Student SOS: 6 ways to avoid “distress” in medical school

AMA Wire
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Burnout can be pervasive through all phases of physicians’ medical careers, beginning with students. But that doesn’t mean you have to live in a constant state of distress. Take time to learn the key signs of “student distress,” so you can boost well-being during medical school. 

Defining distress and its impact on future physicians

Lotte Dyrbye, MD, professor of medicine at Mayo Medical School, has studied burnout in medical education since 2004 and is a member of the AMA’s Accelerating Change in Medical Education initiative consortium, which consists of 11 U.S. medical schools that received $1 million grants to reshape the way physicians are trained. 
During a recent consortium meeting at Oregon Health and Science University (OHSU), Dr. Dyrbye shared this surprising finding about student distress and burnout: Nearly 50 percent of medical students across all U.S. medical schools experience burnout according to several studies over the last decade. And the problem persists throughout physician training. 
Yet “when students matriculate into medical school, they have mental health profiles that are similar or better than similarly aged individuals in the population,” Dr. Dyrbye said, noting that incoming medical students enjoy a better quality of life, lower rates of depression and a more composed state of well-being than their peers in other professions.
So what drains medical students of this healthy optimism? Simply put: They’re under distress, Dr. Dyrbye said. “When they enter medical school, they start to experience a high level of psychological distress, which can manifest in many different ways. For some [students], that means burnout. Others experience depression or have very high levels of fatigue.”    
No matter how it manifests, student distress often involves a trifecta of mental and emotional stressors, coupled with poor learning environments. If unattended, these factors can produce serious personal and professional ramifications for physicians in training.

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.     

Programs also can look at ways to foster diversity in medical schools and improve communication with students.  


“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? 

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It might be my obsessive compulsive personality disorder showing, but I find the fact that the title of the article is "7 ways to avoid distress" but only 6 of them are discussed in the body of the article very distressing
Medical students are human beings in a challenging environment and career. Many survive and thrive. Those whom are struggling more than most or whom don't finish aren't always not necessarily not up to the task but instead wearing down due to lack of progressive support.<br/> <br/> More positive acknowledgement to the stress, more consistent support resources and practice on examining and correcting thinking patterns and cognitive biases, coaching stress management, adopting a healthy lifestyle, learning and practicing effective communication and conflict management or resolution can greatly improve how stress in interpreted and managed, thus lessening burnout and creating more favorable outcomes, benefiting students, the medical profession and society.<br/> <br/> Michael Toebe<br/> High-Value Outcomes<br/> Business First Aid for Communication and Disputes
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Oct 16, 2018
Exam-room discussions about food and diet can be frustrating. These great online nutrition CME courses will give you the knowledge to help guide your patients.