Introduction: Depression and suicidal ideation are common among medical students, a group at higher risk for suicide completion than their age-normed peers. Medical students have health-seeking behaviors that are not commensurate with their mental health needs, a discrepancy likely related to stigma and to limited role-modeling provided by physicians. Methods: We surveyed second-year medical students using the Attitudes to Psychiatry (ATP-30) and Attitudes to Mental Illness (AMI) instruments. In addition, we asked questions about role-modeling and help-seeking attitudes at baseline. We then conducted a randomized trial of an intervention consisting of 2 components: (a) a panel of 2 physicians with personal histories of mental illness speaking about their diagnosis, treatment, and recovery to the students, immediately followed by (b) small-group facilitated discussions. We repeated the ATP-30 and AMI after the active/early group was exposed to the panel, but before the control/late group was similarly exposed. Results: Forty-three medical students participated (53% women). The majority of students (91%) agreed that knowing physicians further along in their careers who struggled with mental health issues, got treatment, and were now doing well would make them more likely to access care if they needed it. Students in the active group (n = 22) had more favorable attitudes on ATP-30 ( P = .01) and AMI ( P = .02) scores, as compared with the control group (n = 21). Conclusion: Medical students can benefit from the availability of, and exposure to physicians with self-disclosed histories of having overcome mental illnesses. Such exposures can favorably improve stigmatized views about psychiatry, or of patients or colleagues affected by psychopathology. This intervention has the potential to enhance medical students’ mental health and their health-seeking behaviors.

Introduction: Medical culture can make trainees feel like there is neither room for mistakes, nor space for personal shortcomings in the makeup of physicians. A dearth of role models who can exemplify that it is acceptable to need support compounds barriers to help-seeking once students struggle. We conducted a mixed-methods study to assess the impact of physicians sharing their living experiences with medical students. Methods: Second-year medical students participated, through synchronized videoconferencing, in an intervention consisting of 3 physicians who shared personal histories of vulnerability (e.g. failure on high-stakes exams; immigration and acculturation stress; and personal psychopathology, including treatment and recovery), followed by facilitated, small-group discussions. For the quantitative component, students completed the Opening Minds to Stigma Scale for Health Care Providers (OMS-HC) before and after the intervention. For the qualitative component, we conducted focus groups to explore the study intervention. We analyzed anonymized transcripts using thematic analysis aided by NVivo software. Results: We invited all students in the class (n = 61, 46% women) to participate in the research component. Among the 53 participants (87% of the class), OMS-HC scores improved after the intervention ( P = .002), driven by the Attitudes ( P = .003) and Disclosure ( P < .001) subscales. We conducted 4 focus groups, each with a median of 6 participants (range, 5-7). We identified, through iterative thematic analysis of focus group transcripts, active components before, during, and after the intervention, with unexpected vulnerability and unarmored mutuality as particularly salient. Conclusions: Sharing histories of personal vulnerability by senior physicians can lessen stigmatized views of mental health and normalize help-seeking among medical students. Synchronous videoconferencing proved to be an effective delivery mechanism for the intervention in a ‘virtual wellness’ format. Candid sharing by physicians has the potential to enhance students’ ability to recognize, address, and seek help for their own mental health needs.

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Objective Video-based depictions of electroconvulsive therapy (ECT) can be useful for educational purposes, but many of the readily available resources may worsen already stigmatized views of the procedure. Educators’ common reliance on such material highlights the paucity of equipoised depictions of modern ECT well suited for the training of health professionals. The authors developed and tested a new educational module enhanced by videotaped depictions of a simulated patient undergoing the consent, treatment, recovery, and follow-up phases of ECT. Methods The didactic intervention interspersed 7 short video clips (totaling 14 min) into a 55-min lecture on treatment-resistant depression. The session, part of an intensive course of preclinical psychiatry, was delivered online through synchronous videoconferencing with Zoom. The primary outcome measure was change in the Questionnaire on Attitudes and Knowledge of ECT (QuAKE). Results Fifty-three out of 63 (87%) eligible second-year medical students completed assessments at baseline and after exposure to the didactic intervention. QuAKE scores improved between baseline and endpoint: the Attitudes composite increased from 49.4 ± 6.1 to 59.1 ± 5.7 (paired t 10.65, p < 0.001, Cohen’s d 0.69), and the Knowledge composite from 13.3 ± 1.2 to 13.9 ± 0.8 (paired t 3.97, p < 0.001, Cohen’s d 0.23). Conclusions These video-based educational materials proved easy to implement in the virtual classroom, were amenable to adaptation by end-use instructors, were well received by learners, and led to measurable changes in students’ knowledge of and attitudes toward ECT.

Accessible SummaryWhat is known on the subject Stigma towards psychiatry and people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Internalized stigma among nurses can affect personal self‐care and limit help‐seeking behaviours. Stigma around mental health nursing can adversely affect recruitment into this already underserved field. What the paper adds to existing knowledge This is the first report on the adaptation and use in a nursing student sample of two widely used stigma‐related instruments that have been normed among medical students. The attitudes to psychiatry (ATP‐30) and the attitudes to mental illness (AMI) instruments proved sensitive to change and can be useful in tracking specific anti‐stigma curricular interventions. Interactive and participatory student activities in courses such as ours (that include simulation with standardized patients, clinical placements and patient interaction) need to be complemented by exposure to individuals with lived experience with mental illness in order to address stigmatized views of SMI. Nursing educators and fellow nurses willing to share their own experiences with mental illness—including diagnosis, health–seeking, treatment and recovery—may prove especially powerful and germane during nursing school. What are the implications for practice Even a strong academic curriculum is not sufficient to change stigmatized perceptions about mental illness, psychiatric care and mental health nursing as a profession. Comparison and potential synergy between ATP‐30, AMI and OMS‐HC (Opening Minds Scale for Health Care Providers) could prove fruitful in identifying a more comprehensive approach to stigma assessment over time. The addition of validated instruments, such as the Self‐Compassion Scale–Short Form (SCS–SF) and the Self‐Stigma of Seeking Help (SSOSH), which tap into internalized stigma and into health‐seeking behaviours and intervening barriers could prove particularly useful in evaluating innovative interventions for stigma‐decreasing initiatives in nursing education. Interactive and participatory didactic offerings need to be complemented by exposure to individuals with lived experience with mental illness and ideally to nursing educators and practicing nurses willing to share their histories of diagnosis, help‐seeking, treatment and recovery. AbstractIntroductionStigma towards psychiatry and to people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Such stigmatized views can adversely affect recruitment into the already underserved field of mental health nursing.Aim/questionWe adapted two stigma‐related instruments in a sample of nursing students and examined change in scores after participation in an eight‐week preclinical psychiatry curriculum. Our goal was to identify stigma‐malleable opportunities that would inform refinements in future iterations of a preclinical psychiatry curriculum in nursing.MethodWe made minor adaptations to the attitudes to psychiatry (ATP‐30) and the attitudes to mental illness (AMI) instruments. We invited first‐year nursing students to complete assessments at two time points: before and after completion of an eight‐week core course in preclinical psychiatry.ResultsSeventy‐one students completed the assessment at both time points. ATP‐30 and three of its eight subscale scores improved by course's endpoint. By contrast, AMI scores did not change. Compared with medical student published norms, nursing students in our sample had higher (less stigmatized) average scores.DiscussionThe ATP‐30 and the AMI can be easily adapted to a nursing student population and may prove useful in tracking specific anti‐stigma educational interventions.Implications for practiceA general psychiatry course during nursing school is, it and of itself, unlikely to change biased views about SMI and should be enhanced with exposure to, and interaction with individuals with lived experiences of mental illness, ideally by nurse educators and practicing nurses.

Purpose We tested the hypothesis that physician assistant (PA) students can benefit from exposure to senior PAs who share their living experiences with mental illness.Methods First-year students from 5 PA programs were asked to participate in this mixed methods study. After completing a pre-activity survey, students from 3 programs participated in an intervention consisting of senior PA faculty sharing their mental health experiences, including treatment and recovery. A facilitated discussion followed, and students not exposed to the intervention served as controls. The qualitative component of the study was based on transcripts from 3 focus groups of students in the exposed group. ResultsWe recruited 167 students from 5 PA training programs, 112 of whom (67%) completed baseline and endpoint assessments (37 in the exposed group, 75 in the control). The intervention resulted in significant improvements on the Opening Minds to Stigma (OMS-HC, p = 0.002, Cohen's d = 0.38) and Self-Stigma of Seeking Help (SSOSH, p = 0.006, d = 0.31) scales. Change in the OMS-HC was driven by its social distance (p = 0.003) and disclosure (p = 0.02) subscales. No comparable changes were found in the control group. We identified 3 overarching themes: 1) active elements of the intervention; 2) mutuality; and 3) peer relationships.Conclusions Senior PAs sharing their lived experiences with mental illness proved to be an effective anti-stigma intervention for PA students. A candid, intimate, and confidential virtual learning space was feasible through synchronized videoconferencing. Our findings can inform programmatic interventions to address stigma, self-stigma, help-seeking behaviors, and the overall mental health of PA students. METHODS Participants, Synchronized Videoconferencing Delivery, and Ethics ApprovalParticipants were first-year PA students enrolled in 5 programs across the United States (one public and 4 private; 3 in the The authors declare no conflict of interest.

Commercially available films minimize the importance of the psychosocial dimension of care, which can perpetuate stigma around psychosocial needs and interventions. These films can be used to encourage discussion about how to optimize psychosocial care in pediatric oncology so that such care is not abandoned in actual practice as it is, for entertainment purposes, on the screen.

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