Enough Talk: Preventing Burnout During Medical Training

Alexa M. Mieses, MD, MPH

Disclosures

January 04, 2019

Burnout is a syndrome of emotional exhaustion and depersonalization, combined with a sense of low personal accomplishment, that leads to decreased effectiveness at work. In the most severe (and tragic) cases, burnout leads to depression and suicide. It does not happen overnight. I argue that it begins before medical training, as early as college. Pre-med students place extreme pressure on themselves to perform well in school and shine on their application to medical school.

In one study, 63% of medical students in their third year of medical school experienced a traumatic event as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). These events included but were not limited to violent patients, death, and patient suffering. Many of these events occurred during internal medicine and surgery rotations. What's more, 89% of students experienced approximately seven nontraumatic stressful events. Traumatic events were associated with personal growth by the end of the clinical year, whereas nontraumatic stressful events were associated with depression and other stress symptoms.

We have all heard warnings about burnout. Some of us may have even experienced it at one time or another. Much time and attention is increasingly being devoted to the issue. I have pondered this issue since I first entered a career in medicine and even wrote about it in my last year of medical school. So, before we get burned out talking about burnout, let's discuss what the medical education community is actually doing about this insidious epidemic that plagues medical students and physicians alike.

A Three-Pronged Overhaul

In August 2016, a fourth-year medical student at the Icahn School of Medicine at Mount Sinai in New York City leapt to her death. While Kathryn Stascavage was not the first or the last medical student to die by suicide in New York City, it certainly pushed that particular medical school beyond a tipping point.

The Icahn School of Medicine responded with a wellness overhaul. A task force was created, and the problem of burnout was broken down into three categories that include addressing the culture of medicine, general wellness activities and resources, and mental health resources. Some examples include the creation of a resiliency curriculum that spans all 4 years. The medical school restructured the distribution of grading and even put a moratorium on inducting medical students into Alpha Omega Alpha, a prominent national honor society. Renovations of the student dormitory building are underway to transform the ground floor into a wellness center.

"Being the person who is there for a patient or family of a patient who is struggling to cope with illness, is at the end of life, or has just gotten bad news...there are so many incredibly stressful things we do in medicine that speak to the core of why we want to be doctors—so that we can carry part of the burden for them," explained David Muller, MD, dean for medical education at Icahn. "That's the stuff that makes you great at what you do. No one likes that, but we signed up for that. But compare that to the stress of Step 1 or the insane pressure that has grown around that exam. It's out of control. It's not about the people in medicine; it's about the environment we put them in."

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