A series of studies published in The Journal of the American Medical Association (JAMA) in December 2015 remind us that physician burnout can and does occur among our medical students, residents, and fellows. Feelings of emotional exhaustion, lack of impact, and depersonalization of patients and staff have been observed among physicians-in-training for decades. In a large meta-analysis, researchers found that 21-43% of residents manifested symptoms of depression, compared with rates of 10-20% among practicing physicians. Other authors in the same JAMA issue addressed the psychological impact of the physical and mental rigors of physician training, as well as the sometimes negative impact of “pimping” (defined by Reifler as a series of questions that “… can allow teachers to assess their learners’ knowledge base and then gauge their further teaching accordingly”, and can have the benefit of “… learning to think quickly, handle the pressure of the spotlight, and develop stronger spines”).
The fact that burnout occurs among physicians-in-training is not a surprise for many of us; physicians of my generation (training 1980-1990) in particular recall all too well working 36 hours straight without sleep, working 29 of 30 days each month, and the constant self-imposed pressure to rapidly develop mastery of always new diagnostic and therapeutic skills. Indeed, the mantra at my august training institution in the early 80’s was proudly “the only thing wrong with every-other-night Call is that you miss half the admissions.” Thankfully, work-hour rules imposed upon residency training programs, and to a lesser extent fellowship training programs, over the last 20 years have somewhat reduced patient exposure to sleep-deprived junior physicians (students, residents and fellows), putatively improving patient safety at academic medical centers (AMC).
For academic medical centers pursuing better care experience for altruistic, financial, or brand reasons, creating burned-out junior physicians will be counterproductive. At Studer Group, we partner with attending and faculty physicians to create high-quality clinician-patient-communication skills for their physicians-in-training and a learning environment that is less likely to lead to burnout. As a result, patients get a better care experience. My colleague, Dr. Barbara Roehl, wrote an insight on the positive impact residents can have on patient experience. It includes two tactics that can have an immediate impact.
Mata DA, Ramos MA, et al. Prevalence of depression and depressive symptoms among resident physicians. JAMA 2015;314(22):2373-2383.
McCarthy CB, McEvoy JW. Pimping in medical education – lacking evidence and under threat. JAMA 2015; 314(22):2347-2348.
Reifler DR. The pedagogy of pimping – educational rigor or mistreatment. JAMA 2015;314(22):2355-2356.
George DR, Green M. Lessons learned from comics produced by medical students. JAMA 2015;314(22):2345-2346.
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