Student SOS: 6 ways to avoid “distress” in medical school
Defining distress and its impact on future physicians
Studies already have shown that students who experience burnout are more likely to engage in “dishonest and unprofessional behaviors,” Dr. Dyrbye said. She gave examples of students who have reported a lab exam as pending when they weren’t sure whether it was ordered. Others have reported a finding on a physical exam as normal when they knew it was actually omitted from the exam. Burned out students also are more likely to believe it is acceptable to self-prescribe antidepressants to themselves or a spouse. They also are less likely to believe physicians should report impaired colleagues.
How educators and students can curb distress
While there’s no simple solution for student distress, understanding what contributes to this state for physicians in training can help educators and students create an actionable plan to support well-being in medical schools, Dr. Dyrbye said. Here are some of the key drivers of student distress.
An unsupportive learning environment and disorganized clinical rotations
“In our studies with students, the number of hours they’re working in the clinic and the patients they’re seeing isn’t necessarily related to burnout. Students expect and want to work hard but need to do so in a supportive and well-organized environment,” Dr. Dyrbye said.
She noted that certain environmental factors—such as unsupportive faculty members, disorganized clinical rotations, inadequate supervision or a lack of variety in medical problems to solve—are commonly associated with student burnout.
Solutions: Monitor students’ learning environment and respond with solutions specific to your medical education program. For instance, schools can evaluate resident-student teaching interactions and determine whether residents are effective teachers for students on clinical rotations. If they aren’t, programs can create new strategies to improve student teaching during clinical rotations, Dr. Dyrbye said.
Also, schools can include students in discussions about curriculum and create courses that embody what they really want to learn. Check out how Mayo Clinic also has created innovative ways to teach students about team-based care.
An overemphasis on grades, especially in the first and second years of medical school
Dr. Dyrbye reports that a longitudinal study evaluated a number of factors that might contribute to student burnout, including hours of lecture, small group experiences, clinical rotations and exams. Grading structure was the one factor that consistently predicted student burnout.
Solution: Implement a pass/fail grading structure during the first two years of medical school, so students can balance learning with well-being instead of over-occupying themselves with competition for the highest letter grade, Dr. Dyrbye advised.
Students who report suboptimal experiences, such as being harassed or belittled, have an increased risk of burnout. “For example, if minority medical students perceive that their race adversely impacted their medical school experience, they’re much more likely to have burnout and depression and poor quality of life,” Dr. Dyrbye said.
Solution: Programs should support students in recognizing mistreatment and offer solutions for reporting and resolving these issues.
“My colleagues [researched] the issue of debt in residents—which contributes to burnout—but this also applies to students,” Dr. Dyrbye said. “If you’re $200,000 in debt, that can be an obvious source of stress.”
Solution: Students can access resources to learn how to properly manage loans and budget now, rather than expecting they will figure out financial planning in residency or practice.
Schools and programs also can continue to develop scholarship opportunities. For example, the AMA Foundation’s Physicians of Tomorrow Award offers $10,000 scholarships to students approaching their final year of medical school.
Personal life events
Medical school coincides with a time in a young person’s life when they are experiencing many personal events. Some of them are positive, such as falling in love and getting married. Some students even choose to have children. But this also is a time when negative life events, such as a family death or a relative who becomes ill, can increase their risk of burnout.
Solutions: “That’s not something that we can fix as educators,” Dr. Dyrbye said. “But it’s important to be aware of them and provide accommodations around [these issues].”
An unwillingness to ask for help, which spurs poor self-assessment
“We know that the willingness to seek help for personal medical problems is a huge issue,” Dr. Dyrbye said. “And it’s not just [among] medical students. It’s also prevalent among residents and physicians in practice.”
“We tend to think, ‘Well, everyone is stressed out, so I’m just like everyone else.’ And then by the time our level of mental distress comes to the attention of the people we’re working with, we’ve really been suffering for a long time and face negative consequences.”
Solutions: Educate students about resiliency and individual choices, so they know how to respond to the common signs of burnout. For instance, Mayo Clinic has created a course on resiliency that teaches students positive coping strategies that support well-being.
Dr. Dyrbye’s school also created a self-assessment tool that students can complete online and get immediate feedback about their stress and their risk of professional consequences. The tool immediately links them to resources.
Dr. Dyrbye also noted that if educators and physicians discuss moments they felt vulnerable in their careers with students, it creates an opportunity for students to openly share their experiences and seek advice. “We have to be role models for students to talk about stressors and how [we’ve managed] them in times when life has been really out of balance,” she said.
Tell us: If you’re an educator, what are other ways you’re supporting students with distress? And if you’re a student, what are other solutions you think would help?