The missing piece of the burnout puzzle may be career regret. Much is written about emotional exhaustion and depersonalization, and as previously discussed, the scales potentially miss the third aspect of burnout — a decreased sense of personal accomplishment. After all, one can recover from “circumstantial” burnout, but an “existential” crisis is far more challenging to resolve. Abedini, et al. took on this important question in a recent paper.
Abedini Nauzley C, Stack Shobha W, Goodman Jessie L, Steinberg Kenneth P. “It’s Not Just Time Off”: A Framework for Understanding Factors Promoting Recovery From Burnout Among Internal Medicine Residents. Journal of Graduate Medical Education. December 14, 2017;10(1):26-32. doi:10.4300/JGME-D-17-00440.1.
The paper look at resolution strategies for the two types in 28 interviews of residents that self-identified as having recovered from burnout as measured by the MBI. They found that recovery from circumstantial burnout was aided by easily changeable actions such as:
- Resolving Workplace Challenges. Examples include difficult interpersonal work stress (e.g., related to hours, caseloads, patient interactions, patient sickness, the EHR). Time heals some of these wounds. Since practicing doctors usually cannot apply the “time” fix to these problems, it may be more problematic for practicing doctors than residents
- Nurturing Personal Lives. Life challenges exist for us all and potentially are part of the journey. Though painful, most resolve over time as we find solutions or take action or the problem fades or resolves spontaneously. But certainly taking action to identify and resolve such issues is something we all must do, whether we are medical students, residents, practicing physicians, or anyone else.
- Taking Time Off. Recovery is key, thus the existing of weekends, holidays, vacation (and for the lucky few, sabbaticals). An overworked society must accept the need for breaks as well as allow breaks in attention. The solution thus requires a willingness to take a break and an organizations expectation and support for individuals taking breaks. As an aside, returning to a higher level of work / immediate return to a high, stressed-out state when one returns is not receiving the full potential of a break.
Resolving existential (career regret) burnout is different. Mostly this involves finding meaning and purpose through:
- A Reality Check. The first step in resolving a problem is to admit that a problem exists.
- Improved Relations. Improving relations with peers and patients and building meaningful connections with role models in the field is important to achieve.
- A Reminder About Medicine. Reminding oneself of the beauty, challenge, and science of medicine, along with the uniqueness that likely drove you to enter medical school, can help provide some clarity.
- Clarifying Your Identity (“I Am ___”). This is achieved through:
- continuing education
- boosting self-confidence via positive cognitions and avoiding negative cognitions (e.g., say “I’m on top of this” vs. “I can never deal with this kind of person”)
- acceptance of limitations (e.g. diagnostic challenges, oaths)
- Accepting The Reality Of The Job. Perhaps we oversell a medical career as “not just a job.” In fact, all occupations are jobs with bosses, institutions, responsibilities, tasks, timelines, and deadlines for which we get paid. Some of the burnout may be the common challenge of migrating from “student” (e.g., paying for experience) to “worker” (e.g., being paid to perform a job), so accepting this reality may be a key component to recovery.
There are two lessons. First, pay attention to different aspects of your emotional state including:
- exhaustion (physical or emotional)
- depersonalization of both patients, peers, and family members
- doubts of accomplishment, both personal and professional
- a regret of one’s career choice
Then, apply the proper fix be it exercise, dietary change, cognitive restructuring, taking a quick break, mindfulness, yoga, improving relationships, going on vacation, expanding your knowledge, watching a movie, accepting reality, or waiting for time to do its magic.
Addressing the issues that lead to burnout is important in overcoming this persistent issue among medical students. We seek to educate medical students about the issue of burnout through game-based learning. In BurntOut, medical students are immersed in a virtual reality environment where they practice coping strategies to improve resilience. The BurntOut role-playing experience delivers targeted, realistic narratives and hands-on scenarios to deepen medical student understanding of how to address and overcome burnout during game-play and beyond.
Currently, we are recruiting medical students to test the BurntOut prototype and provide us feedback, as well as provide us information on their own burnout experiences while in medical school. The data we collect from this experience can help further the research on both medical student burnout and physician burnout by identifying these issues early on and addressing them early on in the medical provider’s career. You can learn more about the role-playing experience and how to get involved at the BurntOut website.