Scenario Info
Name: Jasmine R. Age: 25
3rd Year Medical Student
Scenario Goal: This scenario will help prepare you to provide support for a medical student peer experiencing stress related to medical school.
Scenario Objectives:
After completing this scenario, medical students will be able to:
- Engage supportively with a medical student peer experiencing distress related to school, role modeling use of healthy coping skills.
- Assess the impact of a stress related to medical school on a peer, including use of unhealthy vs. healthy coping.
- Provide interventions and resources to help mitigate a medical student peer’s distress and build resilience.
Your Role: You will play the role of Jasmine’s peer, a 4th year medical student, offering empathy, advice based on experience, and other support by making choices for what to say next when given the opportunity.
Overview
Jasmine R. is a rising 3rd-year medical student who came from a rural area to attend medical school in a major metropolitan area.
Jasmine has just started 3rd-year clinical rotations and struggles with some of the changes and challenges of 3rd-year medical school. She is surprised that she is not enjoying clinic rotations as much as she thought she would due to the unanticipated stresses. She decided to talk to a peer about it through a peer support program available at her school.
Scenario: Jasmine calls the Counseling Department to request peer counseling:”
Jasmine: I’m having some trouble adjusting to 3rd year. It’s different from the first two years of school, and I’m struggling a little. I thought it might help to talk to someone.
Administrator: [The Counseling Office administrator completes a screening assessment to make sure that Jasmine doesn’t need referral for professional counseling or mental health evaluation.] I’ll assign you someone just a year or two ahead of you. They can share what worked for them and warn about things that might help ahead of time.
Jasmine: That sounds like just what I need!
Connecting
Scenario: You are assigned to Jasmine by the peer support program and call her to lay the groundwork for offering support:
You: Hello, Jasmine. This is [Your name]. I’m a 4th-year student, and I’m responding to your request for peer support. Is this an okay time to talk?
Jasmine: Hi, Alexis. I’ve heard your name, but I don’t think we’ve met. Yes, I have just a few minutes. Could we set up a time to talk later this week?
You: Yes, I have Tuesday evening available. Would you like to meet in person, video chat, or phone?
Jasmine: I’d prefer to talk in person if that’s okay.
You: Yes, that is fine, and let’s talk about where we can meet so we can have a private, uninterrupted talk…
Scenario: For your first meeting, you meet Jasmine several days later in person. You first want to get to know Jasmine a little and build a rapport.
You: Are you from around here?
Jasmine: No, I’m from a rural area upstate. It’s much quieter. Not at all like here!
What do you say next?
You: I’m from a small town, not really rural, but still different from here. It is noisy here, isn’t it?
This response helps connect the peers by finding common ground. It also shows that you were listening, by reflecting Jasmine’s emotional statement about the area being different from her home.
You: And where did you go to school?
This is a good question for breaking the ice. It helps in getting to know a peer and find areas in common. But asking this question next did not acknowledge Jasmine’s emotional statement about the area being different from her home.
Please try again.
Jasmine: Yes, the noise can be overwhelming sometimes, especially by the Medical Center.
You: So, I know one stress you’re dealing with: City noise! Let’s talk some more. It can help to have someone to talk to.
Jasmine: Thank you, that’s what I was hoping.
Elicit Your Peer’s Concerns
Asking – Questioning Skills
Scenario: The conversation then came to an awkward stop. Which of the following would be most effective to say to get it started again?
What do you say next?
You: Do you have any other concerns besides the noise around the medical center?
This question correctly asks for more information about Jasmine’s concerns. However, it is a closed question in that it can be answered “yes” or “no.” If you pose open-ended questions, it makes it easier for the other person to follow with more information.
Please try again.
You: So, I gather that you wanted to talk about other concerns, too. What were you hoping to discuss?
This is an open-ended question and invites Jasmine to say more about her concerns. It provides some direction for the conversation by guiding Jasmine, toward talking about the concerns she wants to talk about.
Deepen Your Understanding of Your Peer’s Concerns
Scenario: To elicit Jasmine’s concerns, you use active listening and reflective listening, which help you pay attention and let her know you are listening.
You: The counseling office said you had some trouble adjusting to 3rd year. What’s going on that you hoped to talk about?
Jasmine: It’s several things that just added up, I guess. First, I peaked too early for my Step 1 exam, so I ended up studying more than I had to. I still haven’t recovered.
You: That’s rough! I hope you did alright.
Jasmine: Yes, good enough. But then in 3rd year, we started having clinic from 8 am to 5 pm, and we still have to study for classes. It was tough adjusting to that.
You: It is a tough adjustment, isn’t it? More physically demanding, too!
Jasmine: Yes, and I’m disappointed about how little time I get to spend learning medicine. Instead, I’m spending more time dealing with insurance, learning new EHRs, calling to get patient records.
You: So, the amount of time 3rd year students spend learning medicine relative to administrative work is disappointing.
Jasmine: Yes, but I think the hardest part is that I start to doubt myself when patients seem to not trust me because I’m a medical student. I lose my confidence.
You: It sounds like you pick up on their mistrust and then feel less confident.
Jasmine: Yes! That’s it.
Assess the Impact of Your Peer’s Concerns
Scenario: To check how much distress Jasmine’s concerns are causing her, you ask her about them and include questions about her safety and whether she needs more formal professional help through the school or outside professional help.
You: So, it’s not just one thing that’s getting to you. It’s the noisy metropolitan area, less time spent learning medicine than you want, lots of administrative work, and patients’ lack of confidence in you. Anything else?
Jasmine: Those are the main things.
What do you say next?
You: What I do is I just make sure I get out of the city when the stress builds up too much.
It can be helpful to share coping strategies that worked for you in similar circumstances. However, it is important to first find out how badly these stressors are affecting Jasmine. Also, as with patients, it is best to try to get the other person to come up with solutions for themselves first because people are more likely to follow solutions that they create. Later, you can ask if she wants to hear what you do.
Please try again.
You: How has all that affected you?
This is a direct, open-ended question to determine the impact of Jasmine’s concerns. It will help you learn how she is doing and give you an idea of what she needs.
Jasmine: I’m disappointed and not looking forward to clinic as much as I thought, but not depressed.
You: Good. What other effects is the stress having on you? Is your health okay, for example?
Jasmine: My health is fine. The reason I wanted support is that I sometimes don’t feel like going to clinic. I go anyhow, of course, and try to have a good attitude. But lately, I have been having a drink sometimes after a stressful day, especially if I’m with a group of friends.
You: I admire that you go to clinic anyhow, trying to keep a good attitude. But it sounds like the stress builds up and you’ve been drinking alcohol to cope. As a medical student, that concerns me. Can we talk about that?
Jasmine: Sure. It concerns me, too. Not that I drink much. I never drink more than 1 or occasionally 2 drinks in a night. I use alcohol as a way to cope. And I know it’s not healthy and beyond moderate limits for women which is no more than one drink in a day. I want to use healthier means of coping.
You: Good for you! We could talk about ideas for healthier coping if you like.
Jasmine: All right.
Provide Interventions
Scenario: You offer a number of interventions in response to Jasmine’s concerns and the impact they are having on her.
You: You know, you’re not alone in turning to something that is less healthy to cope with the stresses of medical training. [Normalizing] But you are already on the path to correcting that by recognizing it. [Praise her strengths] What ideas do you have for healthier ways of coping? [Elicit her ideas]
Jasmine: When we talked about where I’m from and the noise of the city, I realized I need to get out in the country more often. Or at least take a walk in the park. I also need to take time for my yoga stretches.
You: Great ideas! Early in 3rd year, I tried to study the same number of total hours as in 2nd year. I soon found out I couldn’t sustain it, and that it is important to just set aside time to refresh yourself and do some things you enjoy. One hour less time spent studying per week will not make that much difference in your academics and could help energize you so you enjoy clinic more. [Sharing coping suggestions based on your experience]
Jasmine: That makes sense.
You: I also wanted to tell you, regarding your disappointment at spending so much time on clerical duties and not much on medicine: It gets better. Already in 4th year, I am doing more exams on patients and some simple procedures. [Anticipatory guidance]
Jasmine: That’s good to know!
You: I’m glad you are getting together with friends. Keeping a good social network is so important. [Talk about the importance of social support] What will you do when you meet with them if you don’t want to use drinking to handle your stress? [Help them set goals]
Jasmine: I think I just need to make up my mind to use healthy coping instead of drinking and sometimes say, “No, thanks” when they offer me a drink.
You: Sounds good. Please do talk with the counseling office if you continue to struggle with that. [Remind them of available supports]
Jasmine: I will. Thank you so much. This has been so helpful!
You: I’d like to check in with you in a little bit to see how it’s going. When’s a good time? [Schedule a follow-up]
Jasmine: Thanks. I’d like that. How about we video chat in a week?
Follow Up
Scenario: You contact Jasmine via video chat a week later as you had scheduled for a brief follow-up to check on her wellbeing and how she’s doing on her goals.
You: Hello, Jasmine. Nice to see you again. How’s it going?
Jasmine: Hello. Pretty well. I did go for a walk in the park this week several times during breaks instead of just collapsing in the break room. And I did some yoga stretches when I could find a few minutes.
You: Hey, that’s good to hear! How was it?
Jasmine: It does help some, like I’m more myself again.
You: Good. And how did it go for your goal of not using drinking alcohol to cope?
Jasmine: That went well this week.
You: That’s also good news. I thought some more about our conversation and thought of something that might help with losing your confidence when it seems that patients mistrust you for being a medical student. Want to hear how I deal with it?
Jasmine: Sure!
You: I remind myself that I can’t really know what patients are thinking. And maybe it makes sense if it does scare them a little to work with a student. They have no way of knowing how well prepared a medical student might be, and they are scared because their health is important. Then I figure it’s up to me to do my best to put them at ease.
Jasmine: I like that. Thanks!
You: Would you like to schedule a regular time to check-in and talk?
Jasmine: I would like to talk again. Could I contact you in a few weeks?
You: Yes, sounds good. If you want to talk before then, please feel free to message me, or contact the school’s counseling office.
Jasmine: I’ll do that. Thanks again!
Scenario Summary
Jasmine R. is a 25-year-old 3rd-year medical student who is having some trouble adjusting to the transition from 2nd-year to 3rd-year medical school.
Her stressors include the difference between her rural home and the more metropolitan medical center, the heavy workload of being in the clinic along with classwork, disappointment about having more administrative duties than patient time, and lower self-esteem from patient reactions to working with a medical student.
In a support session and brief follow-up, a peer elicited Jasmine’s primary concerns and provided interventions of:
- Listening actively and reflectively
- Normalizing her experience and feelings
- Anticipatory guidance
- Review of basic coping skills that have been effective for her in the past (walks in a park, yoga stretches)
- Sharing of coping skills that are effective for the peer (setting aside an hour to do things that refresh her)
- Reminder of available resources to provide support, in particular, the school’s counseling center and the importance of social support.
Quiz
Does this summary cover all of the important peer concerns and interventions that were given?
Yes
It left out the peer’s use of alcohol as a way to cope with stress and the plan developed to address it.
No
It left out the peer’s use of alcohol as a way to cope with stress and the plan developed to address it.
Alcohol Use Recommendations and Upper Limits
Recommendations: Regarding alcohol use, the USDA Dietary Guidelines for Americans 2020-2025 recommends:
- “Adults of legal drinking age can choose not to drink,”
- “Drinking less is better for health than drinking more.”
Upper Limits: When alcohol is consumed, the USDA recommends moderation, “by limiting intake to:
- 2 drinks or less in a day for men
- 1 drink or less in a day for women.”
Binge drinking is defined as:
- 5 or more drinks at one occasion for men
- 4 or more drinks at one occasion for women (CDC, 2022).
References:
CDC, Binge Drinking: Information from the CDC. 2022.
US Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans 2020-2025.
Learning Points
Support from a near-peer, that is, someone just a little ahead of a student in medical training, can help them by providing social support and learning from the more advanced peer’s experience.
Support for a peer in acute distress involves the following steps:
- Assure that your peer is comfortable and you have sufficient privacy.
- Make a connection with your peer.
- Clarify your role of providing social support and describe limits of confidentiality.
- Use open-ended questions to elicit your peer’s concerns.
- Listen actively and reflectively so that they feel heard.
- Assess the impact of your peer’s concerns on them in terms of the severity of their distress, including whether their basic needs are met, if they are able to function well enough or need professional help, and other impacts on their life including mood, appetite, and sleep.
- Refer those needing additional help back to the sponsor of the peer program or school counseling office.
- Provide interventions that are based on what you learn about their concerns.
- Provide resources for additional support and information on how to get professional help in case your peer needs it later.
- Follow up by checking with your peer again after a few days. Consider whether an ongoing peer support relationship would be helpful and is something you both want.
Bibliography
Everly GS, Lating JM. The Johns Hopkins Guide to Psychological First Aid. Vol 1 edition. Baltimore: Johns Hopkins University Press; April 1, 2017.
Miller A. CBT for Front-Line Medical Professionals: Brief Interventions During a Time of Crisis. April 4, 2020. Beck Institute for Cognitive Behavior Therapy.
National Cancer Institute. Body & Soul. Peer Counselor Training. 2006.
Washington Institute, for Mental Health Research & Training (WIMERT). Washington State Certified Peer Counselor Training Manual. July 2009.
To complete this Peer Support Case, please
