Warning: medical education is hazardous to your mental health. Medical students should make an informed decision to begin and continue training
For decades there has been ample evidence that training to become a physician and practicing medicine is hazardous to one’s health and wellness. In the face of the extremely high rates of suicide, substance abuse, depression and burnout in the medical student, resident, and physician populations, it would be dishonest to suggest medical education and practice is all gain and no pain. This article is directed to members of the medical education community and challenges stakeholders to view their teaching and training of medical students as an intervention requiring free and informed consent. We hope this exercise shifts the paradigm of educators and enables students to enter medical training from a free and informed position.
Canadian Medical Association. CMA code of ethics and professionalism. Available at
D'Eon M. Is medical education hazardous to your health? Can Med Ed J. 2014;5(1), e1-e4. https://doi.org/10.36834/cmej.36738
Bligh J. Problem-based, small group learning. BMJ. 1995;311:342-343. https://doi.org/10.1136/bmj.311.7001.342
Government of Saskatchewan. Safety in the workplace: approved standards and practices | Available at https://www.saskatchewan.ca/business/safety-in-the-workplace/approved-standards-and-practices. [Accessed on Jul 15, 2021].
Sletta C, Tyssen R, Løvseth LT. Change in subjective well-being over 20 years at two Norwegian medical schools and factors linked to well-being today: a survey. BMC med ed. 2019 Dec;19(1):1-2. https://doi.org/10.1186/s12909-019-1476-3
Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. Jama. 2016 Dec 6;316(21):2214-36. https://doi.org/10.1001/jama.2016.17324
Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med ed. 2016 Jan;50(1):132-49. https://doi.org/10.1111/medu.12927
Erschens R, Keifenheim KE, Herrmann-Werner A, et al. Professional burnout among medical students: systematic literature review and meta-analysis. Med Teach. 2019 Feb 1;41(2):172-83. https://doi.org/10.1080/0142159X.2018.1457213
Blacker CJ, Lewis CP, Swintak CC, Bostwick JM, Rackley SJ. Medical student suicide rates: a systematic review of the historical and international literature. Acad Med. 2019 Feb 1;94(2):274-80. https://doi.org/10.1097/ACM.0000000000002430
Arnetz, BB. Psychosocial challenges facing physicians of today. Soc Sci Med. 2001; 52(2), 203-213. https://doi.org/10.1016/S0277-9536(00)00220-3
Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. The Lancet, 2009; 374(9702), 1714-1721. https://doi.org/10.1016/S0140-6736(09)61424-0
Yung E, Lagacé F, Zhong YJ, Tabry V, Sarkis B, Sun-Drapeau L, Jin S. CFMS position paper on responding to medical student suicide. In Proceedings of the 2018 CFMS Annual General Meeting. Ottawa: Canadian Federation of Medical Students (CFMS). 2018; pp21-23.
Slavin S. Reflections on a decade leading a medical student well-being initiative. Acad Med. 2019 Jun 1;94(6):771-4 https://doi.org/10.1097/ACM.0000000000002540
Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. In Mayo Clinic Proceedings 2005 Dec 1;80.12: pp1613-1622. https://doi.org/10.4065/80.12.1613
Slavin SJ, Schindler DL, Chibnall JT. Medical student mental health 3.0: improving student wellness through curricular changes. Acad Med. 2014 Apr;89(4):573. https://doi.org/10.1097/ACM.0000000000000166
Pell G, Fuller R, Homer M, Roberts T. Is short-term remediation after OSCE failure sustained? A retrospective analysis of the longitudinal attainment of underperforming students in OSCE assessments. Med Teach. 2012 Feb 1;34(2):146-50. https://doi.org/10.3109/0142159X.2012.643262
Ellaway RH, Chou CL, Kalet AL. Situating remediation: accommodating success and failure in medical education systems. Acad Med. 2018 Mar 1;93(3):391-8. https://doi.org/10.1097/ACM.0000000000001855
Chia TI, Oyeniran OI, Ajagbe AO, Onigbinde OA, Oraebosi MI. The symptoms and stress experienced by medical students in anatomy dissection halls. J Taibah Uni Medical Sci. 2020 Feb;15(1):8. https://doi.org/10.1016/j.jtumed.2020.01.001
Klender SM. Fear of death, dissection avoidance behaviors, and performance in gross anatomy courses with cadaveric dissection. In Doctoral dissertation, The University of Mississippi Medical Center. 2020.
Kwok S, Ostermeyer B, Coverdale J. A systematic review of the prevalence of patient assaults against residents. JGME. 2012 Sep;4(3):296. https://doi.org/10.4300/JGME-D-11-00184.1
Benbassat J. Changes in wellbeing and professional values among medical undergraduate students: a narrative review of the literature. Adv Health Sci Ed. Oct 1 2014;19(4):597-610. https://doi.org/10.1007/s10459-014-9500-1
Kemp S, Hu W, Bishop J et al. Medical student wellbeing-a consensus statement from Australia and New Zealand. BMC med ed. 2019 Dec;19(1):69. https://doi.org/10.1186/s12909-019-1505-2
Radcliffe C, Lester H. Perceived stress during undergraduate medical training: a qualitative study. Med Ed, 2003;37(1), 32-38. https://doi.org/10.1046/j.1365-2923.2003.01405.x
Cusimano MC, Baxter NN, Sutradhar R, et al. Delay of pregnancy among physicians vs nonphysicians. JAMA Intern Med 2021;181:905–12. https://doi.org/10.1001/jamainternmed.2021.1635
Adesoye T, Mangurian C, Choo EK, et al. Physician moms group study group. Perceived discrimination experienced by physician mothers and desired workplace changes: a cross-sectional survey. JAMA Intern Med 2017;177:1033–6. https://doi.org/10.1001/jamainternmed.2017.1394
Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg. 2021;156(10):905–915. https://doi.org/10.1001/jamasurg.2021.3301
Stentz NC, Griffith KA, Perkins E, et al. Fertility and childbearing among American female physicians. J Womens Health. 2016;25:1059–65. https://doi.org/10.1089/jwh.2015.5638
Bering J, Pflibsen L, Eno C, et al. Deferred personal life decisions of women physicians. J Womens Health. 2018;27:584–9. https://doi.org/10.1089/jwh.2016.6315
Cusimano MCBN, Sutradhar R, Ray J, et al. Reproductive patterns, pregnancy outcomes and parental leave practices of women physicians in Ontario, Canada: the Dr. Mom cohort study protocol. BMJ Open 2020;10:e041281. https://doi.org/10.1136/bmjopen-2020-041281
Mills G, Ruzycki SM, JeSabourin J, Dance E. Experiences of breastfeeding among women residents in Alberta: a cross-sectional survey, Postgrad Med. Sept 20,2020; 133:1, 42-47. https://doi.org/10.1080/00325481.2020.1814581
Győrffy Z, Dweik D, Girasek E. Reproductive health and burn-out among female physicians: nationwide, representative study from Hungary. National Library of Medicine. BMC women's health. Oct 2, 2014; 14:121. https://doi.org/10.1186/1472-6874-14-121
Kaye EC. One in four - the importance of comprehensive fertility benefits for the medical workforce. N Engl J Med. Apr 16, 2020;382(16):1491-1493. https://doi.org/10.1056/NEJMp1915331
Mohan H, Ali O, Gokani V, et al. Surgical trainees’ experience of pregnancy, maternity and paternity leave: a cross-sectional study. Postgrad Med J. 2019;95:552-557. https://doi.org/10.1136/postgradmedj-2018-135952
Willoughby KA, Yaworski MJ, Zendel BR, Curran V. National survey of the transition back to Canadian residency programs after parental leave. CMEJ. 2020; 11(5), e16-e30; https://doi.org/10.36834/cmej.68486.
Melnitchouk N, Scully RE, Davids JS. Barriers to breastfeeding for US physicians who are mothers. JAMA Intern Med. 2018;178(8):1130–1132. https://doi.org/10.1001/jamainternmed.2018.0320
Giantini Larsen AM, Pories S, Parangi S, et al. Barriers to pursuing a career in surgery: an institutional survey of Harvard Medical School students. Ann Surg 2021;273:1120–6. https://doi.org/10.1097/SLA.0000000000003618
Halley MC, Rustagi AS, Torres JS, et al. Physician mothers' experience of workplace discrimination: a qualitative analysis. BMJ 2018;363:k4926.https://doi.org/10.1136/bmj.k4926
Schiller JH, Stansfield RB, Belmonte DC, et al. Medical students' use of different coping strategies and relationship with academic performance in preclinical and clinical years. Teach Learn Med. 2018 Jan 2;30(1):15-21. https://doi.org/10.1080/10401334.2017.1347046
Jahrami H, Dewald-Kaufmann J, AlAnsari AM, Taha M, Al Ansari N. Prevalence of sleep problems among medical students: a systematic review and meta-analysis. J Public Health. 2019 Apr 1:1-8.
Abdulghani HM, Alrowais NA, Bin-Saad NS et al. Sleep disorder among medical students: relationship to their academic performance. Med Teach. 2012, 34 Suppl 1. S37-41. https://doi.org/10.3109/0142159X.2012.656749.
Soomi L. Naturally occurring consecutive sleep loss and day-to-day trajectories of affective and physical well-being. Ann Behav Med, 2021; https://doi.org/10.1093/abm/kaab055
D’Eon MF. Enabling and encouraging sleep deprivation among medical students. Can Med Ed J. 2020 Mar;11(1):e1. https://doi.org/10.36834/cmej.69918
Dyrbye LN, Satele D, Shanafelt TD. Healthy exercise habits are associated with lower risk of burnout and higher quality of life among US medical students. Acad Med. 2017 Jul 1;92(7):1006-11. https://doi.org/10.1097/ACM.0000000000001540
Stathopoulou G, Powers MB, Berry AC, Smits JA, Otto MW. Exercise interventions for mental health: a quantitative and qualitative review. Clin Psychol. 2006 May;13(2):179-93. https://doi.org/10.1111/j.1468-2850.2006.00021.x
Landau C, Hall S, Wartman SA, Macko MB. Stress in social and family relationships during the medical residency. J Med Ed. 1986;61.8: 654-660. https://doi.org/10.1097/00001888-198608000-00004
Tillett R. The patient within-psychopathology in the helping professions. Adv Psychiatr Treat. 2003; 9(4):272-279. https://doi.org/10.1192/apt.9.4.272
Wikipedia contributors. Outcome bias. Wikipedia, The Free Encyclopedia. Dec 5, 2020. Available at: https://en.wikipedia.org/w/index.php?title=Outcome_bias&oldid=992511968. [Accessed Jul 15, 2021].
How to Cite
Copyright (c) 2022 Adam Stacey, Marcel D'Eon, Melissa Andersen, Niels Koehncke, Jessica Campoli, Galilee Thompson, Kylie Riou
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.