Content Warning:

This content addresses mental health issues, including research and narratives on suicide. Please take care while engaging with it and only proceed if you feel safe doing so. If you, or someone you love, is having thoughts of suicide, please contact 988. Help is available.

Interviewer: Lisa Meeks

Interviewees

John Ruddell

Jennifer Ruddell

Roja (friend of Jack Ruddell)

Dr. Stuart Slavin

Dr. Christine Moutier

Dr. Srijan Sen

Dr. David Muller

Dr. Justin Bullock

Dr. Jessi Gold

Narrator

Dr. Joseph Murray

Transcript

Keywords: Mental health, Medical training, Stress, Well-being, Jack Ruddell, Depression, Suicidality, Financial counseling, Career counseling, Transferable skills, Medical errors, Medical culture, Opt-Out, Trust, Vulnerability, Open Discussions, Sharing Stories

Description

In this episode, we address the urgent issue of suicidality in medical training, reflecting on the personal and systemic challenges that contribute to this crisis. Building on episodes 102, 103, and 104, we continue to explore the deep impact of these challenges.

We begin by examining the need to address both individual and systemic factors, emphasizing the importance of cultural shifts within medical environments and advocating for meaningful systems change.

As the episode concludes, our experts highlight actionable steps medical schools can take to better support mental health, including fostering open dialogue, ensuring accessible resources, and creating a culture of vulnerability. In memory of Dr. Jack Rudell, we close with a piece of his music—a poignant reminder of the personal nature of this issue and the critical need to keep every trainee's light shining.

Description of Series

DWDI Special Series: Suicidality in Medical Training dives into the critical conversations around mental health, well-being, support systems, and the intense pressures faced during medical training. Through the power of storytelling, the series intertwines these broader themes with the deeply personal story of Dr. Jack Ruddell, a promising medical student who tragically died by suicide. Jack's journey—his strengths, struggles, and the complexities leading to his untimely death—forms the emotional core of this five-part series, giving voice to the loved ones often excluded from these conversations.

Alongside Jack's story, the series incorporates expert insights and data from the literature, offering a human perspective on burnout, depression, and suicide among medical trainees. With a commitment to improving mental health awareness and reducing the stigma around seeking help, the series presents a novel approach by centering personal narratives alongside expert analysis. It also explores actionable strategies for improving medical training environments and highlights the importance of institutional responses after a loss by suicide.

Our mission is to reduce shame, encourage help-seeking among medical students struggling with depression, and ensure that every medical school is aware of the postvention resources offered by the American Foundation for Suicide Prevention (AFSP).

Experts for the Series

• Christine Moutier, MD – Chief Medical Officer, American Foundation for Suicide Prevention

• Jessi Gold, MD – Chief Wellness Officer, University of Tennessee System; Author of How Do You Feel?

• David Muller, MD – Director, Institute for Equity and Justice in Health Sciences Education; Dean Emeritus, Icahn School of Medicine at Mt. Sinai; Author of the NEJM essay, Kathryn

• Srijan Sen, MD, PhD – Director, Eisenberg Family Depression Center; PI of the Intern Health Study

• Justin Bullock, MD, MPH – Fellow, University of Washington; Author of the NEJM article, Suicide, Rewriting My Story

• Stuart Slavin, MD, MEd – Vice President for Well-Being, ACGME

Episode Release Schedule:

• September 17: Episode 102 – Honoring Dr. Jack Ruddell: A Story of Joy, Compassion, and Mental Health in Medical Training.

• September 17: Episode 103 – Suicide and Suicidality in Medical Training: Understanding the Crisis and its Causes.

• September 24: Episode 104 – Silent Struggles: Mental Health and Medical Education.

• September 26: Episode 105 – Repairing the System: How Do We Create Safe Environments?

• September 30: Episode 106 – Responding to Loss: Postvention and Support After a Suicide.

Executive Producers:

• Lisa Meeks

• Rylee Betchkal

• John Ruddell

• Jennifer Ruddell

Sound production:

• Jacob Feeman

• Mark Koha

• Next Day Podcast

Consult Psychiatrist

• Joseph Murray, MD

Resources:

24/7 Suicide & Crisis Hotline Call or text 988 or chat 988lifeline.org.

The American Foundation for Suicide Prevention

https://afsp.org

Intern Health Study

https://www.internhealthstudy.org

https://www.srijan-sen-lab.com/intern-health-study

How are you? By Jessi Gold

https://www.drjessigold.com/how-do-you-feel-book-by-jessi-gold-md/

Make the Difference: Preventing Medical Trainee Suicide

https://www.youtube.com/watch?app=desktop&v=I9GRxF9qEBA&feature=youtu.be

Time to Talk About It: Physician Depression and Suicide" Video/Discussion Session for Interns, Residents, and Fellows

https://www.mededportal.org/doi/10.15766/mep_2374-8265.10508

Action Collaborative on Clinician Well-Being and Resilience

National Academy of Medicine

https://nam.edu/action-collaborative-on-clinician-well-being-and-resilience-network-organizations/

References:

Hogan, W. B., Del Re, A. M., & Daniels, A. H. (2021). A Voice, Singing: Reflections on Losing a Colleague to Suicide. Rhode Island Medical Journal, 104(6), 68-69.

Knaak, S., Mantler, E., & Szeto, A. (2017, March). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. In Healthcare management forum (Vol. 30, No. 2, pp. 111-116). Sage CA: Los Angeles, CA: SAGE Publications.

Malone, T. L., Zhao, Z., Liu, T. Y., Song, P. X., Sen, S., & Scott, L. J. (2021). Prediction of suicidal ideation risk in a prospective cohort study of medical interns. PLoS One, 16(12), e0260620.

Meeks, L. M., Cleary, J., Horwitz, A., Pereira-Lima, K., Zhao, Z., Fang, Y., & Sen, S. (2022). Analysis of depressive symptoms and perceived impairment among physicians across intern year. JAMA Network Open, 5(1), e2144919-e2144919.

Slavin, S. J., & Chibnall, J. T. (2016). Finding the why, changing the how: improving the mental health of medical students, residents, and physicians. Academic Medicine, 91(9), 1194-1196.

Tandon MD, H. K., Kratochvil, M. D., Taylor, J., Keiser, M. S., LIMHP, K. L., Kent BS, N. J., ... & Gold, J. P. (2024). UNMC Quick Checks: An "Opt-Out" Model for Health Profession Student Appointments with Mental Health Counseling Services. Innovations in Health Sciences Education Journal, 2(1), 2.