Neurosurgical How-tos: Mindfulness in Medical School
Our generation of rising physicians confronts an epidemic of burnout and career dissatisfaction.1 Whether immersed in ward activities or battling in the pre-clinical trenches, medical students fight against a rising tide of academic expectations, financial insecurities and emotional exhaustion. A meta-analysis published in JAMA reported a disturbing prevalence of depressive symptoms (27.2 percent) and suicidal ideation (11.1 percent) among medical students worldwide,2 and work presented at this year’s European Psychiatric Association (EPA) Congress found that almost 50 percent of medical students were burnt out before starting residency.3 For the first two years of medical school, I admit to absorbing data like
these without much alarm. Mental anguish, meanwhile, was abound, hiding in plain sight. I watched as personal testimonies reached mainstream news outlets 4,5 and I was proud when my institution launched efforts to foster wellness and resilience among students. In truth, however, my engagement with this topic began in earnest when I encountered Dr. David Muller’s gut-wrenching reflection, “Kathryn,” published in the mournful aftermath of a student suicide at the Icahn School of Medicine.6 I remember feeling the words from that text force past my glazed eyes, linger inside my head and then detonate in my heart.
Aspiring neurosurgeons need to think critically about the mental health issues facing the field. In 2016, AANS Neurosurgeon published a story exploring the rise of neurosurgeon burnout and the potential consequences for patient safety.7 A recent article published in the Journal of Neurosurgery reported burnout rates of 47.7 percent for academic neurosurgeons and even higher among those in non-academic settings.8 The factors contributing to surgeon burnout are easy to understand and have been elucidated in many studies.9,10 These factors also appear to be here to stay. As future shapers of the field, medical students must develop strategies for overcoming these influences and combating burnout. Unfortunately, few studies have been conducted to address this issue, especially in the pre-graduate years.
In this edition of AANS Neurosurgeon, we hear from Julia Schneider, a rising MS-3 at the New York Institute of Technology College of Osteopathic Medicine. Julia’s research within the Department of Neurosurgery at Lenox Hill Hospital examines the role of mindfulness in promoting resilience and well-being among surgical trainees. This work constitutes the focus of her academic year-out at the Feinstein Institute for Medical Research. Her perspective is informed by personal experiences in the operating room as well as her study of the relevant literature. The science of mindfulness and meditation, especially where it pertains to the medical profession, is in its early stages. But we are well-advised to open our ears (and our minds) when a signal emerges in this barren landscape.
Julia Schneider continues the conversation in Gritflowness: Using Grit, Flow and Mindfulness to Reduce Stress
1. Dzau, V. J., Kirch, D. G., & Nasca, T. J. (2018). To Care Is Human — Collectively Confronting the Clinician-Burnout Crisis. New England Journal of Medicine, 378(4), 312-314.
2. Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., . . . Mata, D. A. (2016). Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students. Jama, 316(21), 2214.
3. Davenport L. (6 March 2018). ‘Alarming’ Rate of Burnout in Med Students. Medscape. https://www.medscape.com/viewarticle/893466
4. Krisberg K. (27 Sept 2016). Medical school burnout. AAMC News. https://news.aamc.org/medical-education/article/medical-school-burnout/
5. Morris, N., & Morris, N. (2016, October 7). Medical School Can Be Brutal, and It’s Making Many of Us Suicidal. The Washington Post. Retrieved August 30, 2018, from http://www.highbeam.com/doc/1P2-40122376.html?refid=easy_hf
6. Muller, D. (2017). Kathryn. New England Journal of Medicine, 376(12), 1101-1103.
7. Schmidt, T. & Kimmell, K. (2016). Feeling the burn: neurosurgery, burnout and patient safety. AANS Neurosurgeon. 25(1). http://aansneurosurgeon.org/departments/feeling-the-burn-neurosurgery-burnout-and-patient-safety/
8. Mcabee, J. H., Ragel, B. T., Mccartney, S., Jones, G. M., Michael, L. M., Decuypere, M., . . . Klimo, P. (2015). Factors associated with career satisfaction and burnout among US neurosurgeons: Results of a nationwide survey. Journal of Neurosurgery, 123(1), 161-173.
9. Attenello, F. J., Buchanan, I. A., Wen, T., Donoho, D. A., Mccartney, S., Cen, S. Y., . . . Klimo, P. (2018). Factors associated with burnout among US neurosurgery residents: A nationwide survey. Journal of Neurosurgery, 1-15.
10. Klimo, P., Decuypere, M., Ragel, B. T., Mccartney, S., Couldwell, W. T., & Boop, F. A. (2013). Career Satisfaction and Burnout Among U.S. Neurosurgeons: A Feasibility and Pilot Study. World Neurosurgery, 80(5).
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