Letters to the Editor
To the Editor:
We read with great interest the recent report from Jackson and colleagues1 about medical student well-being and its correlation with student debt and substance abuse. This topic is very important to this caring profession and the country as whole. The study raised two important questions for us.
First, from this study, a disturbing number of medical students met criteria for burnout (54%) and alcohol abuse/dependence (32%). We wonder if the burnout rate was equal for each year of medical school since preclinical students do not have any primary role in patient care.
We wonder also if the Maslach Burnout Inventory–Health Services Survey (MBI-HSS) is the best measure for medical student burnout in the preclinical years. Per Maslach, “Working with other people, particularly in a caregiving relation ship, [is] at the heart of the burnout phenomenon.”2 The major components of burnout include depersonalization, a mechanism of coping by “moderating one’s compassion for clients by emotional distance from them”; and emotional exhaustion, described as “feelings of being emotionally overextended and depleted of one’s emotional resources.”2 Since preclinical students do not really have “clients,” are their responses really reflective of burnout or do they represent general stress, depression, or anxiety? Furthermore, the questions included in the MBI-HSS may be perplexing for a preclinical medical student. A couple of examples of possibly confusing questions include “I deal effectively with the problems of my clients” and “I feel clients blame me for some of their problems.”3
We feel that burnout during the preclinical years may be driven by the tedium of the work and stress related to being learners who have not yet developed the skills of a clinician, rather than “burnout in terms of the social relationship between two people: someone who gives, and the other who receives.”2
Ravi Gopal, MD
Staff physician, Denver Veterans Affairs Medical Center, Denver, Colorado; email@example.com.
Allan Prochazka, MD
Staff physician, Denver Veterans Affairs Medical Center, Denver, Colorado.
1. Jackson ER, Shanafelt TD, Hasan O, Satele DV, Dyrbye LN. Burnout and alcohol abuse/dependence among U.S. medical students [published online ahead of print March 1, 2016]. Acad Med. 2016;91:1251–1256.
2. Maslach C. Schaufeli WB, Maslach C, Marek T. Burnout: A multidimensional perspective. In: Professional Burnout: Recent Developments in Theory and Research. 1993.Washington, DC: Taylor & Francis.
3. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 1996.3rd ed. Palo Alto, CA: Consulting Psychologists Press Inc.