Med Student Burnout

I spent 16 hours at Grainger yesterday. Studying.

And I’m still not ready. Anyway, go to Grainger on a Friday around lunchtime. All you hear is…silence.

Here’s an interesting article that my friend John posted. My response: It really does suck.

Enjoy.

Medical Student Burnout and the Challenge to Patient Care

By PAULINE W. CHEN, M.D.

Not too long ago, I read a paper titled “Burnout and Suicidal Ideation Among U.S. Medical Students” in The Annals of Internal Medicine. It brought back a flood of memories.

Medical school was not easy for me. I knew that I wanted to become a doctor to help people, but I had given little thought to the process. I was poorly prepared for many things: the pressure to excel in ways that seemed so far from caring for people; rapidly mounting debts I signed off on every semester; a roller coaster existence from chronic lack of sleep; hazing from the more experienced students and residents; and the realities of patient suffering despite my best efforts.

Even surgical residency, despite the relentlessly long hours, seemed so much closer to what I wanted to do.

Some of my professors tried to “humanize” the process. They invited us to dinner in their homes, supported our extracurricular efforts to set up health screening clinics in low-income neighborhoods, and tried to make our basic science courses more relevant to working with patients. But sitting where I am now, as someone who teaches medical students and who loves helping others as a doctor, I can understand the challenge they faced. Given the fire hose of information medical students must learn in just four years, how does one ever gently take a sip?

Despite my teachers’ efforts, I was about as miserable in medical school as I had ever been. I felt alone. Neither I nor my classmates could admit to failure, and the last thing I wanted to do was to let anyone but my closest friends know just how unhappy I was. Success in medical school was the first step to a future of helping others, and I was not about to jeopardize that.

Last week I had dinner with two former classmates from that time. We had not seen each other in over a decade, and after catching up on personal news and reminiscing about gross anatomy lab and our first nights on call, one of them said quietly, “I hated med school. I wanted to quit.” The elephant in our collective memories had broken free.

With that elephant now running loose, and the three of us more comfortable with our own professional accomplishments, the conversation grew more honest. “If you look over my entire lifetime,” my other friend said, “those four years were the lowest point in terms of self esteem.” He held his hand out in the air, plotting an imaginary line that dropped precipitously to his knees.

It took nearly 20 years for the three of us to learn that we had each been miserable as medical students. It has taken even longer for researchers to discover the extent to which such feelings exist among American medical students.

In 2006, Dr. Liselotte N. Dyrbye and her colleagues at the Mayo Clinic found that nearly half of the 545 medical students they surveyed suffered from burnout, which they defined as professional distress in three domains: emotional exhaustion, depersonalization and low sense of personal accomplishment. Moreover, the researchers found that each successive year of schooling increased the chances students would experience burnout, despite the fact that they had entered medical school with mental health profiles similar to those of their peers who chose other career paths.

More recently, in the paper on burnout that had first caught my eye, Dr. Dyrbyre and her colleagues widened the scope of their research, analyzing survey responses from 2,248 medical students at seven medical schools across the country. Again, nearly half of the students surveyed met the criteria for burnout. But the investigators discovered an even more ominous finding: 11 percent of all the students surveyed also reported having suicidal thoughts in the past year.

Dr. Dyrbye notes that we are just starting to learn about the high levels of distress in medical students. “It’s incredibly disconcerting,” she said. “What are the causes? And what can we do as educators to facilitate their well-being? We need a better understanding of the causes of stress to design interventions that will help improve student wellness. Students, just like doctors, need to take care of themselves in order to take care of their patients.”

Medical schools have more recently recognized the importance of this issue. For example, the Liaison Committee on Medical Education, the accrediting authority for medical schools in the United States, now mandates that all schools have a program for student wellness in place that includes “an effective system of personal counseling for its students.”

But beyond the personal implications, what are the ramifications of medical student burnout for patients?

In a third study, Dr. Dyrbye found that when tested for empathy, medical students at baseline generally scored higher than their nonmedical peers. But, as medical students experienced more burnout, there was a corresponding drop in the level of empathy toward patients.

“What do they really need to know before graduating from medical school, and how could they most efficiently learn?” Dr. Drybye asked, reflecting on one of the central challenges of medical education. “All the information we want to share with them is not necessarily what they really need to learn.”

By the time my dinner with my former classmates last week had ended, we had made plans to stay in touch and to do something I had never been sure I would ever do: return to my medical school in two years’ time to celebrate our 20th reunion. Over the course of our dinner conversation I felt strangely connected and nostalgic about medical school; I was deeply moved by what my two classmates had chosen to do with their education. One is a well-loved community obstetrician/gynecologist; the other is a psychiatrist devoted to teaching, working in a county medical clinic and caring for severely traumatized Hmong refugees. And both love their work as doctors.

As I listened to them talk about their work, I was reminded of one other thing Dr. Dyrbye had told me. “We need to change things,” she had said, “because maybe the students who are most vulnerable are the ones who are most empathic.”

Marriage and Missions [Part 2]

Trust me, I am not actively seeking out these articles. It’s just been the lastest topic of the Urbana updates I receive…

They’re awesome though because they put into words all of my thoughts and worries about my future calling and marriage.

And these guys are beasts.

Matched for Mission
Marrying into your Calling
by Sophia Pascal

“I didn’t mean to open this can of worms right now, but if you’re up for having a kind of awkward conversation, let me know.”

This was the prelude to my husband’s marriage proposal, one of the most unexpected events in my life. We had been in each other’s presence for a total of seven days, the first of which was in June and the last six in November. Between June and November our only contact had been a series of emails discussing ministry philosophies and practices, as I had in September committed to joining Servant Partners and his team in the Middle East. It was this common calling to incarnational church planting in the urban slums of the Muslim world that brought us together.

For many years, we each pursued God’s calling individually and in different ways, with no knowledge of each other—he in the Middle East, I in the U.S. These years were often difficult and lonely, and the temptation to compromise our ministry callings in order to marry was very strong. We both endured the pain of breaking off relationships due to a lack of common calling, and choosing obedience to God’s will forced us to accept the possibility of lifelong celibacy. Ultimately, we both believed that God’s calling was our highest priority, whether that included marriage or not.

Thus, I was completely unprepared for what happened the evening of the “awkward conversation.” After five minutes of calming breath exercises in a café bathroom, I sat across from him only to hear him say a number of nice things about me and a reiteration of our common ministry calling followed by the words, “So I think we should get married.” I was shocked. I came in expecting to be rejected, and instead he was proposing marriage!

Most people likely consider it rash to agree to marry someone who you barely know, and we also had moments where we wondered if we were just completely crazy. Yes, we were both certain that we had individually received the same calling from God, and that during our brief time together we enjoyed each other’s company, and that we had identical ideas about love being a commitment and choice rather than feelings and passion. To me the decision to say “Yes” seemed rather reasonable. But were these things really enough of a foundation to start planning a wedding?

Everyone we talked to seem to think so. Parents, friends and our spiritual authorities all were extremely supportive. Indeed, a few people who had known us individually for a number of years even said, “We saw this coming a long time ago!” God was clearly confirming His joy in our decision to marry.

Four months later, we were married. Five months to the day after that, we were on a plane to the Middle East where we remain to this day, living in a slum and sharing Jesus with our Muslim neighbors, committed to each other and committed to God’s calling.

If I end our story there, it sounds like a happily ever after tale. But two and a half years into marriage and ministry, our lives have continued to be filled with all the normal joys and sorrows, peace and difficulties experienced by everyone who submits themselves to God’s will. Marriage is not always easy. Ministry is not always easy. There are many similar lessons to be learned from each about perseverance, humility, and sacrifice – daily opportunities to ask the Holy Spirit to transform us and make us more like Jesus.

I often have moments where I am happily surprised at how everything turned out, when the fact that I am married and living out God’s ministry calling feels like such a shock. It seems unimaginable to me, like a gift too good to be real – not the “can of worms” I expected. Indeed, our God is a worker of miracles and faithful to give us everything we need to obediently follow and glorify Him!

Where art thou Ms. Frankie Lee???

I thought this timely article superbly captures my thoughts on finding my wife…and why it’s gonna be difficult.

Simultaneous Waiting and Preparation
by Nairy Ohanian

The interview results are numerous: countless, dedicated Christians who consider themselves to be passionate world Christians, never end up in missionary service.

They have every opportunity, gifting, skill set, resource, encouragement, even completed training for the field, yet they never enter service.  Instead, what they do enter is a relationship with another godly man or woman who does not have that same commitment to cross cultural service as they do.  Sometimes the decision to not further pursue missionary service is direct and obvious and sometimes the decision is gradual and subtle, but either way a once fervent potential missionary never leaves home, but rather sets up home with a less-than-enthusiastic, non-missions spouse.

As single men and women, many of us long for discovery of a life partner to share in marriage and family life.  The difficulty of the search can lead to compromise of some of our intended goals, dreams and callings.  We begin to negotiate what are essential requirements and needs and what are “nice but not necessary” elements in our future mate’s “portfolio of potential.”

This can truly be an excruciating process and one in which eager prayer and pursuit of Christ is absolutely necessary.  Unfortunately, all too often, the desire and even actual calling for cross cultural, missionary service is demoted to the “nice but not necessary” pile.  Rationalizations arise, “We will serve Christ in our local church,” “There are endless opportunities in our home culture,” “Over time, he/she, will share my passion for missions,” and “We just need more time.”

(Here’s a pretty bold and challenging paragraph)

Similar to the Christian commitment to avoid serious involvement in romantic relationships with non-professing Christians, so must our commitment level rise to avoid serious relationships with non-missionary-minded partners.  God is neither pleased nor honored when we compromise or surrender our callings for Him and His service.  Marriage is also a calling. But at times God wants us to wait or surrender as He fulfills His will in other life areas already made clear, such as missionary service.

As always, our dating standards and possible mate selection needs to be considered strategically, prayerfully and thoughtfully.  It is always tricky to decide standards after entering a serious relationship.  Conviction always precedes crisis.  Our convictions of dating and marriage truth must come before the “mate crisis” of determining if this wonderful person is The One.  We need to know now – even before we meet someone – the qualities we are seeking, and our non-negotiable criteria.

We can use several helpful, practical signs of observation and reflection, upon meeting a possible missionary mate.  Below are some missionary-ready qualities and characteristics to look for in a dating partner:

• Dedication to, love and serious understanding of the Word of God

• Listening and responding well to the Spirit in personal and ministry issues
• Love for the Church, involvement in community, and service in local church.
• Mature understanding and practice of evangelism
• Enjoys and values people; serves and honors others above themselves.
• Establishes goals and perseveres to reach them; words and actions match up
• Deep value in practice of prayer
• Communicates well, unafraid of tough discussion, confrontation, or conflict
• Spirit of boldness, potential risk-taker; appreciation for adventure and new things
• Dissatisfied by the Status Quo; desire to live “outside the lines”

The following are further practical and daily aspects to watch for and ask about in a potential missionary mate:

• Friends: are they missions minded? What do they discuss and do?
• Missionaries: does he/she pray for any?  Have missionary friends?

• Finances:  does  he/she tithe, give to others generously?

• Lifestyle choices: materialism and comfort
• Travels: is there an interest in other cultures both locally and abroad?
• Missions trip: has he/she gone on one? Would he/she be willing to join you on one?
• Non-Christian friends: does he/she have any? Care for community, colleagues?
• Adventure: do you go on creative dates or are you resorting to same places and activities?
• Time: do you reach out to others together or only spend exclusive time as a couple?
• Development: what are his/her church involvements? Are spiritual gifts enhancing?

Both of these lists are merely some of the possible characteristics of a person or practical indicators for a missionary mate. Upon reading these lists, one must prayerfully and reflectively create their own “must have” list for a missionary mate and a list of “practical signposts.”

Finally, as we observe and search for these qualities and traits in a dating mate, are we developing these same areas in our own lives?  Hopefully a fine future missionary is out searching for someone like us who is developing these very attitudes and behaviors as well.

May this generation of missionaries cling tightly to their missions call and choose well that right missionary mate to marry!

This is how I feel about this article…great…