“This Isn’t Being a Doctor.”—Qualitative Inquiry into the Existential Dimensions of Medical Student Burnout

Abstract

Recent studies report that up to 50% of medical students feel burned out. Medical student burnout has significant public health consequences—as students detach, the quality of patient care is impacted, and students themselves suffer, as evidenced by the increased risk in substance use and suicide. While some theorize that medical student burnout is due to an inability to confront suffering, death, and their own mortality, this hypothesis fails to explain why pre-clinical students also experience burnout despite having minimal clinical exposure. /r/medicalschool, a news-aggregating website for medical students, was queried for posts from the creation of the subreddit, December 11, 2009, to July 1, 2018, for the term “burnout” and its grammatical variations. Three hundred fifty-two posts and their comment threads were analyzed using a grounded theory approach. When the causes of burnout were interpreted using an existential psychodynamic framework, the predominant themes that arose were difficulties dealing with freedom (groundlessness), existential isolation, and meaninglessness, rather than death anxiety stemming from witnessing the suffering of patients. Students feel as if they are not living up to their own values of what a physician should be like and are troubled by the inconsistent values within the hidden, informal, and formal curriculum. Individualized interventions are temporary fixes that allow people to withstand their environment and complete their training; however, the learning environment needs change to better empower students to live a life full of existential meaning.