How Medical Schools Can Better Fight Burnout
This piece appeared in The Wall Street Journal on September 12, 2017.
BY LLOYD MINOR
Medical training has never been an easy endeavor. When I was a young resident, I had multiple alarm clocks spread across my apartment to help wake me up wherever I happened to collapse from exhaustion.
But physical fatigue is only a part of the problem.
In recent years, we’ve seen increased evidence of real burnout among our medical students. A study in the Annals of Internal Medicine found that approximately 50% of students experienced burnout, a state defined by emotional exhaustion associated with work-related stress, feelings of detachment toward patients, and a low sense of personal accomplishment.
The causes of student burnout are unsurprising. Medical school is demanding and the fact that many medical students have hoped to become doctors all their lives adds to the pressure and to the expectations that students set for themselves.
Burnout is a worrisome crisis throughout the medical profession, but there is something uniquely troubling about the fact that medical students experience pressures so great that they burn out on the profession before they’ve even joined it.
Our students don’t come us to with these issues. Evidence shows that students entering medical school have lower burnout, less depression, and higher quality of life than college graduates pursuing other fields. But that pattern is reversed by the second year of medical school, and burnout crescendos during medical residency.
The amount we expect from our students continues to grow, and with it, our responsibility to help students help themselves. When a student comes to me or a faculty colleague for guidance, we discuss a number of strategies to intervene and fight burnout.
For one, we’ve been looking closely at the relationship between burnout and other issues. Assessments have shown that students who are struggling with burnout often are at high risk for depression and anxiety. They are often well-suited to benefit from screening, coupled with direct provision of mental health care, like cognitive behavioral therapy (CBT). We also launched a pilot program to educate our faculty about teaching CBT methods to their students, in an effort to attenuate the anxiety associated with medical training. Early results suggest the program was well-received by students and warrants further exploration.
In addition, we’ve implemented an annual medical student wellness survey that measures burnout, sleep-related impairment, anxiety symptoms and depression symptoms. The No. 1 health need that medical students self-identify is sleep. One of our own medical students is now leading a study with faculty mentors to test the effects of a video series for medical students designed to teach cognitive and behavioral strategies to improve sleep health.
Other medical schools around the country also recognize the increasing need to provide support and make student wellness an organizational priority.
At Vanderbilt, medical students have established the Wellness Program, an initiative to counteract burnout by supporting student well-being in five facets: physical, emotional/spiritual, interpersonal, academic/professional and environmental/community. The program relies on fellow medical students to support one another and to provide resources to counteract the sacrifices to healthy living that medical training can, at times, force them to make.
Northwestern is teaching its medical students the principles and practice of self-care by turning the students themselves into the test subjects. In the project, second-year medical students choose a personal health behavior to change, set a goal, track progress and assess success. After completing the project, 4 out of 5 students considered themselves to be healthier, and perhaps more importantly, they saw firsthand the obstacles of changing health behavior.
St. Louis University is working to improve student mental health by addressing the root causes of stress, making thoughtful alterations to the medical training curriculum. These changes to course content, contact hours and scheduling, in addition to the addition of required resilience and mindfulness experiences, have helped to reduce symptoms of burnout.
At Stanford Medicine, we’ve established the WellMD Center as a resource for students, trainees and staff physicians alike. The Center has built a national coalition of medical schools and health-care delivery systems that are working together to understand and address the causes of burnout and promote professional fulfillment. In a first for an academic medical center, we recently announced the appointment of a chief wellness officer to further this effort.
Why are these efforts so important? Because patients have a right to expect caregivers who are fully engaged and present, and biomedical research requires nothing less. If we can’t set a pattern of wellness in the medical student years, there’s little hope for improving the burnout problem in the broader physician world.
Medical education will always be demanding, and a certain degree of stress is inevitable. But schools and students can work together to help manage that stress and prevent it from turning into burnout.