Written by: Emily Orille, DO; is an emergency medicine doctor andassistant program director; and also sits on the Wellness Committee at McLaren Macomb Hospital in Mt. Clemens Michigan.
Medical student and resident burnout are caused by many factors and likewise prevention of burnout is accomplished through many factors. If we consider burnout to be a condition with emotional, mental, and physical exhaustion, we need to look at the various causes of each and what toll they take on a person’s wellbeing.
Medical students and residents are consistently in stressful situations. Simply the interpersonal relationships of the medical team and the hierarchy in health care can put emotional stress on a person. Providing medical care to sick and dying patients and having discussions with family and patients regarding this care is emotionally exhausting as well.
Having a trusted support system is crucial for medical students and residents. This support system can consist of people that are both medical and non-medical and that are available to talk, vent, decompress and listen. Having someone that can understand and relate to the emotional stress of medicine is key. Having an outlet to discuss the feelings and struggles one faces caring for patients, making critical decisions, performing procedures, and even making mistakes, helps a person process the daily assault on their wellbeing without a detrimental buildup of emotional stress.
A mentor can help immensely in processing difficult events and offering advice and guidance. A mentor is preferably someone who is also in medicine and can provide support through a relationship cultivated over many years. Making time to unwind and step away from the emotional strain of medicine is also important. Spending time with people who build you up, force you to enjoy life away from medicine, and engage you in activities that bring you enjoyment is helpful as well.
Mental exhaustion is an unsurprising consequence of the extreme cerebral demands of medicine. The sheer quantity of information that is available, and often expected, to be retained by students and residents is enormous. The hierarchy of medicine almost always ensures that there is someone on the team asking questions and demonstrating their superior knowledge to students and residents. In many cases, teaching occurs when the questions are answered wrong after someone has been put on the spot, often in front of a group.
After clinical and practical education there is a vast amount of book knowledge available to students and residents to occupy what is left of their daily time. Students are residents are often taxed with multi-tasking, quick changes from one task to the next, and erratic schedules which all lead to greater mental stress.
To help alleviate this stress, determine your most efficient and effective means of studying and knowledge retention. Use your time wisely and set schedules, limits, and goals, and stick to them. Schedule your study time and your break time as you would schedule an appointment or a clinical shift. Use the tools that work best for you to retain knowledge whether it is apps on an electronic device, note cards, or otherwise.
Remind yourself that you will never know it all and neither will anyone else. It is entirely acceptable to admit you do not know the answer but that you will learn more and be ready to discuss the answer the next time. Stay focused on your goals and your process to achieve them.
Decreasing physical stress to prevent burnout may be the easiest to discuss, however the hardest to implement. Medicine is a twenty-four-hour job and the physical stress on the body of impaired sleep scheduling is large. Often sleep is disordered both in duration and routine. Our bodies need consistency and quantity in sleep. Doing your best to prioritize sleep is essential to performing your best, retaining knowledge, and staying sharp.
Physical health also includes exercise as a physical way to keep your body strong, active, and healthy. Often exercise can allow an outlet for stress as well. Physical health also necessitates a healthy diet with regular meals and adequate hydration.
Although difficult when working long hours with few breaks, a healthy diet is essential to maintaining wellbeing and optimal mental performance and preventing illness. Prioritizing and planning your meals beforehand can help ensure you are getting adequate nutrition while away from home on long days.
Physical wellness also requires medical care, dental care, psychiatric care, etc., and the time to schedule that care. If you can’t maintain your own physical health how can you then help the physical health of your patients? You cannot pour from an empty tank. As many medical education groups are focusing more and more on wellness, advocating for your own components of wellness and health should be better received than it was many years ago.
Finally, reminding yourself of your initial motivation to pursue medicine can help alleviate burnout. Trying to think back and renew your original passion for medicine is helpful. Service to your community or an underserved population can remind you of the great opportunity you have to help people. Keeping a mental file of the instances where you felt you made a difference and were able to help someone a great deal helps you remember your successes. The times where someone recognized your effort and complimented your work validate your efforts and work ethic.
Above all else, a medical student or resident needs to be acutely aware of their own status on the wellness and burnout meter. When the needle trends toward burnout make changes. When you cannot do it on your own ask for help. Medical education comes with a great deal of responsibility to our patients but you must also remain responsible for yourself. There are resources available to all of us, no matter the level of training we are in, to help. Assess your own wellness regularly and reach out for help when needed.