I collapsed onto the rickety cot in the hospital on-call room. It was 3 a.m. Over the last twenty hours, fueled only by coffee and occasional bites to eat, I had done morning rounds on my patients, assisted with appendix and gall bladder surgeries, inserted and pulled tubes into and out of bodies, cut open a large intestine filled with feces, took patient histories in clinic, attended afternoon teaching, and finished four urgent consults in the emergency room. Just another day in the life of a clinical trainee.
But when I look back on that night during medical school, I don’t remember feeling as excited as I normally feel about medicine. Instead, I felt utterly exhausted.
That night, I questioned whether many of the tasks assigned to medical students actually serve a purpose, and whether their supervisors actually care about their development as trainee physicians. The sad but honest truth: not always.
Morning rounds, for instance, often require medical students to feverishly copy patient information into each patient’s chart: a mindless task that doesn’t contribute to student learning, or even to patient care, since senior physicians rarely use these notes to make medical decisions. After morning rounds, I spent most of that day doing scutwork: holding retractors, writing admission and discharge notes, etc. I didn’t mind doing these; they are tasks that need to be done, and I took pride in doing them well. But these tasks teach students only how to hold retractors and write notes. They don’t teach students about the art and science of patient care that is the heart of the medical profession. Even the afternoon teaching session that day were unhelpful – the concepts taught were beyond the medical student level, which left me more confused than before. Through it all, my supervisors that day never asked me whether I was hungry or needed a break, let alone how I felt after one of my patients died. But if doctors are supposed to be kind and compassionate to their patients, shouldn’t they at least care about how their students feel as well?
Don’t get me wrong: I understand that there are always too many things to do and too little time on the frontlines of health care. Despite this reality, student well-being should be a priority. But it rarely is.
The road to medical student burnout
Lying on the cot that night, I felt like a medical robot, subject to the whims of my superiors. My sole comfort (if it can be called that) was knowing that I wasn’t the only one. In fact, almost all medical students, stuck at the wrong end of the hospital hierarchy, live at the mercy of their more senior physicians at some point during medical school. Sadly, most students won’t speak up for change. Even appearing to question a supervising physician might prevent students from getting the reference letter or positive evaluation that is essential for matching to their desired residency placement.
However, when bright, idealistic, passionate students are treated like emotionless robots, they start to become them. In the medical education community, this phenomenon is well-characterized as part of medical school’s “hidden curriculum.” By forcing students to perform menial tasks, we implicitly teach them that hospitals are not enjoyable places to learn and work. By not caring about how students feel, we teach them that getting the job done is more important than considering the feelings of others, which limits students from developing empathy for patients or compassionately treating their colleagues. Such experiences, repeated over and over, drain medical students of their energy and motivation, leaving them emotionally exhausted. Students begin to take less pride in their daily accomplishments. What was once their dream job now leaves them feeling detached and cynical. In short, they burn out – even before they become fully-qualified physicians.
Burnout — defined as the triad of emotional exhaustion, diminished sense of accomplishment, and depersonalization — is a widespread problem in the medical community, affecting 45 to 71 percent of medical students. Not only does burnout diminish medical student happiness, it also increases their risk of suicide. And, since burnout may persist into residency or beyond, our medical education system risks shooting itself in the foot: sapping future physicians of their energy, compassion, and altruism. Society then takes the fall, as its overall health ultimately suffers.
Immunizing students against burnout
Although I experienced my share of “medical-robot” indoctrination, I was also fortunate enough to have experienced better methods of medical education and physician leadership. The majority of my clerkship year was spent serving one rural community. There, I learned medicine in an environment that not only prevents students from burning out, but also allows them to thrive.
In this setting, students were considered equal members of the health care team. I was assigned my own patients, not only to round on but also to follow over time. Such responsibility, and the bonds it created between me and my patients, gave me a sense of purpose that motivated and inspired me. Supervising physicians weren’t commanders; they were mentors, tailoring students’ clinical experiences to what each specific student actually need to learn. These supervisors would often do more scutwork themselves, so that their students can see and learn from more patients. Student wellness was also a priority. When traumatic events like patient deaths occurred, supervisors would gather together all those involved, compassionately ensuring that we were okay.
Sadly, many medical students don’t receive such immunization against burnout. But I have seen it, lived it, and know such an approach to medical training is possible. Instead of assigning the least relevant tasks to the most junior learners, let’s expose students to the best that medicine has to offer. Let’s stop treating students as though their education and happiness do not matter, because they do. Medical students have every right to be proud of the career they are embarking on. They are keen to work hard, and have the highest of ideals. Let’s make sure we do them justice.
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