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Dr Megan de Lambert
First Year House Officer
Tauranga Hospital
Bay of Plenty District Health Board
In the medical world, where it can seem as though nobody has any
spare time, we uncovered something beautiful and too often forgotten:
people want to help each other – especially those in shared struggles.
In response to the experiences University of Auckland clinical medical
students had in the often isolating, intimidating, and uncertain world
of hospital placements, particularly in the larger hospitals, we created
the first Clinical Student Support Programme in 2018. With over 400
students involved, this programme has attempted to start a tradition
of students participating in an environment filled with educational,
emotional, and social support. It seems like such a simple concept,
so why had something like this not already been done? I wondered
the same.
As a new fourth-year student, thrust into the wards harder and faster
than a gravida 4 woman completes labour, I was startled by the na-
ture of being a clinical medical student. It was exciting and self-direct-
ed, but isolating and uncomfortable.
Early medical school itself has its stressors. Remnants of the competi-
tiveness of pre-medicine linger on in a class of 260 or more incredibly
high-achieving peers. You are told you only need to pass, but are
graded from A+ to C- and prestigious awards are given to the top
performing students. Our perfectionist and ‘Type A’ personalities
can render it hard to settle for what we perceive as mediocre. This
is all while navigating the difficulties of new relationships, cliques, a
binge-drinking culture, and living away from family – which is what
many university students experience. Season that with entering the
foreign, confusing (and scarily sterile), environment of the hospital at
the beginning of fourth year, and one can feel helpless, almost de-
pendent on any given team to include you and teach you something.
You meet new people every day and before you can integrate into
a team or department you are shifted on to your next placement.
We are occasionally exposed to suffering, death, and hospital politics.
Many of us were just twenty-one years of age when entering the
hospital on full-time placement. It is the perfect recipe for anxiety
and depression.
I remember being surprised by the lack of university follow-up and
support. It seemed that no one knew who was supposed to be our
principle custodian. The support system provided to us appeared
like an ‘ambulance-at-the-bottom-of-the-cliff’ strategy – once things
go awry, come and see us and we will try help you. However, I can
understand the challenge for the university – there are almost 300
students in each cohort now, all span across eight different placement
sites, and students often raise concerns or ask for help only when the
situation is dire, or not at all. The faculty has employed many superb
individuals acting in pastoral care, as Directors of Medical Student
Affairs, and in the Professional and Personal skills department, advo-
cating for education around medical student well-being. Despite this,
I still felt isolated even though I was placed at a wonderfully sociable
and supportive semi-rural hospital in my first clinical year. There just
is not enough on-the-ground support. In a poem I wrote in my fourth
year for a reflective assignment, one stanza reads ‘[You] travel to and
from the hospital on your own, feeling alone despite being surround-
ed by many others. My only real support is 950 kilometres away, and
this is my mother’s’. We were fortunate to have friendly sixth-year
students and had the opportunity to ask them questions and talk to
each other about difficult experiences on the wards. Students based
in Whangarei for their fifth year have been supported socially, emo-
tionally, and academically as a part of the culture there over the years.
Why is it that this kind of supportive environment only seems to be
reserved for those lucky enough to be placed at certain sites?
During fifth year I fell into a dark and nasty bout of depression, and
only then did I truly realise the immense difficulties that many people
may feel as a clinical medical student. Some of you might think that I
was particularly acopic, susceptible, or pre-disposed to mental illness,
and that it would have happened regardless of what university path
I chose. That could be true, but too many friends, peers, and partici-
pants in international research projects have experienced the same as
me for this phenomenon not to be a pattern. Since opening up about
my own mental-health journey, I have been overwhelmed with the
number of my peers who could relate with their own similar struggles
and, heartbreakingly, how well they hid it.
I wondered what role we, as students, could have to support each
other, so I decided to do something about it at the end of my fifth
year. With the help and advice of many incredible people that I look
up to – Holly Dixon, Ajda Arsan, Jibi Kunnethedam, Sung-Min Jun,
Sophie Maisey, Lucy Gray, Christi Bowen, Zoe Wells, and many oth-
ers – the idea started to come together. I began the arduous process
of creating the “Clinical Student Support Programme” (CSSP).
The crux of this programme is to provide student-led, group-based,
educational, social, and moral support to clinical medical students
from other clinical medical students who have walked in their shoes.
One-on-one mentor programmes seemed too tedious, old school,
and paternalistic to me. I was inspired by Auckland medical school’s
pre-clinical Small Group Activities (SGAs) (or ‘cuddle club’ as some
of my peers adoringly called it, which are group-based teachings en-
couraging learning through sharing experiences and critical reflection).
I also gained inspiration from ‘Balint groups’, which are educational
groups created in the 1960s to discuss cases and to better under-
stand the doctor-patient relationship).
The CSSP was aimed at being done on a regular basis, where students
were encouraged to talk about mental well-being, difficult patient
cases, bullying, their lives outside of medical school, and everything
in between; a proactive approach to well-being was the goal. A sec-
ondary goal of this was for the leaders to gain valuable leadership,
teaching, and peer support skills. Initial sign ups yielded overwhelming
support with over 400 students enthusiastic about being involved. I
found some brilliant sixth-year students at each of the eight Univer-
sity of Auckland clinical placement sites to facilitate the programme
at their site, and these support groups were allocated with sixth-year
students as leaders. The sites are Auckland City, Waitakere/North
Shore, South Auckland, Waikato, Bay of Plenty, Rotorua, Whanga-
rei, and Taranaki. Leaders were encouraged to contact their groups
to organise meet ups and to assist in the orientation of the fourth-
and fifth-year students to the hospital. Leaders were provided with
a guidebook containing ideas on how they can support their students,
conversation starters, a reminder of the assessments in each year,
and a summary of where students can get help. We were fortunate
to have my friend Glenn Nightingale, from the accounting firm Night-
ingale Associates, to generously sponsor us, as well as financial sup-
port from the New Zealand Medical Students Association and the
Auckland University Medical Students Association (AUMSA).
So how did it go?
‘A good first step’ is how I would describe it to those curious. Accord-
ing to a survey I put out in September 2018 to participants, 68% of
fourth- and sixth-year students met with their group at least once,
with 11% meeting three or more times. This was a pleasing start, as
in previous years there had been minimal formally organised support,
so any improvement on this was realistically a positive. Many leaders
found it difficult to engage their groups and to meet on a regular
basis – this may be because of lack of free time, students believing
they are not in any need of assistance, the reactive “she’ll be right”
Kiwi attitude, shyness, or a combination of all of these. As the year
went on, students became more comfortable and confident as clin-
ical students, so the groups met less often, but they had the contact
details of their leaders in case they had any questions or issues. This
emphasised the importance of the meet-ups at the beginning of the
year when the fourth-year students are new to the clinical site. Edu-
cational support was a success; progress test tutorials, mock objec-
tive structured clinical examinations (OSCEs) and electrocardiogram
(ECG) tutorials were some of the events organised by the leaders.
his educational support, accompanied by the enticing effect of free
food, was a great way to gather the students together, show them we
care about them, encourage them to meet with their support group,
and an opportunity for them to ask questions. A barrier to this was
that these educational sessions (and the whole programme for that
matter) relied on fifth- and sixth-year students being motivated, or-
ganised, and willing to give up their spare time.
The September 2018 survey yielded other interesting results. When
asked to rate what being a clinical medical student was like on a scale
of 0 to 10 (with 0 being awful and 10 being amazing), the average
score was 7.3 for the 152 student responders. Fifth-year students’ rat-
ing of what it is like being a clinical student was the lowest of the year
groups. When asked what they felt they needed the most and would
like to see in the programme this year, they responded: (1) mock
OSCEs; (2) meetings to talk about how things are going and to ask
questions; and (3) tips before their placement starts. 95% liked the
idea of having a Clinical Student Support Programme, with 5% who
had not yet made up their mind. Lastly, there was the opportunity for
students to nominate peers who have been particularly helpful and
supportive, and over 50 students were nominated as making a signif-
icant impact. I have personally thanked each of the nominated stu-
dents – possibly the most rewarding part of this journey so far for me.
Going forward, past and present AUMSA Executive members and
I have been working hard to build on this initial year of the CSSP.
2019 is incredibly important, as two successful consecutive years of
this programme will be a key step towards this becoming a tradition.
We are hoping to target the crucial stressful components of clinical
years – the beginning and initial orientation to the hospital, final-year
OSCEs, more intense runs like general surgery, obstetrics and gy-
naecology for fifth-year students, and the orthopaedics practical as-
sessment. In addition, an ongoing aim is to: encourage proactive ap-
proaches to well-being, with AUMSA Site Representatives organising
social events, support group leaders encouraging regular meetings
(at least initially at the beginning of the year); and candid discussions
about mental well-being, bullying, and other difficult experiences.
2019’s AUMSA President, Cameron Tuckey, encouraged me to ar-
ticulate my overall goal for this programme and what I hope medical
student clinical life to be like for my successors, and this is what I came
up with. Ideally, every fourth-year student starts their clinical years
excited to be a part of something special – a connected, supportive,
and enjoyable hospital site environment. They receive an adequate
orientation to the hospital, are in regular contact with fifth- or sixth-
year students throughout the year, and are given opportunities to
speak about any difficulties or challenges they are having or have had.
Any student in distress is referred to appropriate services or esca-
lated to the University. Fourth- and fifth-year students receive ed-
ucational support from leaders, enabling them to feel prepared and
confident for their assessments. Fifth- and sixth-year students get an
opportunity to be leaders and teachers, to improve their emotional
intelligence, responsibility, communication skills, and sense of commu-
nity. This whole environment described becomes a tradition that is
self-sustaining and operates with ease, purely because students care
about, and want to help, each other.
Acknowledgements
Holly Dixon from the University of Auckland’s Health & Wellbeing
department.
Glenn Nightingale from Nightingale Associates accounting firm – for
their generous funding to get University of Auckland’s first formal
Clinical Medical Student Support Programme off the ground.
NZMSA – for funding through their Student Innovation Fund
AUMSA – for moral and financial support of the Clinical Student
Support Programme
Correspondence
Megan de Lambert: [email protected]
Dr Megan de Lambert
First Year House Officer
Tauranga Hospital
Bay of Plenty District Health Board
In the medical world, where it can seem as though nobody has any
spare time, we uncovered something beautiful and too often forgotten:
people want to help each other – especially those in shared struggles.
In response to the experiences University of Auckland clinical medical
students had in the often isolating, intimidating, and uncertain world
of hospital placements, particularly in the larger hospitals, we created
the first Clinical Student Support Programme in 2018. With over 400
students involved, this programme has attempted to start a tradition
of students participating in an environment filled with educational,
emotional, and social support. It seems like such a simple concept,
so why had something like this not already been done? I wondered
the same.
As a new fourth-year student, thrust into the wards harder and faster
than a gravida 4 woman completes labour, I was startled by the na-
ture of being a clinical medical student. It was exciting and self-direct-
ed, but isolating and uncomfortable.
Early medical school itself has its stressors. Remnants of the competi-
tiveness of pre-medicine linger on in a class of 260 or more incredibly
high-achieving peers. You are told you only need to pass, but are
graded from A+ to C- and prestigious awards are given to the top
performing students. Our perfectionist and ‘Type A’ personalities
can render it hard to settle for what we perceive as mediocre. This
is all while navigating the difficulties of new relationships, cliques, a
binge-drinking culture, and living away from family – which is what
many university students experience. Season that with entering the
foreign, confusing (and scarily sterile), environment of the hospital at
the beginning of fourth year, and one can feel helpless, almost de-
pendent on any given team to include you and teach you something.
You meet new people every day and before you can integrate into
a team or department you are shifted on to your next placement.
We are occasionally exposed to suffering, death, and hospital politics.
Many of us were just twenty-one years of age when entering the
hospital on full-time placement. It is the perfect recipe for anxiety
and depression.
I remember being surprised by the lack of university follow-up and
support. It seemed that no one knew who was supposed to be our
principle custodian. The support system provided to us appeared
like an ‘ambulance-at-the-bottom-of-the-cliff’ strategy – once things
go awry, come and see us and we will try help you. However, I can
understand the challenge for the university – there are almost 300
students in each cohort now, all span across eight different placement
sites, and students often raise concerns or ask for help only when the
situation is dire, or not at all. The faculty has employed many superb
individuals acting in pastoral care, as Directors of Medical Student
Affairs, and in the Professional and Personal skills department, advo-
cating for education around medical student well-being. Despite this,
I still felt isolated even though I was placed at a wonderfully sociable
and supportive semi-rural hospital in my first clinical year. There just
is not enough on-the-ground support. In a poem I wrote in my fourth
year for a reflective assignment, one stanza reads ‘[You] travel to and
from the hospital on your own, feeling alone despite being surround-
ed by many others. My only real support is 950 kilometres away, and
this is my mother’s’. We were fortunate to have friendly sixth-year
students and had the opportunity to ask them questions and talk to
each other about difficult experiences on the wards. Students based
in Whangarei for their fifth year have been supported socially, emo-
tionally, and academically as a part of the culture there over the years.
Why is it that this kind of supportive environment only seems to be
reserved for those lucky enough to be placed at certain sites?
During fifth year I fell into a dark and nasty bout of depression, and
only then did I truly realise the immense difficulties that many people
may feel as a clinical medical student. Some of you might think that I
was particularly acopic, susceptible, or pre-disposed to mental illness,
and that it would have happened regardless of what university path
I chose. That could be true, but too many friends, peers, and partici-
pants in international research projects have experienced the same as
me for this phenomenon not to be a pattern. Since opening up about
my own mental-health journey, I have been overwhelmed with the
number of my peers who could relate with their own similar struggles
and, heartbreakingly, how well they hid it.
I wondered what role we, as students, could have to support each
other, so I decided to do something about it at the end of my fifth
year. With the help and advice of many incredible people that I look
up to – Holly Dixon, Ajda Arsan, Jibi Kunnethedam, Sung-Min Jun,
Sophie Maisey, Lucy Gray, Christi Bowen, Zoe Wells, and many oth-
ers – the idea started to come together. I began the arduous process
of creating the “Clinical Student Support Programme” (CSSP).
The crux of this programme is to provide student-led, group-based,
educational, social, and moral support to clinical medical students
from other clinical medical students who have walked in their shoes.
One-on-one mentor programmes seemed too tedious, old school,
and paternalistic to me. I was inspired by Auckland medical school’s
pre-clinical Small Group Activities (SGAs) (or ‘cuddle club’ as some
of my peers adoringly called it, which are group-based teachings en-
couraging learning through sharing experiences and critical reflection).
I also gained inspiration from ‘Balint groups’, which are educational
groups created in the 1960s to discuss cases and to better under-
stand the doctor-patient relationship).
The CSSP was aimed at being done on a regular basis, where students
were encouraged to talk about mental well-being, difficult patient
cases, bullying, their lives outside of medical school, and everything
in between; a proactive approach to well-being was the goal. A sec-
ondary goal of this was for the leaders to gain valuable leadership,
teaching, and peer support skills. Initial sign ups yielded overwhelming
support with over 400 students enthusiastic about being involved. I
found some brilliant sixth-year students at each of the eight Univer-
sity of Auckland clinical placement sites to facilitate the programme
at their site, and these support groups were allocated with sixth-year
students as leaders. The sites are Auckland City, Waitakere/North
Shore, South Auckland, Waikato, Bay of Plenty, Rotorua, Whanga-
rei, and Taranaki. Leaders were encouraged to contact their groups
to organise meet ups and to assist in the orientation of the fourth-
and fifth-year students to the hospital. Leaders were provided with
a guidebook containing ideas on how they can support their students,
conversation starters, a reminder of the assessments in each year,
and a summary of where students can get help. We were fortunate
to have my friend Glenn Nightingale, from the accounting firm Night-
ingale Associates, to generously sponsor us, as well as financial sup-
port from the New Zealand Medical Students Association and the
Auckland University Medical Students Association (AUMSA).
So how did it go?
‘A good first step’ is how I would describe it to those curious. Accord-
ing to a survey I put out in September 2018 to participants, 68% of
fourth- and sixth-year students met with their group at least once,
with 11% meeting three or more times. This was a pleasing start, as
in previous years there had been minimal formally organised support,
so any improvement on this was realistically a positive. Many leaders
found it difficult to engage their groups and to meet on a regular
basis – this may be because of lack of free time, students believing
they are not in any need of assistance, the reactive “she’ll be right”
Kiwi attitude, shyness, or a combination of all of these. As the year
went on, students became more comfortable and confident as clin-
ical students, so the groups met less often, but they had the contact
details of their leaders in case they had any questions or issues. This
emphasised the importance of the meet-ups at the beginning of the
year when the fourth-year students are new to the clinical site. Edu-
cational support was a success; progress test tutorials, mock objec-
tive structured clinical examinations (OSCEs) and electrocardiogram
(ECG) tutorials were some of the events organised by the leaders.
his educational support, accompanied by the enticing effect of free
food, was a great way to gather the students together, show them we
care about them, encourage them to meet with their support group,
and an opportunity for them to ask questions. A barrier to this was
that these educational sessions (and the whole programme for that
matter) relied on fifth- and sixth-year students being motivated, or-
ganised, and willing to give up their spare time.
The September 2018 survey yielded other interesting results. When
asked to rate what being a clinical medical student was like on a scale
of 0 to 10 (with 0 being awful and 10 being amazing), the average
score was 7.3 for the 152 student responders. Fifth-year students’ rat-
ing of what it is like being a clinical student was the lowest of the year
groups. When asked what they felt they needed the most and would
like to see in the programme this year, they responded: (1) mock
OSCEs; (2) meetings to talk about how things are going and to ask
questions; and (3) tips before their placement starts. 95% liked the
idea of having a Clinical Student Support Programme, with 5% who
had not yet made up their mind. Lastly, there was the opportunity for
students to nominate peers who have been particularly helpful and
supportive, and over 50 students were nominated as making a signif-
icant impact. I have personally thanked each of the nominated stu-
dents – possibly the most rewarding part of this journey so far for me.
Going forward, past and present AUMSA Executive members and
I have been working hard to build on this initial year of the CSSP.
2019 is incredibly important, as two successful consecutive years of
this programme will be a key step towards this becoming a tradition.
We are hoping to target the crucial stressful components of clinical
years – the beginning and initial orientation to the hospital, final-year
OSCEs, more intense runs like general surgery, obstetrics and gy-
naecology for fifth-year students, and the orthopaedics practical as-
sessment. In addition, an ongoing aim is to: encourage proactive ap-
proaches to well-being, with AUMSA Site Representatives organising
social events, support group leaders encouraging regular meetings
(at least initially at the beginning of the year); and candid discussions
about mental well-being, bullying, and other difficult experiences.
2019’s AUMSA President, Cameron Tuckey, encouraged me to ar-
ticulate my overall goal for this programme and what I hope medical
student clinical life to be like for my successors, and this is what I came
up with. Ideally, every fourth-year student starts their clinical years
excited to be a part of something special – a connected, supportive,
and enjoyable hospital site environment. They receive an adequate
orientation to the hospital, are in regular contact with fifth- or sixth-
year students throughout the year, and are given opportunities to
speak about any difficulties or challenges they are having or have had.
Any student in distress is referred to appropriate services or esca-
lated to the University. Fourth- and fifth-year students receive ed-
ucational support from leaders, enabling them to feel prepared and
confident for their assessments. Fifth- and sixth-year students get an
opportunity to be leaders and teachers, to improve their emotional
intelligence, responsibility, communication skills, and sense of commu-
nity. This whole environment described becomes a tradition that is
self-sustaining and operates with ease, purely because students care
about, and want to help, each other.
Acknowledgements
Holly Dixon from the University of Auckland’s Health & Wellbeing
department.
Glenn Nightingale from Nightingale Associates accounting firm – for
their generous funding to get University of Auckland’s first formal
Clinical Medical Student Support Programme off the ground.
NZMSA – for funding through their Student Innovation Fund
AUMSA – for moral and financial support of the Clinical Student
Support Programme
Correspondence
Megan de Lambert: [email protected]
