Asian, underrepresented in medicine students with disabilities at high risk for burnout
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Key takeaways:
- Medical student burnout is an important quality assessment metric in medicine.
- Students with multiple disabilities experienced a 254% greater risk for burnout.
Asian and underrepresented in medicine by race and ethnicity medical students with multiple disability types experienced high risk for burnout compared with their white peers.
The findings, published in JAMA Network Open, highlight the importance of addressing the needs of students with disabilities through the intersectionality lens in medical training, especially among those from underrepresented backgrounds with multiple disability types, researchers concluded.
“Medical student burnout is an important quality assessment metric in medicine and has major implications for students’ wellbeing and academic progress,” Mytien Nguyen, MS, researcher at Yale School of Medicine, told Healio. “Understanding the prevalence of burnout risk for these students is the first step to addressing potential inequity in medical learning environments for marginalized students. Providing high-quality care to our patients requires a diverse physician workforce, and we should dream of a medical training path that promotes trainees from marginalized backgrounds for our patients.”
Research inspiration
The challenges students with disability experience during medical training inspired this research, according to Nguyen.
“Prior research from Lisa M. Meeks, PhD, MA, and colleagues showed that students with disability were at higher risk for burnout,” she said. “We were curious whether intersectionality between disability types and intersectionality between disability, race and ethnicity influence students’ risk for burnout.”
Researchers used 2019 and 2020 deidentified student data from the Association of American Medical Colleges Year 2 Questionnaire that included information on self-reported race, ethnicity, age, sex and disability status among 23,889 students (56.29% women; 21.29% Asian; 12.75% underrepresented in medicine by race and ethnicity).
For the purpose of this study, researchers classified high risk for burnout as students in the top quartile of exhaustion and disengagement subscales of the Oldenburg Burnout Inventory for Medical Students.
They used descriptive statistics to assess the prevalence of disability by race, ethnicity, sex, and age, and Modified Poisson regression to estimate the relative risk for burnout by race, ethnicity, multiple disability status and their intersections, adjusting for age, sex, and school-level prevalence of students with disabilities.
Burnout risk
Overall, 8.11% of students reported one disability type and 1.95% reported multiple disability types.
Results showed similar proportions between white students and those underrepresented in medicine by race and ethnicity that reported one disability type (8.94% vs. 9.12%) and multiple disability types (2.21% vs. 2.49%). A lower proportion of Asian students reported one disability type (4.25%) and multiple disability types (0.93%).
Researchers found that 13.66% students experienced high risk for burnout, and the risk increased with increasing number of disability types, with 12.61% of students without disabilities at risk for burnout compared with 21.05% of students with one disability and 31.33% with multiple disability types.
Results additionally showed that after adjusting for race, ethnicity, sex, age and school-level prevalence of disability, students with one disability experienced a 70% greater risk for burnout and those with multiple disabilities experienced a 254% greater risk for burnout.
Of note, compared with white students who reported one disability type, both Asian (adjusted RR = 1.31; 95% CI, 1-1.72) and underrepresented in medicine by race and ethnicity medical students (adjusted RR = 1.3; 95% CI, 1.01-1.68) with one disability type experienced a 30% greater risk for burnout.
Moreover, compared with white students with multiple disabilities, both Asian (adjusted RR = 3.23; 95% CI, 2.21-4.72) and underrepresented in medicine by race and ethnicity medical students (adjusted RR = 3.1; 95% CI, 2.26-4.25) with multiple disability types experienced a more than threefold greater risk for burnout.
“We found that risk for burnout increased with increasing number of disability types, with one in three students with two or more disabilities reporting high risk for burnout compared with one in 10 nondisabled students,” Nguyen said. “Critically, we found that Asian and underrepresented in medicine by race and ethnicity students with multiple disabilities had the highest burnout risk.”
‘Alarming’ findings
“The findings are alarming; however, our research parallels prior research demonstrating that students with disability and students from ethnoracial minoritized backgrounds experience higher risk for burnout,” Nguyen told Healio.
“The higher risk for burnout for Asian and underrepresented in medicine by race and ethnicity students with multiple disabilities suggests there is an allostatic load of having multiple marginalized identities that should be addressed in medical education policy,” she said. “The high prevalence of burnout risk for students at the intersections of race, ethnicity and disability calls for an innovative holistic approach to medical education to address medical student wellness, belonging and professional identity formation. This study demonstrates that intersectionality is critical in understanding the experiences of students with disabilities. Further research is necessary to understand the role of accommodations, disclosure and disability stigma in burnout risk and career retention for [these students].”
For more information:
Mytien Nguyen, MS, can be reached at mytien.nguyen@yale.edu.
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