For Claire Lawlor, MD, a recent clinical fellow in pediatric otolaryngology at Harvard University/Boston Children’s Hospital in Massachusetts, becoming an otolaryngology resident at Tulane University in New Orleans “changed my life drastically.”
Explore this issue:August 2018
“The work hours are long and there’s tremendous pressure put on you by your program, and that you put on yourself,” said Dr. Lawlor, who is also chair of the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) Section for Residents and Fellows-in-Training. “There is very little time for hobbies or the interests that used to define you. There’s a real loss of your former self-identifiers. Plus, friends and family who are outside your field may not always understand—you miss weddings, family events, holidays, and, depending on the program you’re in, it can be hard to go home to visit when family is sick. The time commitments are vast.”
Such environments can foster burnout, a physical or mental collapse brought on by too much work or stress. And burnout at the early stages of a medical career can cause feelings of hopelessness about medicine and/or self, and lead to less empathy toward patients.
Burnout among physicians is growing. A 2015 study found that dissatisfaction with work and life balance among physicians increased from 2011 to 2014, with nearly 60% of the 6,880 physicians surveyed reporting they weren’t happy with their workload and personal life balance (Mayo Clin Proc. 2015;90:1600–1613).
It’s happening to earlier-career medical professionals, too. In a 2012 study of 1162 medical students surveyed annually from 2007 through 2010, researchers found that empathy levels decreased as students advanced through four years of medical school (Med Teach. 2012;34:305–311).
“It’s horrible—these students come to be healers and we squish empathy out of them,” said Sian Cotton, PhD, professor and director of the Center for Integrative Health and Wellness at the University of Cincinnati College of Medicine in Ohio.
Medical School Efforts
Burnout is discussed more openly today than even five years ago, said Dr. Lawlor. “There’s an increasing focus on it in medical school and training, in part due to a lot of well-publicized suicides of both medical students and residents. I think it is garnering the attention it deserves.”
Aviad Haramati, PhD, is the director of the Center for Innovation and Leadership in Education, co-director of the CAM Graduate Program, and a professor in the division of integrative physiology at the Georgetown University School of Medicine in Washington, D.C. Through the mind–body medicine program, the medical school offers students stress management skills training, such as meditation and guided imagery, and other programs to foster self-awareness and self care. Since 2002, the program has trained faculty within Georgetown and other institutions.
“I am a firm believer that medical schools need to create curricular interventions to help students develop the skills,” said Dr. Haramati. As part of the course at Georgetown, groups of students and faculty meet weekly to discuss their challenges. “They begin to realize they aren’t alone, and that they can begin to get over the discomfort of studying all the time to be successful.”
The program gives students necessary interventions that makes self-care easier to implement. “We aren’t taking away stressors; we are giving them the tools at hand,” said Dr. Haramati. “We aren’t babying students; we’re inoculating them with a vaccine that gives them tools, permission, and role models, so they can approach their careers and deal with life and death on a daily basis.”
What Is Unique to Medical Students and Residents?
What’s going on at the preclinical education level? For people used to being academic superstars in college, it can be challenging to get to medical school and realize that everyone around them is also a top-performing student. “The level of responsibility in our culture is jam-packed, and people find they are not necessarily at the top any more,” said Dr. Cotton. “It’s a pressure cooker, and often a very stressful learning environment.”
How Faculty Can Help
With generational shifts, faculty are more in tune with trainee wellness, where the topic wasn’t discussed 20 years ago, said Peter M. Vila, MD, MSPH, chief resident in the department of otolaryngology-head and neck surgery at the Washington University School of Medicine in St. Louis, Mo., the immediate past chair of the AAO-HNS section for residents and fellows (SRF). “There’s a cultural difference in that the Baby Boomers generally don’t talk about difficult things; they stoically get through them and hold it in, and it’s gotten away from that,” said Dr. Vila. “The next generation of faculty realizes it’s OK to get stressed out, but more importantly, it’s OK to talk about it.” He cited his resident advisor Craig Buchman, MD, as a model of resiliency. “He has shown that you can still be a fantastic leader and be a reasonable person and not exude stress on anyone else, and still function at a high level,” Vila said. “He’s an incredible role model to shoot for.” This is an example of what Dr. Haramati describes as faculty helping through modeling desired behavior.
All faculty should be aware that burnout is an issue, said Dr. Lawlor. “The more that faculty become familiar with it, the more they can check on residents, the better.” While in fellowship at Harvard/Boston Children’s Hospital, Dr. Lawlor said that checking in with trainees was part of the program director’s responsibility. “That person was very good at asking if I was enjoying myself, how was my family, and knowing he was thinking about me made me feel supported,” she said.
Cheryl Alkon is a freelance medical writer based in Massachusetts.