The High Cost of Perfection: Medical Student Suicides

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Debt + Deadlines +Depression: A formula for suicide, during medical school?

When you’re a student, especially a medical student, the need for achievement is high and the sources of stress are many: regular exams, National Boards, mounting debt, the need for perfectionism, the fear of failure, isolation, guilt, fatigue, and uncertainty are just a few. For one thing medical school encompasses regular, seemingly endless exams. Some exams are computer or paper-based, riddled with multiple choice questions requiring students to choose the single best answer from a sea of possible selections while others are performance-based, requiring students to demonstrate the clinical skills they’ve learned on real, live simulated patients.

And if that’s not enough, the fear that even bigger exams are ahead is instilled during medical school. Early in Year I, students are made acutely aware of that they’ll soon be facing the National Board Exams; and not just one, but three, innocently referred to as steps 1, 2, and 3. Students are not only under pressure associated with exam-taking, but they must also study for these exams and earn passing scores. These often occur under low fuel, sleep-deprived, and sometimes even panic-stricken conditions. While passing produces relief, near-misses or failed exams incite their own form of stress.

Uncertainty abounds. This begins in the early weeks of medical school, when transitioning from the competitive arena faced as a pre-med student to the pass or fail expanse of medical school. Another source of uncertainty is associated with the inexactitudes of medical knowledge a problem magnified if there is any ambiguity in the learning objectives or course content. All of these have offshoots that impact medical school performance, leaving students who are high achievers with the feeling that it’s never enough, a feeling which paves the way for a fear of failure. High achievers strive for perfection, especially in medical school. Perfectionism has been linked to a fear of failure. When the fear of failure is combined with the need to maintain a strong outward demeanor, ever-increasing debt, the isolation that comes with always having to study and the guilt of spending time away from family and friends, the vulnerability to suicide/suicidal ideation heightens.