Nearly half of all medical students in the United States report experiencing burnout. Feeling exhausted and losing touch with a sense of personal accomplishment can lead to a reduction in quality of care and an increased likelihood of patient safety incidents.
For the first time, researchers were able to assess the effect of burnout on lesbian, gay, and bisexual medical students. This was because the Association of American Medical Colleges (AAMC) added some new sexual orientation-related questions to their major cross-sectional study of medical students.
Burnout occurs more often among lesbian, gay, and bisexual medical students than heterosexual students: 17.2% versus 11.1%.
The study — which Dr. Elizabeth A. Samuels, of the Warren Alpert Medical School of Brown University in Providence, RI, led — now appears in JAMA Network Open.
“Understanding how the current medical training environment impacts lesbian, gay, and bisexual medical students is critical for improving their training experience, building and retaining a workforce of [lesbian, gay, and bisexual] physicians, and also delivering optimal care to all patients — especially those who also identify as LGBTQI+.”
– Dr. Elizabeth A. Samuels
“The impetus for this study,” explains Dr. Samuels, “came out of my own personal experiences as a medical trainee and as a mentor to medical students, as well as a person dedicated to addressing health inequities and improving care for LBGTQI+ patients.”
A welcome research opportunity
Dr. Samuels notes that the AAMC added the new questions regarding sexual orientation to the annual medical school graduation questionnaire in 2016.
These questions presented an opportunity to document the experiences of graduating lesbian, gay, and bisexual medical students.
The survey asked individuals to identify their sexual orientation, selecting “heterosexual or straight,” “gay or lesbian,” or “bisexual.”
Dr. Samuels’ study was based on 26,123 responses from the 2016 and 2017 questionnaires. She and her colleagues combined the available identifiers into a single category of “lesbian, gay, and bisexual” for the purposes of their analysis.
“The health and well-being of trainees,” says Dr. Samuels, “is intimately linked to the quality of patient care, physician retention, and is key to reducing care inequities.”
The study cites “competing time demands, strained finances, and unattainable expectations of medical training” as the most common drivers of burnout.
Mistreatment is also a factor, and other research has investigated its role in the burnout of medical students from racial and ethnic groups. However, says Dr. Samuels, “This is the first work that really looks at the relationship between sexual orientation and burnout and how that is mediated by mistreatment.”
Lesbian, gay, and bisexual students who reported mistreatment as a frequent occurrence were more than eight times more likely to experience burnout.
The study also found that 27% of lesbian, gay, and bisexual students reported having experienced public humiliation, as opposed to 20.7% of heterosexual students.
In addition, 23.3% of lesbian, gay, and bisexual students said that they had experienced mistreatment due to their orientation at least once during the course of their medical education. On the other hand, just 1% of heterosexual students reported such incidents.
Behind the numbers
Dr. Samuels notes that mistreatment does not completely account for this higher rate of burnout. She notes that lesbian, gay, and bisexual people also face pressures beyond that which other medical students face.
Some research has shown that many lesbian, gay, and bisexual medical students conceal their orientation, fearing discrimination. They also report greater feelings of anxiety, depression, and reduced general health.
“Layering concerns about homophobia [heterosexism] and discrimination on top of the general intensity of medical training,” explains Dr. Samuels, “can lead not just to burnout, but also to truly deleterious mental health effects.”
The study’s findings underscore the importance of providing comprehensive support for LGBTQIA+ medical students through mentorship and the need to change medical schools’ institutional culture to more effectively promote diversity and inclusivity.
“Not only is that helpful for individual trainees,” says Dr. Samuels, “but building this workforce is a key strategy in addressing health inequities experienced by LGBTQI+ communities everywhere.”
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