This month the IAMSE Publications Committee review is taken from the article titled This Isn’t Being a Doctor.”—Qualitative Inquiry into the Existential Dimensions of Medical Student Burnout, published online in Medical Science Educator, (July 2020) by Ye Kyung Song.
In a recent issue of Medical Science Educator I was drawn to an article about medical student burnout. The article, “This Isn’t Being a Doctor.”—Qualitative Inquiry into the Existential Dimensions of Medical Student Burnout, provides a unique method and perspective in trying to learn more about this critically important issue. In the current environment affected by a pandemic and the demonstrations demanding a reckoning for racial injustice sweeping the US, this article takes on an even greater importance.
Dr. Ye Kyung Song brings a unique perspective to this matter as a young physician who writes that she experienced burnout during her medical training. She adequately explains in the article text how she designed her study to mitigate any bias of her own experience clouding the results. Another unique aspect of this study is using a qualitative analysis of social media posts by medical students on the sub-Reddit forum – /r/medicalschool as the basis for the study. This is a common forum for students to anonymously post their perspectives. Many in medical education express concern about the “advice” that medical students may find in this forum. However, in this study it seems a reasonable place to find honest, evocative feelings expressed by medical students on this important issue. Even with the limitation that it is only the voices of those who choose to use this forum that are heard, the results offer a look into the feelings being expressed by current and recent medical students. As with much qualitative research, the richness of the data as seen through the direct comments in the posts and comments to those posts allows one to hear those voices and feel empathy for what those posting are feeling.
Searching the archives of /r/medicalschool posts for those using the word burnout or similar words, 352 posts were identified spanning the years 2009-2018. Using an inductive approach three themes emerged to account for burnout in medical students. These included meaninglessness, groundlessness, and existential isolation. In all these areas, analyses of initial posts and comments by readers clearly indicate that it is direct experiences within the learning environment that contribute to the feelings of burnout across the span of all 4 years of medical school. These stressors can include financial instability, feelings of being trapped in completing training after taking on significant debt, pressure to perform well in the preclinical years and especially on Step 1 as influencing the rest of their lives, perceived subjective grading in clerkship experiences and the pressures of performing well in clerkship while preparing for Step 2 examinations and applying for residency. While some have theorized that medical student burnout is due to an inability to confront suffering, death, and their own mortality during medical training, Dr. Song’s research suggests otherwise. She rightfully points out that burnout begins for many students in the preclinical years well before students confront such issues on a regular basis.
Directly addressing root causes of burnout as a systemic issue in the learning environment will not be easy. It does seem that it is an issue that the medical education community must confront. The end result would be graduating kind, caring, virtuous physicians that is part of why so many of us entered medical education. It is our way to do our part to better society.
Dani McBeth, PhD
Associate Dean for Student Affairs
CUNY School of Medicine
Member, IAMSE Publications Committee