When it comes to burnout and depression, research indicates that medical students and residents are more likely to experience these problems than other individuals in the same age range pursuing different careers. This elevated risk persists into residency training. Although the problem of burnout – like many – has only been exacerbated by Covid-19, it was a reality long before the pandemic. This conclusion is evident in a 2014 study in Academic Medicine that found medical students, residents, and early career physicians experience more burnout than their peers outside the medical field.
What is burnout?
According to the Journal of Graduate Medical Education, burnout is a syndrome that results from work-related stress and is characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. This state of chronic stress that contributes to emotional and physical exhaustion and detachment is particularly high during residency training; burnout in internal medicine ranks among the highest of all specialties, with rates as high as 76%. In addition, it is associated with lapses in professionalism, absenteeism, self-reported delivery of suboptimal patient care, and medical errors. A 2008 study in the Annals of Internal Medicine found that approximately 50% of students experienced burnout among more than 2,000 medical student respondents across seven schools.
Although medical students tend to have mental health profiles that are better than their peers in other fields, it can be worsened by a number of factors, including large workloads, increased competition for residency slots, competitiveness, and first-time exposure to human suffering and death.
What are the symptoms?
If you suspect that you or a friend are experiencing burnout, look for the following symptoms:
- Exhaustion. Extreme tiredness is one of the most common 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.
- Emotional detachment. If someone was passionate and positive but now seems desensitized and cynical, he or she could be experiencing burnout. If no one addresses the problem, this can be detrimental to personal relationships and potential future medical careers.
- Feeling incompetent or useless. If someone feels completely incompetent or useless in school and personal life and develops a hopeless or cynical attitude, this can be a sign that a student is feeling they are not smart or good enough to take on their current responsibilities.
- Feelings of alienation. 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 in school to prevent students from feeling alone in their struggles.
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What’s Causing Burnout?
While it would be impractical to try and nail down one cause, there may be a few things that contribute to burnout. These factors should be recognized by medical school administrators. The Well-Being Index Report on Medical Student Burnout notes a few causes:
- Competing time demands. Medical school often consumes the majority of a student’s time and can result in a medical student missing out on important social or family events. Relationships can become strained and even broken if a medical student or resident isn’t encouraged to find a more flexible schedule.
- Financial stressors. It’s no secret that many medical students take on student loans to pay for tuition. It can be stressful to have that debt looming over their heads when most students don’t have time to get a job at the same time they’re in medical school.
- Denial. Many want to believe that doctors or medical students don’t have mental illnesses or deal with things like depression or anxiety, leaving them to feel alone. It’s important to note that mental illness affects anyone, even medical professionals. It’s also vital to foster an environment where students feel comfortable talking about their problems.
- Unattainable expectations. 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.
- A “hidden curriculum.” When medical students are delegated only menial tasks by superiors, their passion for the field can quickly dwindle. When they see their teachers acting indifferent to others’ feelings, students might conclude that being a physician is a compassionless and apathetic career path.
How does it affect medical students or residents?
There can be serious consequences if student burnout is not addressed. An Academic Medicine study published in March 2016 explored the relationship between medical student burnout and alcohol abuse. In a national survey of 12,500 students, more than 32% of the 4,400 who responded met the diagnostic criteria for alcohol abuse or dependence — a rate about twice as high as the general U.S. college-educated population aged 22 to 34. And students who were burned out, depressed, or reported low mental health were more likely to abuse alcohol.
An article on Medical Student and Resident Burnout: A Review of Causes, Effects, and Prevention in the Journal of Family Medicine and Disease Prevention found that smoking and alcohol have been reported to be positively associated with high levels of stress among residents. A survey of residents reported that tranquilizers were frequently or infrequently used by nearly 11% of trainees, opiates by 9%, and alcohol, marijuana, and other drugs by unknown numbers. A confidential survey of residents revealed that many began using benzodiazepines and prescription opiates once they received prescribing privileges. They rationalized the use as self-treatment for stress and lack of adequate sleep.
Additionally, it is estimated that 30-40% of residents have marital and relationship problems, and most attribute this to the stresses of residency training. Further, it has been estimated that 1.4% of all interns and nearly 1% of all residents take leave from training annually for various emotional reasons. Of this group of trainees, 12% were psychiatrically hospitalized, 2% were treated for drug or alcohol problems, and 3% attempted suicide. The frequency of such incidents is greatest during the first postgraduate year and least during the third year.
Some factors are associated with greater resiliency to burnout in residents and medical students. According to the same article from the Journal of Family Medicine and Disease Prevention, a few factors can protect students during their training:
- Having a support system of close family and friends. Peers are the main source of support for residents and medical students during their training years; spouses and family members also provide comfort and support to residents and medical students. Several researchers report that being married and possessing strong social contacts are associated with lower levels of perceived stress by residents and medical students.
- Positive and encouraging learning conditions. Several studies report that positive, satisfying learning environments during training significantly reduces the level of physical and emotional stress as perceived by residents. At the same time, instances of workplace shaming have had positive correlations with depression. Mistreatment of the residents and medical students can lead to long-term stress, may discourage them from being motivated to learn, and additionally have an impact on performance scores.
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Although burnout may be inevitable in some cases, there are proactive steps medical students and residents can take to manage the stresses of training. MedCommons offers these tips:
- Take time for relationships. Spending time with loved ones will help nurture vital social connections in navigating any stressful situation.
- Keep things in perspective. Remember that residency won’t last forever. Knowing there is an end in sight can help alleviate feelings of being “stuck.”
- Stay connected to your mission. Remembering the reasons one got into medicine, and the importance of the work can help restore feelings of fulfillment.
- Focus on learning and professional development. Meeting the basic human need of learning and growth by studying something of interest will challenge one intellectually and help achieve fulfillment.
- Ask for help when needed. Seeking the help of a skilled professional can help develop an individualized strategy to cope with the incredible mental and emotional strain that residents must learn to navigate.
- Get outside. Taking even a small amount of time to step outdoors offers proven benefits, including improved cognitive performance, mental health, mood, and overall well-being.
The American Medical Association has also developed an education module that offers eight key moves medical schools and faculty can make to minimize burnout and improve mental health among medical students and residents.
- Recognize shared responsibility
- Measure student well-being
- Optimize the curriculum
- Help control student loan debt
- Optimize the learning environment and cultivate community
- Promote self-care and resiliency
- Provide adequate services for those already affected by burnout and distress
- Fund organizational research and science around well-being
Just like many problems, burnout should be addressed early to produce the best outcome and protect patients. Addressing medical student burnout right away is essential to stave off depression, anxiety, and sleeplessness. Students often experience such symptoms, and prevention can ensure the future of healthcare.
Learn evidence-based ways to help end burnout among medical students and residents
Healing Breaths is dedicated to helping healthcare students and healthcare workers rejuvenate, build personal resilience and reconnect to the joy in medicine. Our evidence-based programs have demonstrated rapid decline in burnout factors in just 3 days. Click here to schedule a 15-mintues call with one of our wellness experts.