The first step towards the resolution of a problem is acknowledging the problem. The issue of burnout adversely affecting medical school students was acknowledged some time ago. It's now time to work towards a real solution. Deans and doctors agree: medical school burnout adversely affects patient care and damages the American health system overall. Yet, despite everything we know about burnout, there exist no rigorous studies to demonstrate what actually works to combat it. Most articles merely acknowledge the need for change and point out schools making those changes, like the ever-popular Vanderbilt University, which provides a class for medical students to pursue a chosen wellness activity like religious exercise or basket-weaving. No wellness program evaluation system exists; no studies prove one strategy over another; no one knows scientifically how best to balance life and medical school. That needs to change, but for now we may find solutions by backtracking to the causes of burnout. Many student stresses arise from simple first-time introduction into medicine's dark side. A commentary in Academic Psychiatry reported major student stressors to include inter-generational clashes, hierarchical medical culture, high workload and exposure to human suffering - all shocking parts of the real world for students fresh out of college. The American Medical College Application Service (or AMCAS) emphasizes clinical experience to mitigate this. Still, often these experiences consist of low-stress volunteering positions that provide good medical knowledge, but offer no opportunities for students to deal with the aforementioned stressors in any real capacity. Pre-med students might preemptively lower med school stress by selecting higher-stress clinical experience before applying, and actively noting what techniques best help them navigate stress. Students may try choosing Emergency Room volunteering or working at a high-stress job, like an overloaded pharmacy, where hierarchy, generational issues, and constant action become normal. If "normalizing stress" works, one would expect older, non-traditional students with work experience to perform better than traditional students under equal stress. There is no evidence to support this, and it's hard to control for a good study when many non-traditional students balance family or even work on the side. We do know that back in 1992, medical schools began pushing for non-traditional matriculants; just two years ago Harvard Magazine reported that more than two-fifths of students in all of higher education are older scholars. The med school at University of Pennsylvania takes nearly 63 percent of its students from non-traditional backgrounds. Is this because non-traditional students handle the rigors better? That's debatable - traditional students often have the advantage of stamina and studying habits - but there is something to learn here about stress. First, medical students with non-traditional majors - not physical sciences - tend to pursue family medicine and may more readily embrace the human aspects of medicine, according a Canadian Family Physician article. This is important - it may mean many non-traditional students bypass the "dehumanizing" aspects of pre-med rigors that leave some physicians compassion-less. Learning humanities may help students sharpen their focus on human factors, thereby decreasing interpersonal and patient-related stress. Second, many older medical students already have a support system of family or marriage in place. A** ll medical students need to find loving support outside of school. Finally, older medical students often enter with more self-confidence, says Hofstra School of Medicine Dean Lawrence Smith, and "they're more conscious of what they want to do with their time." This seems to be key. In a Duke University-published article, one non-traditional resident explained that he's happier than his fellow students because he does acting on the side. The concept is simple - he does something he loves and comes to work happy. Most wellness programs try to incorporate this principle. So, it is important to note thathappy students don't always put their full identity in medicine.** You aren't your grades, and you aren't your medical school performance. It's tough and scary for students to schedule even two hours a week of "non-medicine" time, but many now believe it's actually essential to reducing stress. These strategies that help non-traditional students may benefit everyone, but effective program implementation will require rigorous evidence that just isn't there yet. In the meantime, students continue to seek support from counselors, family and non-medicine activities to maintain their health.
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