Can I Include Mental Health Struggles in my Application?

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PMY 522: Can I Include Mental Health Struggles in my Application?

Session 522

Today’s episode is about a question that comes up all the time. Can I include talking about some mental health struggles in my application? What will that do? Dr. Caitlin Cooper joins us to talk about that because she and her team do research on that topic.

For more podcast resources to help you with your medical school journey and beyond, check out Meded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

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[01:56] Choosing to Leave Med School

Caitlin is a Ph.D. doctor, not a physician doctor. She wanted to be a physician doctor at one point and actually made it to medical school. Although she loved learning all the physiology, she figured out really quickly that she hated being in the hospital.

She shares that she had a lot of stress and pressure with all the life-and-death decisions she had to make. She had to rotate through all of the intensive specialties to be what she thought she wanted to be, which was a primary care doctor. It weighed heavily on her throughout her first year of med school.

Although Caitlin loved what she was learning and loved the people she was meeting there, she decided to leave. She realized that that was not what she wanted to do with her career. It was a very tough decision to make but she knew it was the right decision for her personally.

[03:42] Factors for Dropping Off

Caitlin explained that her decision to drop out of medical school was primarily due to her lack of clinical experience. Back then, the importance of shadowing, scribing, and gaining clinical exposure wasn’t emphasized to the extent that it is now. In hindsight, Caitlin acknowledges that her perspective was limited. She didn’t come from a family of medical professionals and hadn’t fully grasped the diversity of specialties needed to become a primary care physician.

Although she was drawn to primary care for its potential to develop deeper patient relationships, she didn’t anticipate the weighty, life-or-death decisions that come with the territory. Caitlin realizes that if she had talked to more physicians and done more research, she would have come to this realization sooner. Unfortunately, at the time, she couldn’t find any resources or examples of people who had doubts as she did.

[05:40] Sharing Her Journey

Caitlin says she is always happy to talk about her journey. At that time, she felt that it was shameful to leave medical school after getting in. But it all turned out okay. She admits she is much happier now. The greatest lesson she learned is that people don’t really care about what you do in your life. 

“Once people get talking, they are more than happy to tell you that they wish they would have kind of taken that route.” Click To Tweet

Some would say they are envious of what you got to experience by leaving and the bravery for pulling the plug on that. For some people, who loved it and did not second guess it at any point, it’s absolutely the right decision. But for other people, rethinking it is worth it.

[07:12] Course Correction and Sunk Cost

Caitlin stresses the significance of identifying the mistakes that led to your decision, as it can provide valuable information for others to avoid making the same errors.

It’s essential to make consistent course corrections, even if you’re already a year or further into your journey. 

Many individuals fall prey to the sunk cost fallacy and are hesitant to give up because they feel they’ve invested too much time and effort. While it might be difficult to acknowledge at the moment, you’ll ultimately be grateful for making that course correction.

“Just doing what is right for you and realizing that the sunk cost can be leveraged into another career opportunity.”Click To Tweet

[09:01] Questions Related to Mental Health Conditions

The Dilemma of Discussing Mental Health Conditions in Medical School Applications

Caitlin worked as an academic advisor in the biology department at a university, helping hundreds of premed students every year. Many students approached her with concerns regarding past academic struggles due to mental health conditions such as anxiety, depression, or bipolar disorder, wondering if they should discuss them in their application.

While Caitlin had answers to many of their questions, this was not one of them. Though she wanted to encourage them to speak openly about their experiences, she couldn’t do so in good conscience without evidence that it wouldn’t harm their application.

Exploring the Impact of Mental Health Disclosure on Medical School Applications

As a professor, Caitlin delved into the connection between mental health and how students learn in science. During her talks about anxiety and depression, students would often approach her with questions about their struggles with mental health and how it affected their undergraduate coursework. They would ask if it was appropriate to discuss this in grad school or med school applications.

Caitlin was surprised that even after a decade, she didn’t have a solid answer to this. Intrigued, she decided to systematically investigate the potential impact of disclosing a mental health condition on a medical school application.

[10:50] Investigating the Impact of Disclosing Mental Health Conditions in Medical School Applications: Caitlin’s Audit Study

Caitlin and her undergraduate researcher, Anna Abraham, conducted an audit study. It aimed to understand the potential impact of disclosing mental health conditions in medical school applications. 

They created a mock application, featuring a relatively competitive candidate with excellent grades, except for one semester where they had withdrawn from two courses and earned a C+. The researchers included an excerpt from the personal statement explaining the grade drop attributed to either a mental health condition, a physical health condition, or no explanation at all.

They then asked 100 med school admissions committee members to rate the applicant’s acceptability, likeability, and credibility solely based on the application they reviewed.

“So for these types of studies, you want the person to not be so stellar that they're an automatic shoo-in, but you also don't want them to be terrible.”Click To Tweet

Caitlin shares how they took the MSAR and got what would be the average stats if someone was accepted into med school. They used that to craft the application so they can see all of their great grades along with the one tough semester.

The Blind Evaluation Method

Caitlin and her team incorporated a blind evaluation process to eliminate potential biases in the study. They ensured that the respondents did not know which application had a mental health condition to avoid making direct comparisons and only rated the individual applications as a whole.

To ensure objectivity, the researchers requested the participants to provide anonymous feedback. By making sure that the survey responses were not connected to the respondents’ identities, they hoped to negate the possibility of participants being apprehensive about giving negative feedback due to fears of being judged.

Despite these measures, Caitlin acknowledges that the desirability bias that people might want to answer in a favorable light still exists.

[15:01] Insights from the Study

This was one study with 100 people so there is always room to repeat this study. Caitlin says if they can replicate the findings, they will be more confident in what they can say.

It suggests that neither reviewing nor concealing a mental health condition on a med school application would significantly affect a student’s chances of being accepted into the program.

[15:38] Open-ended Data

Caitln also collected some open-ended data from these admissions committee members. It was helpful because it gave them some insight into what ways these admissions committee members would want to see mental health revealed. Or when would they want to see someone talk about a mental health condition and what details they would want to know.

That gave Caitlin some more insight to say with the caveat that it can be really helpful to know about a mental health condition in these situations:

A – if there is a drop in grades or there is something in the performance that is off to explain because it helps them recognize what was going on;

B – if a student is using it to highlight their resilience. It is really tough to go through any  health crisis and then come back from that. That speaks a lot to resilience, which is one of the core competencies. 

Caitlin thinks that those are personal questions and not something that you necessarily would want to write about. But it gives some insight into how you want to mention your mental health and gives the committee that additional information so they can make a holistic decision.

[19:16] Navigating Personal Integrity and Potential Biases in the Admissions Process

People have biases. We are all human beings and those reviewing the applications are human beings. You may turn in your application and have someone who had a really crappy day or has dealt with students before with a similar situation. They might not want to deal with it and there is nothing you can do about it.

But there are going to be people who will look at the same exact application. They look at the person, what they have been through, and what they have accomplished, and would love to have that kind of student in their school.

They may have had very similar students that are hugely successful. More importantly, they are resilient and can show other students resilience because they have been through it already. They can potentially see signs in other students and be a good part of the community who can help. And so it is almost an impossible question to answer when you should put it in or, whether you should put it in or not.

First and foremost, you need to be true to yourself. It could maybe be a way to weed out schools that are not going to support you when you struggle and if you do struggle. That way, you will not be scared to be truthful about who you are when you have issues during medical school.

[21:56] Finding the School that Supports You

The data that Caitlin collected supports the advice they give to students. Whether they are going up a 75% chance that someone will say that they are not qualified for their school if they reveal their mental health condition.

It was not what they found at all. Some people said it is going to be looked at poorly by the committee at their school. Some said it is going to be looked at positively. And most of the people said it is going to be looked at neutrally.

“For a lot of people, we are at a time and place where it’s going to be really important if this is something you're going to continue to struggle with.”Click To Tweet

If you look at the numbers, most people are going to continue to struggle with their mental health in their 20s, 30s, 40s, and so on, and they want to be open and honest about it.

For Caitlin, she would certainly want a school that accepted her for her with all that is laid out on the table. Getting the kind of support knowing that you could have it well controlled now when things might be great and but then you get into your third year of med school, doing different rotations, and get into a place where you are not really good. You could come to your school and say you need some support. You might need to take a week off or a month off and your school would be supportive of that.

It can be a great way to put it out there and see who is accepting of it. From the data, it is also a way of knowing and showing that you are not stacking the cards against you in any way and it’s not any better than not revealing it.

[23:48] Concerns Around Revealing a Mental Health Condition on an Application

Caitlin says it was insightful to see some of the concerns about revealing a mental health condition on your application.

It was concerning for the committee if there are instances where an applicant has not sought treatment, or if they have a severe mental health condition, or it’s going to continue to negatively affect their experience in medical school. And in a lot of ways, it begs an ethical question if they are right to think that way.

Caitlin thinks they are trying to protect students from going into what they know to be a really stressful situation. They are trying to weigh the odds of whether that candidate is going to be successful and happy on this path.

She says she appreciated that part of the study because it gives some insight if you are going to talk about your mental health on an application and what the committee is going to wonder about you. Something which you can head off in just a sentence or two based on your personal experience.

[24:50] Protecting the School by Protecting the Students

During accreditation processes, schools want to make sure that they are accepting students who they believe are going to make it through medical school, in as clean a path as possible. Schools are judged on whether students are graduating in four years or if they are graduating at all. 

Committees ask these questions concerning mental health as they are concerned about the student themselves if the student is going to be okay during this process. They are trying to protect you and they are trying to protect them. 

“Protecting you is ultimately protecting them.”Click To Tweet

If they are going to protect your mental health and your experience, they are ultimately going to protect their retention rates.

[25:48] Two Questions Students Should Consider Asking Themselves

Students can try to figure out whether this is something they would want to put in their application and how much of it should their application take up. Caitlin’s study gives some insight by asking these two questions:

1 – Has my mental health affected my application in a way where the committee would benefit from knowing about my mental health condition? 

That would explain one particular aspect, whether you left an extracurricular early, or had a couple of bad semesters with your grades.

2 – Has my mental health condition been integral to building one of the core competencies that I want the medical schools to know that I have built? 

Resilience is the most common core competency that is built by struggling with a mental health condition and learning how to get that condition controlled.

If the answer to one of those questions is yes, think about the other things which the med school might want to know about your mental health condition. This will help them see that you have recovered and that you have it under control for the time being. And that you are going to be fine in going through this career path with this particular condition.

If you can answer those kinds of questions succinctly, then that’s a good start. 

There is a lot to be said about how much time you want to spend on the core competency of resilience. That may be the entire theme of your essay, of your personal statement. If that’s the case, you can spend a long time unpacking that.

In her opinion from the data she gathered, Caitlin says you certainly don’t want to unpack something if you are not addressing one of those specific questions.

[28:33] Final Words of Wisdom

You are not alone.

If you have struggled with mental health through this premed process, you are not alone. It is extremely common and it is known to be disproportionately common among premed students. You are in very good company, whether or not you are going to talk about it.

There are no biases against mental health.

Especially if you are able to talk about it in a way and highlight the ways in which you have been positively affected, that is certainly something that would make you unique. Not a lot of people have lived through something by the time they are applying to med school. That is built resiliency.

Being able to speak about it would highlight that you are more mature than some of the other candidates that have come in and have not had to grapple with a particular health condition, figure out how to get it controlled, and go through that process.


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