Burnout is moderately higher in underrepresented medical students
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Medical students from some historically underrepresented populations experienced moderately higher levels of exhaustion-related burnout, according to findings published in JAMA Network Open.
Those who experienced racial discrimination during training were also more likely to experience burnout.
“While underrepresented in medicine (URIM) students experienced similar burnout overall, they were more likely to experience exhaustion-related burnout and less likely to experience burnout related to disengagement with the medical profession,” Jamieson M. O’Marr, MS, of the Yale School of Medicine, told Healio. “More research is required to understand the mechanisms behind this.”
O’Marr and colleagues used the Oldenburg Burnout Inventory for Medical Students and the American Medical Colleges Graduation Questionnaire to assess self-reported measures of disengagement and exhaustion-related burnout among medical students. Allopathic medical students in the U.S. graduating in 2016 and 2017 were invited to participate in the retrospective cross-sectional survey study.
Overall, the researchers received 26,567 completed surveys, amounting to an 81% response rate. Of these respondents, 51.4% were men and 14.9% identified as URIM (eg, Alaska Native, Black, Hispanic, Native American and/or Pacific Islander).
URIM students reported modestly higher levels of exhaustion-related burnout (3.62% vs. 3.61%; OR = 1.19; 95% CI, 1.09-1.29). Conversely, they reported modestly lower mean burnout scores associated with disengagement (3.56% vs 3.58%; OR = 0.87; 95% CI, 0.8-0.94), according to the researchers.
“This burnout is likely multifactorial and could represent a resiliency or survival bias, the burden of increased responsibility and/or recurrent discrimination,” they wrote.
Moreover, URIM students reported marginally less favorable student-faculty interactions in the learning environment (3.45% vs 3.35%; P < .001), according to O’Marr and colleagues. Regardless of URIM status, those who reported the lowest favorability of their learning environment were more likely to experience higher rates of burnout as were those who experienced at least one episode of discrimination, according to the researchers. In total, 19% of URIM students experienced at least one episode of discrimination compared with 7.2% of other students.
“One possible explanation for this differential experience of burnout is that concurrent with a steady increase in diversity-related initiatives in medical schools throughout the past several years, engagement among students who are URIM in the medical school environment may indeed be increased,” O’Marr and colleagues wrote. “This may paradoxically lead to exhaustion-related burnout due to a minority tax, defined as a multifaceted entity that encompasses the extra burdens that physicians and trainees who are URIM often face during their medical career.”
Institutions should evaluate their learning environments to assess root causes of discrimination and burden among students who are URIM, they added.
“Creating and maintaining a diverse physician workforce is an important part of providing the best possible care for patients,” O’Marr said. “Identifying and eliminating discrimination and other causes of burnout among URIM students throughout the training pipeline will be critical as institutions work towards this goal.”
References:
O’Marr JM, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.0115.
Underrepresented med students more likely to experience exhaustion-related burnout. https://medicine.yale.edu/news-article/underrepresented-med-students-more-likely-to-experience-exhaustion-related-burnout/. Published Feb. 23, 2022. Accessed Feb. 24, 2022.
Perspective
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Montgomery Douglas, MD
This study found that medical students who are URIM report higher levels of exhaustion-related burnout but lower levels of disengagement burnout. In addition, regardless of URIM status, those who were in the bottom quartile of learning environment scores had the highest levels of burnout in medical school as were those who experienced at least one episode of discrimination. That latter finding confirms the work of Dyrdye LN, et al, which was reported in the Archives of Internal Medicine (now JAMA Internal Medicine) in 2007. Of note, Dyrdrye had reported a lower level of burnout among URIM students, whereas Jamieson’s study is showing lower level of disengagement burnout but a higher rate of exhaustion-related burnout. The differences between the two may be due to the use of different burnout assessment scales.
The most significant finding of this study is the correlation between discrimination and burnout, regardless of medical students’ race, and is an important addition to the medical literature. This provides support for medical schools’ increased focus on the learning environment. The fact is that learners are adversely affected by racism, microaggressions, feelings of isolation and untoward cultural experiences, and consistent with the racial reckoning that began during the summer protests of 2020, we should redouble our efforts to protect the learning environment from such adverse experiences.
While it is true that our study as well as others have demonstrated a lower level of burnout among URIM physicians, both Jamieson and Dyrdye have shown that medical students may be more vulnerable than attendings, and that if they experience discrimination, it does result in more burnout.
Reference:
Dyrbye LN, et al. Arch Intern Med. 2007;doi:10.1001/archinte.167.19.2103.
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