Burnout affects as many as 50 percent of physicians. Interventions have been proposed at virtually every stage of a physician’s life, from medical school to residency training to professional practice. While the rigors of medical training certainly contribute to the high levels of burnout in the profession, there are indications that the trouble begins at the undergraduate level.
I recently graduated from an undergraduate program geared toward students interested in medicine. Through an anonymous forum on our e-learning platform, numerous students have confessed to feeling a profound sense of inadequacy regarding their achievements, especially in comparison to their peers. In order to maintain a grueling academic and extracurricular workload, students wrote about relying on as little as two or three hours of sleep a night for weeks at a time and caffeine pills. I’ve forgotten meals, skipped exercise and social events, put off doctor and dental appointments and cut back on sleep regularly throughout my four years of study.
The pressure to create a standout application in an increasingly competitive applicant pool is tremendous. A survey of premedical undergraduate students showed that 88 percent were worried about their ability to earn the grades needed to apply to medical school — negative experiences with coursework is commonly cited by former premedical students as a major reason for changing career paths. Even though medical schools have taken steps to develop a more holistic admissions review process, such as the removal of certain academic prerequisites, applicants need to meet grade point average and MCAT score cutoffs to have their applications examined at all. Candidates with a grade point average of 3.79 or higher and a MCAT score of greater than 517 have the highest acceptance rate. There’s no question that these students had excellent applications outside of their scores, but it’s difficult to dispute the importance of the numbers.
The problem goes beyond the grades though. Premedical culture is a collective of students aiming to achieve top percentile grade point averages and MCAT scores, as well as a resume with extensive leadership, research, and volunteer experience. While there is little evidence to support the popular perception of premedical students as cutthroats that actively sabotage one another, there’s an unspoken awareness of the fact that we’re in competition with one another. It’s difficult to avoid social comparisons to see how you stack up as an applicant. There’s the nagging sense that you’re not doing enough, no matter how busy you are — to think that you should add on another extracurricular for the sake of ticking off another box on the checklist. It’s hard not to berate yourself for your lack of published research. Or for taking a night off when you should be working because you have classmates that squeeze out productivity from every hour of the day and seem to be miles ahead of you. Or wonder if maybe, just maybe, you’re not and will never be good enough.
Premedical students also worry about a host of other issues, including whether or not they’ll be able to deal with patient death if they’ll be able to balance work and family life and the debt accrued over the considerable length of medical training. All of these challenges are amplified for students with financial strain and interpersonal stressors such as race and class-based discrimination.
Given the stress of the premedical experience, it’s possible that burnout begins before medical school. A survey found that premedical students experienced a greater degree of emotional exhaustion, which is a component of burnout and more severe depression compared to non-premedical students. Another study of premedical and non-premedical undergraduate students at the University of California San Diego found that premedical students had greater mean scores for depression intensity. They were also more likely to meet screening criteria for major depressive disorder.
There is a dearth of research concerning the premedical experience. In what ways does it differ from other undergraduate student experiences? What are the extrinsic and intrinsic pressures that affect premedical students? Are there ramifications for premedical student mental health and well-being? These are some of the questions that need to be addressed in order to understand better how the premedical experience informs physician development. It would help to identify if premedical students experience burnout and implement primary prevention strategies, such as providing educational seminars to teach students how to recognize burnout and self-care strategies to prevent or reduce its impact. Not only would this help students navigate the stressors of the premedical environment, but also better equip them for medical training.
The MCAT has been changed to include a broader range of topics, such as psychology and sociology. Medical schools are increasingly receptive to applicants from nontraditional paths, such as non-science majors and students who took multiple gap years or had other careers first. All of this is rooted in the belief that the experiences had before entering medical school shape prospective physicians into the empathic, collaborative, critical thinkers and leaders that they are. It’s worth seriously considering that not all of the experiences impact students in a positive way. The road to medical school may make premedical students susceptible to burnout.
Anna Goshua is a medical student.
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