title: A Qualitative Exploration of the Help-Seeking Behaviors of Students Who Experience Psychological Distress Around Assessment at Medical School.
abstract: OBJECTIVE
  Medical students are at high risk of experiencing psychological distress at medical school and developing mental ill-health during professional practice. Despite efforts by faculty to raise awareness about this risk, many students choose to suffer in silence in the face of psychological distress. The aim of this study was to explore drivers that prompted help-seeking behavior and barriers that prevented individuals prioritizing their well-being around the time of high-stakes assessment at medical school.
  
  
  METHODS
  Semi-structured interviews were conducted with fifty-seven students who failed high-stakes assessment at two UK medical schools, exploring their experience of academic difficulty and perceptions about causes. A thematic analysis of twenty transcripts that met inclusion criteria was completed to identify key factors that influenced participants' decisions around seeking help for their psychological distress, and in some cases, mental health problems. Twenty participants who specifically described a deterioration in their mental health around the time of assessment were included in this study.
  
  
  RESULTS
  Barriers to seeking help in these instances included: normalization of symptoms or situation; failure to recognize a problem existed; fear of stigmatisation; overt symptoms of mental distress; and misconceptions about the true nature of the medical school, for example beliefs about a punitive response from the school if they failed. Drivers for seeking help appropriately included: building trust with someone in order to confide in them later on, and self-awareness about the need to maintain good mental health.
  
  
  CONCLUSIONS
  There are various drivers and barriers for students' help seeking behaviors when experiencing psychological distress around the time of assessment, particularly self-awareness about the problem and prioritisation of well-being. Students who fail to recognize their own deteriorating mental health are at risk of academic failure and medical schools need to develop strategies to tackle this problem in order to protect these students from harm.
authors.affiliation: University of Leicester, Leicester, UK. rw205@le.ac.uk.
authors.forename: Rachel I
authors.initials: RI
authors.lastname: Winter
authors.affiliation: University of Nottingham, Nottingham, UK.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Patel
authors.affiliation: University of Leicester, Leicester, UK.
authors.forename: Robert I
authors.initials: RI
authors.lastname: Norman
mesh_terms: D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D000066505:Help-Seeking Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012577:Schools, Medical; D013315:Stress, Psychological / Q000523:psychology* / Q000628:therapy*; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D006113:United Kingdom
keywords: Examination; Medical students; Mental health; Support