Addressing Burnout During Step 2 CK Preparation

Why Are Medical Students at Risk of Burnout?

Research indicates that up to half of medical students encounter burnout, as medicine is an intrinsically demanding profession. If you find yourself among these students, know that there is hope. You are not alone, and strategies are available to alleviate the impact of burnout and guide you back on the path to success. Early identification and intervention play crucial roles in mitigating the adverse effects of burnout on your medical career and mental health. This blog post will explore methods to recognize burnout symptoms, strategies to minimize its impact, and preventive measures to consider.

The demanding nature of medical education, coupled with the pressures of clinical responsibilities, academic requirements, and long hours of study, can often lead students to experience physical, emotional, and mental exhaustion. 

Specific factors that often contribute to burnout include high academic expectations, intense competition, student abuse, sleep deprivation, and the emotional toll of caring for patients (L. Dyrbye, T. Shanafelt. A narrative review on burnout experienced by medical students and residents. Med Educ, 50 (1) (2016), pp. 132-149). This can be acutely and dramatically heightened during the Step 2 CK preparation periods, as students face additional stressors such as the pressure to perform well on the exam, balancing study time with clinical rotations, and the uncertainty of their future careers. It is likely that the intensity of these stressors and associated burnout during the USMLE Step 2 CK dedicated study period has increased in light of the transition of Step 1 to pass/fail grading. 

What Are the Symptoms of Burnout?

Burnout is characterized by a triad of emotional exhaustion, depersonalization, and a decreased sense of accomplishment (IsHak WW, Lederer S, Mandili C, Nikravesh R, Seligman L, Vasa M, Ogunyemi D, Bernstein CA. Burnout during residency training: a literature review. J Grad Med Educ 2009;1:236–242.) These are all known to impact students’ well-being and academic performance negatively. Unfortunately, burnout and the pressure students experience may impair academic performance, professionalism, judgment, and physical and mental health (J. Fares, H. Al Tabosh, Z. Saadeddin, C. El Mouhayyar, H. Aridi. Stress, burnout and coping strategies in preclinical medical students. N Am J Med Sci, 8 (2016), pp. 75-81). 

Burnout can have serious consequences, including, at times, psychiatric disorders and even suicidal ideation. If you or a loved one is experiencing a mental health crisis, please seek help immediately. You are not alone. Contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) for confidential support and assistance, available 24/7. Your well-being is important, and help is available.

What is the Rate of Burnout Among Medical Students?

A recent systematic review of the literature revealed that burnout is prevalent during medical school, with major US multi-institutional studies estimating that at least half of all medical students may be affected by burnout during their medical education. Furthermore, these studies demonstrated that burnout often persists beyond medical school. Burnout has also been demonstrated to impact more than half of practicing physicians. 

How Do You Get Over Burnout During an Exam like Step 2 CK?

Left unaddressed, burnout during Step 2 CK preparation can exacerbate symptoms, hinder effective studying, and impact overall exam performance. Recognizing and addressing burnout during this critical period is essential to ensure the well-being and success of medical students. A recent publication suggests the following “Tips” to prevent burnout during USMLE study periods:

Exercise

For students unfamiliar with regular exercise, adding strenuous workouts during intense study periods may increase stress. Instead, try short, active breaks like 15–20 minutes of movement twice daily. This could include quick exercises like pushups or walks while listening to study material.

Take days off

Three vital strategies for study breaks include scheduling days off, limiting study hours, and incorporating short breaks during study sessions. To fully recharge, it’s crucial to mentally detach from studying during days off, remove study-related items from the environment, and engage in non-academic activities with loved ones.

Limit study hours per day

Students must recognize that individual productivity varies, and there’s a point of diminishing returns with longer study sessions. Recognizing your saturation point is crucial, prioritizing rest and breaks to enhance learning outcomes. It’s helpful to take breaks when attention wanes and reward oneself for meeting daily study goals.

Take breaks

Breaks, akin to interval training for athletes, aid students in evaluating study periods, retaining effective methods, and discarding ineffective ones. They facilitate continuous progress assessment and study plan recalibration. Additionally, breaks enable the integration of other healthy coping strategies into daily practice.

Develop a support system

Regular communication, whether in good times or bad, lessens feelings of isolation and boosts support. You may find this more formally, through programming at your institution, or from your friends and family.

Dedicate time for fun

Using operant conditioning in studying involves planning small rewards (like chocolate or a quick call) and bigger ones (such as watching TV or going out) to reach specific goals. This approach helps train your brain to view studying as worthwhile by associating it with enjoyable breaks and achievements.

Eat well

Preparing meals during dedicated study periods can feel overwhelming for students who aren’t used to cooking regularly. A tip for simplifying the process is setting aside a dedicated time for meal prep. This allows for efficient batch cooking and portioning, saving time, and money, and promoting healthier eating habits. You can also save special meals as a reward, making healthy eating more manageable and rewarding.

Minimize distractions

Put your phone down, set up “do not disturb” and close those extra tabs! Students often face challenges with electronic distractions while studying, especially when using devices for entertainment or social networking. You can use screen time regulatory apps to block access during study sessions. Additionally, you may be dealing with significant personal life stressors, which makes it difficult to focus. Depending on your situation, it may be worth considering a break from studying, seeking supportive care, and adjusting your exam date timeline.

Sleep well

We know that sleep disruption is a key aspect of burnout, so prioritizing healthy sleep habits is crucial for prevention. There is a known positive impact of sufficient REM sleep on memory consolidation and detrimental effects of poor sleep on attention and performance. Therefore, sleep is an essential component of your study routine and performance!

Study with others

Having a peer to study with, in addition to a dedicated Step 2 tutor, facilitates the explanation of complex concepts. This helps to streamline your understanding and identify your strong and weak topics. Furthermore, discussing challenging topics with others enhances long-term retention and fills gaps in knowledge, ultimately boosting morale and confidence in exam preparation.

Identify suitable study spaces

Study environments vary greatly among students and consistency in your routine and secure storage space are beneficial. However, the option of changing study locations throughout a dedicated study period can reinvigorate your energy and focus. Music or noise-canceling headphones can aid focus but should be gradually phased out closer to the exam to avoid reliance on them.

Recognize that feelings of burnout are normal 

All students benefit from additional emotional support during this period of USMLE studying. Try to be proactive and discuss any problems you encounter to establish positive coping strategies. Many medical professionals have experienced burnout – you are not alone. Shifting your focus toward self-care and avoiding isolation if you are struggling is crucial to your success and well-being. 

How Do I Reach Out for Help if I Am Struggling With Burnout?

Despite efforts by medical schools to support students, substantial evidence shows that psychological distress remains common among medical students. Studies indicate that up to half of medical students experience burnout, a quarter suffer from depression, and many endure chronic anxiety and poor mental quality of life. This distress negatively impacts students’ learning, skills, and professionalism, and can lead to serious consequences like suicidal thoughts and intentions to drop out of medical school. Unfortunately, few students seek help, and distress often persists into residency and beyond, potentially affecting the quality of patient care. 

The time to recover from burnout is highly variable among students and depends on an individual’s resiliency and level of perceived support. In navigating the rigorous journey of medical education, you need to cultivate and lean on a diverse support network comprised of family, faculty members, medical school staff, and peers. Each member plays a crucial role in providing different forms of support, whether it’s emotional encouragement, academic guidance, or practical assistance. Your medical school or residency program likely offers advising, so start by looking up your advisor’s contact information if you have not yet met. You also may consider looking into institutional mental health resources such as counseling and therapy, wellness retreats, or even approved wellness days to be excused from class or clinical duties. This information is likely located on your institution’s website or in your student handbook. Multiple levels of support exist, however, you will need to play an active role in identifying yourself as someone who may benefit from these support systems. By actively engaging with and relying on these support system members, you can effectively navigate challenges, overcome obstacles, and thrive throughout your medical education journey, including your USMLE Step 2 CK.