The Potential Consequences of Burnout in Med Students

A new study finds that medical students in the US are prone to burnout, and when they feel this distress, they are more likely to engage in unprofessional conduct. Although stressed out medical students rarely engage in academic dishonesty, they may short-cut aspects of patient care, such as reporting a test result as normal when they actually omitted the test, according to research published in the Journal of the American Medical Association.

The survey of 2,682 medical students from seven US medical schools also found that students experiencing burnout had less altruistic views about physicians' responsibility to society, including less desire to provide care for the medically underserved.

"Although students recognize cheating and dishonest clinical behaviors as unprofessional, feel guilty about engaging in these behaviors and believe that the behaviors make them a less trustworthy physician, a relatively high prevalence of unprofessional conduct related to patient care was reported by students in this study," said the authors, who include David Power, MD, MPH, director of medical student education at the University of Minnesota Medical School in Minneapolis.

According to the study, more than half of the surveyed students were experiencing burnout, based on their measures of emotional exhaustion, depersonalization, and sense of personal accomplishment as assessed by the Maslach Burnout Inventory.

Very few students reported academic dishonesty, such as copying from a "crib sheet" or taking credit for another person's work, the authors said. But many students reported dishonest clinical behaviors; for example, they reported a physical examination finding as normal when they had skipped it entirely.

As a group, students with burnout were more likely to have engaged in one or more unprofessional behaviors than those without burnout, the study said.

"It was rare for any students to engage in clearly unprofessional activities like cheating or blatantly lying—and, of course, this is reassuring for us all," Power said in an online article. "Some of the more subtle behaviors, like documenting something that did not actually occur, are certainly of concern.”

Family physician George Harris, MD, MS, assistant dean for year one and two medicine at the University of Missouri-Kansas City School of Medicine, said in an AAFP News Now report that he has observed burnout in students, noting that it usually seems to appear in the third year of a traditional four-year medical school curriculum.

"Students feel emotionally, physically and mentally worn down," he said. "They feel emotionally and mentally displaced from those around them. Fortunately, during the last year of medical school, most of them reconnect with their environment; and their underlying beliefs, values and attitudes re-establish themselves, and their altruistic views resurface."

Both family medicine educators said medical schools need to attend to noncognitive aspects of their students, including their personal lives, emotional well-being and overall psychosocial health.

"It is important to identify students early in their medical education who are experiencing signs of depression, unresolved parental separation, academic difficulty, limited peer interaction, poor coping skills and personal difficulties," Harris said.

For more information:

• Unprofessional Conduct Among U.S. Medical Students Linked to Burnout, Study Finds
• Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students
• Medical Students and the Depression Stigma

Do you think that enough is being done to address the potential dangers of burnout among medical students? What actions do you think need to be taken?