A poor grade on a final, an ailing parent, or the breakup of a long-term relationship—each has the potential to overwhelm a first-year medical student. But for those enrolled at the University of Tennessee Health Science Center College of Medicine in Memphis, the classrooms and hallways are brimming with encouragement and friendly advice.

As a first-year medical student at age 35, Sandra Kaplan was trying to adjust to the pressures of medical school, when her father suffered a stroke. "I had a great support system, yet I still struggled," she recalled.

"I looked around me and saw much younger students who were living hundreds of miles from home and may have been without a support system. I thought, ‘I can’t be the only one struggling here.’ "

So at the end of her first year, as part of a curriculum assignment, Kaplan worked with faculty and administrators to launch a peer-support service in which medical students volunteer to provide support and advice in a confidential manner to their classmates who feel frustrated or overwhelmed by personal or academic problems.

Audience of One, as the program is known, began in 2001. "I think the best resource for medical students is their colleagues," she said, because they best understand what it’s like to struggle with relationship problems, family issues, and the pressures of medical school. "Many have been there before," she added.

Despite their own hectic schedules and stresses, about 40 students—about 10 in each class year—have signed up as volunteers since the program began, Kaplan noted.

Volunteers are trained to watch out for classmates with a weary or troubled demeanor, Kaplan explained, and often approach first-year medical students to ask them how they are doing.

Support sessions are likely to take place at an off-campus location such as a nearby coffeehouse or restaurant. Volunteers are told by faculty that they are not to have "sessions" in their home or the student’s home, but to meet in a public place.

Kaplan, in addition to being the program’s founder and first student coordinator, has served as a volunteer. In this role, she has reassured classmates with relationship problems and advised those struggling academically. "Once you get to medical school, the bar is raised, and many students who made high grades before aren’t doing as well—that can be stressful," she said.

Advising fellow students often involves "creative problem-solving" on the part of volunteers, Kaplan added. For instance, a volunteer may suggest to a classmate that he or she postpone an exam to attend a parent’s surgery, for example, or take a leave of absence in more serious situations. "We help students to see their options and learn how to balance their priorities," she said.

There are some students, however, for whom friendly advice and emotional support are just not enough.

"Our biggest concern when we started the program was what to do if one of the student volunteers encountered a classmate with mental health problems," said Renate Rosenthal, Ph.D., who is faculty advisor for Audience of One and director of medical student education in psychiatry at the University of Tennessee Health Science Center College of Medicine.

Rosenthal decided to train the student volunteers to recognize the early signs and symptoms of common psychiatric disorders. She also instructs the the students to call her if they encounter a classmate who displays the signs of mental illness and to provide that classmate with phone numbers of the campus counseling service and community-based mental health resources.

Just two students who participated in the program have required the help of a psychiatrist or mental health professional since the program’s inception, Rosenthal said.

Most of the students seek out the volunteers because of academic insecurities, she said. "They wonder, ‘Do I really belong here? Did they make a mistake when they admitted me?’," Rosenthal said. Some have questions about how to resolve a family argument or want to talk about the difficulties of maintaining a long-distance relationship.

The experience of being a student volunteer is a training experience in itself, Rosenthal said. "Many of the volunteers will make good physicians," she said. "They will be attentive to their patients’ concerns."

The service also helps students learn how to balance their priorities, Kaplan observed. "We always say that life doesn’t go on hold for medical school," she said.

More information about Audience of One is posted on the Web at www.utmem.edu/training/AOOWeb/. ▪