More than 40 percent of third-year medical students have symptoms of moderate to severe burnout, according to a study in the August Southern Medical Journal, official journal of the Southern Medical Association. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.
The new results suggest that the common problem of burnout in doctors may start as early as the first year of medical school. "Burnout progressively develops over the course of medical education, while high support and less stress decrease burnout," concludes the study by Dr. Sally A. Santen and colleagues of Emory University School of Medicine, Atlanta.
Low Support, High Stress and Lack of Control Are Key Contributors
Using a standard questionnaire, the researchers assessed symptoms of burnout in 249 medical students. Defined as "a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment," burnout is an important concern in physicians, nurses, and other healthcare providers.
Overall, one-third of the medical students had a moderate or high degree of burnout. Burnout was already present in 21 percent of first-year students, increasing to more than 40 percent of third- and fourth-year students. In fourth-year students, the rate of moderate to high burnout decreased to 31 percent.
The study was the first to assess all three dimensions of burnout in medical students. Symptoms of emotional exhaustion and depersonalization peaked in the third year of medical school, while lack of personal accomplishment peaked in the second year.
Burnout was more likely for students who said they had lower levels of support, increased levels of stress, and a feeling of not having control over their lives. Burnout was more than twice as likely for students with high scores for stress. In contrast, those who were satisfied with their support or felt they had control over their lives were half as likely to be burned out.
The results lend new insights into how and when burnout develops in medical students. Compared to the first year, when students are doing their pre-clinical work (that is, mostly in the classroom), the rate of burnout doubles during the third year when they start their clinical work (working with patients).
Burnout may decrease during the fourth year, as the students' growing sense of personal accomplishment counter-balances the negatives of emotional exhaustion and depersonalization. "However," the researchers write, "it is alarming that so many third year students have either high or moderate emotional exhaustion or depersonalization."
Dr. Santen and colleagues suggest some steps that medical schools could take to help decrease burnout. For example, stress may be reduced by allowing students to take some time off or by de-emphasizing grades, at least in some situations. Decreasing stress, along with steps to increase support and control, may provide students with increased resiliency, providing "a stabilizing effect to prevent the development of burnout." Increasing the sense of personal accomplishment may also have a favorable effect.
Further studies are needed to develop and evaluate strategies to prevent burnout in medical students. If effective, such strategies might ultimately help to decrease the rate of burnout among practicing physicians, Dr. Santen and colleagues believe.
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