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Physician, heal thyself

The impact of stigma and personal experiences on the help-seeking behaviours of medical students with burn out. Dyrbye LN et al. Academic Medicine 2015 [epub ahead of print]

Reviewed by Angela Punnett

What was the study question?
Medical students experience greater burnout than their age-matched peers with the potential for significant personal and professional consequences. This study sought to define the help-seeking behaviors of medical students with burnout and the factors contributing to these behaviours.

How was the study done?
This was a multi-institutional (7 US medical schools) survey study of second through fourth year medical students using validated instruments for measuring personal and professional distress (burnout, depression and quality of life). Students were also asked about help-seeking behaviors and concerns for confidentiality, as well as attitudes toward seeking mental health treatment.

What were the results?
The survey response rate was 61%. Rates of burnout (52.7%) and depression (37.9%) were similar to previous national surveys. Only 1 in 3 students with burnout sought help for an emotional or mental health problem in the preceding 12 months. Students were more likely to seek help with increased levels of emotional exhaustion compared with depersonalization. There were significant concerns regarding stigma and discrimination, particularly among students with documented burnout. Over 20% of students believed any mental health treatment would not be confidential within the medical school. Students reported observing breaches in confidentiality around students’ emotional problems by supervisors (15.8%) and by fellow students (55.9%). The majority of students reported they would hide that they were receiving mental health treatment if such treatment was required. Medical students also reported being less likely to go for such treatment than national comparisons.

What are the implications of these findings?
The high levels of medical student burnout remain poorly understood. This study suggests that efforts aimed at changing the learning environment to decrease perceived and experienced treatment stigma are necessary. Curricula designed to highlight confidentiality, make explicit the hidden curriculum, teach peer support and intervention, and review resources may be helpful. Understanding the differential response to emotional exhaustion and depersonalization symptoms with respect to help seeking behavior is required to better direct curriculum and mentorship activities.

Editor’s note: This study also demonstrated two relationships: a direct one between burnout and self-reported cheating and dishonest clinical behaviors; and an indirect one between burnout and altruistic professional values. The consequences of burnout are thus far-reaching (SLB).

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