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Characteristically, medical school brings on stressors that not every student can handle; however, when bright and passionate students are loaded down with menial tasks, burnout can manifest. Burnout, one of the most prevalent dimensions of distress, is defined by the National Academy of Medicine as a syndrome characterized by high emotional exhaustion, high depersonalization (i.e. cynicism), and a low sense of personal accomplishment - something medical students are all too familiar with. Medical schools in the U.S. have begun to address medical student burnout, but self-regulating habits are not always enough. In addition to burnout, severe fatigue, quality of life, overall well-being, dropout risk, and suicidal ideation are also dimensions of distress and well-being measured among medical students by the Well-Being Index.
“We must figure out how to ameliorate this problem, particularly if you believe that the problem will carry forward (into their careers),” explains Rowen Zetterman, MD, director of faculty mentorship development at UNMC. “If you believe that, then solving the problem of burnout in medical school is crucial to the future of healthcare.”
Long hours of studying, essays waiting to be written, and the changing dynamics of medicine all add up to insurmountable pressure, but medical students are still being told to push through their struggle with burnout. Research has shown that 50 percent of medical students experience symptoms of burnout. Another study shows medical students are more susceptible to burnout than their non-medical peers.
Burnout—and distress in general—has been on the rise in recent years. Medical students are all too familiar with the effects burnout can yield. While in training, some students study up to 30 or 40 hours a week in addition to meeting project deadlines and keeping their accruing debt in mind.
Burnout isn’t a new concept. However, more and more medical students are succumbing to the pressures of becoming a full-time physician. A lack of clinical continuity, poor levels of feedback from senior doctors, and hostile attitudes during training are other factors that have been fueling the burnout flame.
The side effects of medical student burnout can quickly have an impact on the school and community at large. When students are experiencing high levels of cynicism and physical exhaustion, the learning environment suffers. If students are not receiving help with combating distress, it’s likely the negative attitudes will rub off on first-year med students.
Similar to a cynical work environment, burnout can breed rapidly within a school in which students live, go to class, and study together. If students are pushed too far, they will eventually look to a different career path. Decreases in graduation and attendance rates are not attractive to potential medical students, making it even harder for the institution and community to yield successful physicians.
Distress and burnout in medical students can manifest in their personal lives in numerous ways. For instance, medical students are more likely to succumb to substance abuse than people of similar demographics who are not in medical school. Specifically, one study reported that nearly 33 percent of medical students claimed the symptoms of alcohol abuse; just 16 percent of their non-med peers face the same problem.
Medical student burnout can lead to other symptoms such as depression, anxiety, sleeplessness, headaches, gastrointestinal issues, and poor concentration. Consuming more alcohol, developing a cynical outlook on life, and withdrawing socially are all ways medical students respond to distress in their personal lives. Students may even act out disruptively and affect both their classmates and personal relationships. If burnout impacts a medical student’s personal life enough, they can turn to a new career path completely.
Extreme tiredness is one of the most apparent symptoms of burnout in medical students. Intense study and class schedules can easily result in burnout-related exhaustion and other dimensions of distress such as severe fatigue. It’s crucial for students to get the right amount of sleep to be able to perform everyday tasks and retain information.
If a once passionate and positive medical student is now seeming desensitized and cynical, he or she could be experiencing burnout. This is detrimental to the student’s personal relationships and future career if left unaddressed.
A medical student could be fighting burnout if they begin to feel completely incompetent or useless in school and personal life. A hopeless or cynical attitude can be a sign that a student is feeling they are not smart or good enough to take on their current responsibilities.
Many times, medical students take on such a heavy workload that they become burned out and feel no one else understands what they’re experiencing. It is important to promote community within the school, as to prevent students from feeling alone in their struggles.
Nailing down just one cause of medical student burnout is impractical; all potential causes of burnout should be recognized and understood by school administrations.
Medical school often consumes the majority of a student’s time. Feeling the pressures of a strict study schedule can result in a medical student missing out on important social or family events. Relationships can become strained and even broken if a med student isn’t able to find a more sustainable schedule or work-life integration.
Many medical students have to take on massive student loans to pay for tuition. It can be stressful to have debt looming overhead when most students don’t have time to get a job while in school. Extra spending money can be tight as well, due to any living expenses acquired during school.
One serious cause of burnout in medical students is the belief that physicians and physicians-to-be don’t deal with mental illnesses like depression or anxiety. The stigma associated with asking for help can cause medical students to feel alone in their struggle against mental illness. Communicating that mental illness can be present in anyone, including doctors, is crucial to facilitating an environment where students feel comfortable talking about their problems.
When medical students are delegated only menial tasks by superiors, passion for the field can quickly dwindle. Moreover, by acting indifferent about others’ feelings, students might get the impression that being a physician is a compassionless and apathetic career path. These aspects of medical school are known as the “hidden curriculum.”
Expectations from parents, professors, and even themselves can cause medical students to feel inadequate or incompetent. Feelings of deficiency can drive a student to internalize his or her burnout symptoms even further, not wanting to express any vulnerability.
Medical students are being told to “take care of themselves,” but have no incentives to reach out for help. Rachel Stones, a third-year student at the University of Chicago Pritzker School of Medicine, explains, “Students are struggling because there’s no incentive to take care of themselves. And even when we do have a supportive administration saying ‘take care of yourself,’ the larger culture of medicine is focused on sucking up and pushing through.”
Educating faculty on the dimensions of distress such as burnout in medical students can help to identify and address the problem in its early stages. If faculty members understand the symptoms of distress and how to approach a student who seems to be experiencing them, students may be more apt to talk about their struggles.
Offering an accurate and anonymous self-assessment to medical students can help to improve your school’s wellness initiatives. The Medical Student Well-Being Index is a validated nine-question assessment that offers participants custom resources based on their areas of need. Aggregated reports are then available to administrators to see how student well-being progresses over time.
Taking moments in between study sessions and exams to focus on the present can help medical students fight anxiety. Mindfulness sessions help to realign thoughts and take very little time.
Mindfulness and deep breathing exercises can go hand-in-hand. There are several meditation apps for mobile phones that remind the user to take a minute and focus on the breath. This can help students to relax before exams or when they’re feeling overwhelmed.
Medical students can feel so much pressure to continually study that they make little time to socialize or exercise. Having an integrated schedule of school, friends, family, and personal time can make all the difference.
Positive relationships are a vital part of managing the stress that students encounter in medical school. Support groups can reduce feelings of isolation, remove the stigma associated with distress, and greatly improve the well-being of students.
Students oftentimes do not have the time or the budget to prepare nutritious meals at home. Balanced meals should be available to students through meal plans or on-campus restaurants. Medical students fueling up on nutritious options will ultimately be happier, healthier, and more productive.
Medical students are our future physicians in training. If the burnout of school is not addressed, it can carry on to a physician’s professional career. A 2014 study found the training years for physicians result in the most burnout, leading to consequences as serious as suicidal ideation. Luckily, institutions are aware of the problem and many medical schools are stepping up to combat student burnout and distress as a whole.
If the well-being of practitioners-to-be is at risk, the quality of future patient care is in jeopardy. To produce successful doctors, burnout needs to be tended to at the early stages of training. Students who enter medical school are less likely to be depressed than students in other fields; however, this statistic is reversed by the second year of medical school. Addressing medical student burnout right away is essential to stave off depression, anxiety, and sleeplessness that students often experience.
Medical schools are stepping up to fight symptoms of medical student burnout through several initiatives. Some schools are offering pass/fail courses for medical students’ first years. Other institutions administer annual surveys and even stress-monitoring devices.
The Medical Student Well-Being Index is an accurate and anonymous way for students to self-assess their distress and well-being as often as once a month. Over time, students can see the times of year in which their stress may be higher or lower. Additionally, users can compare their results to those of their peers, creating a sense of togetherness. Custom resources are offered according to each individual’s needs, and aggregated reports are available for the institution.
Helping medical students confront distress means fewer people dealing with depression, anxiety, and other serious mental health concerns. Students will be happier and healthier, and schools will be producing doctors that are better equipped to serve patients. In general, more medical students will be successful in attaining a career as a physician if burnout and other dimensions of distress are addressed during training. Students who are not burned out are less likely to drop out of medical school, resulting in more doctors overall.
Administrations who are serious about unearthing and treating distress in medical students need to have an accurate method of assessment for each individual.
The institution should also find value in students routinely reassessing to ensure wellness initiatives are effective. The Medical Student Well-Being Index offers that, and more. The future of healthcare lies in the minds of our medical students.
Join 600+ organizations in using the Well-Being Index. Invented by Mayo Clinic, the Well-Being Index:
The Well-Being Index is available in multiple plans to ensure organizations of all sizes can utilize the tool.