Learning Environment

How lack of mentorship, increased workloads, undue competitiveness, and curriculum changes contribute to burnout in trainees.

Research suggests that half of all medical students may be affected by burnout during their medical education. Evidence also suggests that medical students are not inherently more susceptible to burnout than other age-similar individuals. In fact, upon entering medical school, medical students have lower burnout, less depression, and higher quality of life than college graduates pursuing other professions. By the second year of medical school, however, that pattern is reversed. By the time trainees start residency they report lower quality of life, higher rates of burnout, more depression, and less job dissatisfaction than their peers in other professions.

Medical students aren’t the only trainees experiencing burnout. Although more research is needed, evidence suggests that dental students and nursing students may also experience burnout.

For many, burnout occurs because of excessive workloads, undue competition and exposure to human suffering. It’s clear that burnout is not simply a deficiency of the individual. The symptoms of burnout are indicative of systemic problems in the learning environment that prevent trainees from thriving. Solutions are needed that address the systems in which trainees spend most of their time.

Pressure, Workload, and Lack of Time for Self-Care

The academic burden of clinical education can be intense. Trainees are expected to learn a vast array of material in a very short amount of time.  Medical school has been likened to drinking water from a fire hose. Medical students must grapple with high-volume school workloads while simultaneously attending clinical rounds, studying for national licensing exams and preparing applications for residency and fellowship programs. Nursing, pharmacy, and dental students find themselves in similar predicaments as they contend with the pressures of their academic workload in addition to finding time to study for licensing exams and preparing for jobs or postgraduate programs.

Outside of the classroom, trainees enter clinical settings in which they come face-to-face with sick and dying patients, often for the first time. Being surrounded by human suffering day in and day out can take its toll, especially when there are no programs in place to help trainees process the emotions they experience. Sadly, instead of receiving support, many medical students report mistreatment from supervisors and other senior clinicians.

The workload demands that are thrust onto trainees allow little time for everyday activities like spending time with family and friends, sleeping, and exercising. These demands make it virtually impossible for trainees to maintain balance in their lives. Student affairs offices within learning institutions play a critical role in enhancing trainee well-being and resources should be directed to ensure that programs to enhance trainee well-being are fully supported.

Competitive Environment and Cultural Aspects of Medicine and the Health Professions

By most accounts, the pressures placed on medical and other health sciences students can be brutal. Thousands of applicants compete each year for spots in medical schools but the average medical school accepts less than 7 percent of applicants each year. In addition, one out of three qualified applicants are rejected by nursing schools. In many ways, the competitive environment into which students are thrust may result in many trainees vying for perfection, which can lead to feelings of inadequacy. Reducing competition in the classroom may help enhance student well-being, and many medical schools have instituted pass-fail grading systems to help minimize stress and anxiety.

Aspects of the culture of medicine and medical education may contribute to burnout in trainees. For example, because medicine is a demanding profession, some believe that medical school must be equally demanding. If trainees are surrounded by those who believe that more pressure, more demand, and more hours lead to better educational outcomes, there is little space for trainees to express frustration and concerns without the fear of being chastised by superiors.

 

Medical trainees are burnt out. Learning institutions must provide programs that equip trainees with the necessary skills and resources to thrive.

Lack of Mentorship

Adequate mentorship for trainees is essential, particularly a career mentor who can provide perspective and balance and can help trainees choose goals, values, and a career trajectory. Evidence suggests that those who have mentors make more informed career decisions, are more productive, and experience more well-being than those who do not. Trainees from under-represented backgrounds often struggle to feel accepted within the medical profession, making mentorship even more critical for these trainees. Despite the importance of a mentoring relationship, intense work schedules, patient volumes, inter-professional competition, and lack of autonomy leave many trainees with little time to build or maintain personal relationships, including that with a mentor. Rapidly rotating through various services during training can also leave trainees feeling lost and disoriented.

Caring for our trainees should be a concern for everyone. Trainees need support and the health system could greatly benefit from institutional programs in which mentoring is a core competency of senior clinicians who are trained to mentor those starting their careers. Developing such mentors will require incentives, protected time, recognition, and support from leadership.

Stigma and Social Support

The stigma associated with mental illness may result in reluctance by students to seek help for burnout symptoms. Mental health problems have ordinarily not been taken as seriously as physical health problems, so trainees may find it difficult to find support when it is needed most. Social support networks are also important for students but it is difficult to build these networks when new to a school or program. Medical trainees have little control over where they are placed and may lose their social support system after moving across the country to attend a residency or fellowship program. Demanding schedules also make it hard to establish new support systems. Offering widespread and easily accessible mental health services for trainees—and establishing a non-punitive environment—may allow trainees to seek support without stigma or professional ramifications.

Bottom Line

Trainees are burnt out. The literature clearly demonstrates that medical and other health professions’ trainees are at a high risk for burnout, depression, anxiety, and other mental health problems than others in their age group. Learning institutions should consider providing programs that identify and provide treatment for trainees and that improve well-being by equipping them with needed cognitive-behavioral, mindfulness and coping skills so all trainees can thrive.