There is some disagreement in the literature whether doctors in training suffer more from mental illness than an age-matched population. However, mental illness among doctors in training is a cause for concern because of the dual problems of reticence about accessing help and the clinical risk of doctors practising while mentally ill. The belief that is widely held among doctors in training is that to disclose a mental illness would be seen as weakness and may damage their career. A biographical narrative interview technique was used that enables the informant to tell the story of a painful episode in their lives in their own way and in their own words. Interviews were transcribed, and a thematic framework developed by consensus and then used to analyse all of the narrative interview data. Four major themes were detected: (1) Doing the job while ill, (2) Sick leave (initiating, being on, returning from), (3) Interaction with the employer; and (4) Sources of support. Practising while mentally ill caused significant challenges. Interviewees did the minimum, hated having to make decisions, and failed to study for postgraduate exams. All interviewees took sick leave at some stage. However, most were reluctant to do so. Being on sick leave meant being absent from the career that identified them and running the risk of being perceived as weak. Returning to work from sick leave was often difficult. Back to work interviews and occupational health support did not always happen. This study demonstrates the suffering encountered by doctors in training with mental illness. The job becomes much more difficult to do safely when mentally unwell. A great deal of presenteeism exists, which inhibits doctors in training from getting the medical care they need. It is imperative that confidential medical care is made available to doctors in training, which is sufficiently distanced from their place of work.

The mental health of doctors in training raises two major concerns, first that they are reluctant to, and have difficulty accessing, treatment, and second that undiagnosed and untreated doctors expose patients to unacceptable risks. Four 1-h focus groups were held, with participants' views explored on their observations about mental health as an issue amongst doctors, their personal knowledge of, and preferences for, sources of support, and other related factors. Transcripts were analysed using a thematic framework approach.

In 2012 the United Kingdom's General Medical Council (GMC) commissioned research to develop guidance for medical schools on how best to support students with mental illness. One of the key findings from medical student focus groups in the study was students' strong belief that medical schools excluded students on mental health grounds. Students believed mental illness was a fitness to practice matter that led to eventual dismissal, although neither personal experience nor empirical evidence supported this belief. The objective of the present study was a deeper exploration of this belief and its underlying social mechanisms. This included any other beliefs that influenced medical students' reluctance to disclose a mental health problem, the factors that reinforced these beliefs, and the feared consequences of revealing a mental illness. The study involved a secondary analysis of qualitative data from seven focus groups involving 40 student participants across five UK medical schools in England, Scotland, and Wales. Student beliefs clustered around (1) the unacceptability of mental illness in medicine, (2) punitive medical school support systems, and (3) the view that becoming a doctor is the only successful career outcome. Reinforcing mechanisms included pressure from senior clinicians, a culture of "presenteeism," distrust of medical school staff, and expectations about conduct. Feared consequences centered on regulatory "fitness to practice" proceedings that would lead to expulsion, reputational damage, and failure to meet parents' expectations. The study's findings provide useful information for veterinary medical educators interested in creating a culture that encourages the disclosure of mental illness and contributes to the debate about mental illness within the veterinary profession.

Objective Medical students experience higher prevalence of mental illness than age-matched controls and are less likely to access appropriate help when this happens. The aim of this study was to determine the range of strategies deployed by medical schools to support medical students with mental health concerns and to use this to identify distinct categories. Methods Websites and documents relating to all 32 UK medical schools were looked at, as were reports for quality assurance visits carried out by the General Medical Council (UK). A structured telephone interview was carried out with medical schools. Support services were examined by tracing the path that might be taken by a hypothetical student with mental health concerns of varying severity, seeing what was required and what was available at each stage. Results A range of support strategies is available to most medical students both from their medical school and from generic services in the university. Medical students will usually first contact a personal tutor or a senior member of faculty or be contacted by them as a result of concerns raised either via performance issues or by another student. While individual support interventions are mostly based on evidence of effectiveness, there is no unifying theory in terms of what constitutes effective support. To enable analysis of support interventions and comparison across providers, a six-stage conceptual model of prevention was developed. The six stages are the following: prevention, identification, referral, escalation, treatment, and reintegration. Conclusions The staged model, derived from analysis of existing interventions, provides a framework for evaluation of current provision and comparison of different methods of delivery. Moreover, it provides a framework for future research.