Articles describing physician burnout have dominated the medical reporting landscape recently. The problem is widespread, as many as 44% of physicians met the criteria for burnout in recent studies. The consequences are severe – physicians complete suicide at twice the rate of the general population. While this epidemic is being recognized in attending physicians, the roots of the epidemic have not been fully addressed. Often, by the time that physicians have been worn down to contemplating or attempting suicide, they have been dealing with burnout and depression for much longer. The roots of this current epidemic, and the key to effectively preventing it, lie in the medical training pipeline.

How significant is medical student / resident burnout?

Although the news of acceptance to medical school is often met with unconditional excitement and anticipation, medical school and residency can be two of the most stressful times in a physician’s life. With the beginning of medical training come not only the increased academic stressors and demands, but also a sense of a loss of autonomy, the weight of your responsibility to your future patients, and dramatic lifestyle changes. These changes can be compounded by the increasing sense of competition amongst medical students and a relative lack of desirable residency training positions following medical school. Often, medical students are thrown into a highly competitive environment, asked to succeed at all costs, and isolated from their friends and family by excessive workloads and little free time.

Given these changes, the numbers describing medical student and resident burnout come as no surprise. Two recent large studies of international as well as US medical students found the rates of burnout to be 44% and 49%, respectively^1,2. The rates in residency are even higher, with recent reports describing the rates of burnout in internal medicine and emergency medicine residents to be 75% and 65%, respectively^3,4. An additional study found that 58% of general surgery residents surveyed gave serious thought to quitting medicine or their residency at some point during their training⁵. The results of these studies are sobering. Across different levels and multiple specialties of medical training, the overall reported rate of burnout meets or exceeds half of all trainees surveyed. Clearly, this is a serious problem, but what can we do to reduce the rates of burnout experienced by medical trainees and create a more livable medical training environment?

What can we do to reduce medical student and resident burnout?

Recognize the symptoms of burnout in medical trainees

The first step to mitigating and reducing burnout is recognizing it early. Some of the most commonly reported symptoms of burnout in medical trainees include:

• Fatigue out of proportion to lack of sleep
• Increased irritability
• Difficulty sleeping
• Increased substance use
• Increased cynicism / lack of empathy for patients
• Preoccupation with non-clinical jobs

What can I do to fight burnout?

Find Balance

Recognizing that burnout is happening is the first step in combating it. While the exact strategy is different for everyone, achieving balance is one of the most important aspects mitigating your personal risk of burnout. Some students find balance by incorporating regular exercise into their schedule, while others find it by incorporating a creative outlet such as drawing or journaling. Achieving true lifestyle balance while meeting the demands of being a medical trainee is likely impossible; however, recognize that during training your life may become severely out of balance, and take what steps you can to restore that balance.

Be Mindful

Many burnout mitigation strategies incorporate some degree of mindfulness or meditation. Mindfulness involves being in the moment, not holding on to previous defeats or anticipating future problems. By being in the moment, we can reduce the depression that arises from holding on to the past or the anxiety of worrying about the future.

As a medical student or resident, you may picture mindfulness or meditation as someone assuming the lotus position in a room completely silent and laugh to yourself about how totally unattainable this is in the hospital. Mindfulness does not have to be this involved, and as a neurosurgery resident, I was even able to find time to be mindful throughout the day. Before every surgery, I would make “scrubbing in” my time to be mindful. Whether this was an elective back surgery or an emergency craniotomy, you still need to scrub in. During this time, I would center myself, and let the panic, anxiety, and worry from getting the patient to the OR slip away. I would focus on what the steps of the operation would be and visualize myself completing each step. This form of meditation was almost daily for me and required all of 3 minutes to complete. Mindfulness as a medical trainee is possible; you just need to be intentional about how you will achieve it.

Conclusion

Burnout is a serious problem afflicting not only attending physicians, but also medical trainees at all stages of the training process. The good news is that while this problem is widespread, affecting over half of medical trainees surveyed, it has been recognized and institutions are moving to tackle it head on. Recently, articles highlighting work-life balance strategies and wellness strategies for physicians, residents, and medical students have been published across many medical specialties^6–8. With continued attention towards identifying and reducing burnout, while maximizing physician wellness, this problem can be addressed, and the physician suicide rate effectively reduced.

References

1. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and Suicidal Ideation among U.S. Medical Students. Ann Intern Med. 2008;149(5):334.
2. Boni RADS, Paiva CE, de Oliveira MA, Lucchetti G, Fregnani JHTG, Paiva BSR. Burnout among medical students during the first years of undergraduate school: Prevalence and associated factors. PLoS One. 2018;13(3):e0191746.
3. Campbell J, Prochazka A V., Yamashita T, Gopal R. Predictors of Persistent Burnout in Internal Medicine Residents: A Prospective Cohort Study. Acad Med. 2010;85(10):1630-1634.
4. Kimo Takayesu J, Ramoska EA, Clark TR, et al. Factors Associated With Burnout During Emergency Medicine Residency. Yarris L, ed. Acad Emerg Med. 2014;21(9):1031-1035.
5. Gifford E, Galante J, Kaji AH, et al. Factors Associated With General Surgery Residents’ Desire to Leave Residency Programs. JAMA Surg. 2014;149(9):948.
6. Gelfand D V., TW D, JE W, AL B, TJ FI, MJ Z. Effect of the 80-Hour Workweek on Resident Burnout. Arch Surg. 2004;139(9):933.
7. Shanafelt TD, West CP, Sinsky C, et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017. Mayo Clin Proc. 2019;94(9):1681-1694.
8. Spiotta AM, Fargen KM, Denham SL, et al. Incorporation of a Physical Education and Nutrition Program into Neurosurgery: A Proof of Concept Pilot Program. Neurosurgery. 2016.