The Role of Interpersonal Toxicity on Healthcare Students’ Well-Being : The Journal of Physician Assistant Education

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Research Article

The Role of Interpersonal Toxicity on Healthcare Students’ Well-Being

Sierra, Talia DMSc, PA-C; McCall, Timothy C. PhD; Brown, Heidi BCHS, PA-C; Smith, Noël E. MA

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The Journal of Physician Assistant Education 33(3):p 198-204, September 2022. | DOI: 10.1097/JPA.0000000000000440



Nearly half of all medical students suffer from burnout, which not only has detrimental effects on the students themselves but can transfer into the clinical realm. Yet, studies exploring burnout and interpersonal toxicity in physician assistant (PA) students are rare. This study examined the role that interpersonal toxicity and abuse play in PA student burnout.


Nearly 2500 PA students in the United States responded to a survey about well-being, stress, and experiences with interpersonal toxicity in PA school as part of a larger cross-sectional study on PA student experiences in their didactic and clinical years. The present research focuses on overall measures among all PA students, as well as differences between didactic and clinical students, including the extent to which experiences of interpersonal toxicity predict symptoms associated with burnout.


Overall, PA students reported high levels of satisfaction and happiness in school and life, but enthusiasm for school decreased for clinical students. More than two-thirds of students reported moderate to high levels of life stress, and more than 9 in 10 reported moderate to high levels of school stress. Symptoms of burnout were reported by many students, with clinical students reporting interpersonal toxicity exposure more often than didactic students. Experiencing interpersonal toxicity or abuse predicted symptoms of burnout.


While PA students report high levels of life and school satisfaction, given the high levels of stress also reported, burnout metrics and well-being programs are needed. PA programs should work to create a supportive and engaging educational environment to ensure students’ long-term career success.

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