Exploring Japanese Medical Students' mental distress and wellbeing challenges

Medical practitioners often perceive patients primarily as clinical subjects rather than as individuals they themselves might one day become. When physicians become patients and are unable to work full-time, they may experience marginalisation within the medical community. In undergraduate medical curricula, the ability to work hard is strongly emphasised. While physicians are expected to demonstrate generosity and altruism toward disabled patients, professional relationships are frequently shaped by competition and a prevailing drive for excellence. Medical students similarly navigate a demanding environment, characterised by examinations and practical training, where continuous competence is expected. This focus on individual ability reflects the structural ideology of ableism. This mixed-methods study explores how medical students experience mental health challenges and seek wellbeing under the influence of ableism. Quantitative data from questionnaires revealed a high prevalence of anxiety and depression. Qualitative insights from a focus group and a World Café discussion illustrated a nuanced understanding of wellbeing, ranging from basic self-care (e.g., eating and sleeping) to the pursuit of meaningful engagement. Students reported anxiety stemming from feelings of incompleteness and social comparison. Many expressed difficulties in discussing mental health concerns with familiar individuals due to fear of judgment. However, the development of trusted relationships was identified as a potential strategy for fostering safe spaces. These relationships may facilitate open dialogue about struggles and limitations-moving beyond a narrow focus on competence and achievement. The findings highlight the role of ableism in shaping distress and silence in medical education, pointing to the need for more inclusive and supportive learning environments.