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Mistreatment during medical school is associated with burnout and career regret by graduation, study finds

Roughly 23% of medical students surveyed during their second year reported mistreatment, according to the JAMA Network Open study.

As a group, medical students begin their training with lower levels of burnout than their general peer group, according to a new study in JAMA Network Open. During medical school, however, med students’ burnout levels rise to the point that they exceed their peers’ burnout.

Medical students who are mistreated in medical school and those who view their school as unsupportive are more likely to have burnout, tend to have lower empathy scores and are more likely to say they regret their career choice by the time they graduate, the study found.

Examining the learning environment

“These findings suggest the prevalence of burnout among medical students and students’ empathetic orientation and career satisfaction are, at least partially, attributable to factors within the learning environment,” the study’s authors wrote.

To conduct the study, researchers examined data from the American Association of Medical Colleges’ surveys of a cohort of students. These students completed surveys in their second year and again when they were graduating. The researchers examined data from over 14,100 medical students’ surveys.

Roughly 23% of the students reported mistreatment—defined by the researchers as experiences of negative behaviors and discrimination related to sex, race/ethnicity and sexual orientation. Students who reported more positive faculty interactions were more likely to have higher empathy scores upon graduation; students reporting better interactions with their peers were less likely to report career regret upon graduation.

The study researchers believe this is the first longitudinal study to examine the association between mistreatment and empathy and career choice regret.

Interventions to reduce mistreatment and alleviate burnout

In the study, the researchers offer several potential interventions to improve the medical school learning environment and reduce mistreatment. By extension, these could lower students’ burnout levels and improve their empathy levels. The researchers recommend fostering learning communities, implementing pass/fail grading, providing faculty development and considering approaches to eliminate mistreatment.

“Pass/fail grading during the preclinical years has been shown to be associated with better group cohesion and lower stress levels among students without a detrimental effect on subsequent academic performance,” they wrote. “Our study further suggests that lower stress levels at the beginning of year 2 of medical school may lessen the gravity of burnout symptoms during the clinical years.”

9 comments

  1. Gosh, I never saw anyone speak rudely to the kid working at the register at MacDonald’s. I feel so badly for the medical students of today. Oh the humanity!

    1. Perpetuating toxic environments just because older generations went through it doesn’t make it right and can make healthcare better overall by correcting poor institutional actions. I recommend reading about the abuse to medical students and perhaps take some time to open your eyes by talking directly to a few of them.

    2. The medical community is currently grappling with burn-out, self care, and a newer awareness about a “toxic culture in medicine.” Unfortunately, I feel that this comment from Dr. Highley really exemplifies that toxic culture.

      Are some medical students, residents, and even physicians overly sensitive? Maybe. But there have been plenty of cases of unprofessionalism that I have witnessed and heard of, including one of my peers being called stupid by our attending physician at the time. Behaviors like that have no place in education. It’s one thing to deal with a rude patient or family member – that’s just part of the job – it’s another entirely to be stabbed in the back by someone you’re supposed to be learning from, and who is ideally serving as a role model.

      I’ve been out of training for a few years now. The practice of medicine is grueling and difficult. I am not suggesting that we make training a walk in the park. People are going to get thrown into the deep end sooner or later, and I think it’s better to do it a bit earlier. But we don’t need to be holding our students’ and trainees’ heads under water. Teaching is tough, and it’s tough to balance it with clinical practice. That doesn’t mean we shouldn’t continue to strive to do better.

    3. A few points:

      1. They define mistreatment as “experiences of negative behaviors and discrimination related to sex, race/ethnicity and sexual orientation.” So we are talking about bigotry and discrimination, not rude behavior.

      2. If they were talking about rude behavior, can we agree that this would be problematic wherever it occurs, whether at McDonald’s or in medical school? That is not acceptable human behavior.

      3.They do mention positive peer and faculty interactions. Medical school is highly competitive, and student competition is toxic and leaves students feeling friendless. Don’t dismiss the importance of friendship for human happiness. Happy people are better doctors who are more empathetic, period. Achieving this without sacrificing academic achievement is a noble goal.

      4. With regard to positive faculty interactions- Graduate school is inherently massively power imbalanced- as a student, you consent to turn over your education to the school you agree to attend, and in exchange faculty have free reign to treat you as they see fit. Sometimes this works well, other times it doesn’t. I have had faculty go out of their way to make me feel stupid, and it just isn’t good pedagogy, and it is demoralizing. Instruction should be collaborative and focus on education, not be a power trip. Too often in medicine it falls short.

      5. 400 doctors a year commit suicide. Obviously the happiness of doctors is an issue and is important.

  2. I’m sorry but medical school challenges were never meant to be easy. I certainly do not want to be treated by a physician who has just gotten by at graduation. If medical school is to tough for today’s students maybe they should choose another career. Perhaps obtaining a PA degree or nurse practicioner degree would be abetter choice. If they think that medical school is tough they ain’t seen anything yet. Get a backbone and prepare yourself for even harder work and longer hours which you will certainly face in your internship and residencies. Problem with a lot of young people today is that they have been coddled their whole life. It’s time to face the real world of hard work, long hours, responsibilities and tough decisions.

    1. Well, I can imagine how comfortable medical school was in the 1980s-1990s. After all, there were like, 3-4 diabetic drugs to know, 1-2 HIV meds, and cancer drugs were likely nonexistent. Moreover, all doctors from that generation needed to learn in terms for charting was writing with a pen. Some never even learned how to type or use the EMR eventually and had to retire early… and yet, still talked big. If only they had to juggle with the vast amount of learning the current med students are going through, they would have been more sympathetic.

  3. The “Woke” kids of today are mistaking the difficulty of medical school with “mistreatment”. Medical school is hard. It’s just that simple. No one ever “mistreated” me during my training. I just had to work 120 hours a week (which can never even happen for today’s doctors in training due to limits on work hours, call etc.) during my residency. We are experiencing a generation of young adults who triggered by just about anything. Including apparently, the rigors of medical training.

  4. A lot of students, me included, are very grade conscious during preclinical years and have been vocal about asking for pass/fail grading but our admin has stated time and time again that they will never be for pass/fail due to them thinking that it promotes minimum effort needed to move on, so admin has to wrangle with student wellbeing vs their own internal analytics and how they perceive student effort. Not saying that it’s a simple solution, but both sides have end goals and opinions about how they think med school should be ran and oftentimes admin win despite outcry from students.

  5. My experience was from the late 70s, early 80s. My educational and professional experience in graduate school, prior to med school, was far more nurturing than anything I experienced in medical training. In contrast, with some exceptions, medical education, then at least, was more about intimidation. In grad school I was treated by the professors respectfully as a future peer; in med school, by the doctors, condescendingly like a child.

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