PHYSICIAN SPOTLIGHT: Stuart Slavin, MD, MEd
For Stuart Slavin, MD, MEd, the sobering national statistics about anxiety, depression and burnout among medical students didn’t relate to the eager young people he saw in his classroom.
Until, that is, their medical school decided to ask them about it.
“Frankly, I was surprised,” said Slavin, associate dean for curriculum at Saint Louis University School of Medicine, where an anonymous survey of students in 2009 helped trigger sweeping reforms of the four-year curriculum.
“The students seemed happy; they smile and seem engaged,” said Slavin, a professor of pediatrics. “But the results of the survey were just like that of every other medical school. With outcomes like that, I don’t think anyone could defend the status quo.”
Using an evidence-based approach, Slavin led the campaign for a host of changes that took effect over a three-year period. The overarching goals included reducing stress on students, better equipping them to deal with stress, and engaging them in more activities where they would find meaning.
The changes were bold: The medical school replaced its grading scale with a pass-fail system in the first two years and cut its required curricular time by 10 percent across the board. The latter move freed up a full day every other week, allowing students to engage in electives and have more free time.
Students also for the first time received training on how to cope with stress through resilience and mindfulness. Surveys taken after the changes confirmed the positive benefits.
“We’ve seen dramatic decreases in the rates of depression and anxiety, so it’s had a tremendously positive impact on student mental health,” Slavin said. “And there was no negative impact on educational outcomes, in the students’ performance on step one of the boards.”
More recently, Slavin spearheaded the restructuring of the medical school’s entire four-year program, shortening the pre-clinical phase and allowing students to enter the clinical setting earlier before.
“There are a dozen or so schools around the country that have made this change, and we thought it made a great deal of sense,” he said.
The reforms also included significant changes to the curriculum itself — realigning and combining some preclinical courses, expanding the focus on clinical issues in basic science courses, and better integrating material across courses.
In 2013, Slavin’s efforts earned him one of the Association of American Medical Colleges’ highest teaching awards: the Alpha Omega Alpha Robert J. Glasser Distinguished Teaching Award for significant contributions to medical education.
The task of leading such sweeping changes calls for cooperation and communication between Slavin and his colleagues. He has worked closely with the medical school’s Curriculum Management Committee and other committees to push the reforms through.
“One of the keys for me is trying to figure out what directions the school needs to be going,” Slavin said. “Everyone is aware of the dramatic pace of change in the overall healthcare environment, and having a medical school curriculum that doesn’t change is really problematic. It’s important that we have an educational system that is flexible and dynamic.”
Even more important for Slavin — both for the sake of education and that of campus politics — has been the need to ground all proposals in solid scientific evidence.
“I don’t expect the faculty, or the students for that matter, just to trust me because I think things need to move this way,” he said.
“The politics of change is difficult, but I’ve been very fortunate, because the faculty and students here overall have been very open to change. The key is making a compelling argument for change, and having changes that make great sense.”
A native of the St. Louis area, Slavin was raised in Clayton and received his undergraduate degree from Haverford College in Pennsylvania. For his medical degree, he returned home to SLU, where his father, Raymond, served on the faculty as an allergist and immunologist for more than 40 years.
Slavin completed his residency training in pediatrics at the University of California, Los Angeles. He served as a faculty member there for 17 years before returning to St. Louis in 2004. At the UCLA David Geffen School of Medicine, he was co-founder of the Doctoring Curriculum and spearheaded other changes in the medical school curriculum.
At SLU, Slavin remains actively involved in teaching medical students. He has revamped and expanded the Applied Clinical Skills course series, which spans the first three years of medical school. He serves as the course director for each of the courses, and also directs a three-week required capstone for fourth-year students.
Maintaining a close connection to students keeps Slavin attuned to how well curriculum reforms are working. The results of SLU’s interventions to curb stress, anxiety and depression in medical students will be detailed in a paper to appear in the April issue of Academic Medicine.
“I think we’re way out ahead,” Slavin said. “The really sad thing is, this problem has been known about for 60 or 70 years, and the response of medical education has been really inadequate.”
Among the most chilling statistics he cites: Each year, two entire medical-school classes are needed simply to replace the some 400 physicians nationwide who commit suicide.
“I take all of this incredibly seriously,” he said. “The good news is that, with the advances in cognitive psychology over the last 10 years, there are so many tools now that we can use that are evidence-based.”
Outside of work, Slavin spends time with his family, takes on projects around the house, tends a vegetable garden and cheers on St. Louis sports teams. He and his family also work with the Dent County Animal Welfare Society to provide foster care for rescue dogs, particularly those with medical needs.
Slavin and his wife, Helene, have two daughters: Alana and Natasha.
Suggested resources: To learn more about coping strategies for stress, anxiety and depression, Slavin recommends “Search Inside Yourself” by Chade-Meng Tan, and the mindfulness writings of Jon Kabat-Zinn, PhD.