Medical students and residents are more susceptible to burnout due to the pressures of being a full-time student while also training in clinical care. Burnout is defined as emotional and physical exhaustion, feelings of derealization, and heightened underachievement perceptions. Medical school and residency require students to absorb large amounts of information, have higher demands for clinical performance, and have increased student loans. Additional family or personal concerns can also become a stressor.
Causes of Burnout
One of the significant causes of burnout is sleep deprivation. While it is known that sleep deprivation can lead to reduced focus and worse decision-making, residents are expected to be awake for long periods and make impactful decisions for patients. A cross-sectional study of internal medicine residents mentions how they “learn to tolerate sleep deprivation” and that it is “an expected part of training.” Another major factor of burnout is the emotional baggage from taking care of ill and dying patients. Medical students and residents must learn to cope with this emotional strain without being explicitly taught. There are also higher levels of stress when interacting with patients with infectious diseases and diseases that cause long and slow declines, as well as patients in palliative care and patients with more “difficult” families.
The lack of personal time outside of schooling is another stressor, with many medical students and residents often having to change plans around having a family and miss events due to schooling.
Effects of Burnout
Effects of burnout during medical school and residency are proven to lead to emotional distress and depression, with about 7 to 8.6% incidence of depressive symptoms occurring among first-year residents. There has also been an association between the depression of residents and their marital relationships, with about 30 to 40% of residents reporting marital problems. The difficulty of managing stress in medical school and residency can also lead to reconsideration of the physician path, leading to residents often considering dropping out. Drug, alcohol, and substance abuse is calculated to be 30 to 100 times more common in physicians in contrast to the general population with higher usage of alcohol and smoking when there are higher levels of stress in residents. Suicide is another severe effect of burnout, with suicide being the second leading cause of death among medical students. Dissatisfaction and stress are two of the major reasons for attempted suicide among medical students and residents.
Protective Factors Against Burnout
Even with the causes and effects in mind, there is still light at the end of the tunnel for medical students and residents. Peers are a major source of support as everyone is going through similar stress levels in this pathway. Supportive spouses and family can also relieve some of the burden these students feel. Additionally, having a positive learning environment for medical students and residents can ensure less physical and emotional stress. For instance, less workplace shaming and less mistreatment from attendings can provide more motivation to learn and higher performance scores.
Changes to the Curriculum
While medical students and residents have high stress levels, implementing preventive programs into the training curriculum can ensure lower student burnout rates. Active learning sessions around teaching students how to reflect, practice healthy coping skills and time management, and maintain a social life in and outside of school are done by some medical and resident programs. Other programs incorporate social events among students, such as annual picnics and birthday celebrations. However, while some programs do their best to support their students, there’s a structural change in the number of hours residents work. The 80-hour work weeks for residents still have many students reporting being overworked, fatigued, and lacking sleep. Training programs should widely implement protective factors, such as modeling attendings who show how to manage their work/life balance and cope with intense patient cases. Emails from human resources that promote self-care and rest are another suggestion. Free counseling is another aspect that should be offered by all programs to ensure mental health care is accessible for all students. Changing institutionally and increasing protective factors are some ways to reduce burnout rates among medical and resident students.
Thank you,
Siri Nikku
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