A peer counseling phone line created by two fourth-year medical students demonstrates how a resource can be set up at low cost, in little time and adapt as needed.
The all-volunteer service at Rutgers New Jersey Medical School (NJMS) is focused on wellness and resilience, has a system in place for ensuring a call is not missed, and protocol for directing students to help beyond what it can offer—all on a shoe-string budget.
Filling a gap in finding help
Ragha Suresh, MD, and Varsha Radhakrishnan, MD, the medical students who started the NJMS Peer Wellness program, are now first-year residents.
The two NJMS alumni said that while the medical school had various support services in place, there was a gap in terms of focus and availability, pointing to a need for access to immediate support. The program started in September 2017.
Students can call “when they're feeling down, struggling with school-related stressors, including sleep hygiene, time management, board exams,” Dr. Suresh said at the International Conference on Physician Health in Toronto. The event was co-sponsored by the AMA, Canadian Medical Association and British Medical Association. “A trained fourth-year peer coach is available seven days a week.”
That first year, about 50 volunteers were selected for the program. Each volunteer went through a simulated call training session on appropriate coaching within the scope of the project.
The call center is not intended to be a substitute for psychiatric care or professional therapy. The emphasis is on connecting callers with peers who are familiar with the strains of medical school and can provide “positive motivation and a listening ear.”
Callers receive a package with wellness information as part of a follow-up to the call. This includes tools to support resilience, such as relaxation techniques, mindfulness, good sleeping practices and exercise. The volunteers are also trained to spot if a caller needs a referral to a higher level of service and, when warranted, will contact the school.
A third-year student, who called the peer support line, said it was in the aftermath of an academic setback. “It was great to talk to someone” who was a peer, the student said, and not feel like she was “going to be judged in any way.”
Putting this support program together was inexpensive—less than $100—and took about six months to launch, including working with faculty advisers. It uses no-cost Google tools for scheduling, voicemail and other phone necessities. Marketing was done with business cards, social media and speaking to gathered classmates.
New focus on clerkship
The program now has about 30 volunteers and remains as a student-led program. The original vision for the program was that it would be directed at first-, second- and third-year students. That focus has changed to third-year students because the transition to clerkship can be especially stressful. Other services are available to students in lower years, though.
The project has added group sessions for third-year students, which are mandatory as part of clerkship training. Each session has about 10 or 12 attendees led by a fourth-year volunteer. The focus is on recognizing burnout and being open to talking with others—especially peers—to get support and perspective throughout clerkship.
The transition from year two to three involves “unique stressors—workplace, social, emotional considerations,” said third-year student and support line board member Serra Akyar, MPH.
"You might have expected that students would be reserved or hesitant to open up in group sessions,” said Akyar. “But most were willing to talk about their experiences, and left feeling heard and supported by their peers.”
On a larger scale, the AMA is also focused on systematic approaches to make physician burnout a thing of the past. The AMA has studied and is currently addressing issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand and reduce the challenges physicians face. By focusing on factors causing burnout at the system-level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction.
The AMA Ed Hub™—your center for personalized learning from sources you trust—offers CME on a broad range of topics including medical student well-being and prevalence of depression using JN Learning™ from the JAMA Network™.
AMA’s STEPS Forward™ is an open-access platform featuring more than 50 modules that offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These toolkits can help you prevent physician burnout, create the organizational foundation for joy in medicine, create a strong team culture and improve practice efficiency.