In recent years, the medical community has recognized that burnout — a sense of exhaustion, loss of motivation, and growing cynicism — is prevalent among physicians and other medical providers.
We’ve also learned that stress and burnout are experienced by medical trainees: the students, residents, and fellows who are learning the ropes of medicine and specializing in their fields of interest. For the physicians of tomorrow, student loans, expansive work demands, constant assessments, and poor work environments are contributing to burnout.
Leadership in medicine has begun to accept and address the mental burden of the medical training process. However, amidst the COVID-19 pandemic, there has been little talk about the immediate need to address the collective mental health challenges that many trainees must navigate during a global pandemic.
To start, students at all stages of their medical school education are experiencing remote teaching and learning. Medical students have had to learn not just didactic knowledge but the art of doctoring and patient interview skills through video platforms and not in person. First-generation medical students and those from underserved backgrounds face further disadvantages with difficulties navigating education opportunities and finding mentors in a virtual medical environment.
As a result, many medical students are feeling unproductive and emotionally detached. The increased stressors during the pandemic are particularly diconserting, given evidence that about half of medical students experience burnout that can persist later on in training and increase the potential for suicide and mental health problems in the future.
Residents and fellows are also facing difficulties in maintaining their mental health amidst their training. Medical residents who treat patients with COVID-19 are experiencing increased levels of stress and burnout, which are often exacerbated by non-medical obligations like childcare.
Caring for patients during the pandemic has compounded the stress that physicians feel at baseline during residency and fellowship training.
To better support the mental health of medical trainees, a series of formal steps must be implemented at institutions training medical students and residents to help alleviate the increased mental pressures of the times. Such programming, along with an eye toward systemic reform in training, could reduce the stress and burnout amongst medical trainees that have only worsened during the COVID-19 pandemic.
First, mental health care access must be augmented. There are often limited resources and long waiting periods, sometimes for weeks to months, to access mental health resources at medical schools and training programs, which only adds stress for folks seeking help. Training programs should create readily available access to in-house mental health counseling services, with these services ideally enrolling everyone and allowing trainees to opt-out if they choose not to use them.
These ought to be covered by the programs themselves and not necessitate cost-sharing obligations to ensure that those from financially disadvantaged backgrounds do not hesitate to access care.
Second, community resiliency should be bolstered. At a time when people are feeling more isolated than ever, especially as trainees travel across the country to new schools and hospitals with limited support systems, intrinsic support systems must be developed and supported. Formalized peer support systems should be established with structured time within training blocks to help foster connection and allow opportunities to debrief about stressful situations. Community listening sessions should be routine, which would allow administrations to understand the perspective of trainees who are not able to simply walk up to their offices or pass them in the hallways for feedback.
We must also think differently about medical assessments. It does not make sense for students to have to pay thousands of dollars to sign up for and then travel to an exam during a pandemic that, while improving, has yet to end, especially as many families are facing increased financial hardships.
There should therefore be opportunities to take USMLE exams at or near students’ home institutions or homes instead of forcing students to travel to a few unique locations. Such a policy change would be safer, less expensive, and less stressful for medical students.
Moreover, we must provide more robust childcare options for medical trainees. One option could be stipends to subsidize the cost of childcare at the location of their choosing. Another option would be to provide on-site childcare options that are available 24/7 to accommodate the 80-hour resident workweek. While some programs have childcare options for health care workers, they are often full, with years-long waitlists; these programs must be expanded and subsidized, with spots reserved for trainees who may not be able to afford childcare elsewhere.
Finally, medical institutions must improve their racial and cultural competencies to reduce bias against minority and underrepresented trainees in medicine. As the field of medicine continues to diversify in the coming years, it is important that current trainees do not have to deal with the additional stress that comes from weathering discrimination that hinders performance in the classroom or on the wards. This is especially true in light of the numerous killings of black and brown people during the course of the pandemic, which only adds stress to the lives of minority trainees.
Mandatory anti-bias training for trainees, medical school professors and clerkship directors, and residency and fellowship programs is necessary to develop a common understanding and language to address discrimination in and out of the workplace.
The mental health effects of COVID-19 on medical trainees must be addressed immediately as a bridge to improving mental health within the field in general. Doing so will also result in a more effective and motivated future medical workforce, which will help our nation heal from the COVID-19 pandemic and address the other health problems that continue to ail us.
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