Learning from the past: medical school experiences, stigma, and help seeking for depression

Experiencing lower psychological safety during medical school is linked to higher levels of impostorism and a diminished sense of meaning in work among incoming resident physicians. Furthermore, perceptions of a harmful hidden curriculum in medical school are associated with elevated levels of impostorism. This study aimed to build on these findings by examining whether incoming residents' perceptions of psychological safety and hidden curriculum in medical school correlate with various forms of mental health stigma and residents' intentions to seek help for depression. The participants (n = 244), surveyed from June 2023 to July 2023, were incoming medical residents starting their residency in the fall of 2023 at a large hospital organization. Residents responded to items inquiring about their medical school's psychological safety and hidden curriculum, as well as items asking about mental health stigma (i.e. self-stigma, perceived stigma from other doctors, and the perceived career consequences associated with help seeking) and current intentions to seek help for depression. A series of correlations and path analyses were conducted to examine relationships between these variables. Lower perceptions of psychological safety and higher perceptions of a harmful hidden curriculum in medical school were significantly correlated with higher levels of perceived stigma from other doctors, greater agreement that seeking help would harm their career, and lower help-seeking intentions. Psychological safety, but not hidden curriculum, was significantly related to self-stigma. Moreover, self-stigma, perceived stigma from other doctors, and perceived career consequences mediated the positive association between psychological safety and help-seeking intentions, while only perceived career consequences were a significant mediator for the negative relationship between hidden curriculum and help-seeking intentions for depression. These findings have implications for both understanding and improving resident well-being.