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14 Mar 2019


I never thought I would say this, but I broke. I give up.” - Dr Yumiko Kadota, The ugly side of becoming a surgeon (February 4, 2019)


Dr Kadota’s recent blog post, outlining her gruelling experience as an unaccredited registrar in a New South Wales hospital, has resonated with many doctors and medical students. Perusing the comments on her post reveals a sea of similar experiences, many tracing back to time spent as a medical student.

Medical students report high rates of burnout and emotional exhaustion, with demands of study, clinical contact hours and financial difficulties as the most significant stressors, according to Beyond Blue’s National Mental Health Survey of Doctors and Medical Students.

Burnout continues after graduation. Half of all doctors are working hours that place them at risk of developing fatigue and burnout, with this risk being highest for junior doctors.

I recall my own experience on a two-month rotation last year, which required a reasonable 35 hours per week of clinical contact. Then, I added the 20 hours per week studying for the end-of-placement exam, and the 20 hours I worked part-time on weekends to support myself. Taking days off, even for illness, would mean having to remediate those hours on a weekend and having to forgo my weekly income.

To make matters worse, I was placed at a satellite hospital an hour away from our main teaching site, with only one staff member of our medical school trying their hardest to support the dozen students on the rotation.

A month into this placement, I went to the only local GP available after-hours. I was convinced I had developed narcolepsy as I frequently found myself on the verge of falling asleep throughout the day, most worryingly during my hour-long drive to and from the hospital. I never had the chance to go back to confirm a diagnosis. Perhaps I did have a temporary bout of narcolepsy... perhaps I knew it was the stress and lack of sleep, but I wanted a tokenistic title to my fatigue, because I didn’t have time for anything else.

By the end of the rotation, I had developed acid reflux symptoms, daily headaches, sleep paralysis and an overwhelming feeling that despite the hours I was pulling at the hospital, I would fail and have to repeat the placement. I passed with a score of 54, a welcome surprise after having been yelled at by an examiner for misreading part of the exam prompt.

This is far from an isolated incident in medical school. 70 per cent of medical student respondents to the AMSA 2017 National Survey found that lack of sleep, financial pressures, and a large academic workload, were major factors contributing to poor mental health. If this is the environment in which we start our journey into medicine, what happens when we have the responsibility of patient safety on our shoulders?

Medical students are hopeful that culture is changing and are keen to be drivers of that change. Representatives from each of Australia’s 22 medical schools voted on AMSA’s 2019 National Priorities, with improving medical student mental health and wellbeing sitting at the top of that list. Medical schools across Australia are listening to feedback and implementing more rigorous support services for their students (see: AMSA’s Mental Health Initiatives Guide for Australian Medical Faculties).

Dr Kadota’s story is a disappointing but not a surprising reminder to the medical profession that there is still progress to be made.

AMSA is proud to have Dr Kadota as a plenary speaker at the upcoming National Leadership Development Seminar in May. AMSA hopes to normalise discussion on burnout  and continue to advocate for the improvement of the working lives of Australian doctors.

Published: 14 Mar 2019