Enough Talk: Preventing Burnout During Medical Training

Alexa M. Mieses, MD, MPH


January 04, 2019

Jonathan Ripp, MD, MPH, chief wellness officer for Icahn, elaborated that "because medicine is a calling, the idea that we might be flawed may be surprising." Ripp focused on advancing idealism in medicine from an academic perspective early in his career. He founded the Collaborative for Healing and Renewal in Medicine (CHARM), a group of medical educators, leaders of academic medical centers, and experts in burnout research and interventions designed to promote learner wellness. It was formed with the support of the Alliance for Academic Internal Medicine (AAIM). His research initially focused on burnout in residency but has since expanded to include medical students and faculty.

Ripp hopes to make changes on multiple levels. He is measuring success in a multitude of ways, including using objective metrics related to burnout and wellness, assessed with validated tools. Other outcomes or process measures are sometimes harder to quantify but are just as important. For example, Ripp aspires to change the culture around wellness, ensuring that different forms of intervention and support are available when someone is in crisis, and he hopes that medical leaders (eg, medical directors and division chiefs) will also pay attention to well-being.

While Ripp has dedicated his career to physician well-being, he recognizes the magnitude of the problem and limitation of his role. "I can't be the one that enacts all change...it's too big. I need to partner and collaborate to get the message out and drive change." Although building individual resilience is important and often a part of the burnout conversation, the greatest change comes from the top down, at the system level.

Confidential Mental Health Services for Students Are Key

The University of Pittsburgh School of Medicine (UPitt SOM) has focused on the ability (or lack thereof) of medical students to access confidential mental health services without stigmatization. As detailed in the New England Journal of Medicine in September 2018, UPitt SOM funded a mental health team to which medical students are introduced during orientation. It's led by a psychiatrist and psychologist but was not funded to deal with mental health emergencies, as the team policy is to see students within 5 days of initial contact.

In 2016-2017, 16% of students accessed the mental health care team. This team interfaces with already-existing entities at the medical school. For example, 20% of students who self-referred did so for issues related to concentration and academic performance. In such cases, the team collaborates with academic specialists to help students who are failing. The mental health team is augmented by the Student Health Advocacy Resource Program (SHARP), a confidential peer-counseling advocacy and referral service. The Faculty and Students Together (FAST) program helps students transition to medical school and get to know the faculty for support, and also interfaces with the mental health team.


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