Burnout in Health Professions Education

by Karli Kurwicki, Pharm.D., PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Burnout among healthcare students and professionals has been studied for many years. Burnout is typically caused by stress that builds over time and can cause students to have damaging thoughts about themselves, anger, frustration, and even depression. A student experiencing burnout might also develop paranoia and skepticism about their future, and this may lead to distrust in colleagues or mentors. Burnout contributes to poor mental health.

There are three dimensions of burnout: emotional exhaustion; depersonalization and cynicism; and a lost sense of personal accomplishment. Emotional exhaustion occurs when a student feels indifferent towards the outcome of school work. Students may feel apathy toward studying so they perform poorly on tests and other assignments. Depersonalization and cynicism typically occur after the student has developed emotional exhaustion. Cynicism causes the student to have negative feelings towards school work and their profession. A decreased sense of personal accomplishment causes the student to feel incompetent. These feelings can ultimately lead to depression and impact the student’s emotional well-being. Many healthcare professionals and students feel a stigma with admitting they are depressed because there are negative connotations towards mental illness, even among those who work in the medical field. Students often see depression or anxiety as a weakness.¹

Marshall et al² investigated stress, quality of life, and burnout among pharmacy students attending a US pharmacy school. Third-year pharmacy students filled out a questionnaire that asked about stressors, how the students handle stress, and health-related quality of life over the previous four weeks. Female students had higher perceived levels of stress than males and the mean mental health score was significantly lower for the female students. A majority (56.9%) of the students admitted to feeling nervous or anxious, ranging from fairly often to very often, over the previous four weeks. The investigators also compared perceived stress levels between the graduate students and undergraduate students. The graduate students were significantly more stressed than the undergraduate students. The most common stress trigger for students was not examinations and tests (23.9%) but family and relationships (36.7%). They also asked students to suggest ways the college could help address their stress. The most common recommendation was to move Monday examinations to another day (67.9%) so that they could enjoy their weekends with family and friends. These results remind faculty that school is not the only stressor students face and that to have better learning outcomes and reduce the risk burnout, asking student opinions is important.

A survey of medical students at 7 medical schools across the United States examined the correlation between burnout and suicidal ideation. The authors report that 49.6% of students experienced symptoms of burnout and 11.2% experienced suicidal ideation. Burnout and low mental quality of life were strong predictors of suicide ideation. They also noted that students who recovered from burnout later were less likely to report suicidal ideation.³ This study serves as a good reminder that burnout can be so mentally taxing that it may cause a student to have suicidal thoughts.

Another study done in Portugal compared stress and burnout between students in the first two years of pharmacy school to students in the last two years.⁴ The results of this study are similar to the study done in the United States. Female students were significantly more likely to report emotional exhaustion compared to male students (p=0.017). Students in the last two years of pharmacy school experienced more depersonalization (p=0.006) meaning that they felt less connected to those around them. They found that students with more anxiety and higher personal accomplishment had higher scores on the Maslach Burnout Inventory. Burnout was associated with higher rates of dissatisfaction with school.

Lastly, a study performed in Australia aimed to measure burnout and engagement of nursing, occupational therapy, social work, and psychology students.⁵ The students were sent a survey to fill out. The investigators assessed burnout using the Maslach Burnout Inventory. The majority of the students who completed the survey were nursing students (53.5%). They found that burnout increased and engagement decreased as students progressed through the curriculum. However, they did not find a difference in burnout rates among the different health profession students. The authors speculated that improving student resources to help with exhaustion and burnout may be beneficial.

Burnout among students in health profession programs is higher in female students, high achievers, and increases as students progress through the curriculum. Faculty at all health profession schools must consider the negative effects stress has on students. Faculty should be able to recognize signs of burnout and should be prepared to help students by talking about burnout. Providing resources to students so that they can recognize the signs of burnout is a must. Faculty should encourage students to reach out to school counselors, mentors, and faculty if they are experiencing these symptoms, and they should help the students to understand that burnout is something that happens to many students. They should not be ashamed. It is also important to provide mental health counseling to those who are experiencing burnout. Offering free services to help students such as free tutoring could potentially decrease student stress and ultimately burnout. Lastly, schools should perform annual student opinion surveys to try to find ways to help students in terms of mental health and adding more resources to help students.

References

1. Bridgeman PJ, Bridgeman MB, Barone J. Burnout syndrome among healthcare professionals. Am J Health-Syst Pharm. 2018;75:147-52.
2. Marshall LL, Allison A, Nykamp D, et al. Perceived stress and quality of life among doctor of pharmacy students. Am J Pharm Educ. 2008;72(6): Article 137.
3. Dyrbye LN, Thomas MR, Massie MF, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334-341.
4. Silva RG, Figueiredo-Braga M. The roles of empathy, attachment style, and burnout in pharmacy student’s academic satisfaction. Am J Pharm Educ. 2018: in press. DOI 10.5688.
5. Robins TG, Roberts RM, Sarris A. Burnout and engagement in health profession students: the relationships between study demands, study resources and personal resources. Australian Journal of Organisational Psychology. 2015;8(e1):1-13.