In the years before the COVID-19 pandemic, many medical students were already experiencing burnout. Symptoms include emotional exhaustion, interpersonal disengagement, and a low sense of personal accomplishment.1 Organizational factors that result in overwork, sleep deprivation and little time for a personal life outside of medicine are contributing factors. When COVID-19 began to have a broad impact in 2020, the problem of burnout in medical students increased even further.
Medical student Jordyn Feingold, from Mount Sinai’s Icahn School of Medicine, described the added burdens being experienced by medical students and trainees as part of the May 7, 2020 “Supporting Clinician Well-Being During COVID-19 Webinar” hosted by the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience.
Feingold’s list of new medical student concerns related to the pandemic (based on her personal experience, op-eds, and preliminary and published data) included academic concerns arising from academic program changes when medical schools closed. Pre-clinical students started e-learning from home and grappled with adapting to this new style of learning while missing the social connection they had enjoyed with their peers. Confusion reigned as to whether qualifying exams would be postponed or become pass/fail. Students wondered how they would get their clinical training when schools pulled them out of their clerkship experiences. Some missed opportunities to do outside rotations, which they feared would put them at a disadvantage in getting into the more desired residencies. Many 4th year students even graduated early without completing their final year. Some joined the workforce to help with the pandemic.
Medical students who volunteered to help with the pandemic and reassigned medical residents had concerns of not being adequately prepared to perform their new pandemic-related tasks. Although the AMA’s policy is that organizations should not directly solicit students to help, medical students who did not volunteer felt there was a stigma associated with their choice. The group also felt the same concerns as has been reported for other medical personnel regarding inadequate personal protective equipment and fear for their safety. Added to all this, medical students were feeling the same pandemic-related stress and concerns that the whole world was feeling.
Many medical residents in specialty training, who were pulled from their training programs to help in wards treating patients with COVID 19, wondered if they would be able to complete their specialty training. Some had jobs that were waiting that required the skills they feared they would not learn. Amid the chaos of rapid change, a lack of clarity and difficulties in planning their professional and personal lives led to anxiety for these students and trainees.
Health care providers in a pandemic typically go through phases of emotional reactions and mental health over time as they meet the intense demands of the ongoing trauma. After the early phases (initial impact, heroic, and honeymoon periods), feelings of disillusionment often settle in for months or more. The disillusionment phase often includes depression and other mental health symptoms, increased substance use, and a higher rate of suicide2. Eventually, there is a reconstruction phase. In the webinar, leaders in charge of health professional well-being in their organizations agreed that they need to provide interventions to minimize the stress as much as possible and address the trauma as it happens to decrease the severity of this anticipated phase.
Many medical centers and schools offer centralized resources on well-being. An example of a resource specifically for medical students is the Slack channel, “Medical Students vs. COVID-19,” which connects medical students from across the country as they share their coping strategies and discuss their activities in support of pandemic care teams. Students can also benefit from the advice given to all healthcare providers at this time, such as this list of tips provided by the AMA in their webpage on Managing Mental Health During COVID-19:
- Feel free to feel your feelings.
- Intentionally employ coping strategies.
- Perform regular check-ins with yourself.
- Take breaks from the news and social media.
- Be fortified by remembering the importance and meaning of your work.
Following clear, evidence-based steps such as these is likely to mitigate some of the impact of what medical students and healthcare professionals are going through. Additionally, many of the students’ stresses described above have to do with a temporary state of high uncertainty about academic issues, which academic leaders are working to address. School administrators in this webinar described steps they are taking for open communication with students. This should help students better plan their studies and lives, which will decrease one source of the increased stress that medical students have been facing from the pandemic.
Bohman, Bryan, Dyrbye, Liselotte, Sinsky, Christine A., et al. Physician Well-Being: The Reciprocity of Efficiency, Resilience, Wellness Culture. NEJM Catalyst. August 7, 2017.
SAMHSA. Phases of Disaster. SAMHSA. April 17, 2020.