Interviewer: Physician burnout. We know what it is. We've all heard of it. Today on The Scope we're going to talk about how medical students can learn how to cope with it later on in their careers. That's today on The Scope.
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Interviewer: Today on The Scope Radio we're talking with Tony Tsai. He's the Director of Education Strategy at the University of Utah School of Medicine. So, Tony, you and some colleagues at the University of Michigan where you used to work published this article essentially about burnout and how medical students can learn to cope with that later on in their careers by what they learn while they're in medical school.
Before we get to talking about that, though, what can you tell me about burnout and what it looks like?
Tony: When I was at the University of Michigan, we were looking at some admissions information, our applicants, whether their parents were doctors or not essentially. It was like if your parents were doctors, did you apply to medical school. And for a long time this number has been going up, but in the recent years, we've seen that number starting to dip and that was kind of an interesting statistic. I mean, that itself doesn't say everything but there is something in there.
And if you look in the literature, there's been a number of surveys recently done and what the surveys found is that about 50% of the clinicians experience some sort of burnout and that number is on the rise. As well as number of physicians who say they would choose medicine over again, that number has been dropping significantly. So this is what we know regarding the challenges of the current clinical practice environment.
Interviewer: So in the introduction of your article, Tony, it says that, "Most doctors also feel immense frustration as they attempt to deliver great care amid the demands, limitations and inconsistencies of today's healthcare system. Burnout becomes epidemic when this frustration kills physicians' sense of meaning and purpose." Tell me a little bit more about what that means.
Tony: When in medical school I talked to a lot of medical students and they say one of the reasons they chose to become a doctor was in order to be able to help patients. You can sense that they're very idealistic when they're starting. And then over time, they encountered the challenges of the healthcare system.
Charting. So once they see a patient, they have to document that encounter, and they have to interact with the electronic medical records, which is a very time-consuming process. Sometimes you're doing that and you're saying, "Did I become a doctor to do this?" Again, if you only get to see a patient for a couple of minutes and you don't really have the time for that meaningful dialog and you're making a prescription, sending them off, you're thinking to yourself, "Am I really helping this person?" There are these challenges currently in the way that we practice healthcare today that I think is putting pressure on a lot of clinicians to kind of reexamine what is it that they're really doing.
Interviewer: So burnout is something that medical students are thinking about, they're aware of. What is it that can be done in medical school to help them prepare for the stress in their career?
Tony: I had the chance to talk to a lot of doctors who I would consider resilient and I asked them, "What is it that makes you able to get up in the morning and go to work?" And they would say, for example, "When I was young, I had irritable bowel," let's say, "and so I know what that's like. So now when I go into clinic and I'm helping people with stomach issues, it's meaningful for me."
So I've seen a lot of doctors who despite all the challenges, again, the practice environment is consistent and yet different clinicians have different levels of satisfaction. So a lot of that can be attributed to, in a way, the meaning they create for themselves.
I wanted to maybe give you another quick example. There was an actual study done at the University of Michigan where they asked the custodial staff, "What do you do? What is your job?" Some people would say, "You know, I scrub toilets," and some other people would say, "I contribute towards the care of patients." And again, they're doing the same exact thing, but they create different meanings.
And what they found out was that the people who say, "I contribute to the care of patients," they were happier, more engaged, and they actually helped patients, so when let's say a patient got lost in the hospital, they would actually help them get to where they were going. So the actual meaning is something that I think we control. This is one of the things in medical school that our group, we were thinking, "How can we help medical students and residents and fellows develop that meaning so when they go into this challenging environment, they can be resilient?"
Interviewer: One of the concepts that you and your colleagues talk about in this article is the concept of the "why" and that medical education has maybe focused too much on the how and not so much on the why. What can you say about that?
Tony: I kind of think about education in two halves. There's the half that deals with knowledge and skills, and there's the half that deals with meaning and purpose. If you look back at your education, how much of it was dealing with knowledge and skills versus meaning and purpose?
One of the examples I give was the quadratic equation. How many hours did you spend solving for x in the quadratic equation? And then how many hours did you actually spend on using the quadratic equation in your job? Versus the question on the other side of what matters in your life. How much time did school actually devote towards helping with that? You look at the balance and you see that really things are quite imbalanced.
So if we look at the issue of meaning, if school does not help you, does not teach you how to create meaning, you go into these very challenging environments, you can only sort of see the tasks, I think that contributes to burnout. Then the idea was, okay, if we think about meaning and purpose, how do we get it? These things about meaning and purpose are never really finished.
You're really living your life and you're asking yourself these questions, and as you become more mature, the answer to these questions may be different. I'm hoping that one day having a much better clarity about certain aspects of their life through this reflection and they are set up through these questions that they can ask themselves in the future to be able to, you know, continue that journey for developing meaning and purpose for the rest of their lives.
Interviewer: So for medical students today, those that you deal with on a day to day basis, what would be your advice to them in how to find their own meaning and purpose in what they're studying as they're cramming for exams and they're attending class and they're getting ready for clinical experiences and all these things that they do in medical school?
Tony: When I talk to med students I see two types of med students. I see one type of med student that says, "I just need to get through med school so I can go to the next thing. And these tests I take, I just do it so I can just get them over with." Then I see another set of med students that says, "You know, it's a privilege to be in medical school. I want to use this time wisely to develop myself into a certain type of physician. And this is a good opportunity for me to go and explore what that looks like."
And I think that really changes the way that you behave in terms of your studying and in terms of how much you learn, really. One of the things about medical school is that people tend to be in their mid-20s, and it is a time where it is a transition between kind of childhood and adulthood. When you're a kid, learning is something that other people told you you had to do. You just go do what your teacher told you to do. But later on, what you'll realize is that as adults, we learn the things we want to learn. We don't have people telling us, "You need to learn this, you need to learn that."
Eventually what you'll need to be able to do is just, the things that you're interested in, you'll naturally be able to learn those things better. And so again, it's kind of like defining your own meaning. Now, if you have a real need or meaning to learn something, you'll learn that better, you'll retain that better. So that is scientifically proven.
So not only is this really just in the "soft domain," but actually once you have developed the meaning, it will actually help you as a medical student to learn better.
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