Sepi Jooniani, MD, MPH, Resident, Henry Ford Hospital, Detroit, MI
What does burnout mean?
Do your feelings of cynicism mean you've lost your heart and soul through the course of medical school?
If, as a resident, you roll your eyes each time a new patient rolls through the door, have you lost all compassion?
Transitioning from your third to fourth year in medical school is significant in many ways because of all it foreshadows. It symbolizes your final year as a student. It means you are about to begin the long (and expensive) process of applying to residency. And it means that this year, Match Day is all about you! Similar feelings are had by most students moving into intern year, and for the senior residents preparing for fellowship and attending positions.
Yet despite all the seemingly positive things on the horizon, you may have become different – somehow more complacent about your fate, more cynical towards medicine and the health care system in general. Whether you acknowledge it or not, with these feelings, you've become “symptomatic.”
Somewhere along my own path through medical school, I seemed to have lost my appreciation for what I was doing. Was it because I was so wrapped up in studying for shelf exams and boards that I forgot I was finally doing what I had always wanted most? Or was it because every time I looked at my student loan account balance, I questioned why I ever chose to go to medical school?
These thoughts plagued me during my third year. One day while doing some light reading, I came across an article that publicly voiced these feelings: “The Darkest Year of Medical School,” by Danielle Ofri. The article is about how third-year medical students “come in altruistic and empathetic,” and leave “jaded and bitter.”1 While I appreciated that the article finally validated my feelings, it did little to answer the essential question of why.
About a month later, with only one week between me and the end of third year, I found my answer while listening to an EM:RAP podcast. As I listened to Aaron Bright and Jan Shoenberger discuss career burnout in emergency medicine,2 I thought, “This is it!” Third year was when I, as a medical student, had finally experienced burnout. And with the looming pressures of residency interview season requiring me to be at my best, I was even more aware of how burned out I had truly become.
If, while sitting down to compose your personal statement for ERAS, you find yourself having to think back to your first year — or perhaps even to before medical school — in order to remember all the compelling reasons that led you to choose this career, then you, my friend, are burned out.
As Dr. Shoenberger outlined in her podcast, feelings of cynicism are natural components of burnout — a “symptom,” if you will. Other symptoms include emotional exhaustion, compassion fatigue, depersonalization, and a low sense of personal accomplishment. But these feelings don't have to last forever! Although it gets far less attention than career burnout, medical school burnout is a real phenomenon and should be addressed and dealt with appropriately. So to all of you jaded medical students: you're cynical because you're burned out — and you have a right to be. In fact, you've earned it. And now that you've identified it, you can move forward. Recognize the issue, take the time to rest, and give your workaholic self a well-deserved break. You may even begin to rediscover the inspiration you once had (just in time for interviews!). For the residents out there feeling the drag of residency, think about why you got into the game and force yourself to take time out of your busy schedule to reconnect with life.
Remember, burnout can occur and return at any level of training and experience, but keeping in mind the principles above will help keep us motivated, compassionate, and inspired by what we do.