|Year : 2020 | Volume
| Issue : 1 | Page : 1-4
The skills medical students need to succeed in medical school and prevent burnout
Vijay Rajput1, Anuradha Lele Mookerjee2
1 Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine (NSU MD), Fort Lauderdale, FL, United States
2 Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States
|Date of Submission||02-Jan-2020|
|Date of Decision||11-Jan-2020|
|Date of Acceptance||16-Jan-2020|
|Date of Web Publication||12-Feb-2020|
Dr. Vijay Rajput
Professor & Chair, Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine (NSU MD), 3200 South University Drive, Fort Lauderdale, FL 33328
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rajput V, Mookerjee AL. The skills medical students need to succeed in medical school and prevent burnout. Indian J Med Spec 2020;11:1-4
|How to cite this URL:|
Rajput V, Mookerjee AL. The skills medical students need to succeed in medical school and prevent burnout. Indian J Med Spec [serial online] 2020 [cited 2020 Feb 25];11:1-4. Available from: http://www.ijms.in/text.asp?2020/11/1/1/278084
| Introduction|| |
Burnout is known to be a chronic response to prolonged work-related stressors. Learners, faculty, and other health-care professionals experience burnout since they often lack the emotional, physical, and mental means to overcome the demands of professional duties, their careers, and life in general. There are several reasons for the rise in the burnout rate among learners.
The current literature suggests that interpersonal strain can lead to suboptimal functioning, emotional exhaustion, depersonalization, and decreased job performance. These factors have a direct impact on empathy in clinical care, professionalism. In a broad sense, burnout and professionalism and clinical outcomes have a significant relationship with each other. Occupational stress and exhaustion have a negative impact on one's professional life leading to poor quality work, low morale, absenteeism, and decreased motivation. Learners' burnout has a direct impact on professionalism in medical education success in their career. A method of protection against burnout, for example, is strong professional engagement which may lower rates of burnout. The advent of burnout has been on a progressive rise among learner due to individual and organizational factors. Due to the increasing prevalence of burnout, interventions to combat burnout are being researched across the world. According to a recent systematic review and meta-analysis, some useful interventions include reducing duty hours, learning about mindfulness practice and stress management, as well as being involved in small group discussions. There are different types of skills: life skills, coping skills, generic skills, skills you can learn, and some that are relatively fixed that can be improved on. Although there are many interventions to overcome burnout, the prognosis is uncertain from one individual to another. Medical Schools and Education leaders should take the initiative and need to recognize what promotes joy, effectiveness, and engagement among staff, with the view to improving work and satisfaction outcomes. It is also important that students and all learners be aware of the various ways to combat burnout to improve work performance, motivation, student learning, and patient safety. We have highlighted few examples from personal experience and observation over the past few decades [Table 1].
| Social Connectedness|| |
To get through medical school, students need to build and maintain social networks and have two strong support systems. One of those is family, and the other consists of mentors, colleagues, friends, and acquaintances. One of the biggest reasons for medical students to maintain support systems is the high risk for burnout, isolation, depression, and suicide, with a 2016 JAMA meta-analysis estimating the prevalence of depressive symptoms at 27.2% and the prevalence of suicidal ideation at 11.1%. Students' relationships with their families and friends are an important protective factor against burnout, and yet institutions do not offer any resources to help families and loved ones maintain ongoing strong connections with their learners.
It is a good idea for students to assess who is an integral part of their network. Who would they call if they get arrested or they have a problem with a relationship. People in their twenties need to understand the value of family ties. They need to call home, go home, and get recharged by those who have seen them succeed in the past and believe in their future. Students should not be hyper-focused on their studies that they postpone having social lives. They should be open to the possibility of beginning a romantic relationship and not be held back by the fear that their studies will suffer.
| Study Habits|| |
Students need to develop study habits that work for them. Some learn by listening, some by visual, some take notes, and some learn by teaching others.
Students need to create individualized learning methods to achieve standardized optimal outcomes. They should study to learn, not to memorize, and the best way to do this is to make a study plan at the beginning of each core rotation and be realistic with their expectations. Students should develop the habit of studying a minimum of 2 hours every day during core rotations by putting the times on their personal calendar, which is the same calendar on which they list dates with family and friends. They should choose two or three resources from the school assigned curriculum. There are many resources out there, including online videos, forums, textbooks, and review books. Students should choose only two or three resources that give a well-rounded overview of the specialty topics and that they can complete from beginning to end during rotations. They should develop their own product, where they transfer notes from the resources that can be reviewed two times before subject examinations and two times prior to final or national examinations. This is in addition to the multiple-choice questions from the question banks. Students should also share clinical cases with peers and learn from their fellow students outside the classroom.
If students can talk about patient cases they have encountered, they can drastically improve their learning and memory retention. It is important for students to evaluate past study habits and understand the strategies that have worked for them previously. They need to make the necessary adjustments for future examination preparation, whether that is focusing on completing question banks, using less resources, or managing external life stressors. Students can learn from these experiences to improve their scores going forward.
| Time Management Is Important|| |
Students cannot binge study and expect it to work. Studying and learning is a marathon, not a sprint. There are very limited positive effects of all-nighters to study. In high school or college, students may have been able to learn a semester's worth of material in one night, but not in medical school. There is too much information to learn, apply, and integrate. At the same time, students have to find a way to take quality breaks. During a typical study day or school day, students have to find methods to identify their peaks and valleys of energy and productivity. There is a rhythm called ultradian (hourly) as opposed to circadian (daily) rhythms. Most people have cognitive focus and energy cycles of 90–120 min long. It is a great idea for students to move away from studying for a few minutes to reset their recharging buttons of energy and attention. The long-term benefit is that students can preserve energy, prevent burnout over the course of days, weeks, and months.
| Study Hours Must Match the Number of Sleep Hours|| |
There is no point to studying 12-14 hours in a row because a typical human brain will not be able to process information for that long. Ideally, the number of hours a student studies should equal the number of hours they sleep. Students' brains are like computers. Only when one sleeps does the information they studied get stored on the hard drive of the brain. It would not make sense for a student to deprive themselves of sleep because getting enough sleep is so important for brain function. Only when a student gets to Stage 4 sleep can they store memory. They must know their sleep cycles or learn how to track and develop healthy sleep habits. Moreover, they must find out where they study best. Some like to study in group settings, and some like to study alone in their own room. They need to ensure, however, that the significant part of their study time is by themselves. A study group is ideal for a couple of hours to review something, which can enhance learning.
| Punctuality and Hard Work Is not Optional|| |
“The habit of being prompt once formed extends to everything – meeting friends, paying debts, going to church, reaching and leaving places of business, keeping promises, retiring at night and rising in the morning, going to lectures and town-meetings, and indeed to every relation and act, however trivial it may seem to observers” – William Makepeace Thayer, Tact and Grit, 1882.
Things have not changed for the past 150 years regarding the role of punctuality, whether it is going to class or the clerkship hospital assignment. Some students feel that they do not learn in the classroom; yet they should give it a try and see if it works. Then when it is required of them to attend mandatory sessions they feel that showing up is hard work. There is no excuse, no choice, no alternative – in medical school, students must work hard.
| Not All Stress Is Bad, Find Methods to Manage Stress Differently|| |
Emotional states can enhance or depress learning. Beware: certain emotional, cognitive states will depress learning. Reducing stress can help. What can a student do to reduce stress levels? They can call a friend, talk to people, log on to Facebook, exercise, go to the gym, listen to music – whatever works. There is also stress that can have a positive effect on well-being and productivity. These good stressors are called “eudaemonic stress.” These difficulties and problems can be seen as opportunities to grow rather than a stressful, daily grind. There is also a way to develop mental agility that allows students to respond rather than react to stress. The agility can allow students to juggle between their cognitive neural networks and emotional networks.
Students should also do their best to recharge their batteries. Students should schedule time to be with their family and friends during routine study time. They need to have time away from medicine. Staying in contact with the regular world outside of a hospital or clinic will help prevent burn out or emotional exhaustion.
| Get Regular Advice and not Feedback on Performances|| |
It is important in medical school years to learn to ask for and receive advice and accept it without being defensive. They should use it and learn from it. It is a good trait, and it does not come naturally. Students should ask, “How am I doing?” “Are there things I should be doing differently?” They should get regular advice on their performance.
New research studies in the business world recommend a framework of “advice giving” in lieu of feedback, focusing on future actions compared to the assessment of past actions. Prior research on advice as a theoretical framework is seen in the context of judgment and decision making. This frame of communication can create a psychological safety for learners and shape their effectiveness. The novice or low performer learner may still need feedback versus advice to decrease criticality and focus more on task persistence action. “Advice” language can be framed around key outcomes and evaluator's instinctive reactions to good performance and can promote interruption when it is of high priority. There are examples of advice language in the business world that can be translated to the advice in medical education. “Asking for advice” may be an effective alternative strategy of soliciting excellence compared to feedback. Advice helps to enhance the constructive input leading to excellence and reduces the focus on assessment.
| Students Must Care and Learn from Their Patients|| |
Building trust with patients and other health professionals is critical for students during their learning experience. Patients can see the difference between getting treated or cared by physicians within a few minutes of a patient–physician encounter. Caring itself can help improve social and emotional well-being. Students can take pride in and be motivated to help when taking in-depth medical history and conducting a physical examination which includes communicating about a patient's disease. Students can then engage with their patients better which helps decrease personal insecurities in a safe learning environment. Students should read about diseases they see their patients have during clerkships. They should study more about these diseases when they have downtime during calls and in between rounds. To do this, students must go to clinical conferences, morning reports, and grand rounds and learn from fellow students outside the classroom. They should talk to other students about these diseases to learn and read about them from textbooks or a good review article from reliable peer-reviewed journals. The goal is to not just read it for an examination.
| Learn How to Handle the Fear of Failure and Avoid the “marginal Cost” Mistake|| |
Fear of failure will happen throughout the training and practice of medicine. Some days will not be so good. Students must learn how to convert their thinking from competition to individual success. They must understand that learning and knowledge mean to prepare to become excellent doctors, not to be competitive with other students. It is important for students to learn how to live life with integrity.
The meaning of the marginal cost of production is the change in cost that comes from making more of something. There is downside when we try to give up the integrity or ethics for a short-term gain with marginal cost. The Clayton Christensen said in his famous commencement speech that, “If you give in to 'just this once', based on a marginal cost analysis, as some of my former classmates have done, you'll regret where you end up. You've got to define for yourself what you stand for and draw the line in a safe place.”
| Dress and Act Professionally|| |
If the pilot on a plane showed up in shorts and a Hawaiian shirt, one would think twice of flying on that plane. When a student becomes a doctor, they have to think of themselves as pilots. Do passengers tip their pilots? No. If students do their job well as future physicians, they cannot expect a reward in return. Medicine is a high-level profession. It requires hard work and an excellent work ethic. Doctors must always be good to everyone and always take the high road even when patients or other health-care professionals are being difficult. Even minor lapses in judgment can be detrimental to a future doctor's career. Students must be aware of their image both inside and outside the work environment. Recently, a large study of ten academic centers in the USA found that 53% of patients indicated that physician attire is important for them during their clinical care. Formal attire that included a white coat was rated at a higher level compared to other attire.
| Students Should Be Nice to Everyone Including Patients, Peers, and the Public|| |
When a student is smart but rude and difficult to engage, it can cause problems in how their care is perceived by others. These attitudes may not seem like a real issue, but communicator credibility requires not only expertise but also trustworthiness. On the other hand, a student can be overwhelmingly friendly and warm to their patients but have poor knowledge and skills. That lack of knowledge can make a doctor seem incapable of providing adequate care, and thus untrustworthy. Aristotle once described proper communication as a combination of logic and knowledge with emotion and values. Today, students and educators often have an easier time earning the respect of people, but not their trust.
Cultivating positive relationships is an intuitive process during clinical clerkships. However, the ability to build these relationships with peers over the duration of medical school may not be obvious or explicitly encouraged by medical schools. Students matriculate in medical school with the idea that they must try to be better than everyone surrounding them. Therefore, these ideas of building positive relationships are threatened due to this tension and competition of being the best in the class.
In clinical clerkships, students must try harder to go the extra mile for the people who are going to evaluate them. They should strive to make their resident and attending look good in front of others. They need to do more than they have already done to make patients feel more comfortable. They should open the milk carton for an elderly patient when they are with their patients as part of their clinical care. Modern medicine now consists of teamwork, so students must be team players. They cannot practice medicine alone. In a clinic or on the floor, students should meet and greet everyone and introduce themselves in a polite and confident manner. They should allow people to take credit for the work of the team. They should use the word “we” rather than “I” when managing a patient with a team of residents and interns.
| Conclusion|| |
The skills and attitudes described here are simple and easy to embrace during the activities. The challenges are other commitments often supersede over these priorities. In the current medical education system, it is of prime importance to teach these skills and attitude to medical students. This will enable them to grow and flourish in their career and be successful in medical profession. It will help prevent burn out during the arduous years of medical education.
I would like to acknowledge Ms. Meera Rajput for her valuable critique for this manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Brazeau CM, Schroeder R, Rovi S, Boyd L. Relationships between medical student burnout, empathy, and professionalism climate. Acad Med 2010;85:S33-6.
Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al
. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: A systematic review and meta-analysis. JAMA 2016;316:2214-36.
Fernandez R. Five Ways to Boost Your Resilience at Work. Harvard Business Review; 2016.
Thayer WM. Tact, Push and Principle. Boston: James H. Earle Publisher; 1882.
Grant H. How You Can Benefit from All Your Stress. Harvard Business Review; 2013.
Yoon J, Blunden H, Kristal A, Whillans A. Framing Feedback Giving As Advice Yields More Critical and Actionable Input. Harvard Business School Working Paper, No. 20-021; 2019.
Buckingham M, Goodall A. Managing People: The Feedback Fallacy. Harvard Business Review; 2019.
Gao X, Manjunath M, Mookerjee A, Rajput V. They Like Me, They Like Me Not? Attaining Trust from Residents and Medical Teams during the Clinical Rotation of a Medical Student. MedEdPublish 2019;8:64.
Christensen CM. How Will You Measure Your Life? Harvard Business Review; 2010.
Petrilli CM, Saint S, Jennings JJ, Caruso A, Kuhn L, Snyder A, et al
. Understanding patient preference for physician attire: A cross-sectional observational study of 10 academic medical centres in the USA. BMJ Open 2018;8:e021239.
Fiske ST, Dupree C. Gaining trust as well as respect in communicating to motivated audiences about science topics. Proc Natl Acad Sci U S A 2014;111 Suppl 4:13593-7.