Supporting medical students to support peers: a qualitative interview study

Abstract Background Students may be the first to recognise and respond to psychological distress in other students. Peer support could overcome medical student reluctance to seek help despite their high rates of mental ill-health. Yet, despite the adoption of peer support programs, there is little evidence of impact on students. Peer support programs may assume that medical students accept and view peer support positively. We explored these assumptions by asking students about their experiences and views on peer support. Methods Qualitative semi-structured interviews exploring peer support experiences and views on peer support were conducted with ten medical students at two contrasting medical schools. Informed by a constructivist stance, interview transcripts underwent thematic analysis. Results Three groups of themes were identified: participants’ experiences of peer support encounters, concerns about providing support, and views on students’ roles in peer support. Participants readily recalled signs of peer distress. Encounters were ad hoc, informal, and occurred within relationships based on friendship or by being co-located in the same classes or placements. Concerns about initiating and offering support included lack of expertise, maintaining confidentiality, stigma from a mental health diagnosis, and unclear role boundaries, with implications for acceptance of student roles in peer support. Conclusions Our study emphasised the centrality of social relationships in enabling or discouraging peer support. Relationships developed during medical studies may anticipate the collegial relationships between medical professionals. Nevertheless, only some students are willing to undertake peer support roles. We suggest different strategies for promoting informal peer support that can be offered by any student, to those promoting formal support roles for selected students. Future research focusing on the impact for both the students who receive, and on the students who provide peer support is called for.

## 摘要
### 研究背景
学生往往是最早察觉并回应其他学生心理困扰的群体。尽管医学生群体的精神健康问题患病率较高，但他们仍不愿主动寻求专业帮助，而同侪支持（Peer support）或可破解这一窘境。然而，尽管不少院校已推行同侪支持项目，但鲜有证据表明此类项目能对学生产生实际影响。同侪支持项目往往默认医学生能够接纳并积极看待同侪支持，本研究通过调研学生对同侪支持的经历与看法，对这一预设展开探究。

### 研究方法
本研究采用质性半结构化访谈（Qualitative semi-structured interviews）法，对两所办学背景迥异的医学院校的10名医学生，就其同侪支持经历与相关看法展开调研。本研究秉持建构主义研究范式，对访谈转录文本开展主题分析（Thematic Analysis）。

### 研究结果
本研究归纳出三类主题：一是参与者的同侪支持互动经历，二是提供支持时的顾虑，三是对学生在同侪支持中角色的看法。参与者均能清晰回忆起察觉同侪心理困扰的场景。此类互动多为临时、非正式的，依托友谊关系或因同班上课、同场实习的共处场景而发生。在发起与提供支持方面，参与者存在诸多顾虑：包括缺乏专业应对能力、难以保障保密原则、担心因精神健康诊断遭遇污名化，以及角色边界模糊，这些因素均会影响学生对同侪支持角色的接纳程度。

### 研究结论
本研究强调，社会关系在同侪支持的开展中起到核心作用——既可能推动也可能阻碍同侪支持的实施。医学生在校期间建立的人际关系，或可预示未来医疗从业者之间的同事关系。然而，仅有部分学生愿意承担同侪支持相关角色。本研究针对两类场景提出不同的推进策略：一是面向全体学生的非正式同侪支持推广方案，二是为特定学生设置的正式同侪支持岗位。未来应开展聚焦于同侪支持接受者与提供者双方影响的相关研究。