As educators, we often step back to look at the outcomes we are producing in an effort to ensure that our processes are optimal. We, as editors of the Journal do the same. Recently, our focus has been on garnering strong research for our readers, trying to poise our Journal for an upcoming review as we attempt to become indexed to add value to our publishing authors and readers. To do this, we stepped back and determined that in order to actualize the mission of the Journal to “… advance the scholarship of physical therapy education … enrich(es) physical therapy academic and clinical education environments …” required us to reflect on the broad spectrum of topic areas that are published in the JoPTE. These topic areas often reflect the trends and evolution in the profession and higher education, a focus we intentionally pushed. But what we noticed was a growing area of attention in higher education and health professions education was the health and wellness of students. Review of the current literature does in fact indicate an increase in research exploring students’ well-being. This research seems to fall into 2 categories—studies describing the prevalence and characteristics of a variety of student health issues (the “what”) and studies that explore interventions to improve health measures in students (the “how”).
Exploration of the mental health of undergraduate students demonstrates that the prevalence of college students who report psychological distress, depression, and anxiety related to their academic experience has greatly increased over the past decade.1,2 The nature of graduate professional education is an acknowledged stressful experience. A meta-analysis of the health of students in medicine3 identified that depression was a global issue, affecting more than 28.0% of students. Students across a number of health professions identify academic factors, followed by financial factors, as the primary sources of perceived stress.4 Findings such as these certainly resonate with the discussion we have been having within our profession about the burden of student debt and rigors of physical therapy education. These examples highlight what is a very real issue that students and faculty are challenged to manage effectively. Although there has been an uptick of papers submitted to the Journal on this topic over the past 2 years, it was unexpected to discover the number of articles exploring student wellness that have been published in JOPTE over the past 10 years.
Two articles in this issue have tackled the “how” issue to explore strategies to improve the health and wellness of physical therapy students. Drs. Shearin and Brewer-Mixon piloted an intervention to reduce depression and anxiety in physical therapy students. Dr. Mejia-Downs explored the impact of a resilience curriculum in providing students with the tools to manage the rigorous expectations of physical therapy education. Both of these articles are examples of interventions focused on assisting student to survive and thrive in a demanding Doctor of Physical Therapy program, and both of these studies provide models and recommendations for success to the education community. Such efforts are commendable and reflect an empathetic student-centered orientation.
As with most problems, the issues and the solutions are multifaceted. Beyond exploring these “what” and “how” issues is the importance of investigating the “why” issues related to student health and well-being as well. These “why” issues include the internal and external factors that contribute to a student's degree of well-being or distress. Students enter our programs with prior experiences that have established mind-sets that too often are detrimental to their well-being and academic success. These mind-sets manifest as behaviors that we see in students—anxiety, depression, cognitive distortions, and maladaptive perfectionism, to name just a few. And while we are not in a position to change these prior experiences, we are faced with the challenge of effectively meeting student needs. Support services for students provided at the university and within our programs are common within our respective institutions. But such support services are only one component of the “why” issue.
An article exploring mental health issues in medical students written by Dr. Stuart Slavin back in 2018 used the “canary in the coal mine” metaphor to discuss the multifactorial nature of mental health and wellness initiative in medical education.5 Just as a canary becoming sick or dying indicated dangerous environmental conditions in the coal mine, he suggests that the prevalence of mental health issues observed in students is likely a reflection of the environment and culture in our respective academic programs. Providing our students with resources and support focuses on the canary but does not address the coal mine. The extent to which the culture of our respective program and institution creates experience that fosters and/or amplifies these maladaptive mind-sets is something we should examine within the context of student well-being. As educators and administrators, we have the opportunity and the responsibility to assess the extent to which our program contributes to achieving and maintaining student well-being. Beyond studies that explore how to support students as the papers in this issue have, as educational researchers, we should also strive to identify academic environments that contribute to the goal of student well-being. Address the coal mine, don't just watch the canary.
1. Eisenberg D, Hunt J, Speer N. Mental health in American colleges and universities: Variation across student subgroups and across campuses. J Nervous Ment Dis. 2013;201:60–67.
2. Baldwin DR, Towler K, Oliver MD II, Datta S. An examination of college student wellness: A research and liberal arts perspective. Health Psychol Open. 2017;4:doi: 10.1177/2055102917719563.
3. Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of depression amongst medical students: A meta-analysis. Med Education. 2016;50:456–468.
4. Jacob T, Itzchak EB, Raz O. Stress among healthcare students—A cross disciplinary perspective. Physiother Theor Pract. 2013;29:401–412.
5. Slavin S. Medical student mental health: Challenges and opportunities. Med Sci Educator. 2018;28(suppl 1):13–15.