Wow! That is scary! These are practicing physicians who are
working themselves to a state of emotional and physical exhaustion. When
physicians feel like this they are more likely to make mistakes and medical errors.
So, bringing this back to medical education, is there evidence about burnout in
learners? Well, a recent article in AcademicMedicine by Dyrbye, et al (4) addressed this question. The authors found
that positive mental health had a protective effect on burnout.
In this study, 4,400 medical students from seven medical
schools (Mayo College of Medicine; Uniformed Services University of the HealthSciences; University of Alabama School of Medicine; University of California,San Diego; University of Chicago Pritzker School of Medicine; University ofMinnesota Medical School; University of Washington School of Medicine) were
surveyed. The students’ mental health was measured using a validated instrument
that measures emotional, psychological, and social well-being. The symptoms of
burnout were measured using the same Maslach Burnout Inventory that was used in
the practicing physician survey.
What the authors found was not surprising: medical students also
had high levels of burnout. 42.1% of the students had high scores in emotional
exhaustion, 52.5% had a positive depression screen, and 17.4% reported suicidal
ideation. When they asked about mental health, interestingly, most students
were doing well. 53.1% were flourishing and 42.5% were moderately healthy,
while only 4.3% were languishing. Students that were described as languishing
reported a low frequency (“never” or “once or twice” in the past month) on more
than one of the emotional well-being items and a low frequency on at least six
of the signs of positive functioning.
48.2% of students who were languishing reported suicidal
thoughts in the past 12 months compared to 25.1% who were moderately mentally
healthy (p< 0.001). The scary part was that those who were flourishing still
had a 9% rate of suicidal ideation. Students who were languishing were more
likely to cheat, more likely to display other dishonest behaviors, less likely
to endorse altruistic beliefs, and less likely to care for medically
underserved patients.
This is scary stuff! It suggests that a lower, more negative
mental attitude in a medical student is correlated with not only their personal
feelings about themselves (ie: suicidal ideation) but also how they act within
the professional environment (dishonesty and cheating). It may be that if we
could identify those students who are languishing, we could intervene to help
them improve their mental health. Interventions could impact their professional
behavior and quite possibly their performance in the academic realm of medical
school. The question is: what are those interventions? More research will be
needed to figure out what can be done and what works best.
(1) Chen PW. The Widespread Problem of Doctor Burnout. New YorkTimes. August 23, 2012
(2) Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. Published online August 20, 2012.
(3) Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, Calif: Consulting Psychologists Press; 1996.
(4) Dyrbye LN, Harper W, Moutier C, et al. A Multi-institutional Study Exploring the Impact of Positive Mental Health on Medical Students’ Professionalism in an Era of High Burnout. Academic Medicine 2012;87(8):1024-1031.