Medical training has historically been known for its intensity, during which work-life balance is traded in for intensive study sessions and early morning rounds. In recent years, medical schools have become increasingly interested in programs to improve student wellbeing. Many of these programs teach students the importance of wellness, touting the value of exercise, hobbies, and spending time with friends and family without providing the time needed to participate in those activities. Schools and national organizations provide webinars, subscriptions to meditation services, and discounts on fitness platforms, but these programs are insufficient for improving student wellbeing.
Wellness programs particularly fail to meet the needs of clinical students, who cannot carve out time in their day for a family dinner, much less a required “wellness” lecture. To train well-rounded and compassionate physicians and fight burnout, medical schools have a responsibility to support the needs and challenges their students face. Taking into account the life stressors and quick transitions expected of clinical medical students is an excellent place to build a more supportive medical school environment. Here are six strategies medical schools can employ to impact student wellbeing during the clinical years.
1. Consider life transitions when building academic schedules. Building a more accommodating schedule is one step that medical schools can take to reduce burnout. Studying for NBME exams is undoubtedly stressful, and it often causes life responsibilities to fall to the wayside. Breaks between exam dates and the start of new academic years should consider that students need time to move, acquire cars, purchase professional clothing, and much-needed rest and relaxation.
2. Provide scheduled discretionary time. Accommodating students’ needs for medical appointments and the like, that may occur during the workday, is also crucial to fighting burnout. While many schools state that students will not be penalized for attending a medical appointment, most of these policies require advanced notice and approval from deans. There is little recourse if a student is ultimately penalized in their evaluations. These policies are not designed for students with medical issues that require frequent monitoring, as well as the many students who participate in psychotherapy. Many of the students I spoke with reported stopping therapy during the third year because it could not fit in their schedule, and they did not feel comfortable disclosing the need to attend a weekly appointment to their superiors. With 1 in 4 medical students reporting being depressed, these policies must go beyond “accommodation” and become standard practice. A standard practice could involve providing all students with half a day off per week, during which they can schedule therapy or other personal matters at their discretion.
3. Provide students with information about the typical clinical schedule for each rotation well in advance.
4. Consider a templated FAQ for each rotation. Sending out schedules further in advance can also positively impact student wellbeing. Many clinical schedules are set months in advance, but students rarely have access until weeks or even days before the start of their rotations. This precludes scheduling appointments, planning time with family, and having a sense of security and preparedness for what is to come. The clinical years are unique because rotations are short and have extremely varied schedules. MS3 Sydney points out that having more uniformity in clinical schedules could reduce stress. When uniformity is not possible, as specialties differ greatly, they suggest providing students with information about the typical clinical schedule and guidelines for rotations at the start of the year rather than just before the start of a rotation. Many students worry about not only start and end times but when students will be able to eat, if they are expected to bring or buy lunch, and whether they will have downtime or be standing for most of the day. This information is particularly important for students with disabilities but can benefit all students.
5. Reduce weekend and call responsibilities. Third-year medical students are in the unique and challenging position of being asked to work the hours of a full-time job while also being full-time students. During my medicine rotation, I averaged 55 hours per week, reaching over 70 hours on my surgery rotation. While it is important for students to get a sense of life as a resident and attending, the expectation that students work a full schedule while also studying for Shelf exams is unnecessary. In particular, working weekends and taking calls puts a huge burden on students and does not add much to learning. MS4 Sabina reports that her surgery clerkship switched to no longer requiring students to work weekends halfway through, and it was “life-changing.”
6. Re-consider holiday policies. In addition to many schools requiring students to work on weekends, many medical schools require students to work a significant number of holidays. Some argue that students need to “prepare” for residency when they will be working most days of the year. Because of the residency schedule, however, medical school may be one of the last times in many years that students have the opportunity to participate in family holidays and long weekend gatherings and attend weddings, graduations, and other family events. With work-life balance in mind, medical schools should support students’ ability to engage with their personal lives outside of medicine by excusing students from clinical duties on major and minor holidays, such as Memorial Day and the Fourth of July.
Medical school is an undoubtedly challenging time, during which soon-to-be doctors are tasked with the responsibilities that will train them to be excellent physicians. Historically, disregarding medical students’ personal needs was seen as necessary to prepare them for the intense time commitment of a career in medicine. Increasingly, however, medical schools are re-emphasizing wellbeing and work-life balance. While some so-called wellness initiatives make little impact, concrete policy changes that increase flexibility for medical students and provide them with the information needed to plan their lives can significantly improve the wellbeing of medical students across the country.
Natalie LaBossier is a medical student.
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