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By and Sept. 21, 2021
We started medical school at Columbia University Vagelos College of Physicians and Surgeons in August of 2020, with classmates scattered all across the world. For some, the educational day ended in the late afternoon; for others, just before dawn.
Our cohort of 140 students had imagined embarking on this path toward physicianhood together but, because of the Covid-19 pandemic, we started several time zones apart.
Our class started school eager to connect with others answering the call to medicine but, like many professionals who were forced to pivot to remote work during the pandemic, we were confronted with new, lonelier routines. Instead of learning how to use stethoscopes by listening to each others’ hearts in Columbia’s high-tech simulation rooms, we’ve struggled to learn medicine by watching YouTube videos alone. Day after day, interactions via black Zoom boxes have displaced forming real connections with classmates and teachers and distanced us from our budding profession and passion.
This disconnection has led to burnout.
Even before the pandemic, medical students around the country were burning out at alarming rates. Medical school burnout typically peaks during clinical training in the third year. Many in our class could already self-diagnose symptoms of burnout after a few months: emotional exhaustion, cynicism, detachment toward work, and a low sense of personal accomplishment.
Left untreated, burnout erodes physician compassion. As compassion is a key determinant for quality patient care, this is a major concern. With more than 22,000 students nationwide who started medical school in the fall of 2020, not long after the height of the Covid-19 surge in New York City — with a second cohort of 22,000 beginning this fall— such early-onset burnout is hazardous to the nation’s health.
Medical trainees with burnout are at higher risk for psychiatric disorders and suicide. Before the pandemic, 27.2% of medical students fit a probable diagnosis of major or mild-to-moderate depressive disorder, and a monumental 11.1% reported having thoughts of suicide. Recent studies of the pandemic’s impact on medical students reaffirmed our own experiences at Columbia, one of which showed a 61% increase in anxiety and 70% increase in depression during the pandemic.
Along with challenges to mental health, the pandemic has deepened other vulnerabilities. Medical students are frustrated with their schools’ responses to the crisis. While many families in the U.S. lost their livelihoods, the cost of attendance has still increased at many schools, despite the already prohibitively high cost of medical education. At the same time, adapting to new online formats necessitated additional expenses: laptops, tablets, and high-speed internet to keep up with the demands of virtual classes. Despite these hardships, many medical schools — including Columbia — opted not to reduce the cost of attendance, sparking tuition strikes across the country.
To remedy a complex situation, medical schools need to systematically understand and address how their students have been uniquely affected by the Covid-19 pandemic. As members of the inaugural cohort of online medical students, we believe that medical schools should:
Evaluate the problem of early medical student burnout as a result of the pandemic. Medical schools, hospitals, and institutions need to devote resources and attention to systematically understanding how the pandemic has affected trainees’ mental health, burnout levels, and postgraduate goals. With the recent appearance of the Delta variant, rise in breakthrough cases, and enduring vaccine hesitancy, the effects of the pandemic appear long-lasting. For medical students, as well as trainees from other health professionals like nursing and pharmacy, solutions to burnout are needed to prevent future impacts to compassionate care.
Focus on small-group interactions, limit screen time, and make other curricular adjustments. While virtual learning might remain a component of education far beyond the pandemic, medical schools need to acknowledge and mitigate some of its harmful consequences on student well-being. In keeping with the CDC’s revised guidelines on reopening schools and universities, in-person activities should be given priority whenever possible as schools balance the benefits of virtual learning with their negative ramifications. Limitations on screen time should also apply to both live and pre-recorded lectures.
Facilitate student social support and resilience. While the current stress burden on medical trainees is unprecedented, our capacity to build resilience against burnout has also been compromised. Notably, because of the cohort’s lack of in-person connections, we have had fewer social networks to mitigate emotional hardships and protect against professional burnout. Medical schools can help enhance resilience by increasing student access to long-term therapy, offering free subscriptions to meditation apps, and facilitating greater time devoted to wellness and recovery.
We began medical school in a pandemic, eager to contribute our energy and effort to the field of medicine when our communities needed us the most. So far, the pandemic has changed medical education in ways that have not only made burnout more probable but also increased the burdens faced by our underrepresented and underprivileged colleagues. The future of medicine depends on medical schools understanding the consequences of online medical education on students’ well-being — to ensure the well-being of our future patients.
Aomeng Cui and Amir Hassan are second-year medical students at Columbia University Vagelos College of Physicians and Surgeons. As part of a course on social justice led by STAT columnist Jennifer Okwerekwu, they wrote this essay in collaboration with their Columbia colleagues Cameron Clarke, Jennifer Egbebike, Carly Mulinda, Diana Perez, Anna Rose, Peter Suwondo, Wesley Vear, and Kevin Wang.
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