“Burnout” in healthcare has reached epic proportions.
Progressive organizations such as The Cleveland Clinic have gone beyond most healthcare organizations, who are still struggling to even define and identify the conditions leading to physician burnout. They’ve actually made an organization-wide cultural commitment to preventing (not just reacting) to potential burnout using a crisis intervention model called Code Lavender, with timely support given at all levels of leadership and staff. It’s a model yielding impressive results (although one observer stated most of the codes were for nurses, rather than physicians – but that’s another post!).
We applaud this effort and ask: what if we applied a proactive approach to where burnout begins in medical school?
Medical students must have training in leadership from their first year of education.
Physicians who are social media contributors, most notably at KevinMD, are consistently raising red flags of warning regarding how the medical school and resident expectations set physicians on the path toward burnout (and decrease patient safety). Most agree it will take much more than changing the MCAT to transform the “lone expert” model historically rewarded by medical schools. In Things we should be teaching in medical school, but aren’t, Dr. Alexandra S. Brown states 4 essential elements currently missing from the average medical school curriculum:
- The current financial state of US Healthcare
- The tremendous variation in how we practice medicine
- Quality controls cost
- It’s impossible to keep up
PLI supports all of Dr. Brown’s suggestions for adding to the med school curriculum, but it’s #4 that best communicates what’s wrong with medical school: medical students aren’t told, nor ever allowed to admit, they feel “it’s impossible to keep up”.
At PLI, we ask:
- What does society stand to gain by upholding an impossible standard for medical students, residents, and physicians to Know All and Be All, achieve singular excellence, and ignore that they as humans need other humans to succeed?
- Why do we as an industry still allow this traditional med school recipe to produce clinicians, only to watch highly capable ones crash and burn, at times blamed for “not being cut out for the job”?
The med school message of “individual infallibility equals excellence” must be named and ended. Certainly, the stakes are high, and that is how this tradition of unrelenting stress on individual clinicians was born. Yes, the success of an individual physician can literally be a matter of life and death for a patient, and that cannot be understated. At PLI, we say this is all the more reason to equip med students with self-awareness, leadership, and collaborative skills, from their very first year, that will enable them to thrive (not just survive) during medical school and beyond.
So what will this look like?
Research shows medical students show an alarming drop in empathy, a critical component of “emotional intelligence,” between their first and third year of training. This must be solved for. The “broken covenant” in healthcare further increases this cynicism in physicians, sapping the motivation needed for collaboration, patient-centric care, organizational commitment, and leadership qualities, and ultimately, leads to burnout.
It’s now time to ask deeper questions about changing the entire culture of how physicians are prepared, both in clinical and non-clinical capacities.
An integrated approach is needed for medical schools and residencies integrate physician leadership into their curriculum. We strongly recommend the adoption of a PLI Leader-ist Med School Model:
This is just the beginning of the conversation and change effort that must happen. It’s not just the admissions committees and College of Medicine presidents that own this problem and its solution: it’s all of us.
We applaud the physician leaders who are getting the word out about what’s missing in medical schools, residencies, and fellowships, and how providing leadership development from the very start can create a collaborative culture and help stem the tide of physician burnout. We also applaud the American Medical Association – Residents & Fellows initiative to increase wellness among physicians in training for their surveys and other support efforts.
We are here to support the physicians of tomorrow.
The framework of a medical school curriculum will have to become one of personal, as well as professional, transformation. Healthcare now has enough specialists, we need more Leader-ists!