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By Katelyn M Cooper, Ph.D.

Upwards of 50% of college students struggle with mental health, often severe anxiety and depression.  Therefore, it’s unsurprising that these conditions, just like physical health conditions, can impact premedical students as they prepare for medical school.  From an uncharacteristic drop in grades, to abruptly leaving an extracurricular commitment, to taking a leave of absence for a semester or more, mental health conditions can have a notable effect on one’s college experience and subsequently their medical school application. 

While students often feel comfortable writing about physical health, such as managing diabetes or navigating an autoimmune diagnosis, it’s much less common to write about mental health on a med school app.  But why?  Well, mental health carries a stigma, defined as a mark of disgrace, not only within the U.S. but also within the medical community. 

As a previous academic advisor and now biology faculty member who studies undergraduate mental health, I often get asked by students if I think they should reveal their struggle with a mental health condition on their application. Historically my response was always, I don’t know, we just don’t have enough evidence about how it will affect your application.  After a while, I got tired of saying I don’t know so an undergraduate researcher and pre-med student, Anna Abraham, and I teamed up with another biology education researcher, Dr. Sara Brownell, and Ph.D. student Carly Busch to answer this question!

We conducted an audit study of 99 medical school admissions committee members from over 40 medical schools in the United States (MD-granting institutions).  We asked each of the committee members to review a medical school application and provide feedback for the purpose of helping undergraduates strengthen their applications.  We created a set of three fictitious med school applications, each designed to represent an average admitted medical student’s application according to the most recent AAMC data available for 2021 matriculants (See Figure 1 and Figure A1 in the paper).  

The three applications were identical with one difference: all three applications reflected a drop in grades during one semester but (1) one application attributed the drop to a mental health condition, (2) one application attributed the drop to a physical health condition, and (3) one application offered no explanation for the drop in grades.  The committee members who agreed to review an application were randomly assigned to one of the three conditions.  The committee members were asked to rate the applicant on their acceptability, competence, and likeability. 

After rating the respective application, all committee members were asked on the survey whether they perceived that revealing a mental health condition on a medical school application would be perceived neutrally by a committee, perceived negatively, or perceived positively.  Then, they were asked about when revealing a mental health condition would be beneficial and when it would be detrimental to a medical school application.

We found no significant differences in how committee members rated the acceptability, competence, and likeability of candidates among (1) the application that revealed a mental health condition (2) the application that revealed a physical health condition, and (3) the application that did not reveal any health conditions.  

Most committee members reported that they perceived revealing one’s mental health condition on an application would be viewed by the committee as neutral.  When asked about why revealing a mental health condition might be beneficial or detrimental, some committee members even highlighted that it could be beneficial if it were mentioned with the intent to demonstrate resiliency, but if the reference is vague or the condition is not being managed, it could be detrimental.  

So, what can we learn from this work? First, it seems as though not all medical school admissions committee members exhibit a bias against mental health conditions. If a student chooses to write about mental health on their application, we recommend they describe how their experience navigating a mental illness has helped them develop AAMC Core Competencies, such as resilience and adaptability.  

Additionally, we encourage applicants to consider sharing details such as the severity of their mental illness and how it is being managed, because this information may help committee members determine whether it’s the right time for the student to navigate the stressors of medical school.  After all, research shows that medical school, residency, and even being a practicing physician can take a severe toll on one’s mental health, so making sure it’s the right time to embark on the challenge is important.

Given the ubiquity of mental illness among adults, physicians will undoubtedly continue to struggle with mental health. While the results of our study are encouraging, they do not prove unequivocally that stigma surrounding mental health in medical school admissions no longer exists. The question is, are we moving toward a medical culture where mental illness is less stigmatized and medical personnel can openly seek help and support?  We hope that the results of this study inspire a new generation of med school applicants to be more open about their mental health, establishing the foundation for an evolved culture of medicine where mental health is as championed as physical health.

Katelyn Cooper, Ph.D. is an assistant professor in the School of Life Sciences at Arizona State University where she leads the Cooper Biology Education Research Lab, which studies the relationship between undergraduate and graduate mental health and various biology learning environments.