After 10 months in the hospital, burnout

Short White Coat is a blog about learning to be a doctor. Posts appear here as part of White Coat Notes. Ishani Ganguli is a third-year Harvard medical student. E-mail her at shortwhitecoat@gmail.com.

Which is worse, being a third-year medical student or an intern (ie. a first year resident)? One of our clerkship directors raised this somewhat disheartening question the other day, and I was as struck by the underlying assumption as by the question itself.

Third year, our first immersion into patient care, represents a welcome transition from the lecture hall to the hospital floor. But it can also be an awkward and uncomfortable year, marked by constant evaluation, the tension between being a member of the medical team and advocating for our education, and long hours that leave little time to absorb what we see.

We’re in our tenth month of the experience, and from talking to my classmates, I’m not alone in feeling exhausted.

Researchers are starting to pay more attention to medical student burn-out, as part of a growing effort to redress longstanding neglect of mental health issues among students. Most recently, it was the subject of several studies in this month’s Academic Medicine. In a survey of 125 third-year students at Mount Sinai School of Medicine in New York, many reported experiencing traumatic events or personal mistreatment, a finding that was associated with higher rates of stress and depression down the road.

Not surprisingly at this time of year, the bitterness is felt through all stages of the training process. It’s the focus of cafeteria chatter over our team breakfasts of scrambled eggs and home fries, the unmistakable undertone in complaints about anybody and everybody we interact with in the care of our patients.

New research shows that an alarmingly large subset of all trainees struggles with mental health problems. Another survey that targeted both medical students and residents at six sites found that 12 percent likely had major depression and 9.2 percent had probable mild to moderate depression. Notably, medical students and women were disproportionately affected. The researchers worry about long-term effects on trainees and stress the importance of assessing and treating these individuals.

There are, of course, many factors -- long hours, difficult patients, inefficiencies in the system -- that contribute to this widespread discontent. Only some of them can, and should, be addressed with policy changes and better care of would-be caretakers. After all, our own moods affect the way we treat patients, as much as we strive to put on a game face at the bedside.

As for the original question, most interns and residents say that internship -- with its unforgiving ramp-up of patient load and brutal work schedule -- takes the prize. Bad news for medical students at the tail end of third year. But at least we’re talking openly about it.