Medical School Support of Trainees through Family Illness: A Student’s Perspective

In the spring of my second year of medical school, my mom got sick. Due to her illness, she couldn’t drive or cook, so I became the primary caregiver responsible for taking her to doctor’s appointments, picking up medications, cooking, and cleaning. I had to do this while completing my preclinical coursework and studying for USMLE Step 1. As medical students take more gap years between undergraduate and professional school, the age at medical school matriculation of students and parents alike increases. Given this, how can we best support the needs of students taking care of sick parents? My school, and specifically my society dean (a faculty member who meets with medical students throughout their medical school career), went to great lengths to support me through this difficult time. Opportunities for medical schools to support students taking care of sick parents, along with adaptations for different curricular structures, will be proposed.

Being a Caregiver While Being a Medical Student

There is insufficient literature exploring medical student stressors, such as parental illness and caregiving responsibilities. A few reasons come to mind. First, family illness is a private matter and can be a sensitive topic. Second, many students may come from privileged backgrounds, and their families can hire help instead of having the student take on some caregiving responsibilities. Finally, many students fear that being a caregiver will be seen as a red flag by residency programs, since caring for ill parents may lead to fewer extracurricular activities or lower academic performance due to their added caregiver responsibilities.

There are no studies to date that have investigated caregiving responsibilities of medical students. However, there is literature that explores how caregiving responsibilities affect medical school faculty members. In a 2021 study published in Human Resources and Health, it was found that in a sample of 2,126 medical school faculty, 19 percent were taking care of a friend, a neighbor, or a family member with chronic illness.¹ More than 90 percent of those who reported being a caregiver experienced caregiving-related mental or emotional strain.¹ It is important to note that similar strains are likely faced by medical students shouldering these responsibilities, especially while going through a rigorous medical education curriculum.

Due to the paucity of peer-reviewed literature exploring caregiving responsibilities of medical students, we investigated the gray literature, including popular news outlets and online medical student forums. Our research revealed that being a caregiver for family members is common among medical students. In a Washington Post article, one medical student described her experience taking care of her mother throughout high school, college, and medical school and highlighted “missed opportunities” and “surges of guilt” that have accompanied her experience.² Additionally, medical students described coping with illness and loss of close family members in more than 12 entries from the last 8 years alone on online medical student forums, such as Reddit and Student Doctor Network. Eight students asked for advice on navigating sick parents. A common question is how taking a leave of absence will be perceived by residency programs.

This shared experience affects many students and will shape the formation of their professional identity and how they provide care to patients. Supporting medical students through these moments will ensure a physician workforce that is resilient and able to relate with patients and their families through one of life’s most difficult challenges.

How Medical Schools Can Support Students through Family Illness

As medical students get older, their parents and other loved ones will experience health setbacks. Providing meaningful support through these challenging times is one way that medical schools can demonstrate genuine care for students and ensure their success. In my experience, curricular flexibility, close mentorship from my society dean, and strong peer support are three things that have been instrumental:

• Curricular flexibility. A large component of my medical school’s curriculum involves case-based learning in small groups. My school understood my situation and allowed me to participate virtually as needed for a brief period, with constant communication with my dean to ensure academic progress and personal well-being. While this setup would not have been sustainable over an extended period, it allowed me to coordinate doctor’s appointments for my mom during the critical period. Evidence suggests that increased medical school attendance flexibility does not harm academic performance and is paradoxically associated with improved board exam passing rates.³ For schools with lecture-based curricula, this may be more easily accomplished with lecture recordings, but even for schools with case-based learning, it may be worthwhile to assess the need for temporary virtual attendance in special circumstances.
• Close personal relationships with faculty members. Because my society dean had established a close relationship with me through regular meetings from the beginning of my first year of medical school, I was able to access academic and personal support immediately. During these meetings, we discussed academic and personal matters. A program at Vanderbilt University School of Medicine that implemented a similar structure of advisory colleges was associated with increased perceived advisor accessibility, as well as overall satisfaction with career counseling and wellness, compared to traditional mentorship models.⁴ Establishing a personal relationship with a faculty member through programs like advisory colleges or societies is an excellent way for schools to ensure that students have a point person to confide in about their life inside and outside academics.
• Peer support. In my school’s curriculum, our small group sessions usually begin with social check-in questions. This creates a sense of camaraderie and moral support. Studies examining more formal peer support programs at medical schools have demonstrated decreased burnout, stress, and anxiety.⁵ For schools that feature small groups heavily, having a short check-in at the beginning of each session may be helpful in building team rapport. At schools that are lecture-based, creating a weekly small group session may help students feel more connected and less isolated during their medical education.

These are just a few examples of curricular adaptations that would help support medical students who are taking on caregiving responsibilities of family members.

It is important that medical schools and their faculty remain mindful of the students’ well-being who are going through family illness. As a community of clinician educators, mentors, and leaders in academic medicine who frequently interact with students, SGIM members can serve as their advocates. SGIM mentors can highlight the positivity of this special caregiver responsibility during residency applications and interviews to turn the student’s concerns into a positive experience. It is critical that we promote a support structure in medical training that will help the future generations of clinicians succeed.