WWe began our medical studies at Columbia University Vagelos College of Physicians and Surgeons in August 2020, with classmates scattered around the world. For some, the pedagogical day ended at the end of the afternoon; for others, just before dawn.
Our cohort of 140 students had imagined embarking on this path to medicine together but, because of the Covid-19 pandemic, we started in several separate time zones.
Our class started school with a desire to connect with others answering the call for medicine, but like many professionals who have been forced to turn to remote work during the pandemic, we have been faced with new, more lonely routines. Instead of learning to use stethoscopes while listening to each other’s hearts in Columbia’s high-tech simulation rooms, we struggled to learn medicine by watching YouTube videos on our own. Day after day, interactions via Zoom black boxes have shifted the formation of real bonds with classmates and teachers and have taken us away from our profession and our burgeoning passion.
This disconnection led to burnout.
Even before the pandemic, medical students across the country are burning out at an alarming rate. Burnout in medical school typically peaks during third year clinical training. Many in our class could already self-diagnose the symptoms of burnout after a few months: emotional exhaustion, cynicism, detachment from work, and a low sense of personal achievement.
Without treatment, burnout erodes the compassion of physicians. As compassion is a determining factor in the quality of patient care, it is a major concern. With more than 22,000 students nationwide starting medical school in fall 2020, shortly after the peak of the Covid-19 outbreak in New York City – with a second cohort of 22,000 starting this autumn – such early exhaustion is dangerous for the health of the nation.
Medical trainees suffering from burnout are at greater risk of psychiatric disorders and suicide. Before the pandemic, 27.2% of medical students had a probable diagnosis of major or mild to moderate depressive disorder, and 11.1% reported having had suicidal thoughts. Recent studies on the impact of the pandemic on medical students have reaffirmed our own experiences at Columbia, one of which showed a 61% increase in anxiety and 70% in depression during the pandemic.
Besides mental health issues, the pandemic has exacerbated other vulnerabilities. Medical students are frustrated with their schools’ responses to the crisis. While many families in the United States have lost their livelihoods, the cost of attendance has increased further in many schools, despite the already prohibitive cost of medical education. At the same time, adapting to new online formats has required additional expenses: laptops, tablets and high-speed internet to meet the demands of virtual classrooms. Despite these difficulties, many medical schools, including Columbia, have chosen not to cut tuition fees, triggering tuition strikes across the country.
To remedy a complex situation, medical schools must systematically understand and address how their students have been particularly affected by the Covid-19 pandemic. As part of the inaugural cohort of online medical students, we believe medical schools should:
To assess the problem of early burnout of medical students 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 mental health, burnout levels, and postgraduate goals for interns. With the recent appearance of the Delta variant, the increase in the number of revolutionary cases and the persistent reluctance to vaccinate, the effects of the pandemic appear to be lasting. For medical students, as well as interns from other health care professionals like nursing and pharmacy, solutions to burnout are needed to prevent future impacts on compassionate care.
Focus on small group interactions, limit screen time, and make other adjustments to the schedule. While e-learning may remain a component of education well beyond the pandemic, medical schools need to recognize and mitigate some of its negative consequences for student well-being. In line with the CDC’s revised guidelines for reopening schools and universities, in-person activities should be prioritized where possible, as schools balance the benefits of virtual learning with their negative ramifications. Screen time limitations should also apply to live and pre-recorded conferences.
Facilitate social support and resilience of students. While the current stress burden on medical trainees is unprecedented, our ability to build resilience against burnout has also been compromised. Notably, due to the cohort’s lack of in-person relationships, we had less social media to ease emotional difficulties and protect us from burnout. Medical schools can help improve resilience by increasing students’ access to long-term therapy, offering free subscriptions to meditation apps, and making time for wellness and recovery even easier.
We began our medical studies during a pandemic, eager to contribute our energy and efforts to the field of medicine when our communities needed us most. So far, the pandemic has altered medical education in a way that has not only made burnout more likely, but has also increased the burden on our underrepresented and disadvantaged colleagues. The future of medicine depends on medical schools understanding the consequences of online medical education for the well-being of students, in order 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.