Westfall’s commentary “You Will Miss Your Grandmother’s Funeral: Surviving Medical School Just in Time to Burnout [1]” highlights the negative messages about physician-hood that faculty portray to medical students. We are deeply affected by its relevance, importance, and urgency.
Medical students find, to their ontological distress, that being a physician is not what they dreamed of. Yet a transformative learning experience has to take place to enable the student to understand concepts essential to becoming a physician. These learning experiences are Mezirow’s [2] “disorienting dilemmas” and Meyer and Land’s [3] “threshold concepts.” Disillusionment is inevitable as students face this awareness. Medical students struggle; but because stoicism [4] is taught in the hidden curriculum; they cope by isolating themselves and their emotions from faculty “Knowing that I am completely human/and trying to prove that I’m not [5].” In contrast, reflections from students who have achieved a level of comfort with their new reality are profound and pure poetry “How blessed we are, how sacred to repair these lives [6].”
Because student burnout is rampant, as faculty, we have a responsibility to support students as they transition into physician-hood and to prepare them for the reality of medicine in a manner that will facilitate their resilience, satisfaction, and joy in the role of physician. This type of teaching could involve Lin’s [7] “directed teaching” (role modeling, scaffolding, and coaching) during the clinical years, which was associated with lower rates of burnout among the students.
At the Uniformed Services University, we offer self-care opportunities and courses (such as yoga, meditation, Healer’s Art, and Humanities in Medicine). As a military medical school, we also emphasize opportunities for appropriate physical fitness and weight management. Furthermore, we took the suggestion of Westfall to re-evaluate the titles of our lectures, and now present “How to Prosper in Your Clerkship Year” (as opposed to using the previous title of “Clerkship Morbidity and Mortality”).
We completely agree that the narrative has to change, and that faculty must be a part of that by changing how they talk and interact with each other, with other services, and with our medical students. What makes it such a long game is that it requires each generation moving further and further away from the “way it always has been,” creating a slow but progressive dilutional effect that is spread out over several generations. It is a slow crawl, but a worthy effort.
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The views expressed are those of the authors and do not necessarily reflect the official position of the Department of Defense or the Uniformed Services University.
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The authors declare that they have no conflict of interest.
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References
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