Resident & Student Health

Student SOS: 6 ways to avoid “distress” in medical school

Burnout can be pervasive through all phases of physicians’ medical careers, beginning with students. Nearly 50 percent of medical students across all U.S. medical schools experience burnout, a problem that persists throughout physician training. Take time to learn ways you can boost well-being and prevent medical student burnout. 

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If unattended, factors of distress can produce serious personal and professional ramifications for physicians in training, according to Lotte Dyrbye, MD, professor of medicine at Mayo Clinic School of Medicine, who has studied burnout in medical students since 2004. Mayo also is a member of the AMA’s Accelerating Change in Medical Education Consortium.

At an AMA meeting at Oregon Health & Science University, Dr. Dyrbye discussed ways that medical schools can help students overcome key drivers of distress. 

Monitor student learning environments. Certain environmental factors—such as unsupportive faculty members, disorganized clinical rotations, inadequate supervision or a lack of variety in medical problems to solve—are commonly associated with medical student burnout.

Monitor students’ learning environment and respond with solutions specific to your medical education program. For example, schools can evaluate resident-student teaching interactions and determine whether residents are effective teachers for students on clinical rotations. If they are not, Dr. Dyrbye recommended creating new strategies to improve student teaching during clinical rotations.

Change the grading structure in the first two years. A longitudinal study evaluated several factors that might contribute to medical student burnout, including hours of lecture, small group experiences, clinical rotations and exams. Grading structure was the one factor that consistently predicted medical student burnout.

One solution is to implement a pass-fail grading structure during the first two years of medical school. This can help students balance learning with well-being instead of over-occupying themselves with competition for the highest letter grade, said Dr. Dyrbye.

Support students. Students who report suboptimal experiences, such as being harassed, belittled, or discriminated against, have an increased risk of burnout.

“If minority medical students perceive that their race adversely impacted their medical school experience, they’re much more likely to have burnout and depression and poor quality of life,” Dr. Dyrbye said.

Support students in recognizing mistreatment and offer solutions for reporting and resolving these issues. Programs can look at ways to foster diversity in medical schools and how to improve communication with students.

Provide resources on debt, budget. “My colleagues [researched] the issue of debt in residents—which contributes to burnout—but this also applies to students,” said Dr. Dyrbye. “If you’re $200,000 in debt, that can be an obvious source of stress.”

Create access to resources for students to learn how to properly manage their loans and how to budge while in medical school instead of expecting them to figure out financial planning in residency or practice.

Schools and programs can also continue to develop scholarship opportunities. For example, the AMA Foundation’s Physicians of Tomorrow Awards offers $10,000 scholarships to students approaching their final year of medical school.

Be aware of negative life events. Medical school coincides with a time in a young person’s life when they are experiencing many personal events. Some of them are positive, such as falling in love and getting married. Some students may even choose to have children. However, this is also a time when negative life events, such as a family death or a relative who becomes ill, can increase their risk of burnout.

Educate students on resiliency. “We know that the willingness to seek help for personal medical problems is a huge issue,” Dr. Dyrbye said. “And it’s not just [among] medical students. It’s also prevalent among residents and physicians in practice.”

“We tend to think, ‘Well, everyone is stressed out, so I’m just like everyone else,’” she said. “By the time our level of mental distress comes to the attention of the people we’re working with, we’ve really been suffering for a long time and face negative consequences.”

Educate students about resiliency and individual choices, so they know how to respond to the common signs of burnout.