Medical Student Burnout: The Problem and Interventions

What is the problem?

The burnout triad of emotional exhaustion, interpersonal disengagement, and a low sense of personal accomplishment¹, impacts half of all medical students², and persists in residents and practicing physicians³. Interpersonal disengagement interferes with social support and hinders proper treatment of patients^4–6.

Burnout correlates with alcohol and substance use problems^7,8. Overall use of alcohol in medical students (91%⁹) is substantially higher than that seen in the general population (56%) as measured by the 2017 National Survey on Drug Use and Health (NSDUH) data on young adults aged 18 to 25 with past month alcohol use¹⁰. In a 2016 study by Jackson et al., ⅓ of medical students had symptoms of alcohol abuse/dependence and that use correlated with the burnout domains of emotional exhaustion and depersonalization². A separate study found that ⅓ of medical students fit criteria for binge drinking and over ¼ used cannabis in the past year⁹.

Burnout and depressive symptoms overlap¹¹. In a cross-sectional analysis of studies by Rotenstein et al., the rate of depression in medical students averaged 27%¹². Burnout continues to be a problem into medical practice. A similar cross-sectional analysis of depression in residents found an average of 29%; the rate of depression increased as training progressed¹³. The linkage of depression and suicide is well-established including in general as well as in physicians¹⁴. The 2016 study by Rotenstein et al. also found that 11% of medical students expressed suicidal ideation and ~16% sought psychiatric treatment¹². Given the common reluctance of individuals to admit to symptoms of suicide or seek psychiatric treatment these figures are likely even higher.

Burnout also correlates with higher BMI^15,16, poor sleep^17,18, and increased motor vehicle accidents¹⁹. In addition to the common use of alcohol as a coping mechanism, medical students often utilize ineffective coping responses to stress, such as unhealthy self-indulgence or self-criticism^20–22.

Women and minority medical students face unique challenges. Physicians have known implicit bias with minority patients; physician colleagues and supervisors are also like to have implicit bias toward minority medical students as well^23,24. Despite much progress recently, gender-based assumptions and stereotypes affect mentoring relationships and gender-based power dynamics can influence actual mentoring²⁵.

Any interventions?

Institutional change is an important means to address the problem of burnout since organizational factors are a major cause of burnout^3,26. Unfortunately, the individual cannot modify the challenge of clinical medicine; nor is it prudent, given the above statistics, to wait for changes that can only occur at an institutional level.

Individual focused solutions empower the student to enhance or modify a student’s coping strategies, pursue well-being, and enhance resilency^27–32. Such interventions include:

Improving interpersonal communication skills, using mindfulness, focusing on increased self-care, or expanding meaningful social connections^27,33^–39.
Recognizing factors causing stress⁴⁰, developing assertiveness, self-reflection, using cognitive restructuring to think about problems in a productive way, focusing on the quality of life, and learning new interests^21,37,41,42.
Self-reflection such as identifying self-imposed social isolation or acknowledging financial or relational concerns⁸.
Enhancing resilience via skills training ²⁶^–29 including emphasis on work-life balance³⁰ and focusing on positives in life (gratitude, and awe²⁸), self compassion, taking an optimistic perspective, focusing on others^31,32, or taking advantage of supportive factors such as a wellness culture¹.

References

Bibliography

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