Summary
Health care providers, resident physicians, and medical students are at significantly higher risk of psychological distress than the general population. Almost half of all medical trainees have documented provider burnout, commonly described as emotional exhaustion, cynicism, and depersonalization, and, alarmingly, as many as one in ten medical students reported suicidal ideation within the past 12 months. There are numerous interventions that can improve health care providers' mental health and sense of well-being, helping to prevent the catastrophic consequences of unaddressed psychological distress. A top priority is ensuring that all students and providers have information on self-identification of suicidal tendencies and access to suicide prevention resources. Additional interventions to promote mental and physical well-being can be implemented at an individual and institutional level. Mindfulness meditation is increasingly recognized as a powerful tool to improve providers' well-being. Mindfulness meditation utilizes techniques such as focused breathing and guided imagery to bring the user's attention to the present moment to reduce stress and anxiety and is associated with positive long-term physical, cognitive, and behavioral changes.
If you are transitioning to residency, see also “Life outside of the hospital.”
Epidemiology
Occupational distress, though difficult to define and quantify, is common among health care providers and trainees. Almost half of all providers meet some criteria for provider burnout or lack of job satisfaction. [1][2]
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Physicians
- Satisfied with work-life balance: 46% [2]
- Met criteria for physician burnout: 38% [2]
- Positive screen for depression: 40% [3]
- Suicidal ideation: 7% [3][4]
-
Resident physicians
- Met criteria for physician burnout: 45% [5]
- Depression or depressive symptoms: 29% [6]
-
Medical students [4]
- Met criteria for physician burnout: 50%
- Suicidal ideation: 10%
Epidemiological data refers to the US, unless otherwise specified.
Mindfulness
Research shows that mindfulness practice and lifestyle interventions to enhance nutrition, sleep, and physical conditioning boost cognitive performance and improve health and well-being. [7]
Mindfulness practice
- Mindful breathing focuses the individual's attention on the natural rhythm of inhalation and exhalation.
- Any physical sensation that occurs while breathing may be used as a point of focus.
- Common sensations to focus on include:
- The alternating sensation of cool and warm air in the nares
- The sound of air moving through the nose and throat
- The expansion and contraction of the chest
Scientific evidence for the benefits of mindfulness
Neurophysiology
- Increased quantity of gray matter in areas of the brain associated with learning and memory [8][9]
- Enhanced activation of areas of the brain associated with attention [7]
Cognitive performance
- Improved attention even after brief mindfulness meditation [10]
- Increased working memory after sustained mindfulness [11]
- Improved learning effectiveness and cognitive performance in university students after structured mindfulness programs [12][13]
Physical health [8]
- Decreased sympathetic nervous system activity and increase parasympathetic nervous system activity
- Decreased concentration of proinflammatory cytokines and increased concentration of antiinflammatory cytokines [14][15]
- Decreased epigenetic changes associated with cell aging [13]
Mental health
- Decreased depression, anxiety, and social impairment in emergency medicine providers practicing mindfulness [16]
- Decreased self-reported stress in health care workers [17]
- Improved scores on the Maslach Burnout Inventory in health care providers [18]
- Reduced depressive symptoms in patients with major depressive disorders (as adjunctive therapy) [19]
Healthy living
Maintenance of strong social support
-
Staying connected with classmates
- Join a social media or in-person group.
- Organize a meal (e.g., try new restaurants, cook at home).
- Celebrate medical school milestones!
- Consider joining a club or a sports team at the medical school.
- Schedule weekly or monthly meetups and take advantage of local events.
-
In the classroom
- Consider joining a study group.
- Inquire about student body organizations and mentorship programs.
- Share tasks with others and pool your results (e.g., when creating Anki cards).
- Utilize your institution's support services.
-
During clinical rotations
- Pursue recreational activities in your free time.
- Maintain relationships with family and friends outside of the university.
- Check-in with yourself and share these feelings with close friends.
- Spend time in nature.
-
During away rotations
- Find a local area events calendar.
- Join local meetups.
- Find a place to live that is both convenient and fun.
- Determine what style of living is right for you (e.g., private room or apartment, flat sharing, shared common spaces).
- Ask a student at your medical school who has rotated there for advice.
- Engage in conversation and form relationships with members of your care team.
Movement and exercise
- Stimulates synaptic transmission and release of endorphins [20]
- Improves memory retention; likely due to increased production of neurotrophin [21]
- May be beneficial as adjunctive therapy in major depressive disorder and anxiety disorder [22]
- Reduces fatigue and pain and improves overall quality of life [23]
Healthy diet
- Reduced risk of depression with a diet high in fruit, vegetables, and unprocessed grains [24][25]
- Improved academic performance with the consumption of breakfast, regular meals, and fruit [26]
- Benefits of the Mediterranean diet
- Reduced serum inflammatory marker concentration [27]
- Improved glucose metabolism
- Decreased blood pressure
- Decreased levels of cholesterol, triglyceride, and HDL [28]
Sleep and rest
- Improves long-term memory [21]
- Positive impact on academic achievements [29]
- Regular breaks decrease the level of fatigue during the workday. [30]
Suicidality and burnout
In the United States, approximately 10% of medical students experience suicidal ideation and approximately 50% meet the criteria for clinician burnout. [4][31][32]
- If you are experiencing suicidal ideation, seek immediate care.
- Never downplay or dismiss suicidal ideation.
- Be vigilant for factors that are associated with suicidal ideation: e.g, depression, anxiety, burnout, substance use
- Reach out to a mental health professional.
- Consider taking an online mental health test: See “Tips and Links.”
- Find out if your university, hospital, or health system offers health care provider-specific resources, e.g.:
- Screening: e.g., interactive screening programs
- Crisis resources and counseling services
- Peer and/or mentor-based support networks
- Confidential text and/or phone hotlines
- Feedback mechanisms to improve the learning and work environment
- Ask peers, friends, and family for support.
- Family and friends are frequently the first to recognize warning signs.
- Friends and peers may be going through or may have been through similar struggles, which can mitigate feelings of isolation.
- Sharing feelings and being vulnerable is often easier with family and friends; do not be afraid to broach these subjects if you are concerned.
- Take a leave of absence if your health and/or mental health are at risk.
Do not attempt to diagnose or treat yourself and do not wait until symptoms become severe to seek help.
If you are a resident of the United States and are having suicidal ideation, seek help immediately (e.g., call 911 or go directly to the ER or a mental health intake facility). If you feel uncomfortable seeking care in your own health system, go to another health facility, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741).
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