Whenever I hear the word “burnout,” I’m reminded of the ugly, oh-so-dark side of being a medical student, the side that hides in the shadows, away from the prestige and privilege that comes with the noble profession. Maybe it seems like I’m exaggerating; I mean, it’s just me jumping to conclusions when I associate the feelings of being overworked with the days where I can’t seem to find the bright side of anything, right?
Before my first year of medical school, I don’t think I had ever suffered the experience of really truly feeling overwhelmed and overworked. Of course, I had heard the parables foreshadowing the rigors of medical school by comparing it to taking a drink out of a fire hose or to the expectation of eating a stack of pancakes every day, but I don’t think the gravity of those Aesopian sayings really had much significance until I was knee-deep in the quicksand of lectures, dissections and team-based learning exercises. Only then did I start to reflect, begin to doubt my mental fortitude, and seriously question whether or not I deserved to be in medical school.
Although my experiences don’t necessarily speak for every single first-year medical student, I don’t think that they’re unique. My point is that it’s not hard to see how the expectations of medical school, even after just the first 4 to 5 months, can take a toll on a student’s psyche. The problem is that medical education focuses wholly on cultivating individuals who can competently and compassionately treat patients without realizing that we physicians-in-training often become patients along the way. Fortunately, peer-reviewed journals and researchers have also been picking up on the reality of this burnout phenomenon. The German Medical Society Journal (GMS) for Medical Education, Canadian Medical Education Journal, Association for the Study of Medical Education (ASME), and Academic Medicine all have published articles about burnout, stress and related initiatives within the past year.
One of the more interesting pieces I found was a literature review about burnout experienced by medical students and residents published by the UK based ASME Medical Education journal. On top of highlighting the downward trajectory of medical students’ mental health when compared with that of peers pursuing careers outside the field of medicine, the article not only describes stressors that may contribute to burnout but also addresses potentially effective strategies. One of the most poignant statements from that paper is the statement that “[o]ne reasonable step is to introduce the concept of self-care, well-being and resilience into the training curriculum.”
Now you might be thinking that this whole idea of “burnout” is blown out of proportion because hey, let’s be honest, who hasn’t felt emotionally drained or unaccomplished in the face of working towards an ambitious goal? That’s a fair point, but I’d argue that undergraduate and graduate medical education are unique in that students never really get a break. Unlike many of my friends on the 9 to 5 grind (who have nights off, earn a wage and usually don’t work weekends) our lives are engulfed by the compulsion to study, whether by the difficulty of the material, the fear of failure, or the simple egotistic desire to outshine our classmates. Regardless, it’s easy to see how the nature of the territory guides so many to work-life imbalance that isn’t realized until a consequent feeling of exhaustion permeates so deeply that it affects our personal lives and professional conduct. In fact, research shows that students’ professionalism, integrity and competency all suffer when there’s unaddressed burnout. Additionally, medical students are often stigmatized from seeking mental help. However, institutions are adopting multi-tiered approaches that include implementing wellness curriculum, mandating screening tools and improving provider access, all to promote cultures of wellness. Pieces from the Canadian Medical Education Journal discuss peer-led initiatives that have seen preliminary successes at reducing stress and cultivating well-being, respectively.
Across the United States, medical schools have started to build student wellness components into their curricula. For example, Vanderbilt University School of Medicine has incorporated a five committee student-run program that supports student well-being from physical, emotional/spiritual, interpersonal, academic/professional and environmental/community perspectives. UC Davis and UCSF also have institutionalized initiatives that provide a combination of mental health care resources such as free psychotherapy and workshops for students. Even here at home in the Midwest, the administrations of various medical schools seem to be interested in championing student wellness.
I spoke with a friend at Rush Medical College, and he told me that part of their first year curriculum includes “Physicianship” blocks that give students a place and space to talk about stress. Additionally, when students practice with standardized patients, they are debriefed in one-on-one settings with a clinical psychologist who both evaluated their patient interactions and contextualized their encounters, almost acting as a de-facto therapist. At the University of Chicago Pritzker School of Medicine, students have regular wellness and mental health events around twice a month. The student I spoke with expressed that at Rush, the administration is proactive about reaching out and listening if anything ever comes up. In his words, “It’s definitely an essential part of our med school. The administration really cares about us and supports us, and we recognize it early on and deeply appreciate it.” Even at schools that haven’t yet integrated student wellness curriculum like Loyola University Stritch School of Medicine, students have organized and formed an extracurricular group that puts on wellness events. Students also have the opportunity to seek free psychiatric help.
Yet, despite the efforts of these schools, wellness curriculum is not a standard offering. So where does that leave us, the medical students subject to suffer from the slings and arrows of outrageous student debt, lack of personal time and volumes of testable clinical material? It’s my opinion that if there isn’t some kind of student wellness initiative on campus, whether it be a student group that hosts relaxation-based events (yoga, mindfulness talks, group dialogues, whatever gets you out of your head for a little while) or a professional you can reach out to for help, then it’s on you to speak up. For those of us who are fortunate enough to have wellness related events on campus, attend them! I know that the idea of talking about your feelings seems a little hokey at first, but for the sake of our patients, futures, and colleagues, seize those opportunities to do some sun salutations, to quietly sit and focus on your breathing or to play ball with some friends because, after all, “prevention is preferable to cure.”