Yes, you heard it here, we as a society need to care more about our future doctors and medical professionals. Medical schools are one of the “breeding grounds” for these future medical professionals to prosper and grow into individuals who will dedicate their life to caring for society. However, there is hardly any resources given to students to address the rigorous academic demands, personal sacrifices, clinical rotations and exposure to traumatic experiences. This creates a breeding ground for two issues that are growing in demand in these institutions every year: Why is student burnout and mental health challenges popping up? Why are there no resources to address this? Medical schools are the guardians of the profession, and it is greatly imperative that these institutions acknowledge and combat these growing issues. Student burnout does not only affect the well-being of the students but also have implications of patientcare, the healthcare system, and integrity of medical schools.

The Toll of Burnout

Medical schools are already known as an institution that is “not for the weak” and is undeniably demanding. From the long hours of studying, intense coursework, high-pressure examinations, and intense on the spot clinical experiences the increased expectation of excellence of students leads to neglect of their wellbeing. Students sacrifice sleep, social connections, their jobs, and self-care to continue with the increased demands of medical school curriculum. These characteristics result in burnout which defined by the American Psychological Association is “physical, emotional, or mental exhaustion accompanied by decreased motivation, lowered performance, and negative attitudes toward oneself and others“.

Recent studies conducted within the last few years have shown alarmingly high rates of burnout in medical students. Symptoms of these burnouts can range from emotional and physical exhaustion to depression. When burnout is left unaddressed there are serious consequences such as anxiety, depression, substance abuse (alcohol, drugs, sex, etc) and suicide. Recent study done by Cambridge University (2022), discussed the three different stages of burnout: stress arousal¹, avoidance², depression³. It is also addressed that throughout this study data was collected from around the world, however there is correlation with burnout and excessive substance abuse of alcohol and cannabis. The effects of burnout go beyond the students, it is impacting their academic performance, professional development, and patient care.

How COVID-19 Has Played a Significant Role

Ever since the COVID-19 pandemic there has been a significantly higher rate of burnout across all disciplines. A recent study conducted by researchers in China (2022), expressed the aftermath of COVID-19 on students. The expressiveness of COVID-19 mitigation period (aftermath) affecting undergraduates of any major were compared to those pursuing a degree in the medical field. Individuals in this study were to represent those pursuing higher education in all of China, which can be compared to other studies in other countries such as the United States. Data showed how there is an increase in depression by 9%, anxiety, and a correlation between mental health of undergraduates and severity of a burnout. Data was collected through a public university wide survey where individuals would answer questions in relation to sleep, alcohol consumption, media addiction, and motivation which are different third variables that can influence survey results.

The study concluded that there was an increased dilemma of academic burnout in all students, however more in non-medical undergraduate’s students. This still raised the question about what resources medical schools should be providing to students in order for their continued pursuit of academic excellence without burning out. Located below is the comparison table:

Table 2: Mental health conditions and academic burnout of medical undergraduates and non-medical undergraduates

Burnout And Patient Care

Burnout can affect the quality of patient care provided by these students during their clinicals. Burnout diminishes things such as self-worth, confidence, and empathy. It also can increase medical errors and compromises the ability to make good judgements under pressure which can affect whether a patient lives or dies (based on extreme scenarios). Current research has showed that there is a correlation between burnouts and decreased patient satisfaction, increased cost, and increased medical errors. A Meta-analysis paper released in 2022, discussed the importance of patient satisfaction in relations to burnout. The results found a relationship between the development of burnout and patient safety actions with a probability of 66.4%; meaning that with the increase of burnout there was a decrease of patient safety. Addressing burnout in students in not only a matter of taking care of these future physicians but also ensuring the safety of the patients they are serving.

How Your Role Has Significance

Education, Funding, Reputation

Healthcare professions are surrounded by the core values of compassion, empathy, and patient-centered care which cannot prosper if the medical professionals do not have good mental health. Burnout erodes motivation, creativity, and the ability to engage in learning processes. Students that are burned out are less likely to complete their degree, participate in research, or advocate for the healthcare system in general. Neglecting the mental health of the students can jeopardize the future of medicine.

Funding is also a huge way to combat the increasing numbers of students who experience burnout. As previously mentioned, burnout could be caused by financial need and stress from loans. Being able to provide more scholarship and financial opportunities for students. If there is transparency between medical schools and students in terms of aid and how to receive the best financial help this would release a burden that can plague their minds during their education. Recently universities such as Columbia and Albert Einstein College of Medicine are just some of the universities that have been able to provide 100% financial aid to their students.

Though the American Association of Medical Colleges has not released information regarding drop-out rates in the past, studies have shown that there is a significant number of students that dropped out within the last 4 years. The increased rates of students dropping out tarnishes the programs creditability and with social media such as TikTok, Instagram, twitter, and Facebook students are able to freely express why others should not attend those programs. That is why it is extremely important to make sure that students are satisfied and can achieve academic success in medical schools.

Solutions

Supportive Environments

Medical schools should foster a culture of support, where students should feel comfortable seeking help without the fear of judgement. This involves open dialogue about mental health, 24/7 access to mental health services (counseling), and improvements of wellness initiatives on the campus. A study done by Portuguese researchers in relation to burnout in medical students (2022), showed that increasing students social support satisfaction, having a psychology-psychiatric office, and having workshops about preferring adaptive coping showed an increase of students wellbeing in courses.

Curricular Reform

There are plenty of systematic issues within medical schools, such as excessive workload, competitive environments, and a huge lack of work-life balance for their students. Medical schools should evaluate and revise their practices and policies to reduce the stress and exhaustion students have. This way the institutes can ensure that the learning environment is not damaging their student’s personal wellbeing but ensuring they can pursue academic success.

Mentorships and Faculty Support Systems

Faculty members can play a huge role on the experience of students whether it be good or bad. Medical schools should provide training for faculty members to be able to recognize signs of distress, burnout, and depression. Voluntary faculty members would participate in a faculty led program in relations to pairing students with mentors who can provide guidance and support throughout their educational journey.

Overall, students should not be the only individuals putting in efforts to combat the burnout. Simple solutions by the different institutional communities could provide a solid learning experience for students. It does not only have to be through financial aid but through mentorships and 24/7 access to mental health services. Our future doctors should not be risking their mental health or lives to pursue the degree they want.

1. poor memory, poor concentration anxiety ↩︎
2. skipping class, unmotivating, social withdraws ↩︎
3. apathy, depression, anxiety, suicidal ideations ↩︎

Sources

1. Abraham, A., Chaabna, K., Sheikh, J., Mamtani, R., Jithesh, A., Khawaja, S., & Cheema, S. (2024). Burnout increased among university students during the COVID-19 pandemic: a systematic review and meta-analysis. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-52923-6
2. Abreu Alves, S., Sinval, J., Lucas Neto, L. et al. Burnout and dropout intention in medical students: the protective role of academic engagement. BMC Med Educ 22, 83 (2022). https://doi.org/10.1186/s12909-021-03094-9
3. APA Dictionary of Psychology. dictionary.apa.org/burnout
4. Alves, S. A., Sinval, J., Neto, L. L., Marôco, J., Gonçalves-Ferreira, A., & Oliveira, P. (2022). Burnout and dropout intention in medical students: the protective role of academic engagement. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-021-03094-9
5. Bhugra, D., & Molodynski, A. (2022). Well-being and burnout in medical students: challenges and solutions. Irish Journal of Psychological Medicine, 1–4. https://doi.org/10.1017/ipm.2022.26
6. “—.” CBC, 10 Nov. 2017, www.cbc.ca/radio/whitecoat/doctor-burnout-1.4395549/how-to-tell-if-your-doctor-is-burned-out-1.4395655.
7. COVID-19 and Mental Health. www.who.int/westernpacific/emergencies/covid-19/information/covid-19-mental-health.
8. Garcia, C. L., Abreu, L. C., Ramos, J. L. S., Castro, C. F. D., Smiderle, F. R. N., Santos, J. A. D., & Bezerra, I. M. P. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina (Kaunas, Lithuania), 55(9), 553. https://doi.org/10.3390/medicina55090553
9. Yang, Q., Liu, Y., Yang, W. F., Peng, P., Chen, S., Wang, Y., Wang, X., Li, M., Wang, Y., Hao, Y., He, L., Wang, Q., Zhang, J., Ma, Y., He, H., Zhou, Y., Long, J., Qi, C., Tang, Y. Y., Liao, Y., … Liu, T. (2022). Mental health conditions and academic burnout among medical and non-medical undergraduates during the mitigation of COVID-19 pandemic in China. Environmental science and pollution research international, 29(38), 57851–57859. https://doi.org/10.1007/s11356-022-19932-2