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brady23

How can we reduce burnout in clerkship?

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Just from anecdotes I'm hearing from upper year students, I get the vibe that clerkship drains you mentally and physically, makes you jaded, where you are chronically sleep-deprived, working hours in a hospital only to come home and having to find time to study for all types of exams every few weeks. It's hard to find the time to see your friends as regularly as you did, and your weekends can be spent sleeping in a hospital. 

We always talk about resilience but I feel like the long hours we put in clerkship makes this not possible. Our training is intensive, and reducing our workload comes at the expense of learning less or extending our training.

Any solutions/proposals that you can think of that would improve burnout in clerkship? I've always thought something as small as having the day after call can do wonders, or having one weekday off per week could be worthwhile, but not sure how realistic this is as hospitals do rely on clerks for their functioning as well, and it does cut into our learning time as well.

 

 

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Any decrease in the workload will just lead to being less prepared for the workload of residency. Medical school already has lighter clinical duties then what the residents are doing, which is appropriate for the level of training. Being able to manage your time in clerkship is very important. Overall clerkship is very doable and changing it any more will just hinder the transition to residency. Things you mentioned such as post call days are common place on almost all services (aside from certain surgical services).

If you manage your time well, you can have time to excel at your rotations, study for your exams, see your friends, do research etc.

Clerkship has a steep learning curve, but it is so much better than Preclerkship. 

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7 hours ago, brady23 said:

Just from anecdotes I'm hearing from upper year students, I get the vibe that clerkship drains you mentally and physically, makes you jaded, where you are chronically sleep-deprived, working hours in a hospital only to come home and having to find time to study for all types of exams every few weeks. It's hard to find the time to see your friends as regularly as you did, and your weekends can be spent sleeping in a hospital. 

We always talk about resilience but I feel like the long hours we put in clerkship makes this not possible. Our training is intensive, and reducing our workload comes at the expense of learning less or extending our training.

Any solutions/proposals that you can think of that would improve burnout in clerkship? I've always thought something as small as having the day after call can do wonders, or having one weekday off per week could be worthwhile, but not sure how realistic this is as hospitals do rely on clerks for their functioning as well, and it does cut into our learning time as well.

 

 

leads into the general problem of physician burnout - clerkship is a lot easier than residency, and it isn't much of stretch to say that in many fields being staff isn't much better than a resident either (better often yes but it is relative). That in no idea is to imply that we shouldn't be concerned with clerkship burnout/stress/mental health - which are all huge problems. 

The overall problem is that medicine in general is full of long hours at weird times, playing games with your sleep schedule. There are fields where it is better than others but it is a problem for the vast majority of us. 

I have struggled with trying to figure out ways of making it better - I have never come up with anything dramatic. When you are working 80+ hour weeks, doing call shifts, and trying fit in both life and advancing your career in other ways in what meager time that is left there is no simple answer. Other than extend out training time - which for obvious reasons there is a great time of resistance - there is no way to make it go away. There are ways to reduce it - training, not being a complete ass in scheduling people, and fostering small mercies when possible but that is about it. 

 

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Most of what I did in clerkship was scutwork, so I feel the pareto principle applies readily to me, namely that 80% of my learning came from 20% of what I actually did. So, I don't believe that a higher workload necessarily leads to a better educational experience (or that a lower workload necessarily leads to less learning), since it depends entirely on how you're actually using that time. It's possible to reduce burnout, but I don't think anything substantial is going to happen until there's a general shift in the entire medical culture. The increased social demand for wellness and improved work/life balance will eventually integrate itself in medical student environment, but like most things, it will take time. 

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A realistic (i.e. tough) clerkship is more useful than a soft one when it comes to preparing you for residency and also teaching you what being a resident in X specialty is like. The biggest career mistake a medical student could make is choosing the wrong specialty because they got the wrong impression of what it was like.

The issues are that preclerkship curricula do not do a great job at preparing students for clerkship, and many students have the wrong expectations from the get-go.

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Go into it with few expectations and you won't be disappointed. Hold on tight to your memory of true life and your humanity and don't let the scut eat into it, and always know that in the end you will be able to return to the life you deserve. Every time you hate your life in clerkship say to yourself that life is actually more than just this bullshit. Every day you go into hospital tell yourself you are one day closer to autonomy. You don't need to agree to or even rationalize the status quo to be resilient, you just need to show your staff that smile in that very moment they fuck up your day, and not let it shitstain your memory of happiness.

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7 minutes ago, Hanmari said:

Go into it with few expectations and you won't be disappointed. Hold on tight to your memory of true life and your humanity and don't let the scut eat into it, and always know that in the end you will be able to return to the life you deserve. Every time you hate your life in clerkship say to yourself that life is actually more than just this bullshit. Every day you go into hospital tell yourself you are one day closer to autonomy. You don't need to agree to or even rationalize the status quo to be resilient, you just need to show your staff that smile in that very moment they fuck up your day, and not let it shitstain your memory of happiness.

Agreed. Good post.

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27 minutes ago, Hanmari said:

Hold on tight to your memory of true life and your humanity and don't let the scut eat into it, and always know that in the end you will be able to return to the life you deserve.

Really? Because I am staff and life still sucks. Hahaha

I do agree autonomy is awesome. I could never go back to being a resident/fellow. Hell, i don't think I could even be salaried staff at this point. 

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17 minutes ago, NLengr said:

Really? Because I am staff and life still sucks. Hahaha

I do agree autonomy is awesome. I could never go back to being a resident/fellow. Hell, i don't think I could even be salaried staff at this point. 

I mean, becoming staff is not the end, right? ;P 

I am just being a friendly reassuring resident for my students! Surely I get a good eval for that. In any case y'all staff staying resilient with no one above you to lift you to your feet are amazing. I am sure, amongst many other things picked up along the way, that it must take the same kind of focus on your true life goals that I encourage all my students to remember.

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18 hours ago, brady23 said:

Just from anecdotes I'm hearing from upper year students, I get the vibe that clerkship drains you mentally and physically, makes you jaded, where you are chronically sleep-deprived, working hours in a hospital only to come home and having to find time to study for all types of exams every few weeks. It's hard to find the time to see your friends as regularly as you did, and your weekends can be spent sleeping in a hospital. 

We always talk about resilience but I feel like the long hours we put in clerkship makes this not possible. Our training is intensive, and reducing our workload comes at the expense of learning less or extending our training.

Any solutions/proposals that you can think of that would improve burnout in clerkship? I've always thought something as small as having the day after call can do wonders, or having one weekday off per week could be worthwhile, but not sure how realistic this is as hospitals do rely on clerks for their functioning as well, and it does cut into our learning time as well.

 

 

Clerks do get post-call days though? What I found stressful about clerkship was not just the work, but also the stress of CaRMS and the uncertainty of your future. Leaving where you would potentially be living and working and settling down for the next 5+ years to the whims of a few reference letters and first impressions is positively stress inducing. 

Honestly though, if clerkship doesn't drain you mentally/physically, residency probably will. From speaking with staff, we already have it so much better than they did, I think even that thought is comforting. The best way to improve burnout in clerkship is also to develop those coping mechanisms. It may be having a hobby, doing what you enjoy, family and friends, getting comfortable with taking time for yourself/refusing work.

Finding good ways to cope will make you a stronger person. They do say that pressure makes diamonds after all. 

During my bad days, I try to remind myself that if others can do it, so can I. I also remind myself of honestly how good we actually do have it. A stable job, well respected profession, food on the table, shelter. I mean if you want to look at how others have it it isn't difficult to find people who've had it much worse. 

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1 hour ago, Edict said:

Clerks do get post-call days though? What I found stressful about clerkship was not just the work, but also the stress of CaRMS and the uncertainty of your future. Leaving where you would potentially be living and working and settling down for the next 5+ years to the whims of a few reference letters and first impressions is positively stress inducing. 

Honestly though, if clerkship doesn't drain you mentally/physically, residency probably will. From speaking with staff, we already have it so much better than they did, I think even that thought is comforting. The best way to improve burnout in clerkship is also to develop those coping mechanisms. It may be having a hobby, doing what you enjoy, family and friends, getting comfortable with taking time for yourself/refusing work.

Finding good ways to cope will make you a stronger person. They do say that pressure makes diamonds after all. 

During my bad days, I try to remind myself that if others can do it, so can I. I also remind myself of honestly how good we actually do have it. A stable job, well respected profession, food on the table, shelter. I mean if you want to look at how others have it it isn't difficult to find people who've had it much worse. 

Each to their own, but I have never derived any comfort from seeing those worse off; just because they shit melena doesn't mean I shit gold. It also doesn't do wonders for clerks who always feel mediocre to feel like even their suffering is nothing to write home about.

I do agree with reminding ourselves that others have done the med ed path before us. A big crowd of people make it through this alive every year. We'll all get there someday.

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2 hours ago, Edict said:

What I found stressful about clerkship was not just the work, but also the stress of CaRMS and the uncertainty of your future. Leaving where you would potentially be living and working and settling down for the next 5+ years to the whims of a few reference letters and first impressions is positively stress inducing. 

I would tend to agree with this most. To help with burnout, I'd encourage students to hold on to the sense of purpose and meaning in your work. What led you to medicine in the first place? With the long hours you put in, was there a time that you were able to make a difference to a patient, or offer some comfort to a family?

Re: delayed gratification, there's no reason to expect that one could suddenly arrive at a sense of meaning and satisfaction once a practicing physician, if it wasn't there while training to become one. As alluded to above, the increased responsibility and workload as the years advance bring their own set of challenges. Clerkship is the time when you have the most security to learn practical medicine while always having a safety net to rely on.

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14 hours ago, Aetherus said:

Any decrease in the workload will just lead to being less prepared for the workload of residency. Medical school already has lighter clinical duties then what the residents are doing, which is appropriate for the level of training. Being able to manage your time in clerkship is very important. Overall clerkship is very doable and changing it any more will just hinder the transition to residency. Things you mentioned such as post call days are common place on almost all services (aside from certain surgical services).

If you manage your time well, you can have time to excel at your rotations, study for your exams, see your friends, do research etc.

Clerkship has a steep learning curve, but it is so much better than Preclerkship. 

Agreed.

Make people have real jobs before med school? Aside from surgery, and 24hr call clerkship isnt crazy draining compared to a normal career job and such. Especially since the buck rarely stops with an msi3/4. Nothing compared to residency I'm sure

 

 

Post call is generally a thing. Only time it wasnt was on my FM rotation with emerge coverage. Even then it wasnt too busy and only a few minor calls.overnight and nothing compared to a busy CTU overnight admitting.

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Several of the things I found difficult about clerkship have largely been fixed by becoming a resident. I love that as a resident I have things like employee protections, vacation days I can book, a contract I can refer to for resolving disputes, actual maternity leave, a paycheque, and a signature that actually does something. That’s all pretty cool. I’m far more accustomed to being an employee than a postsecondary student, so the fact that I’m now the former instead of the latter is considerably more comfortable. 

One thing I do absolutely think clerkship could use is some sort of floating time off for personal use, like doctor’s appointments. I found the difficulty scheduling time off in clerkship for self care - as there is no built in time off outside of scheduled vacations, so all missed time must be made up, which makes it effectively impossible to actually take time off - to be very frustrating and I was not able to adequately attend to my own health, which became an issue. 

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