AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
System-level solutions for medical schools and residency programs to reduce burnout. Lotte Dyrbye, MD, MHPE, chief well-being officer at the University of Colorado School of Medicine, joins to discuss the latest data on student and resident burnout and the steps that institutions can take to address it. AMA Chief Experience Officer Todd Unger hosts.
The American Conference on Physician Health (ACPH) is a scientific conference sponsored jointly by the AMA, Mayo Clinic and Stanford University. Don't miss Dr. Dyrbye's opening keynote address about UME-GME well-being at ACPH on Wednesday, Oct. 11 at 1:30 p.m. Pacific. Learn more.
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- Lotte Dyrbye, MD, MHPE, chief well-being officer, University of Colorado School of Medicine
Unger: Hello, and welcome to the AMA Update video and podcast. Today we're talking about steps that medical schools and residency programs can take to reduce burnout. Here to discuss this issue is Dr. Lotte Dyrbye, chief well being officer at the University of Colorado School of Medicine in Aurora, Colorado. Dr. Dyrbye is also a featured keynote speaker at our upcoming American Conference on Physician Health sponsored by the AMA, Stanford Medicine and the Mayo Clinic. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Dyrbye, it's great to have you back.
Dr. Dyrbye: Thanks a lot for having me.
Unger: It's been, believe it or not, over a year since we last talked, and at that time, we talked about physician harassment as a driver of burnout. Today, we're talking about physician well-being again, but we're looking earlier in the physician life cycle at burnout in medical students and residents. We know this is a problem and it's not just something that we suspect is an issue, there's now data to back this up. What is that data telling us?
Dr. Dyrbye: There's really been many large study of residents and medical students across the United States over the last several decades. And even contemporary data tells us that this is really still an issue. About 50 to 60% of our medical students and our residents in training are really suffering from high degrees of burnout. So it's very much there. It's very much there early before even we start practicing.
Unger: Now diving into this a bit, we know that medical students and residents often experience a lot of stress. And many have reported at times experiencing imposter syndrome as they're well into their training. Tell us a little bit more about some of these stressors and what impact they have not just on the individual students and residents, but also on the profession if they don't get addressed.
Dr. Dyrbye: That's a really great question. So like with physicians in practice, the drivers of burnout in medical students and residents really come from the system. So it relates to their workload, their work intensity, or work compression, in many cases, because of duty hours that the residents are under.
And then they similarly can struggle with losing sort of sense of meaning in their work because they're trying to balance education and service as they're out there taking care of patients on the wards and in the clinic. And at times, there's also issues related to the organizational culture, if faculty don't treat them well or don't afford them the right amount of autonomy. Those are some of the factors that really can drive their stress.
And one thing that's a little bit unique to the medical students, also, is social isolation. So when medical students have their clinical training, sometimes they get really scattered throughout a state—if not multiple states—and they lose their social support and that can really add another huge challenge. And, as in physicians, it has a lot of ramifications to them personally and professionally.
So the medical students and residents who are burnt out are much less likely to behave sort of in accordance to our values. They have more professionalism lapses, they don't perform as well on competency exams. It can impact their career decision-making. So there's really lots of ramifications across multiple fronts. So it's a really serious issue for us to deal with.
Unger: And you mentioned before that a lot of this—and we know this with burnout—is at the system level. So it's not just on students and residents to fix this problem. That's one of the key reasons why that reducing physician burnout is a key pillar of what we call the AMA's Recovery Plan for America's Physicians.
Now while a lot of institutions understand this, it can be difficult to know where to begin. Let's talk a little bit about the key first steps both schools and programs can take to reduce burnout and depression among their cohorts.
Dr. Dyrbye: Well the first thing is that there really needs to be organizational will. There needs to be that—really that will from the top leadership to try to impact the system that's driving a lot of stress for the trainees, so the medical students and the residents. And that will is manifested in resource allocation. It's manifested in having an individual who's in charge with driving the bus to try to improve the work and the learning environment for the trainees. And it's manifested by being willing to be a learning organization.
So by that, I mean doing surveys with validated measures, preferably with national benchmarks, transparently sharing the findings with the trainees and the faculty, and meaningfully engaging in action planning, really at all levels of the organization. If that will isn't there, if you don't have the first step, the rest of it is just like building scaffolding on top of sand, right? It's not really going to hold.
Unger: The will, isn't that always a key part of the foundation to change like this? Institutions can always also begin to look at ways to optimize their curriculum and clinical experiences through that well-being lens. What does it look like?
Dr. Dyrbye: Well a big piece of that is empowering and equipping the faculty to teach. So if the demands in the clinic and the systems in the clinic are so inefficient that the physician can't manage to get through the day taking care of patients, delivering outstanding patient care, how are they going to be able to incorporate really teaching, mentoring, support of younger physicians, of medical students and residents?
So a big piece of the puzzle is really empowering, equipping and enabling the faculty to be able to prioritize education of the medical students and the residents who are in that clinical learning environment. That is really a key piece.
A second key piece is that faculty have to have the skill set to be that outstanding educator. They have to know how to create a positive learning environment that's inclusive of our increasingly diverse medical students. They have to understand the principles of giving good feedback, really helping the learner along and detecting physical exam findings. And how do you sort of teach in a busy clinical setting? That isn't something that people know how to do just because they went to medical school. Rather it's really a skill set that faculty have to learn.
So there's a lot of different components there to optimizing that clinical experience, but certainly, making sure that the faculty are able to teach and that they have the time to teach is really two key components.
Unger: Is there anything else about the learning environment beyond the faculty points that you're making right there that can help to create the right kind of environment not only for learning, but to be more successful and to address some of these issues around burnout?
Dr. Dyrbye: There's a lot of other different components. One is to making sure that the resident and the student have enough supervision, but not too much, and not absent supervision so they can really get into that growth piece. Making sure that the trainees see a variety of different types of problems, types of patients in different practice settings is also key.
And then the third piece that we also really have to tackle is just how our learners are being treated, not only by faculty and by staff, but also by patients and families. As you mentioned in your introductory comments, we know that mistreatment by patients, families and visitors of our physicians is quite common, unfortunately. And as you can imagine, the students are not immune from that. So really working on making sure that patients and families and visitors know what our values are and know what the expectations are around behavior is also really important piece to promoting that positive learning environment for the students and the residents.
Unger: And there's obviously so much more that we could talk about on this topic and we don't have time to get into here. But as we mentioned in your introduction, you're going to be addressing this topic in your keynote speech at the American Conference on Physician Health that takes place October 11 through the 13th in Palm Desert. Dr. Dyrbye, why are conferences like ACPH so critical to the solution?
Dr. Dyrbye: A big piece of it is it gives us an opportunity to share with each other what the newest research is, to get those ideas out there so they can be translated into practice, into everyday medical schools, curriculum, faculty development programs, et cetera. So it's a key piece to getting the word out, and it's also really a key place where we can build off of each other and we can think critically about what's the next step. What are we going to do next in our research? What are the important questions that we need to answer together as a community?
And then that third piece as I sort of alluded to is that community building. So I really think that those are the three top reasons why we need meetings such as the ACPH.
Unger: Well Dr. Dyrbye, thank you so much for your perspective and being here today, and we're going to look forward to seeing your keynote speech at ACPH. Everybody out there, you can register for ACPH now at the link in the description of this episode, or visit physician-wellbeing-conference.org. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcast. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.