Medical students are reporting faults in their own professional conduct in the medical field directly related to personal distress and depression. This is commonly called “burnout.”

In an issue dedicated to professional education, a study in the September 15 JAMA states:

Professionalism is a core competency for all physicians. Professionalism includes being honest, acting with integrity, advocating for the needs of patients, reducing barriers to equitable health care, and adhering to an ethical code of conduct. Despite the widely acknowledged importance of professionalism, how personal distress (such as depression or low mental quality of life [QOL]) and professional distress (such as burnout) relate to professionalism is largely unexplored.

In Spring 2009, Liselotte N. Dyrbye, M.D., M.H.P.E., of the Mayo Clinic College of Medicine, Rochester, Minn., and colleagues conducted a study of 2,682 medical students across seven medical schools analyzing several dimensions of medical professionalism, and compared these levels to relationship with leading measures of distress: burnout, depression, quality of life, students’ personal engagement in unprofessional conduct, understanding of appropriate relationships with industry, attitudes regarding physicians’ responsibility to society. Among the outcomes, included were frequencies of self-reported cheating/dishonest behavior as defined by American Medical Association (AMA) policy.

Fifty three percent of the students studied reported straight burnout. Actual cheating on exams etcetera were quite rare, holding at less than 10%. However professional downgrades to direct patient care were reported at 43%. Students’ opinions on relationships aligned with the AMA policy held at 14%.

However, in those students that did cheat academically, more than most copied from a crib sheet or from another student during an exam, or reported a physical examination tests as normal when it was clearly tainted. Students with burnout (35%) were more likely to report engaging in one or more unprofessional behaviors than those without burnout (22%). Worn out students were also less likely to hold unselfish concern for the welfare of others regarding physicians’ responsibility to society, including personally wanting to provide care for the medically underserved.

The authors wrote:

Burnout was the only aspect of distress independently associated with report of 1 or more cheating/ dishonest clinical behaviors or with disagreeing with 1 or more altruistic attitudes regarding physicians’ responsibility to society after adjusting for demographic characteristics (sex, age, parental status, marital status, year in school, student debt load), burnout, positive depression screen, mental QOL, and physical QOL.

In final conclusions, the researches state:

In this large, multi-institutional study, self-reported cheating and dishonest clinical behaviors showed a direct association with burnout, while altruistic professional values regarding physicians’ responsibility to society showed an inverse relationship with burnout. In addition to exploring these associations further, future research should investigate whether interventions designed to reduce burnout help students cultivate professional values and behavior.

JAMA. 2010;304[11]:1173-1180

: Sy Kraft, B.A. – Journalism – California State University, Northridge (CSUN)