Early learning experiences in medical school impact students’ burnout, exhaustion, empathy, and career regret levels at graduation. A longitudinal study, published in JAMA, finds that medical students who report experiencing mistreatment prior to their second year have higher levels of burnout and career regret two years later. And the opposite also holds true. Students with positive experiences report lower burnout levels, higher empathy, and less career regret at graduation.
The study, led by Liselotte Dyrbye, MD, MHPE, Daniel Satele, BA, and Colin West, MD, PhD, includes over 14,000 students from 140 allopathic medical schools who responded to the AAMC Medical School Year Two Questionnaire and the 2016-2018 AAMC Graduation Questionnaire.
The study findings show that just over three-quarters of students reported no mistreatment (77.1 percent) on the Year Two Questionnaire. Among the remaining 22.9 percent of students, 11.3 percent reported mistreatment in one instance, and 11.6 percent reported mistreatment in more than one instance. Within the group who experienced mistreatment more than once, the Graduation Questionnaires were more likely to indicate:
Career choice regret (6.4 percent for those who never experienced mistreatment, 7 percent for once, and 11.4 percent for more than once)
Greater exhaustion (mean scores: 12 for never, 13 for once, and 13.8 for more than once)
Higher levels of disengagement (mean scores: 5.3 for never, 5.5 for once, and 6.0 for more than once)
Among those students who reported a more positive emotional climate on the Year Two Questionnaire, the relationships were the opposite. Their Graduation Questionnaires were more likely to show:
Lower exhaustion levels (for each 1-point increase in emotional climate, there was a reduction by .05 in exhaustion)
Lower disengagement scores (for each 1-point increase in emotional climate, there was a reduction of .04 in disengagement)
Students who reported positive faculty interactions on the Year Two Questionnaire were more likely to receive higher empathy scores on the Graduation Questionnaire. And, positive interactions with other students resulted in lower instances of career regret at the conclusion of medical school.
The study authors note that medical school administrators may use these findings to craft learning environments that “mitigate burnout, decline in empathy, and career choice regret among their students.” The authors write, "Although the most effective approaches to addressing mistreatment of learners remain elusive, the frequency of mistreatment varies between educational programs, suggesting there are likely to be levers within the control of the organization that adequate commitment, leadership, infrastructure, resources, and accountability can lead to a meaningful reduction in mistreatment." The authors also suggest that schools consider strategies to reduce stress among students and promote positive learning environments, such as installing learning communities, pass/fail grading, and faculty development.
MedPage Today quoted Charles Griffith III, MD, of the University of Kentucky College of Medicine, who noted in a commentary on the study that, while the authors’ use of student-level, rather than institution-level data, limited the utility of the analysis, it may still inform interventions. "Some students in this study perceived mistreatment and did not believe the learning environment was supportive, but students from the same school believed the learning environment was indeed supportive," he wrote. "For a school considering change, based on these findings, does the school focus on making global changes to aspects of the overall learning environment, or do they identify students not supported by the current learning environment to tailor support on an individual level rather than a macro level?"