Is Medical Education Ready for Generation Z?

Sigis a 21-year-old who is considering medical school. Accustomed to hard work, he has received all As in college, while majoring in computer engineering. Sig longs to do something meaningful-to make a difference in the lives of others. He feels paralyzed with self-doubt about incurring massive debt associated with medical school. He also dislikes the idea of taking courses that don't seem relevant. Four years of medical school seems like an eternity, and then there is residency. Sig has never faced such a hard decision. It is disrupting his sleep. On one hand, he could make a good living with his bachelor's degree, but will the job be satisfying? On the other hand, he can commit to 7 or more years of medical education, with more debt, but potentially more enjoyable work. Sig has also heard a lot about dissatisfaction and burnout among physicians. Sig talks with his parents, whose advice he values. He will take some time off to make the best decision. He is in no hurry.

The Problems With Burnout Research.

Burnout among physicians and physicians-in-training is well established as a potential threat to the health and well-being of health care providers and patients. However, there are myriad problems with current burnout research and its ongoing measurement that threaten the validity of the conclusions. For example, researchers have used differing ways of defining and measuring burnout. Those who have used the Maslach Burnout Inventory vary in recommended use of the instrument and cutoff scores. As a result, the authors suggest that the term "burnout" may be misused and recommend some reconsideration of the meaning of burnout. The measurement and discussion of burnout have strong implications for interventions and policy alike. In this article, the authors review the problems with burnout research and ask important questions about the future directions of research efforts. The authors recommend a consistent measurement approach and perhaps moving toward a focus on physician wellness from a positive psychology perspective.

Self-Report Study of Predictors of Physician Wellness, Burnout, and Quality of Patient Care.

OBJECTIVE: The goal of this self-report study was to examine the relation of work variables, self-rated health and mental health status, and perceived social support to physician wellness, physician burnout, and quality of patient care. METHODS: We administered a demographics questionnaire, the Physician Wellness Inventory, the Maslach Burnout Inventory, and the Patient Care Scale to a random sample of full physician members of the American Academy of Family Physicians. We performed regression analyses on self-reported health status, work variables, and social support data as predictor variables and the subscales from the Physician Wellness Inventory, Maslach Burnout Inventory, and Patient Care Scale as the outcome variables. RESULTS: The response rate was 22%. Self-reported mental health status significantly predicted all of the wellness scales, the burnout scales, and the quality of patient care. The ability to manage the workload was the second strongest predictor of multiple scales. CONCLUSIONS: More work should be done to explore the factors related to physicians' self-ratings of mental health status and what that means to them. Also, it is important to study whether self-rated mental health status is related to objective patient care quality measures.

Relation Between Physicians' Work Lives and Happiness.

OBJECTIVES: Although we know much about work-related physician burnout and the subsequent negative effects, we do not fully understand work-related physician wellness. Likewise, the relation of wellness and burnout to physician happiness is unclear. The purpose of this study was to examine how physician burnout and wellness contribute to happiness. METHODS: We sampled 2000 full-time physician members of the American Academy of Family Physicians. Respondents completed a demographics questionnaire, questions about workload, the Physician Wellness Inventory, the Maslach Burnout Inventory, and the Subjective Happiness Scale. We performed a hierarchical regression analysis with the burnout and wellness subscales as predictor variables and physician happiness as the outcome variable. RESULTS: Our response rate was 22%. Career purpose, personal accomplishment, and perception of workload manageability had significant positive correlations with physician happiness. Distress had a significant negative correlation with physician happiness. CONCLUSIONS: A sense of career meaning and accomplishment, along with a lack of distress, are important factors in determining physician happiness. The number of hours a physician works is not related to happiness, but the perceived ability to manage workload was significantly related to happiness. Wellness-promotion efforts could focus on assisting physicians with skills to manage the workload by eliminating unnecessary tasks or sharing workload among team members, improving feelings of work accomplishment, improving career satisfaction and meaning, and managing distress related to patient care.

Physician Depression and Suicide: A Shared Responsibility.

ISSUE: Although the exact number is often disputed, it has been reported that approximately 300 to 400 physicians in the United States take their own lives annually. Despite calls from key interest groups for prevention and treatment protocols of physician suicide, little systematic change has taken place. EVIDENCE: Research on suicide risk factors among physicians has expanded. Increasing reports are surfacing that highlight suicidal ideation and depression in medical school, residency training, and later professional practice. IMPLICATIONS: The purpose of this article is to draw attention to the problem of physician suicide with an emphasis on the role of medical education. Multiple accreditation bodies should be involved to effect a change in physician suicide prevalence. Thirty years have demonstrated that without mandates, large-scale change will not occur. We adapted some of the 2012 National Strategy for Suicide Prevention goals to medical education as a guide.

An exploratory study of resident burnout and wellness.

PURPOSE: Physicians have a higher rate of burnout compared with the general population, and burnout's origin can be traced to residency training. Little evidence exists documenting the causes of burnout, and there is even less evidence on protective factors. The goal of this exploratory study was to determine which resident-identified stressors are associated with the presence of burnout and which resident-identified wellness factors are associated with the absence of burnout. METHOD: In the fall of 2006, residents from 13 specialties completed a demographics questionnaire, a survey of factors that promote burnout and wellness, and the Maslach Burnout Inventory. RESULTS: From a pool of 395 residents, 150 (38%) completed the questionnaires. Of 32 burnout factors, 27 were significantly associated with at least one burnout scale. Pessimism was the only burnout factor associated with all three burnout scales; 11 other burnout factors were associated with at least two burnout scales. Of 29 wellness factors, 25 were significantly associated with at least one burnout scale, indicating a lack of burnout. Use of prescription medications was the only wellness factor associated with all three burnout scales, indicating low burnout. Thirteen other wellness factors were associated with at least two of the scales. CONCLUSIONS: Significantly more research is needed to further define and measure wellness. Program directors should consider multiple burnout and wellness factors associated with burnout (or its absence) when designing treatment interventions. The aim should be to identify and bolster wellness factors that protect from burnout while minimizing the stressors that cause it.

Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs.

BACKGROUND: The existing literature either does not address physician wellness or defines it as a lack of burnout. The goal of this article is to call attention to this important gap in the literature and provide ideas for how to fill it. We need a culture change, and we propose that this change begin within graduate medical education. METHODS: We describe a case example of culture change and definitions of wellness at William Beaumont Hospitals, Troy Family Medicine Residency Program, a community-based, university-affiliated program in suburban Detroit, Michigan. RESULTS: We developed a toolbox of practical steps to create a culture that emphasizes wellness. We present a general timeline illustrating necessary steps toward accomplishing a true cultural change. DISCUSSION: The time has come for academic medicine to move beyond a simple discussion of physician burnout. To do this, we must first develop a shared definition of physician wellness followed by interventional strategies to bolster it. The benefits of cultural change include providing a more positive educational environment for residents and faculty, raising awareness of burnout and its symptoms, decreasing the stigma associated with admitting burnout symptoms, enabling the development of prevention strategies, and creating a more positive, strength-based approach to understanding the toll of physician-patient relationships on physicians.

Sociocultural interpretations of social phobia in a non-heterosexual female.

Social Phobia is a prominent anxiety disorder that is not well-understood, especially among socially marginalized, non-heterosexual individuals. A case description of Social Phobia symptoms in a female who is unsure of her sexual identity is presented and analyzed. The diagnostic assumptions of Social Phobia as applied to the case are critically examined. The goal is to highlight unanswered questions regarding social anxiety among non-heterosexuals and to open a discussion of cultural etiological theory. Implications for treating Social Phobia with a cultural component are discussed.