By PAULINE W. CHEN, M.D.
Published: October 30, 2008
Not too long ago, I read a paper titled “Burnout and Suicidal Ideation Among U.S. Medical Students” in The Annals of Internal Medicine. It brought back a flood of memories.
Medical school was not easy for me. I knew that I wanted to become a doctor to help people, but I had given little thought to the process. I was poorly prepared for many things: the pressure to excel in ways that seemed so far from caring for people; rapidly mounting debts I signed off on every semester; a roller coaster existence from chronic lack of sleep; hazing from the more experienced students and residents; and the realities of patient suffering despite my best efforts.
Even surgical residency, despite the relentlessly long hours, seemed so much closer to what I wanted to do.
Some of my professors tried to “humanize” the process. They invited us to dinner in their homes, supported our extracurricular efforts to set up health screening clinics in low-income neighborhoods, and tried to make our basic science courses more relevant to working with patients. But sitting where I am now, as someone who teaches medical students and who loves helping others as a doctor, I can understand the challenge they faced. Given the fire hose of information medical students must learn in just four years, how does one ever gently take a sip?
Despite my teachers’ efforts, I was about as miserable in medical school as I had ever been. I felt alone. Neither I nor my classmates could admit to failure, and the last thing I wanted to do was to let anyone but my closest friends know just how unhappy I was. Success in medical school was the first step to a future of helping others, and I was not about to jeopardize that.
Last week I had dinner with two former classmates from that time. We had not seen each other in over a decade, and after catching up on personal news and reminiscing about gross anatomy lab and our first nights on call, one of them said quietly, “I hated med school. I wanted to quit.” The elephant in our collective memories had broken free.
With that elephant now running loose, and the three of us more comfortable with our own professional accomplishments, the conversation grew more honest. “If you look over my entire lifetime,” my other friend said, “those four years were the lowest point in terms of self esteem.” He held his hand out in the air, plotting an imaginary line that dropped precipitously to his knees.
It took nearly 20 years for the three of us to learn that we had each been miserable as medical students. It has taken even longer for researchers to discover the extent to which such feelings exist among American medical students.
In 2006, Dr. Liselotte N. Dyrbye and her colleagues at the Mayo Clinic found that nearly half of the 545 medical students they surveyed suffered from burnout, which they defined as professional distress in three domains: emotional exhaustion, depersonalization and low sense of personal accomplishment. Moreover, the researchers found that each successive year of schooling increased the chances students would experience burnout, despite the fact that they had entered medical school with mental health profiles similar to those of their peers who chose other career paths.
More recently, in the paper on burnout that had first caught my eye, Dr. Dyrbyre and her colleagues widened the scope of their research, analyzing survey responses from 2,248 medical students at seven medical schools across the country. Again, nearly half of the students surveyed met the criteria for burnout. But the investigators discovered an even more ominous finding: 11 percent of all the students surveyed also reported having suicidal thoughts in the past year.
Dr. Dyrbye notes that we are just starting to learn about the high levels of distress in medical students. “It’s incredibly disconcerting,” she said. “What are the causes? And what can we do as educators to facilitate their well-being? We need a better understanding of the causes of stress to design interventions that will help improve student wellness. Students, just like doctors, need to take care of themselves in order to take care of their patients.”
Medical schools have more recently recognized the importance of this issue. For example, the Liaison Committee on Medical Education, the accrediting authority for medical schools in the United States, now mandates that all schools have a program for student wellness in place that includes “an effective system of personal counseling for its students.”
But beyond the personal implications, what are the ramifications of medical student burnout for patients?
In a third study, Dr. Dyrbye found that when tested for empathy, medical students at baseline generally scored higher than their nonmedical peers. But, as medical students experienced more burnout, there was a corresponding drop in the level of empathy toward patients.
“What do they really need to know before graduating from medical school, and how could they most efficiently learn?” Dr. Drybye asked, reflecting on one of the central challenges of medical education. “All the information we want to share with them is not necessarily what they really need to learn.”
By the time my dinner with my former classmates last week had ended, we had made plans to stay in touch and to do something I had never been sure I would ever do: return to my medical school in two years’ time to celebrate our 20th reunion. Over the course of our dinner conversation I felt strangely connected and nostalgic about medical school; I was deeply moved by what my two classmates had chosen to do with their education. One is a well-loved community obstetrician/gynecologist; the other is a psychiatrist devoted to teaching, working in a county medical clinic and caring for severely traumatized Hmong refugees. And both love their work as doctors.
As I listened to them talk about their work, I was reminded of one other thing Dr. Dyrbye had told me. “We need to change things,” she had said, “because maybe the students who are most vulnerable are the ones who are most empathic.”
Master of Arts in Bioethics Wake Forest University
Bioethics addresses ethical and policy issues raised by the biosciences and their applications, reaching from the laboratory to health care delivery to industry and government, affecting both individuals and society. The MA in Bioethics at Wake Forest University will equip graduates to practice, teach, or conduct research about bioethics — as integral to the work of health care, biotechnology, and the basic sciences. The MA provides an educational opportunity at the graduate level for current and future professionals, including health care providers, researchers in biomedicine and the life sciences, lawyers, and professionals in religion, health and research administration, and the biotechnology industry. The program has two characteristic emphases – Bioethics in Social Context and Bioethics and Biotechnology.
Applications for Fall 2009 are being accepted now. Full-time students can complete the degree in slightly less than a calendar year. Part-time students have up to 6 years to complete the 30-hour degree.
For more information, contact Brad Tharpe at bioethics@wfu.edu or 336-716-1499.
Brad J. Tharpe, MDiv
Associate Director
Master of Arts in Bioethics
2000 West First Street
Piedmont Plaza II, Suite 204
Winston-Salem, NC 27104
brtharpe@wfubmc.edu
p (336) 716-1499
f (336) 716-7554
If you plan on coming through the Prehealth Committee for DECEMBER 1, 2008 in support of your UB Medical School Early Assurance application (Early Assurance to UB’s School of Dental Medicine and SUNY Upstate Medical Early Assurance can use the April 1, 2009 Committee deadline), please carefully read the following information. Again, you will need at least 4 individual letters of recommendation by DECEMBER 1, 2008.
Please turn in your materials to Virginia Majewski in 109 Norton Hall. Her phone is 645-6012; email – vmajewsk@buffalo.edu. You will need to set aside at least 10 minutes so that she can review your packet with you. Please do not simply drop off your materials to the office and leave.
YOU ARE SUBMITTING:
1) A printed copy of the Prehealth Committee Application and/Data Sheet
2) Unofficial Transcripts from UB (My Grades off of MyUB) and any transcripts from transfer work.
3) Items #7-9 from the Prehealth Committee Application/Data Sheet. Please type out “resume style”
4) Personal Statement - #10 on the Prehealth Committee Application/Data Sheet
5) Be sure to read and answer appropriately #12 on the Prehealth Committee Application/Data Sheet. Please be sure to read the question carefully and contact us if you are unsure how to answer it. You want to report any disciplinary action/academic integrity issue regardless of whether you completed the required community service hours or regardless of whether you applied for the record to be expunged or you believe any record has already been expunged.
6) $40 fee.
7) A black and white headshot (passport size photo).
The ONLY materials sent on to the professional schools from our office include your individual letters of recommendation and Prehealth Committee composite letter. We do not forward your essay, Prehealth Committee application, photo, transcripts, etc.
The SRC in 232 Capen must forward your official transcripts to the individual medical school.
Setting the Interview
Once you have submitted all your materials and have at least four letters in, you will be assigned a Prehealth Committee interviewer. In 3-5 days, you will be emailed your interviewer’s name and contact information. It is important that you contact this person promptly. They will be expecting to hear from you to arrange the date and time of your interview.
Please do arrive more than 10 minutes early for your interview but strive to be on time.
Please do not ask us to accept your application past the deadline or assign your interviewer without at least 4 letters by December 1. Doing so holds up the process for the entire pool. Our goal is to complete all letters by February 1, 2009.
Vanderbilt Medical Center offers seven programs under the umbrella of the Summer Science Academy. A student can apply to up to 3 different programs through the on-line application system. Please review the website and use the contact information below if you have any questions.
For questions, please call or contact:
Tom Oeltmann, PhD, Biomedical Research, Education, and Training
340 Light Hall
Vanderbilt University School of Medicine
Nashville, TN 37232-0301
Phone: 615-322-7368
FAX: 615-343-0749
St. George’s Med/Vet Summer Academy offers 10 day premedical and preveterinary didactic lectures, small group problem solving sessions, practical lab work as well as hands-on training through simulated and real life situations. The expereince is further enhanced by several educational off-campus excursions including snorkeling, dolphin watching, hiking and island touring. Qualifying participants will also receive college credit through St. George’ School of Arts and Sciences for participating in lectures and clinical work.
College Session (age 18 and older) Monday, June 8 through Wednesday, June 17, 2009
The 10 day program cost of $1800 includes housing, meals, medical instruction and activities (excluding the optional scuba diving option) and all transportation while in Grenada. More details and the application can be found off the link provided at the beginning of this posting.
The Weill Cornell Medical College will conduct a seven week program for 25 premedical students from diverse backgrounds who have a major interest in working with underserved populations, and will have completed their JUNIOR year of college. The program provides an opportunity for the student to do an independent study-research project under the supervision of a faculty memeber, and to become acquainted with clinical and public health aspects of medicine that have a particular impact on underserved and minority populations. Information on the program can be found at the link provided.
It is not too early to be thinking about summer clinical and research opportunities in health care settings. Please check this blog often over the next several months as numerous opportunities tend to surface in late fall/early winter. Also, many programs have late winter/early spring deadlines.
JUST ANNOUNCED - For opportunities in research at Case Western in Cleveland, Ohio as well as at associated medical facilities in the area, please click on the link.
The Department of Emergency Medicine is looking for a clinical data collector to work in the Erie County Medical Center Emergency Department located at 462 Grider Street. The clinical data collector will be responsible for identifying any emergency department patients who meet inclusion criteria for on-going clinical research. The data collector will be responsible for interacting with patients and emergency department staff to gather relevant study data. The data collectors will also screen all female patients for domestic violence and will present all patients with care satisfaction surveys.
The shift(s) that will become available are: Saturdays 8a-4p starting November 29
The shift from 4:00 p.m. -12:00 a.m. Monday has been filled.
The pay is $7.50 per hour and assigned shifts are constant. If you are interested in this position please forward resume to Liana Dypka at ldypka@ecmc.edu
The School of Medicine of the University of Queensland, Australia, has joined with Ochsner Health System in New Orleans, Louisiana, to create a medical education program for qualified students leading to the practice of medicine in the U.S.
Please note the accreditation review status at the end of this posting.
Applicants must have achieved a solid GPA and 8/8/M/8 minimum MCAT score. Admitted U.S. students will study two years of preclinicals at The University of Queensland School of Medicine. They will then spend two years in New Orleans, Louisiana at Ochsner Health System, completing their clinical education. Upon satisfactory completion of the four years, students will be eligible for ECFMG certification, to take the USMLEs, the NRMP match, and, subject to meeting other state and federal criteria, eligible for licensure and to practice medicine in the U.S.
The University of Queensland was founded in 1936 and it is renowned globally as an award-winning research institution of excellence and rigor. The standards of the accreditor of Australian medical schools, the Australian Medical Council (AMC), are held by the U.S. Department of Education as comparable to the accreditation standards for U.S. medical schools.
The Ochsner Health System has a nationally recognized forward-looking clinical delivery system, anticipating the medical needs of the future. Ochsner is highly regarded for the quality of its patient care, clinical services and as an independent Academic Medical Center. At Ochsner students will have the distinct advantage of a well supervised and cohesive clinical experience.
To learn more about the program, please click on the link forth website (above) or call 1-877-777-0155.
If you feel are a qualified candidate, please go to the program website, or feel free to contact U.S. representatives:
Admissions
International Pathways
163 William St.
New York, N.Y. 10038
1-877-777-0155
admissions@mededpath.org
Sincerely,
Professor David Wilkinson, University of Queensland,
Head of School of the University of Queensland School of Medicine
Dr. William Pinsky, Ochsner Health Systems, Chief Academic Officer
Important Message Regarding Accreditation:
This M.B.B.S. program (with 2 years of pre-clinical education at University of Queensland in Australia and 2 years of clinical instruction at Ochsner in Louisiana) (the Program) is subject to approval by the Australian Medical Council (AMC). The University of Queensland has submitted to the AMC an application for accreditation of the Program. Until the AMC completes its review of the Program, Queensland will accept students eligible for the Program into Queensland’s four-year M.B.B.S. program in Australia. In the event that the AMC does not timely accredit the Program, students who enroll will be expected to complete their four-year medical education at University of Queensland in Brisbane.
