Burnout in Medical Students Linked to Self-Reported Unprofessional Conduct

September 14, 2010 — Burnout in medical students is highly prevalent and is associated with self-reported unprofessional conduct involving patient care, according to the results of a Mayo Clinic study reported in the September 15 issue of the Journal of the American Medical Association.

"Our findings suggest future physicians' altruism, professionalism, and commitment to serve society are eroded by burnout," lead author Liselotte Dyrbye, MD, from the Mayo Clinic in Rochester, Minnesota, said in a news release. "This is concerning since burnout is a pervasive problem among medical students, residents, and physicians in practice."

The goal of this cross-sectional survey was to examine the association between anonymously reported measures of professionalism and burnout among 4400 eligible students from 7 leading medical schools (Mayo Medical School, University of Washington, University of Minnesota, University of Alabama, University of California–San Diego, University of Chicago Pritzker School of Medicine, and the Uniformed Services University of the Health Sciences). The survey included the Maslach Burnout Inventory (MBI), the Primary Care Evaluation of Mental Disorders depression screening tool, and the SF-8 quality of life (QOL) assessment tool. Response rate was 61% (n = 2682).

More than half (52.8%) of the respondents were found to have burnout on the MBI, and those students were more likely to report some form of unprofessional conduct. Although relatively few (<10%) reported academic cheating, up to 43% percent of third- and fourth-year students admitted to some form of unprofessional conduct involving patient care. For example, they may have reported a physical examination finding as normal even though they had not examined that area.

Because the students knew that the reported behavior was inappropriate, the investigators suggest that some elements in the educational process may promote dishonesty.

Burnout was the only aspect of distress independently associated with reporting at least 1 unprofessional behavior, based on multivariable analysis with adjustment for personal and professional characteristics.

For 6 different scenarios, the opinions of only 14% of the students regarding relationships with industry were in line with the American Medical Association policy regarding appropriate interactions between physicians and pharmaceutical companies.

The study authors therefore called on medical schools to "do a better job teaching students about conflict of interest and appropriate relationships with industry."

Altruistic feelings concerning a physician's role in society, such as a desire to provide medical care to the underserved, were less often reported by medical students suffering from burnout.

"As our nation reforms its health care system, it is essential that physicians advocate for patients, promote the public health, and reduce barriers to equitable health care," Dr. Dyrbye said. "Burnout appears to be a threat to this process."

Limitations of this study include response bias, assessment of only a limited number of behaviors and attitudes representing professionalism, reliance on self-reported behavior, and inability to determine causal relationships.

"Future research should investigate whether interventions designed to reduce burnout help students cultivate professional values and behaviour," the study authors conclude.

The Mayo Clinic supported this study. The study authors have disclosed no relevant financial relationships.

JAMA. 2010;304:1173-1180.