By Darrell G. Kirch
We face a crisis of well-being in medicine. From the acceleration of science to the implementation of the Affordable Care Act, rapid change has become the “new normal” for our profession. While many of the changes have the potential to revolutionize health care, they also create stress and uncertainty within our community about our personal futures and the future of academic medicine. At its worst, this stress contributes to the high levels of burnout, depression, and even suicide we are seeing in health care professionals. As a psychiatrist who has treated physician colleagues, I have seen depression interrupt promising careers in medicine and science. As dean of two medical schools, I saw the impact of burnout along the entire continuum, from students to senior clinicians…
I find the statistics deeply troubling. In 2015, Tait Shanafelt, MD, and colleagues at the Mayo Clinic published a study that found that 54 percent of physicians reported at least one symptom of burnout—an increase of nearly 10 percent in just three years.[i] The same study found that the depersonalization rate among U.S. physicians had grown from 30 percent to 35 percent, suggesting that more than one-third of physicians have lost touch with the humanism and empathy at the heart of our profession. We became physicians and scientists to care for patients, teach the next generation, discover new cures, and improve the health of our communities. But too often, the reason we chose a career in medicine gets lost amid the stress of caring for patients in moments of vulnerability or crisis.
For generations, health care has been a field characterized by hierarchy, autonomy, competition, and individualism. It is not easy to seek help in that type of environment. For the health of our profession, we must create a culture of medical education and practice that promotes wellness, community, and social support. We need to train medical students and residents with strategies to manage stress and bolster resilience throughout long careers in medicine. As Rosabeth Kanter says: “Complacency, arrogance, and greed crowd out resilience. Humility and a noble purpose fuel it.”[ii]
We share a “noble purpose”—a mission to improve the health of all patients, including those who face significant social and health inequities. Connecting to this mission will help build resilience among medical students, residents, faculty, and administrators. In a February 2016 column for the AAMC Reporter, Linda Brubaker, MD, MS, dean and chief diversity officer of Loyola University Chicago Stritch School of Medicine, wrote about Loyola’s university-wide commitment to reducing health disparities and improving the lives of the most vulnerable members of society. This mindful commitment to social justice not only serves our greater purpose in improving the health of our patients and communities. It will also make all of us—physicians, scientists, educators, and learners—healthier and more empathetic practitioners.
We must foster this connection with our communities and with our mission from day one of medical school if we are to educate the next generation of physicians to be not only compassionate caregivers, but also resilient physicians and supportive colleagues. If we are to provide the best possible care for our patients and support for our communities, we must begin to take better care of ourselves and each other. Resilience and humanism are qualities that will serve our students not only through the difficult years of medical school, but throughout their careers.
Darrell G. Kirch, M.D., is president and chief executive officer of the Association of American Medical Colleges (AAMC).
1Tait D. Shanafelt et al. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings, 90(12): 1600-1613.
2Rosabeth Kanter. (July 17, 2013). Surprises are the new normal; resilience is the new skill. Harvard Business Review. Retrieved from hbr.org/2013/07/surprises-are-the-new-normal-r. Accessed Sept. 23, 2016.
8 thoughts on “Educating for Resilience and Humanism in an Uncertain Time”
Your identification of the four characteristics of the health care field – hierarchy, autonomy, competition, and individualism, – supports the anxiety patients feel when speaking to health care providers about their health care concerns. Thank you for including a reference to “community,” an important starting point to better operationalize this “noble purpose.”
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Wonderful and important sentiments. I missed references to the pervasive territoriality, patriarchy and hierarchy that feed the problem. I’m amazed there are as many survivors of the training and practice environment as there are.
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Wonderful article! I find Antifragile by Taleb to be quite helpful tome for more resilience in uncertain times. https://www.amazon.ca/Antifragile-Things-That-Gain-Disorder/dp/0812979680
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Thank you for your vision Dr. Kirsch and for your leadership. In line with conceptualizing our role within medical education as responsible educators guiding professional identity formation (PIF) to prevent burnout, Academic Medicine’s recent theme issue on PIF included my Commentary highlighting resiliency as a component of PIF (http://bit.ly/1XKSOEs) and our article on pedagogies for promoting resilient, humanistic practitioners (http://bit.ly/1IKfPPb). Appreciate your (and AAMC’s) call to “bolster resilience” in students. This in combination with healthcare organizational initiatives to reduce stress and cultivate a culture of resilience and wellness may indeed contribute to practitioner wellbeing, ultimately impacting patient wellbeing. It is a shared responsibility. Thank you Loyola University Chicago Stritch School of Medicine for prioritizing this topic here and for the opportunity to present at your school on this vital topic.
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