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  • There are multiple statistical trends among medical students and resident physicians that

  • are worrisome - the most poignant of which is the fact that doctors, including medical

  • students and resident physicians, have the highest suicide rate of any profession.

  • In this video, we'll cover burnout, a common precursor to depression and suicide, in medical

  • trainees.

  • We'll go over what burnout is, what causes burnout, and how you can reduce your own risk

  • of burning out.

  • What's going on guys, Dr. Jubbal, MedSchoolInsiders.com.

  • Burnout can be described as a physical or mental collapse caused by overwork or stress,

  • often relating to caregiving activities or work.

  • It is thought to be derived from three distinct elements, including emotional exhaustion,

  • depersonalization, and reduced sense of personal accomplishment.

  • Keep those three elements in mind, as we'll be referring to them throughout this video.

  • Burnout is everyone's business. Burnout has reached epidemic levels, in some studies

  • exceeding 50% of medical trainees or doctors in practice.

  • It's not exclusive to just medical students and residents, but rather workers in all industries.

  • In this video, we'll be focusing on the data regarding burnout in medical trainees

  • and doctors.

  • This, too, is everyone's business, as burnout contributes to an increased risk of medical

  • errors, depression, and adverse effects on patient safety. You don't want your

  • doctor burned out.

  • There are several theories on what causes burnout, the most convincing of which is the

  • Job Demands-Resources Model.

  • In its simplest terms, the Jobs Demands-Resources Model states that high job demands lead to

  • exhaustion, and low resources lead to cynicism and feelings of low personal efficacy.

  • Overall, chronic exposure to stress is the main risk factor. It's no surprise, then,

  • that medical students and residents in particular are subject to extraordinarily high rates

  • of burnout.

  • It's common for medical trainees to be deprived of sleep, have a high workload, relatively

  • low salaries, and several responsibilities in their workplace.

  • Yet there are other tremendous but often overlooked stressors in this profession, including the

  • great responsibility for the health of other people, dealing with patients, their pain,

  • and their families.

  • In a 2018 meta-analysis and systematic review by Rodrigues and colleagues, it was found

  • that residents in surgical, like general surgery and ortho, and urgent specialties, like anesthesiology

  • and OBGYN, demonstrated significantly higher rates of burnout.

  • Additional factors correlated with burnout include younger age, female gender, and having a high workload.

  • Interestingly, students who are single are significantly more emotionally exhausted than

  • classmates in relationships.

  • This doesn't mean to run out and get into a relationship pronto, but it does highlight

  • the importance of social support in warding off burnout.

  • If you look at the rates of burnout over the past few decades, there has been a consistent

  • and steady rise.

  • After scouring the literature and trends in medical training, I would attribute this to

  • three main factors:

  • First, increasing competitiveness.

  • Over the past 10 years, medical school has become significantly more competitive, with

  • a significant rise in the number of applicants, but not enough new positions in medical school

  • to accommodate the increase.

  • In such a landscape, pre-med and medical students are subject to ever increasing levels of stress.

  • Dr. Atul Gawande wrote an excellent piece in The New Yorker about how technological

  • changes in medicine have contributed to burnout.

  • In short, increasing requirements for computer documentation are highly correlated with burnout,

  • which is why neurosurgeons are less likely to be burned out than emergency physicians

  • they just spend less time documenting.

  • Additionally, decreasing physician autonomy is a major factor, as outlined by the Jobs

  • Demand-Resources Model.

  • Having more equal representation by both men and women in medicine is no doubt a great thing.

  • There are more female physicians now than ever before.

  • In fact, 2017 marked the first year where there were more women than men enrolled in

  • medical schools.

  • It is important to note, however, that the literature has consistently demonstrated that

  • women are more likely than men to experience burnout, and the increasing rates of women

  • in medicine is one of many factors contributing to increasing rates of burnout over the years.

  • This is obviously not a judgement in any way, but rather an objective reporting of

  • the data.

  • By understanding differences in burnout pattern causes and behaviors between men and women,

  • we become better equipped to solve a multifaceted and complex issue.

  • For example, as reported by the AMA, burned out female physicians are more likely to sleep,

  • eat junk food, or binge eat than their male counterparts.

  • The 2018 Medscape Physician Burnout & Depression Report noted that women rank family and romantic

  • relationships as top factors contributing to burnout, whereas for men, finances was

  • number one.

  • Further examination of the patterns in burnout between men and women is necessary in order

  • to best address and overcome this complex issue.

  • In order to address burnout, we must look at both preventative and therapeutic interventions.

  • How do we reduce the risk of it happening, and if it has happened, what can we do about

  • it?

  • Similarly, we must examine how individuals can best deal with burnout, and what we need

  • to change on a systemic level to reverse the trend of increasing burnout over the last

  • several decades.

  • On an individual level, there are 4 main pieces of actionable advice:

  • First, social support.

  • The most consistent finding throughout the scientific literature is that social support

  • reduces burnout.

  • Women seem to be better at this, seeking professional help for burnout on average 31% of the time

  • compared to men at 24%.

  • My advice to you is two-fold: first, seek professional help if you believe you are burned

  • out, depressed, or suicidal.

  • Second, seek the support from your friends, family, and colleagues.

  • I advise doing a shared activity where you can speak at ease and with relative privacy,

  • such as during a hike, a relaxed sport, or grabbing a meal or coffee.

  • Second, sleep.

  • Sleep duration is negatively correlated with burnout, meaning the more you sleep, the less

  • likely you are to be burned out.

  • Unfortunately, if you're burned out, your sleep quality is likely to suffer.

  • I have an entire playlist on sleep videos going over the best ways to optimize your

  • sleep, with actionable advice on improving sleep hygiene and consistently waking up significantly

  • more refreshed.

  • Link in the description below.

  • Number three, optimize your day-to-day life.

  • Life optimization is the name of the game here at Med School Insiders.

  • In creating a future generation of happier, healthier, and more effective doctors, we

  • understand that your personal and professional lives are not siloed apart, but rather are

  • closely intertwined.

  • Optimizing your sleep, productivity, and overall efficiency is going to go a long way.

  • However, there are frequently overlooked aspects that deserve highlight.

  • First, shorten your commute.

  • When I was in plastic surgery residency, I paid a premium to live near the hospital.

  • This reduced my commute drastically and also allowed me to cycle to and from work.

  • Ultimately, this meant more time for sleep, and I was able to get cardio twice daily,

  • automatically.

  • Other ways you can buy yourself more time include ordering takeout instead of cooking

  • yourself, getting a housecleaning service, or using ride-sharing services like Uber or

  • Lyft rather than driving.

  • Maintaining healthy habits such as proper nutrition and regular exercise will also go

  • a long way in sustaining this intense lifestyle and warding off burn out.

  • And number four, an important point about vacations.

  • Contrary to popular belief, they may not be as helpful as you think.

  • The reduction in burnout symptoms is short lived, lasting on average less than 3 weeks.

  • Plus, we want sustainable fixes, and vacations are relatively infrequent if you work in the

  • medical profession.

  • Now onto the systemic causes.

  • Ultimately, burnout is more of a systemic issue than a personal issue. While we must

  • all take responsibility and mitigate it in our own lives, the fact that burnout among

  • medical students, residents, and attending physicians has been consistently rising for

  • decades points to a systemic cause.

  • More and more medical schools and residency programs are pushing wellness programs to

  • address this growing issue.

  • While these programs may have good intentions, their utility and ultimate benefit is questionable.

  • A major point of contention is the fact that these programs push an undertone that burnout

  • is the responsibility of the medical student or resident – a failure of individuals to

  • properly self-care, sleep, and mitigate stress.

  • Rather, we need to urge our programs and institutions to make meaningful changes.

  • Facilitating social support, sleep, and autonomy are areas that, based on the scientific literature,

  • would be beneficial to this growing issue.

  • Burnout has been strongly correlated with suicidal ideation, even after controlling

  • for depression.

  • This is something I care deeply about, as I've lost friends, colleagues, and classmates

  • to suicide.

  • Nothing was being done about it, and suicides were being swept under the rug.

  • So I decided to do something about it.

  • Together with a team of other medical students and residents passionate about this issue,

  • we have started an initiative to raise awareness and help fund proposals in reducing medical

  • student and resident physician burnout, depression, and suicide.

  • It's called the #SaveOurDoctors Grant.

  • If you too refuse to sit idle in this epidemic, this is your chance to take a stand.

  • There are three ways for your to help: first, submit a video on the submission page

  • outlining your own proposal and enter for a chance to win yourself.

  • Second, blast #SaveOurDoctors on your social media accounts.

  • And third, donate to the cause.

  • Fully 100% of all proceeds go toward the grant and addressing this issue.

  • I've personally put $1,000 from my own pocket into this, but if you're willing to donate

  • even $5, that too will go a long way.

  • Thank you for watching.

  • I hope this video has helped you understand burn out and provided you with actionable

  • advice.

  • If you too are passionate about doing something, please get involved with the #SaveOurDoctors movement

  • Thank you for your support.

There are multiple statistical trends among medical students and resident physicians that

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B2 burnout medical sleep issue burned increasing

Why Are Doctors Miserable? | The BURNOUT Epidemic

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    Summer posted on 2020/09/20
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