In an era where half of U.S. physicians are, in some way, professionally burned out, medical program directors and administrators are looking for ways to prevent the current generation of medical students from meeting a similar fate—and they’re finding the problem might be rooted in education.
Physician burnout increases the risk of broken relationships, substance abuse and suicide. It can also have a profound impact on patient satisfaction and quality of care. We’ve known that for a while, Felix S. Chew, MD, and co-authors wrote in the Journal of the American College of Radiology, but many radiology practices still grapple with how to prevent or mitigate the issue.
“Although the prevalence of one or more components of burnout among diagnostic radiologists is unacceptably high, the prevalence among radiology fellows and residents seems to be even higher,” Chew wrote. “Today’s burned-out fellow is often yesterday’s burned-out resident and may become tomorrow burned-out radiologist.”
Chew, a fellowship program director at the University of Washington, joined a handful of other directors and deans from across the country to share advice on maintaining wellness and optimism among a demographic that’s almost predisposed to burnout. These are their suggestions:
Establish learning communities within medical schools.
At Vanderbilt University, where Amy E. Fleming, MD, MHPE, works as an associate dean for medical student affairs, connection is key. Fleming said she works with the Vanderbilt Colleges, four communities comprising two faculty members and 100 students, where all participants “learn and grow together longitudinally.”
Through the establishment of a student-led wellness organization that caters to the specific needs of Vanderbilt’s student body and facilitating activities that promote well-being, Fleming said her students can be better adjusted to the high-stress life of a medical student. The colleges offer team sports, cooking events, trivia competitions, dances, mindfulness training and art events, all of which lower stress and increase morale.
“Our students are incredible—full of curiosity, creativity and hope, with the intellect and grit to make a difference,” Fleming said. “Early in my career, I heard a colleague say, ‘Students enter medical school with a desire to change the world, and we beat the empathy out of them by the end of their third year.”
Devote curricular time to wellness.
Fleming said Vanderbilt also delivers a wellness curriculum within the learning community structure and offers designated curricular time to wellness activities, which “openly demonstrates institutional understanding that maintaining personal health and well-being is a necessary responsibility in a physician’s professional life.”
Students emulate what they learned in medical school once they reach residencies, fellowships and eventual jobs, she said, so it’s important to ground them in a sense of wellness.
Foster a supportive environment and encourage counseling.
“Well-being is multifaceted and complex and holds a different meaning for each individual,” Madelene C. Lewis, MD, a residency program director at the Medical University of South Carolina, wrote in JACR. “This inherently creates a challenge, because there is no ‘one-size-fits-all’ solution, initiative, program or curriculum to optimize wellness.”
Lewis said she tries to circumvent burnout by trying to overcome the stigma of mental health, offering counseling services that are available at all times and encouraging students to seek help when they feel they might need it. The university also trains its faculty to look for subtle signs of concerning behavior and refer residents to appropriate resources when necessary.
Stay cognizant of the sky-high standards students, residents and fellows are held to.
While ineffective leadership, scarce human resources and ever-shrinking budgets threaten the quality of radiology teaching programs, Jessica B. Robbins, MD, a residency program director at the University of Wisconsin School of Medicine and Public Health, said, national requirements are constantly demanding more of trainees.
“Some factors contributing to burnout are rooted in the institution, community or culture of healthcare in our country,” she said. “There are increasing expectations of a physician’s time and fewer resources to support physicians’ efforts.”
It doesn’t help that creating wellness programs or initiatives often requires chipping into an already-tight budget, she wrote.
Recognizing that’s what being asked of students is difficult—and providing them with strategies to cope with that stress—is important, Robbins said. It could also be invaluable to show praise and focus on trainees’ successes, rather than the conventional route of identifying only mistakes or possible improvements.
Make sure students’ voices are heard.
Chew said a lot of what contributes to the systemic issues of stress and burnout is beyond the scope of a program director, but that, as someone in a position of power, he’s able to keep fellows engaged in their work by asking for their input and opinions on administrative and clinical matters. He tries to give them as much autonomy as is practical for their education, he said.
“I can ensure that the fellows’ priorities and responsibilities are clearly understood, that the workplace is calm and safe, that the workload is fairly distributed and that everyone is professional in their conduct,” he wrote. “It is important that fellows feel valued and respected and have opportunities to maintain their work-life integration.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.