Nothing in the Tank: Burnout at Med School

In race car driving, running or any other sport where sustained energy is required, a simple philosophy underpins any, and all, strategy.

If you go too hard, for too long, you’ll run out of gas. No matter how well-disciplined or well-prepared you thought you were, the same equation can ring true for any medical student. 

The rumors are all true: the pressure of med school is unrelenting. 

Classes and study consume more and more time, with the volume of information required to learn seemingly endless. Money is tight, and the student loan is bulging. 

A hidden curriculum from faculty slow to embrace the need for change must be negotiated. A stigma grows against those who begin to feel their mental health struggle under the demands of it all.

Like an over-eager Formula 1 driver at Monaco, or a marathoner whose start was too quick, the tank starts to run dry. Burnout occurs. 

According to multiple studies, burnout affects American med students, residents, and practicing physicians at rates far higher than those of the average population. 

With around half of all American med students suffering from it, burnout is a med school experience that is more than just a common experience; it is virtually an institution, in itself. 

Though improvements are being made, failure to accept its presence—and change to accommodate it better—means that, too often, med students have little resources to get ahead of burnout, or deal with problems downstream of it.

Nothing in the tank

Every person who has experienced burnout at med school, or any other professional pursuit, knows when it has finally caught up with them.

The exhaustion and workload becomes too much, creating its own feedback loop. The mountain of work in front of you only seems to grow, fostering a feeling of detachment, helplessness – even apathy. 

Passion can fade, but, hang on, this comes with the territory in med school – right?

“For many generations of students, medical school has traditionally promoted a culture of self-sacrifice over self-care,” Dr. Augustine Choi, the dean of New York’s Weill Cornell Medicine, wrote for STAT News, last August.

“Pressure to perform academically is relentless. Reaching the point of being able to practice medicine is the overriding focal point, even in the face of frustration and fatigue over long hours studying a tremendous volume of complex information, learning to treat patients, and tackling other unfamiliar challenges.”

Compared with other U.S. college graduates in their 20s, an extensive 2014 study showed that medical students experienced higher degrees of “high emotional exhaustion, high depersonalization, and burnout.” 

56 percent of students involved in the study said they had experienced burnout. The same study showed a higher rate of alcohol dependence for med students, compared to peers not at med school.

Burnout and ‘high depersonalization’ were at their height in the residency phase of the med student’s trajectory, before ebbing as—still stressful—professional careers were entered into. 

Higher emotional exhaustion was more prevalent among med students and residents than EC physicians, the study reported. 

“Training appears to be the peak time for distress among physicians, but differences in the prevalence of burnout, depressive symptoms, and recent suicidal ideation are relatively small,” the study’s authors wrote, in Academic Medicine. 

“At each stage, burnout is more prevalent among physicians than among their peers in the U.S. population.”

Similar conclusions have been reached internationally, as recent studies in the United Kingdom and Hong Kong have shown. 

In the U.S, the industry trends have become so alarming that a bi-partisan U.S. Senate bill was tabled this August to address the healthcare industry’s issues surrounding burnout, and depression.

Named after a New York-based physician who took her own life during the COVID-19 pandemic’s brutal first wave earlier this year, the Dr. Lorna Breen Health Care Provider Protection Act would authorize Title VII funds to train students, residents, and practicing physicians in preventing early symptoms of struggling mental health from becoming much, much worse.

If passed, comprehensive studies on mental health and burnout within healthcare, “including the impact of the COVID-19 pandemic on such professionals’ health,” would also be commissioned. 

The med school response

Though progress might seem slow, med schools and student-orientated medical associations are responding to burnout in ways that might surprise previous generations of med students.

This February, it was announced the USMLE program will implement simple pass/fail grading for Step 1 by 2022 (numerical grading for Step 2 will remain in place), in attempt to reduce student competition and isolation. The University of Nebraska Medical Center has already gone further, adopting it for the first two years.

Several med schools have made noticeable tweaks to their medical training circumulums, with Northwestern having second-year students choose a “personal health behavior to change, set a goal, track progress, and assess success.” 

Four out of five students considered themselves healthier, completing the mental health-specific exercise.

The University of Pittsburgh School of Medicine, meanwhile, has adopted progressive approach to mental health support services that one in six students utilize.

Choi says that medical educators are increasingly “paying particular attention to common stressors in medical education …. to assess if academics [are] keeping pace with the ways newer generations learn or function.”

Even the most belligerent professor would have to admit that assisting students through burnout is a clear and obvious investment to make, not only in terms of managing their med school experience better – but making them more understanding physicians in the future.

“In addition to more medical students getting the treatment they need for emotional difficulties, including medication or talk therapy, more are coming to better understand the humbling experience of being a patient and increased their capacity for empathy,” Choi wrote. 

“[P]atients have a right to expect caregivers who are fully engaged and present, and biomedical research requires nothing less,” Lloyd Minor wrote for Stanford Medicine, and the Wall Street Journal, in 2017.

“If we can’t set a pattern of wellness in the medical student years, there’s little hope for improving the burnout problem in the broader physician world.

“Medical education will always be demanding, and a certain degree of stress is inevitable. But schools and students can work together to help manage that stress and prevent it from turning into burnout.”

In the meantime, med student gas tanks will still reach empty. 

The first step of acknowledging its presence, and the industry-wide negatives downstream of it, has been made.

What lasting changes it forces may well define medical education in the coming decades, just as much as any other curriculum change.