performance are closely related to each other. Poor academic performance leads to the students are not satisfied with their studying result. All of them cause stress and depression. However, the influence of these factors depends on the individual's personality.
The insensitivity of medical students: Although the noble obligation of the medical student is to be interested in helping people. The Reducing empathy in medical students starts to do from the pre-clinical, especially, adversely decline in the clinical years. Emotionless attitude can be developed to require learning at university, to help them to combat the anxiety and the fear when exposing the suffering of patients and patients' relatives. The consequences of insensitive are that doctors do not care about a mentality of patients and the relative’s patients. They only think about how to cure, without thinking about the cost and whether patients can afford or not. Finally, they lose the humanitarian ideals of medicine.
Deception in the process of learning is taking examples, such as cheating during examinations and finding all the tricks to achieve high scores
in exams. Cheating in patient care activities is such as taking care of patients thoughtlessly, increasing the unnecessary tests for patients,...
The use of stimulants such as alcohol, drug and neuroleptic drug.
Suicide: Although suicidal ideation and deliberate suicidal of medical students have not been studied, but the risk of suicide in students during the clinical year are seriously high. The research from the Norwegian medical students, 14% of students have suicidal thoughts, 6% of the students deliberate suicide to commit suicide [18]. Depression, stress in personal life, the personality characteristics are factors affecting the process from idea to be deliberated suicide and suicidal action.
Figure 1.1: Proposed model of causes and consequences of student distress [18]