Most Osteopathic Medical Students Report Burnout, Study Finds

Veronica Hackethal, MD

January 10, 2020

Many osteopathic medical students in the United States may suffer from burnout, especially feelings of low accomplishment, a study has found.

Burnout can develop after prolonged exposure to stressful work experiences, and typically includes three dimensions: emotional exhaustion, low sense of personal accomplishment, and depersonalization (feelings of alienation or apathy concerning work or patient care).

Jennifer Brubaker, MS, a fourth-year medical student at Ohio University Heritage College of Osteopathic Medicine in Athens, and colleagues published their findings online in the January issue of Journal of the American Osteopathic Association (JAOA).

"That 80% [of osteopathic medical students in this study] feel a low sense of achievement is a bit ironic, considering that these are all high-performing individuals. However, it also makes sense in that they have gone from an environment where they were standouts to one where they are now on an equal academic playing field," senior author Elizabeth Beverly, PhD, said in a news release. Beverly is an associate professor of family medicine at OU Heritage and a JAOA associate editor, but was not involved in the editorial review or decision to publish the article.

"Throughout medical school there is always another test or requirement for students to prove themselves in a new way. Over time that can feel quite discouraging," she added.

Stress, poor sleep, and smartphone addiction were tied to emotional exhaustion and depersonalization. Nighttime use of smartphones is particularly concerning because blue light emitted from these devices may disrupt circadian rhythms and contribute to sleep problems.

"I think the findings warrant additional research into how smartphone addiction can exacerbate burnout," Beverly explained. "Increasingly, medical education incorporates smart devices, so we want to be mindful of how much we condition students to rely on them."

"I agree with the authors that trying to reduce phone usage as a way of improving sleep and perhaps resilience is a potential intervention," Jason Rosenstock, MD, director of medical student education at the University of Pittsburgh School of Medicine in Pennsylvania, told Medscape Medical News.

He cautioned that results only show a correlation between high smartphone use and high burnout.

"It’s not clear if one causes the other, or if they’re both proxies for some other issue," he said. 

Regardless, decreasing burnout is a "huge challenge," for medical schools, he stressed. Burnout has been linked to a large range of negative consequences, including worse patient care, adverse health effects among providers, and mental health problems (including thoughts of suicide). However, less progress has been made on how to manage or decrease burnout.

"I believe that medical schools have an obligation to try to build learning environments that foster a sense of accomplishment, minimize sources of distress, and allow students to connect with their personal missions and values," Rosenstock said. 

"Utilizing pass-fail curricula, stamping out mistreatment, giving students more autonomy over their schedules and activities — these are hard to do but are most likely to benefit students in terms of improving their situation," he concluded.

Past studies have suggested that burnout can start as early as medical school, but few studies have looked at the issue among osteopathic medical students.

To study the issue, the researchers conducted a cross-sectional study during the 2017-2018 school year at Ohio University Heritage College of Osteopathic Medicine. The study included 385 osteopathic medical students who completed an anonymous online questionnaire about burnout. Respondents had a mean age of 25 years, 54% were women, 74.3% were white, and 35.8% were second-year medical students.

The questionnaire included the Maslach Burnout Inventory, which asks about emotional exhaustion, depersonalization, and feelings of personal accomplishment; the Perceived Stress Scale, which asks about stress over the past month; the Pittsburgh Sleep Quality index, which asks about sleep quality during the past month; and the Smartphone Addiction Scale Short Version.

Overall, 2.3% (n = 9) of respondents reported high emotional exhaustion, 17.4% (n = 67) reported high depersonalization, and 80.5% (n = 310) reported high levels of low personal accomplishment.

About 9.6% (n = 37) reported high levels of stress, 66.2% (n = 255) met criteria for poor sleep quality, and 22.3% (n = 86) met criteria for smartphone addiction.

Further analysis suggested that higher levels of perceived stress, worse sleep quality, and high levels of smartphone addiction were independently linked to emotional exhaustion (P < .001, P = .001, and P < .001, respectively), as well as feelings of depersonalization (P < .001, P = .001, and P = .001, respectively). Only high levels of stress levels were linked to feelings of low personal accomplishment (P < .001).

The authors mention several potential limitations. Because the study took place at a single osteopathic medical school in the Midwest among mostly white medical students, results may not generalize to other settings. The moderately low response rate of 42.5% could have biased results if students who volunteered had different levels of burnout compared with those who did not. Finally, the study took place during spring, a particularly stressful time during medical school due to medical licensing exams and preparation for residency.

More studies are needed to evaluate these factors in more diverse medical student populations, as well as at different times during the school year, the authors conclude.

The study was supported by an Ohio University 1804 Fund Award. The authors and Rosenstock have disclosed no relevant financial relationships.

J Am Osteopath Assoc. Published online in the January 2020 issue. Full text

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