MPS Foundation
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Our randomised controlled trial, funded by the MPS Foundation, is evaluating whether Thumos (a cognitive-behavioural intervention) has mental health benefits for medical students.
Many medical students experience mental health distress, with one in two reporting burnout, one in three experiencing depression, and one in ten disclosing suicidal thoughts). 1-3 Interventions have been designed and evaluated to support medical students’ mental health, but they have largely been generic, failing to address the specific challenges faced by medical students. Furthermore, studies suggest that these generic interventions have only weak and mixed effectiveness. 4
To explore this area, a project funded by the MPS Foundation is evaluating a new, tailored cognitive-behavioural intervention, Thumos, in medical students. Thumos has been designed with clinicians in mind and aims to equip clinical professionals and students with the psychological tools they need to cope with stressful workplace events. The Thumos intervention involves two small-group online workshops and a one-to-one phone or video call with the workshop facilitator, who is a qualified clinical psychologist or cognitive behavioural therapist. The intervention uses case studies which are tailored to the specific stressful events the participants will face in the course of their work. For medical students, the case studies focus on placement-based stressors, such as making mistakes, difficult interactions with families or patients, and managing inter-professional relationships.
Thumos has been developed, evaluated, and refined over time in response to participant feedback. There have been three previous pilot studies of earlier versions of Thumos which all suggest it could have mental health benefits for qualified clinicians and students. 5-7 The first study on the intervention was in a group of 66 multi-disciplinary healthcare professionals and students, including obstetricians, paediatricians, midwives, and paramedics.7
Case studies were tailored for each group included in the study and results indicated improvements in resilience and confidence in coping with adverse events.7 A second study was conducted in 80 Critical Care Nurses (CCNs) during the peak of the COVID-19 pandemic.6 Results indicated improvements in confidence, resilience, burnout, depression, and intentions to leave the profession.6 Most recently, the intervention was delivered to 115 medical students.5 Findings indicated improvements in confidence, resilience, burnout, and depression.5
Following these studies, feedback has been used to further improve the intervention, leading to a reduction in didactic teaching prior to and during the workshops, and the addition of new cognitive-behavioural exercises to help participants identify and challenge unhelpful thinking patterns. We have also further refined the approach taken in the one-to-one phone and video calls with the facilitator.
While these previous studies have been positive, none have included a control condition, and so we cannot be confident that improvements seen were caused by the intervention. The new trial, beginning in May 2025, will address this gap, establishing for the first time whether Thumos delivers significant mental health benefits. The trial will run over two years and recruit medical students UK-wide in years involving clinical placements. We will recruit 200 participants altogether, 100 of whom will take part in Thumos, and 100 who will be allocated to the control condition and followed up over time. As Thumos is a positive, preparatory intervention, participants in both conditions can continue to access other mental health support services as they usually would.
Thumos could be particularly well suited for medical students for several reasons. For example, its pro-active, preventative-focused approach reduces stigma in participating. Stigma is known to act as a barrier against medical students accessing mental health support, but as we are targeting all medical students – not just those with mental health distress – Thumos may feel easier for medical students to access.8 Thumos also targets maladaptive perfectionism, by using cognitive-behavioural techniques which tackle rigid, unhelpful thinking and enhance mental flexibility. Levels of maladaptive perfectionism are known to be high in medical students and are linked with greater risk of mental health problems. Furthermore, Thumos is delivered online and in the evenings. Previous participants have said this makes it possible for them to take part, as it fits with their busy schedules.
If the trial finds that Thumos is effective, it could have global impacts. As it is mostly delivered in groups, Thumos is cost-effective to deliver, supporting widespread roll-out. Thumos uses cognitive-behavioural techniques and is delivered by psychologists or therapists trained in cognitive behaviour therapy (CBT). As CBT is the most evidence-based psychological therapy approach worldwide, there is large potential to train new facilitators in the approach. Culturally adapted CBT has also been found to be effective internationally, suggesting similar adaptations of Thumos may too have wider benefits beyond the UK.