Restrictions imposed by COVID-19 couldn’t stop Jonathan Seok from finding a research opportunity during the summer of 2020. In between his first and second year in the College of Medicine, Seok became an integral member of an interdisciplinary research team that is developing a mental health training initiative. It’s all part of a growing relationship between Northeast Ohio Medical University and Miami University.
Seok (pronounced soak) has been assisting on a project involving Mental Health First Aid, an evidence-based training program that began in 2001 in Queensland, Australia. NEOMED researchers Natalie Bonfine, Ph.D., Rebecca Fischbein, Ph.D., and Christian Ritter, Ph.D., are collaborating with Miami University faculty members Amity Noltemeyer, Ph.D., and Rose Marie Ward, Ph.D., along with Caitie Zierden, a graduate student at Miami. Greg Koman, a program coordinator at NEOMED, provided administrative assistance for the many Zoom meetings over the summer, as well as for previous meeting related to the growing relationship with Miami.
“Mental Health First Aid focuses on understanding common signs and symptoms of mental health problems, such as depression, eating disorders and anxiety – and helping learners know how to best respond to a person who may be struggling or in crisis,” said Dr. Bonfine, an associate professor of psychiatry at NEOMED, in a recent Zoom conversation among the group.
This summer, she says, “Jonathan has been helping immensely in getting information together.”
The NEOMED-Miami University research team would like to determine if the MHFA training program is an effective means of helping health professions students to recognize signs and symptoms of mental health problems that may appear in clinical settings, and how to best intervene.
In addition, the researchers hope to develop and evaluate supplemental training materials to enhance and amplify the MHFA training with a randomized controlled trial. To accomplish this, the team has engaged partner clinicians: Mariquita (Kit) Belen, M.D., (NEOMED’s director of geriatrics), Chris Paxos, Pharm.D., (associate professor of pharmacy practice and psychiatry) and John Ward, Ph.D. (director of student counseling services at Miami and a MHFA trainer for the last 10 years).
The route to research
There are many opportunities for students to get involved in research at NEOMED, as Seok discovered this summer. He had informally gotten to know Dr. Ritter, a professor in the Department of Psychiatry and director of the community-based mental health research area at NEOMED, through Seok’s former involvement as a student representative on the NEOMED Board of Trustees.
“The chance to bump into a professor in line at the café and have conversations about your common interests is one of the advantages of a smaller school,” notes Seok.
Since May, Jonathan has volunteered 3-15 hours a week on the research project. (NEOMED also has a Summer Research Fellowship Program, which pays students a stipend.)
“This summer was the perfect time to do research, because we had a lot of time due to the COVID-19 Pandemic. I was stuck at home. Mental Health First Aid resonated with me because I’ve been thinking about going into psychiatry,” says Seok. “The part about this project that I love the most is, it that it just lets you be more creative and learn in a pressure free environment. That’s the beauty of research compared to a structured curriculum.
“I’m also in the Ohio Army National Guard, where Mental Health First Aid is also used to spot soldiers with depression. I did not know anything Mental Health First Aid before I started doing research with the team, let alone that the guard used the program. I am glad I ran into Dr. Ritter, because I learned so much about this valuable tool for my future career.”
Looking into student mental health
The story of the research project actually goes back to 2019, when Dr. Bonfine and Dr. Fischbein, an assistant professor of Family and Community Medicine, published a paper in the American Journal of Pharmacy Education. Drs. Fischbein and Bonfine analyzed data from the Healthy Minds study, a national survey of college students. Their focus was on better understanding the prevalence of mental health problems, attitudes about mental illness and service engagement among a sample of medicine and pharmacy students who participated in this study.
“This study was among the first in the literature to explore these issues among both medicine and pharmacy students,” says Dr. Fischbein. “We were also able to use this data to create a research opportunity for two College of Medicine students, Carla Baaklini and Zeynep Ozgur.”
The NEOMED-Miami research team has launched its own survey to gather some pilot-level data – baseline information about knowledge of mental health issues and attitudes about mental health problems. The research team wants to study attitudes of health professions students related to depression and anxiety, including questions related to anxiety around COVID. The methodology being used is what’s called a vignette study – a paragraph description of a fictitious person, describing the issues that they’re experiencing, followed by questions asked by the researcher. After gathering baseline data this summer, the team will apply for grant funding to support the development of supplemental training aids to go along with education and awareness trainings.
Testing the training
“This is where the Mental Health First Aid piece comes in,” explains Dr. Bonfine. Some groups of students at NEOMED and Miami will receive the Mental Health First Aid training. Others will also receive an enhanced opportunity to practice using Standardized Patients at NEOMED’s Wasson Center for Clinical Skills Training, Assessment, and Scholarship.
Researchers will assess the subjects to determine if the additional enhanced training improves the subjects’ ability to choose the right action steps, as well as their confidence in choosing those steps.
“What they would do, if faced with a patient in their future profession? What steps they would do if they saw somebody presenting with these different issues?” asks Dr. Ritter, rhetorically.
A new researcher’s perspective
“I wanted to see how research is started from the ground level,” says Seok. “It’s not like we had already collected the data and I’m just like analyzing data in Excel spreadsheets and stuff like that. I get to see everything from the beginning – how the questions are formulated and how to do the pretest and posttest.
“And I get to learn from everyone involved in this project – not only Dr. Bonfine, Dr. Fischbein and Dr. Ritter, but the Miami professors as well.”
Seeing the messiness underneath
The qualities that help a person get into medical school are not exactly the same as the traits or skills they need to succeed in medical school – and those aren’t necessarily the same things that will make you a good physician, says Dr. Ritter, paraphrasing a memorable statement by his colleague Chris Vinyard, Ph.D., a professor of anatomy and neurobiology at NEOMED. Dr. Ritter elaborates on this by offering that along the way, transitioning from being a smart person who simply likes the subject matter into a physician calls for developing a tolerance for ambiguity. Hands-on experience can demonstrate the power of research and the passion of researchers while also revealing the process. Which is not always linear and often ambiguous, says Dr. Ritter.
“I have learned from physicians at NEOMED that there isn’t a simple algorithm for practicing medicine,” says Dr. Ritter. “And I think that’s the benefit of learning to do research. You see the finished product and it all looks like nice and shiny and seamless – but there’s lot of messiness, (and immense satisfaction) in between.”