Minority Attrition and Burnout Among US Medical Students

Nisha N. Branch
SNMA Chapter President, Region VI Corresponding Secretary, Region VI Research Liaison
2012 M.D. Candidate
Howard University College of Medicine

It has been well documented that an ethnically/racially diverse physician workforce is essential in eliminating health disparities which currently exist in this nation.  To that end, entities like the Student National Medical Association and the Association of American Medical Colleges have advocated and encouraged medical schools to increase the number of underrepresented minorities (URMs) within each entering medical school class.  Additionally there has been a call for an increase in the absolute number of physicians needed to address the healthcare needs of the US population.  Attrition rates, specifically among URMs, are of particular concern as this directly impacts the racial/ethnic makeup of the physician workforce.  An increase in class size and the formation of new medical schools necessitates adequate support for all students academically, personally, and with regards to other life stressors.  However, in the absence of such support, students are more likely to experience burnout or high emotional exhaustion, and consequently increase the rates of attrition.

Over the last several years the issue of burnout, among other factors, has been studied within the minority medical student population.  With minorities accounting for only eight percent of the physician workforce, determining the factors that contribute to burnout is essential in combating the issue.  While there is an increased likelihood of attrition among URMs, the reasons for their departure from medical school are not well understood.

One study found similar rates of burnout among minority and nonminority students.  However, more minorities met the criteria for low sense of personal accomplishment.  In the area of quality of life the minority students had similar physical quality of life scores but tended to have lower mental quality of life scores as compared to nonminority students.  They also found that while minority and nonminority students faced similar major life events their coping strategies differed, and in some instances minority students felt inadequately supported by their school.  Nonminority students emphasized protecting time away from schoolwork, recreation, hobbies, or exercise and alcohol in their coping strategies.  Conversely, minority students valued involvement in research activities and assuming a survival attitude expecting that things will ultimately improve to counter stress.  It is perhaps this combination of factors that significantly contribute to minority burnout.  If students are less satisfied with their accomplishments, and their methods of coping rely on delayed gratification, the lack of rewarding activities could make the goal appear farther away and thusly evoke feelings of distress.

Burnout however, is not unique to minority medical students.  A later study conducted by many of the same authors found that nonminority students were more likely to experience burnout.  While burnout is more common among medical students than the general population, they found that race does impact the distress felt by minority students.  There was an almost five fold greater likelihood that minority students had an experience that adversely impacted their training due to their race.  Although the prevalence of depression among all minority students surveyed was not greater than nonminority students, those students who had an adverse race related experience were also more likely to screen positive for depression, and have high emotional exhaustion scores.  This trend was not found among the nonminority students.

It is clear from these studies that while burnout has been theorized to account for the disproportionate attrition rates among minority medical students, there are other factors at play.  It has been speculated that minority students are less likely to experience burnout due to having overcome educational or professional challenges prior to entering medical school that have made them more resilient to obstacles faced while in school.  Consequently, as burnout in isolation is not the sole contributing factor in minority student attrition rates, identifying the areas of distress which are uniquely experienced by these medical students that contribute to their attrition are of greatest concern.

Medical schools need to take a more active role in indentifying and addressing areas of distress particularly as it relates to perceived discriminatory practices or behaviors.  As schools and advocacy organizations actively work to enhance the diversity of medical student matriculants, addressing these issues immediately can help prevent further distress for current and future minority students.  Moreover, proactive assessment ensures that minority students are not negatively impacted by faculty discrimination and evaluations of student’s performance are not tainted.

Another area in which medical schools can significantly effect change is assessing the effectiveness of their office of diversity/minority affairs.  There are multiple reasons nonminority and minority students alike cite for underutilizing these support offices.  They include beliefs that they will not get the assistance they need, problems with access, and fear of reprisal.  This department can act as a first line of support, and a litmus test for the level of student distress.  Furthermore, if it becomes a part of the culture of support, self limited factors such as belief that help is not accessible will no longer be of concern.

The last and most profound role that should be shared by the medical school and student body is to welcome the differences and variation that diversity brings to the learning environment.  A culture of acceptance and eagerness to learn from one another will foster a collaborative and supportive environment.  This could serve to decrease the sense of isolation felt by minority medical students as reported in some studies.  Facilitating shared events and forums for open discussion can mitigate what is already a stressful time in a student’s life.  This allows the focus to return to excellence in education, and the highest standard for patient care.  While there is obvious room for improvement it will require collaboration, commitment to improvement, and an open mind from all stakeholders to adequately address factors which contribute to minority medical student burnout and attrition.  Advocacy on behalf of those most impacted and bringing increased awareness to these issues are essential first steps in providing real solutions.

References
Dyrbye, L. N., Thomas, M. R., Eacker, A., Harper, W., Massie, J. F., Power, D. V., et al. (2007). Race, Ethnicity, and Medical Student Well-being in the United States. Arch Intern Med, 2103-2109.
Dyrbye, L. N., Thomas, M. R., Huschka, M. M., Lawson, K. L., Novotny, P. J., Sloan, J. A., et al. (2006). A Multicenter Study of Burnout, Depression, and Quality of Life in Minority and Nonminoirty US Medical Students. Mayo Clin Proceedings, 1435-1442.

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