September 21st, 2011
Modern society is becoming increasingly frantic. If we are not rushing to get somewhere, we are reading headline news or replying to text messages, in between preparing our next tweet and Facebook post, while planning how we can afford an iPad, get fit, feed ourselves, pass our exams and see our friends; I could go on.
Photo by chris@APLStress has become an acceptable cliché, ignored by most and discarded as normal by most medical students and junior doctors alike.
In the United Kingdom, studies have determined that the proportion of medical professionals demonstrating above-threshold levels of stress is around 28%, compared to around 18% in the general working population. The British Medical Association (BMA) has estimated that one doctor in 15 could develop a dependency on alcohol or drugs at some point in their career.
So what’s the moral of this research? Identify when you are being affected by stress and tackle it early. Sara Williams and Gareth Gillespie have written an article in MPS’s signature journal Casebook exploring the indicators of stress and how to tackle it in the medical world – you can read it here.
MPS has also launched a worldwide counselling service for members, to provide support in times of work-related stress. It is available to members who have experienced an adverse incident or medicolegal issue and are experiencing emotional or psychological difficulties. For further information contact MPS at 0845 605 4000 or querydoc [at] mps.org.uk.
September 25th, 2010
Take our quiz below to check if you are experiencing features of burnout. Tick the number of questions you answer yes to, then see what your score means.
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What does your score mean on our burnout self assessment?
- 0-4 Minimal signs of burnout as a student.
- 5-8 There are some factors here supporting a level of burnout.
- 9-12 You are exhibiting several features of burnout, and this could become a serious problem.
- 13+ You are exhibiting multiple signs of burnout. Talk to someone, soon
Now, see how you score against other medical students by entering your score below and clicking submit:
What can you do about burnout?
Nina Feghali, A General Practitioner and Contributor to Medical Educator gives her opinion. Nina was not involved in the construction of the burnout survey.
“If you are concerned you have burnout, the first thing is to talk to someone: be it a friend, colleague, fellow student, member of family, personal tutor, head of year.
It’s generally going to be up to you to make that judgement, as to who is going to be the most appropriate person. Don’t shy away from this and if you do recognise signs of unprofessional behaviour, this is even more important. Acknowledging there is a problem is often the first step to solving it. Whilst I am always sceptical of self-assessments like this, they can provide important pointers. The example presented here simply tests a number of constructs associated with burnout. Remember burnout is common (over half the students studied in the JAMA paper), but it has also been linked with suicidal ideation, and a lack of empathy, and here, poor professionalism. Think carefully about this, and seek help if you are concerned.”
Disclaimer: This is an informal score, intended for medical students, and does not represent medical advice. This score has not been validated, but it is free to use, and modify. This means you can use it yourself under a Creative Commons Licence (Attribution-Non-Commercial-Share-Alike). This means you can use it, edit it and share it, as long as you acknowledge the original source.
September 25th, 2010
Image credit: freedigitalphotos.net
We have recently featured an article from the respected Journal of the American Medical Association, JAMA in our blog. This highlighted the important issue of ‘burnout’ amoung medical students, found in upwards of 50% of those studying in the US.
We thought we would offer some thoughts on burnout for you, a view from a general practitioner, and an option to answer some questions to see if you are exhibiting features of burnout.
What is Burnout?
Burnout is the term given to long term physical and emotional exhaustion, and a lack of interest particularly related to an individual’s occupation (we consider this to be ‘being a medical student’).
Its simple to think of burnout as the consequence of long term professional and social stresses that are signs that you may be struggling as a student. Important? Yes, as the suggestion from the research in the US is that students who are suffering from burnout (as opposed to depression and other medical problems) are more likely to behave in an unprofessional manner. This is a real concern, given the penalties and problems associated with this behaviour in both the short and the long term.
Why is burnout important?
Interestingly, and perhaps surprisingly the research evidence suggests that students who are suffering from other medical problems, such as depression, are no more likely to engage in unprofessional behaviour (e.g. cheating) than compared to other student’s not suffering form that ailment. This is not the same for burnout. When you consider things, its perhaps unsurprising that the we struggle with openness and candour when you are struggling mentally with your medical school burnout.
How do I know If I’m experiencing burnout?
Unfortunately the best validated burnout tests are not available freely, so we can’t offer you a validated scoring system here! Nevertheless, instead of taking a validated self-reported test, we are giving you the opportunity to work through our own simple checklist, which has the advantage of being tailored especially for medical students. Its quick, free, and you can take it here.
September 20th, 2010
A recent paper in JAMA, the journal of the American Medical Association has found that over third of students with ‘burnout’ had 1 or more ‘self reported’ features of unprofessional behaviour, significantly more than their colleagues not exhibiting these features. Examples included copying other students work, misrepresenting examination findings, and essentially cheating in closed book medical examinations.
As responsibilities of student in the US could be argued to fall above those in the UK (whose work is almost always supervised and duplicated by qualified personnel) these findings are concerning, but perhaps we need to be worrying more about the students than the patients at this stage. The paper handles this issue well, and rather than focusing on sticking the scalpel into students who are clearly struggling the authors make some very sensible conclusions. The following excerpt fits in with the overall tone of the report. Researches used composite self reported measures including depression scores and quality of life indices.
The fact that students frequently engage in dishonest behaviours despite knowing they are inappropriate may imply that some elements of the learning climate foster dishonesty. This could lead to a situation in which students are more willing to falsely report physical examination findings than admit they performed an incomplete examination. In addition to students’ fear of poor evaluations and a desire to fit in with the team,9 this study suggests that burnout may be another important variable contributing to unprofessional behaviour
The first conclusions we draw reading the report is credit to the authors to allow students to actually report these items: admission of guilt by cheating in a closed book exam is professional misconduct that could end the career of a medical student in Europe or the US, and all the student’s we have spoken to today were surprised students would report these attitudes, even anonymously. The method of determining burnout although robust, is not the point here, the message from the paper speaks clearly: students that are struggling are more likely to fall on the wrong side of professional expectations.
Interestingly the behaviour also related to patient care: such as essentially lying about a test that may not have been requested, or documenting an examination as ‘normal’ which had not in fact been done.
Although students recognize cheating and dishonest clinical behaviours as unprofessional,5-7 feel guilty about engaging in these behaviours, and believe that the behaviours may make them a less trustworthy physician, a relatively high prevalence of unprofessional conduct related to patient care was reported by students in this study.
These things in their own right are small comments, and perhaps not quite the crime they initially seem. If a doctor is filling in a proforma where they ‘have’ to document a certain finding (paper or online) then it is inevitable that at times it is necessary to cut certain corners to deliver the care to the patients. There is a very fine line between poor professionalism and living with the reality of ‘real’ clinical care. What of the student being asked of the Professor of Hepatology if they have counted and charted the location of splinter haemorrhages on the patients fingers. Yes? Or the request for an obscure immunology request (‘I’ve done it’), or the “you do know how this new biologic drug works don’t you?” (no I haven’t a clue but I’m clearly not going to tell you that now Prof).
As such this study perhaps represents a wake up call to those physicians and trainers both teaching and looking after/out for medical students on a day to day basis, and from our own experiences as educators we will conclude with a few lines of verse.
Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.
Poor chap, he always loved larking
And now he’s dead
It must have been too cold for him his heart gave way,
Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.
Stevie Smith, “Not Waving but Drowning”, 1957