Academic Burnout in Medical Students

by dr. Zahra Mustavavi, MMR National Public Health Officer CIMSA 2013/2014

In this pandemic era, many people experience ever-increasing pressure in their daily life, including in the education sector. Then, medical students have more psychological problems than other students. It takes at least 5 years to become a doctor and during the process and because of the pandemic the student should be adapted to the online academic process. Sometimes students are faced with academic stress that occurs due to the intense competitive environment in medical school.

Nowadays, many of the learning processes in medical school have gradually returned to the offline format. Theoretically, the education style should become more effective compared to online learning. However, it can also cause confusion and stress due to the ever-changing learning environment. If they feel stress for a long time, it will cause burn-out.

According to the WHO, burn-out is defined by Herbert Freudenberger in the 1970s; a syndrome conceptualized as resulting from chronic workplace stress that is not managed successfully. Burn-out syndrome has three classic symtoms:

1. Exhaustion or feeling of energy depletion.

2. Feelings of negativism or cynicism related to one’s job (depersonalization).

3. A sense of inefficacy and reduced a ccomplishment

Burn-out was worse than ordinary fatigue. Burn-out can disrupt not only personal, but also social functioning. If an individual is not able to handle the stress, then the body will respond psychologically and physically. Physiological processes that are caused by stress are involved by three systems, which are central and peripheral nerve system, endocrine system, and also immune system.

All of that system stimulates the hormone secretion to change homeostasis of the body. Then the body will be ready to change into a ‘Fight or Flight’ mechanism. Person with burn-out syndrome can be associated with physical symptoms such as gastrointestinal disorders, sleeplessness, and shortness of breath. They also can feel frustrated, angry, fearful, or anxious.

In 2019, Rossalina et al.in Ananda et al found low levels of wellbeing and high levels of burn-out among 1.792 respondents of Indonesian medical students, from across the six regions of Indonesia. Multiple causes of stress are 71% from studies, 46% because of relationships, 29% from financial and 7% from accommodation. Burn-out can reduce professional development of medical students. As a result, medical students feel uncomfortable in the educational process that can lead to inappropriate learning out-come even thinking to drop-out of college. They can be in a dangerous sitution, some of them would have suicidal ideation.

Burn-out doesn’t appear all at once. Herbert Freudenberg and Gail North described it in 12 stages and currently it is simplified into a 5 stage model.

1. Honeymoon Phase

It happens when you start the job or project, you feel enthusiasm, energized and no stress.

2. Onset of stress

This stage is characterized by stagnation. During this stage you feel that life becomes limited to work, while family, social life and personal priorities are neglected. You are starting to feel stress about work.

3. Chronic Stress

During this stage, you are stressed everyday at work. You feel physically and emotionally exhausted and this stage leads to frustration.

4. Burnout

It leads to a stage of apathy where despair and disillusionment occur. You feel physical and mental exhaustion and no amount seems to help. You don’t see a way out of the situation.

5. Habitual burnout

As the name stage, it happens when the experience of burning out becomes chronic and habitual. These may prompt one to look for help and intervention.

Here some tips to prevent Burn-out syndrome for medical students:

As we know that burnout is preventable. So, if you read the stage, signs and symptoms of burn out, and feel that you are at one of those stages, just follow the tips and it's important to reach out for help. But if you feel asking for help is difficult, consider developing self check-in with close friends and family members, so you can take care of each other during the times.

References

Ananda Nabila et al. Mental health and wellbeing of Indonesian Medical Students; A regional comparison study. International Journal of Social Psychiatry 2022, Vol.68960 1295-1299.

Firdaus et al. Potensi Kejadian Burnout pada Mahasiswa Kedokteran di Masa Pandemi. Hang Tuah Medical Journal. Vol 18 No. 2. 2021

De Hert,Stefen Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies. Dove Press Journal Local and Regional Anesthsia 2020;13 171-183.

Soo Jin Lee, Young Jun Choi, Han Chae. The effects of personality traits on academic burnout in Korean Medical Students.Integrated Medical Research 6 (2017) 207-213.

WHO. 2019. Burn-out an “occupational phenomenon”: International Classification of Disease. Accessed from https://www.who. int/news/item/28-05-2019-burn-out-an-occupational-phenom enon-international-classification-of-diseases.