Physician burnout impacts doctors in all clinical areas and at all levels. And much of the recent focus is given to the ill effects on medical students and residents.
There’s significant belief that students and residents are impacted due to their lack of understanding of the pressures of practicing medicine and the difficulty of navigating these new challenges. Medical school introduces stress that they never previously endured.
According to the American Medical Association (AMA), 100 medical students commit suicide each year and the AMA has adopted a new policy to help predict and prevent these unnecessary deaths. Burnout is a primary factor — studies published this year in Academic Medicine and the Journal of the American Medical Association (JAMA) showed that more than a third of trainees are currently experiencing depressive symptoms.
This is an issue, which is why administrators at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell have implemented wellness programs to alleviate stress among its students, as well as strategies to help identify candidates who have grit and empathy during the application process.
“These are highly functioning people,” said David Battienlli, MD, Northwell Health senior vice president and chief medical officer, and dean of medical education at Zucker School of Medicine. “There is a lot of pressure to perform. It’s very competitive. Most of these students were at the top of their class, in the top one percent.
“There are a lot of people, myself included, who think people who apply to medical school don’t really know what medical school is. The toll that death takes on people, and the stress and demands of taking care of sick people can be very overwhelming. Patients don’t care that you see 5,000 other patients. To them, you only have one.”
Data from the Association of American Medical Colleges suggests that burnout starts to emerge between the start of medical school and a student’s second year, when the average amount of sleep drops from 7.7 to 4.8 hours each night.
The Zucker School’s cure starts with its innovative approach to medical education — rather than teaching to the test and focusing on memorization, the Zucker School rewards practical experience, making it a less-competitive environment in a supportive, pass-fail curriculum rather than grades.
“They compete against the standard of excellence, not their peers,” Dr. Battinelli said. “When we started our school, we only mandated 20 hours a week of class time as opposed to a lot of other places that require significantly more.”
The Zucker School of Medicine also provides debriefing and counseling resources for students feeling overwhelmed, especially after stressful experiences such as their EMT training during the early months of the curriculum.
The Zucker School of Medicine has also celebrated wellness among its students. Dr. Battinelli said they survey classes to evaluate morale, needs and resiliency. Programs are then curated and offered accordingly.
“We get student affairs deans involved,” he said. “We get a lot of compliments that our students seem happier and less stressed than most students. That doesn’t mean we still don’t have a ways to go. When they leave our school, they are thrown out into the rest of the world.”
He said one of the more popular surveys has been about empathy skills.
“When they come to us, they are the most idealistic, committed and empathic people in the world, but we have excellent data that shows medical school changes them,” Dr. Battinelli said. “When you survey students about what they want, the results never say wellness classes or tai chi, they want extra time off. They want to see their friends.”
Make no mistake, medical school is tough and much different than what students were used to before they started. If they were unaware of the amount of work and challenging situations, it begs the question, shouldn’t these individuals be weeded out before enrolling?
Dr. Battinelli says it’s not that simple. Typically, 30-40 percent of students who apply are enrolled.
“If you look at athletics, there are only a couple Tiger Woods-types who have the whole package,” Dr. Battinelli said. “You must have some grit to be the valedictorian of your class. Hopefully, they have some empathy. We make the assumption that they have the grit, but there isn’t a way to measure it. There are a number of ways of looking beyond being No. 1 in your class — you’re three-lettered in sports, an Eagle Scout and an orchestra-qualified violinist. Everybody would like a more holistic person.”
The interview process segregates the highest scoring individuals. However, flaws in the system can lead to obscure results. “Often, interviewers are trying to select people who are like them,” Dr. Battinelli said. “You are more comfortable choosing someone who has a similar work ethic and personality because you expect the same productivity that you do from yourself. We moved away from that and moved to the MMI -- the multimodality school interview.”
During the interview, prospective students rotate through eight stations, spending a few minutes at each. They are given the same scenario and are scored based on responses.
One situation could detail an elderly lady who takes five medications. Evaluators are looking at how the student approaches the conversation and deals with the patient when questions arise.
“You can determine grittiness and empathy, and see how they explain it to her,” Dr. Battinelli said. “Some lose their cool. We try to put them in these stressful situations, where there isn’t a good answer, so we can identify who can deal with the stressors of school and practicing medicine. This way, they aren’t destined for burnout or failure.”