Abstract
Burnout is a highly prevalent issue among medical trainees, but there has been limited research characterizing burnout specifically among medical students from groups who are underrepresented in medicine (URIM). To assess the association between components of the medical school learning environment and burnout among medical students who are URIM vs those who are not. This retrospective cross-sectional survey study evaluated responses of allopathic medical students graduating from all US allopathic medical schools in 2016 and 2017 to the American Medical Colleges Graduation Questionnaire. Analysis was completed between December 1, 2019, and July 1, 2020. Self-identification as a medical student who is URIM. Self-reported measures of medical student overall, disengagement, and exhaustion-related burnout using the Oldenburg Burnout Inventory for Medical Students. The American Medical Colleges Graduation Questionnaire had an 81% response rate, yielding 26 567 complete participant responses that were included the analysis. A total of 13 645 individuals (51.4%) were male, and 3947 (14.9%) identified as URIM (ie, Alaska Native, Black, Hispanic/Latinx, Native American, and/or Pacific Islander). Medical students who are URIM reported modestly higher levels of exhaustion-related burnout (mean [SD], 11.84 [3.62] vs 11.48 [3.61]; P < .001) and modestly lower mean burnout scores associated with disengagement (mean [SD], 9.24 [3.56] vs 9.36 [3.58]; P = .047). Medical students who are URIM also reported marginally less favorable student-faculty interactions in the learning environment (mean [SD], 14.09 [3.45] vs 14.29 [3.35]; P < .001). Medical students who are URIM were more likely to be in the top quartile of those who experienced exhaustion-related burnout (odds ratio, 1.19 [95% CI, 1.09-1.29]) but less likely to be in the top quartile for disengagement (odds ratio, 0.87 [95% CI, 0.80-0.94]). Regardless of URIM status, those who reported learning environment scores in the bottom quartile were more likely to experience higher rates of burnout as were those who experienced at least 1 episode of discrimination. This survey study found that medical students who are URIM had a higher risk for exhaustion-related burnout. This burnout is likely multifactorial and could represent a resiliency or survival bias, the burden of increased responsibility, and/or recurrent discrimination. The learning environment can play a key role in mitigating burnout in both medical students who are URIM and those who are not and is deserving of further research.
Highlights
Burnout is a common phenomenon among medical professionals[1,2] and can lead to emotional exhaustion, depression, and suicidal ideation.[3,4,5,6,7] In addition to negative effects on clinicians, burnout significantly impairs patient care and contributes to decreased patient satisfaction and interactions, quality of medical care, and medical errors.[8]
Medical students who are underrepresented in medicine (URIM) were more likely to be in the top quartile of those who experienced exhaustion-related burnout but less likely to be in the top quartile for disengagement
Regardless of URIM status, those who reported learning environment scores in the bottom quartile were more likely to experience higher rates of burnout as were those who experienced at least 1 episode of discrimination. This survey study found that medical students who are URIM had a higher risk for exhaustion-related burnout
Summary
Burnout is a common phenomenon among medical professionals[1,2] and can lead to emotional exhaustion, depression, and suicidal ideation.[3,4,5,6,7] In addition to negative effects on clinicians, burnout significantly impairs patient care and contributes to decreased patient satisfaction and interactions, quality of medical care, and medical errors.[8] Burnout in medicine can occur as early as during medical school training and even prior.[9] Among medical students, burnout has been reported to affect up to 50% of trainees.[5,10] Recent research has focused on identifying factors such as adverse medical school experiences, including mistreatment, that contribute to burnout among medical students.[11,12] sociodemographic factors have been explored, and students identifying as sexual or gender minorities, including lesbian, gay, bisexual, transgender, queer, or intersex individuals, have been shown to experience increased rates of burnout owing to mistreatment.[13]
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