Stressing the journey: using life stories to study medical student wellbeing

Abstract

While previous studies have considered medical student burnout and resilience at discrete points in students’ training, few studies examine how stressors and resilience-building factors can emerge before, and during, medical school. Our study focuses on students’ life stories to comprehensively identify factors contributing to student wellbeing. We performed a secondary analysis of life-story interviews with graduating fourth year medical students. These interviews were originally conducted in 2012 as part of the Project on the Good Physician, and then re-analyzed, focusing on student wellbeing. Respondents were encouraged to identify turning points in their life stories. De-identified transcripts were then coded using a consensus-based iterative process. 17 of 21 respondents reported feeling burned out at least once during medical school. Students identified three major stressors: negative role models, difficult rotations, and the United States Medical Licensing Examination Step 1. Two “motivational stressors”—financial concerns and personal life events—emerged as sources of stress that also motivated students to persevere. Finally, students identified four factors—positive role models, support networks, faith and spirituality, and passion—that helped them reframe stressors, making the struggle seem more worthwhile. These findings suggest that a life-story approach can add granularity to current understandings of medical student wellbeing. Initiatives to reduce stress and burnout should extend beyond the immediate medical school context and consider how past challenges might become future sources of resilience. This study also provides an example of secondary analysis of qualitative data, an approach which could be useful to future research in medical education.

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Notes

  1. 1.

    The Gold Humanism Honors Society recognizes peer-nominated medical students, residents, fellows, and attendings who demonstrate compassion in patient care. See http://www.gold-foundation.org/programs/ghhs/.

  2. 2.

    These stressors emerged in parts 2 and 5 of the interview guide (see Table 1), where respondents were asked to identify key moments (including high points and low points), and burnout, respectively.

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Acknowledgements

This project was supported by the New Science of Virtues Project at The University of Chicago through a grant from the John Templeton Foundation. This project was also supported by pilot grants from the Center for Health Administration Studies and the Bucksbaum Institute for Clinical Excellence at The University of Chicago. TMJ is grateful for salary support from the Canadian Institutes of Health Research (CIHR; No. 140811). We thank Kelly Harris and Annikea Miller for their research assistance on this study. Lastly, we thank Furr Curlin for his overall mentorship and support of the Project on the Good Physician.

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Correspondence to Tania M. Jenkins.

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This study was approved by the University of Chicago Institutional Review Board.

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Jenkins, T.M., Kim, J., Hu, C. et al. Stressing the journey: using life stories to study medical student wellbeing. Adv in Health Sci Educ 23, 767–782 (2018). https://doi.org/10.1007/s10459-018-9827-0

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Keywords

  • Medical education
  • Medical students
  • Burnout
  • Resilience
  • Life stories
  • Secondary qualitative data analysis