Now, research presented at the 2018 European Psychiatry Association congress indicates that mental health problems often arise far earlier in a physician's career. A meta-analysis of over 16,500 medical students lead by Ariel Frajerman, a medical doctor at the Centre Hospitalier Sainte Anne in Paris, found that 45.8%, or almost half of all medical students, suffer from a burnout before they even begin their residency. We talked to Frajerman to find out what's causing these alarming burnout rates and what changes need to be made to reduce the pressure on medical students.
Morressier: What are the main symptoms of a burnout?
Frajerman: Burnout occurs when three categories of symptoms combine. The first is emotional exhaustion, where students feel drained of emotional resources and experience extreme fatigue due to continuous exposure to stressors. The usual rest periods are not enough to relieve this fatigue, which then becomes chronic. The second is depersonalization, when the attitude of the individual becomes negative and detached from their work and the people around them. This then leads them to reduce their investment in their work and develop pejorative, cynical conceptions about the people they are working with. The final symptom is reflected in the sufferer's feeling of personal accomplishment. They have low self-esteem and, despite their best efforts, they believe they are ineffective in their work and not up to the job.
Morressier: Did you find geographical differences in burnout rates?
Frajerman: In our meta-analysis, the highest prevalence of burnout rates is in Middle East, and the lowest is in South America. Additionally, medical students are more likely to burnout if they are located in the United States than in Europe.
Morressier: What are the limitations of your study?
Frajerman: One limitation of all studies into this is the honesty of the study participants. Previous studies have shown that medical students had difficulty admitting when they are not doing well for fear of being stigmatized. This could lead them to lie in questionnaires, resulting in an underestimation of the prevalence of burnouts.
Morressier: What do you think are the main causes for medical students to burnout?
Frajerman: Burnouts do not occur as the result of a single cause. The main factors contributing to burnouts in medical students include workload, the stress related to the competition and the significance placed on successful exam results, the brutality of the hospital environment, including bullying between staff members, and the lack of consideration of students.
Morressier: What could be done to help reduce stress levels and burnout rates?
Frajerman: There is no one cause of a burnout, and there is no single solution. In my opinion, the first step would be to consider the students as human beings endowed with emotions, who can suffer, and to set up structures of psychological support in every medical faculty to help with orientation. These support structures should be available to all students in all health facilities and guarantee full confidentiality.The second step is to reduce the workload and adapt the examination modes – several studies have found a decrease in stress levels when deleting rankings. The third is to train hospital doctors and teachers to learn how to behave better towards students and to recognize the symptoms of students in distress. Finally, we should consider specific interventions, including Cognitive Behavioral Therapy, hypnosis, and relaxation to help students fight against burnout.
