How did you handle stress in college? Are you ready for the additional stresses of professional medical education? A medical student can bring poor stress management skills from college to their medical training. That’s risky since stress starts in college. Alongside excitement and opportunity, stresses and challenges await the approximately 20 million students in 4-year colleges1. Transitioning to college often yields increasing stress2,3, binge drinking4,5, substance misuse5,6, depression, and anxiety7,8.
Medical school amplifies these challenges by demanding attention to a complicated topic and adding the unique challenges of clinical training in medical school.
Medical schools impart clinical encounter and decision-making skills. These skills are unfamiliar challenges that impact future provider and patient care. The difficulty follows the student as they progress through residency and into practice, potentially leading to physician burnout and other complicating effects.
Physician burnout impacts self-care. Excessive alcohol use is a significant problem, both for the individuals and for the patients under their care. US physicians report higher than normal burnout rates9 and burnout correlates with alcohol use problems10,11. Specifically, AUDIT-C scores in 15.3% of physicians were consistent with diagnoses of alcohol abuse or dependence, especially for women (21.4% vs. 12.9%). Burnout also correlates with higher body mass index (BMI)12,13, poor sleep14, less exercise15, and low career satisfaction16. Medical students also show high rates of burnout (up to 50%) and suicidal ideation (estimated at 10%)17. For medical students, 32.4% met the diagnostic criteria for alcohol abuse/dependence11.
Each of these topics is discussed in more detail in other blogs including the facts that
- Medical students are not Leaving College Coping Strategies Behind
- Burnout & Decreased Personal Accomplishment are probably happening but the scales aren’t measuring it.
- The answer to the question Does Burnout Get Better During Medical
School is No. Burnout persists into later years of training.
- Physician burnout has downstream negative effects on patient care (coming soon)
- Burnout is related to Risky Alcohol Use & SI. Addressing burnout decreases the risk of alcohol use in professionals
Preparation for a career in medicine must then include:
- understanding factors leading to burnout,
- preventing burnout, recognizing burnout, and
- intervening when burnout is a personal issue or noted in a colleague.
Existing efforts at building physician resilience while still in medical school show promise15,18–22. However, medicine needs a scalable, comprehensive, standardized solution.
In Lift, a medical student entering clinical training experiences a series of interactive scenarios including study, clinical duties, professional development, diet, and exercise, and social activities. The player encounters problems of hunger, stress, preparedness, and hygiene and makes choices that achieve health and resiliency.
- The Institute of Education Sciences, U.S. Department of Education. Digest of Education Statistics, 2016. National Center for Educational Sciences. https://nces.ed.gov/programs/digest/d16/tables/dt16_308.10.asp. Published May 2017. Accessed August 29, 2017.
- Hurst CS, Baranik LE, Daniel F. College Student Stressors: A Review of the Qualitative Research. Stress Health. 2013;29(4):275-285. doi:10.1002/smi.2465.
- Vázquez FL, Otero P, Díaz O. Psychological distress and related factors in female college students. J Am Coll Health J ACH. 2012;60(3):219-225. doi:10.1080/07448481.2011.587485.
- Pedersen DE. Which Stressors Increase the Odds of College Binge Drinking? Coll Stud J. 2017;51(1):129-141.
- Deasy C, Coughlan B, Pironom J, Jourdan D, Mannix-McNamara P. Psychological Distress and Coping amongst Higher Education Students: A Mixed Method Enquiry. PLoS ONE. 2014;9(12). doi:10.1371/journal.pone.0115193.
- Kirst M, Mecredy G, Borland T, Chaiton M. Predictors of Substance Use Among Young Adults Transitioning Away from High School: A Narrative Review. Subst Use Misuse. 2014;49(13):1795-1807. doi:10.3109/10826084.2014.933240.
- Auerbach RP, Alonso J, Axinn WG, et al. Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychol Med. 2016;46(14):2955-2970. doi:10.1017/S0033291716001665.
- Torres C, Otero P, Bustamante B, Blanco V, Díaz O, Vázquez FL. Mental Health Problems and Related Factors in Ecuadorian College Students. Int J Environ Res Public Health. 2017;14(5). doi:10.3390/ijerph14050530.
- Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among us physicians relative to the general us population. Arch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199.
- Oreskovich MR, Shanafelt T, Dyrbye LN, et al. The prevalence of substance use disorders in American physicians. Am J Addict. 2015;24(1):30-38. doi:10.1111/ajad.12173.
- Jackson ER, Shanafelt TD, Hasan O, Satele DV, Dyrbye LN. Burnout and Alcohol Abuse/Dependence Among U.S. Medical Students. Acad Med J Assoc Am Med Coll. March 2016. doi:10.1097/ACM.0000000000001138.
- Peckham C. Physician Burnout and Weight. Medscape Physician Lifestyle Report. http://www.medscape.com/features/slideshow/lifestyle/2015/public/overview#12. Published 2015. Accessed March 10, 2016.
- Mota MC, De-Souza DA, Rossato LT, et al. Dietary Patterns, Metabolic Markers and Subjective Sleep Measures in Resident Physicians. Chronobiol Int. 2013;30(8):1032-1041. doi:10.3109/07420528.2013.796966.
- Vela-Bueno A, Moreno-Jiménez B, Rodríguez-Muñoz A, et al. Insomnia and sleep quality among primary care physicians with low and high burnout levels. J Psychosom Res. 2008;64(4):435-442. doi:10.1016/j.jpsychores.2007.10.014.
- Peckham C. Physician Burnout and Exercise. Medscape Physician Lifestyle Report. http://www.medscape.com/features/slideshow/lifestyle/2015/public/overview#11. Published 2015. Accessed March 10, 2016.
- Keeton K, Fenner DE, Johnson TRB, Hayward RA. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2007;109(4):949-955. doi:10.1097/01.AOG.0000258299.45979.37.
- Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and Suicidal Ideation among U.S. Medical Students. Ann Intern Med. 2008;149(5):334-341. doi:10.7326/0003-4819-149-5-200809020-00008.
- Saleh KJ, Quick JC, Sime WE, Novicoff WM, Einhorn TA. Recognizing and Preventing Burnout among Orthopaedic Leaders. Clin Orthop. 2009;467(2):558-565. doi:10.1007/s11999-008-0622-8.
- Jensen PM, Trollope-Kumar K, Waters H, Everson J. Building physician resilience. Can Fam Physician. 2008;54(5):722-729. http://www.cfp.ca/content/54/5/722.full.pdf. Accessed August 30, 2016.
- Hassed C, Lisle S de, Sullivan G, Pier C. Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Adv Health Sci Educ. 2008;14(3):387-398. doi:10.1007/s10459-008-9125-3.
- Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program. J Gen Intern Med. 2007;22(11):1544-1552. doi:10.1007/s11606-007-0363-5.
- Nedrow A, Bailey M, Ratner E. Place Your Own Oxygen Mask First. https://som.ucdenver.edu/FIMS/Content/faculty/23058/Curriculum%20Vitae%209.7.17.pdf. Accessed August 30, 2016.