Expressions of Medical Student Burnout on Reddit: An Autonetnographic Study of /r/medicalschool

Medical student burnout is currently incredibly common. Recent studies report that approximately 50 percent of students had scores indicative of burnout on the Maslach Burnout Inventory. Burnout can become chronic, and up to 73.2 percent of the afflicted fail to recover while they are trainees. This is significant because burnout profoundly affects the inner world of the physician and places them at a higher risk of depression, substance use disorder, and suicide; in turn, burnout impacts their professional behaviors and the quality of patient care. This dissertation explores the hypothesis that negative emotions that arise from unresolved ethical, technical, behavioral, and existential discomforts and their role in mediating burnout; this includes the discomforts experienced due to the lack of decision-making power held during medical training. I utilize an autonetnographic approach to understand how medical students on /r/medicalschool, an online news-aggregating forum, conceptualize and operationalize the term “burnout,” how they cope with burnout, and what barriers and attitudes they face that perpetuate a system that fosters burnout. This autonetnography is a study of spaces and interactions on a freely accessible, anonymous public forum. Within these spaces and interactions, I explore how the social, economic, and political forces present within medical education shape the ethical affordances that medical students have. Based on these understandings, I challenge the notion that medical student burnout is due to unresolved existential discomforts – an inability to come to terms with patients’ death and suffering – but is rather due to the creation of an Existential void. Students feel lost as they question the purpose of their training because of the incongruency between the values and moral norms professed and those practiced in medicine, and they experience being objectified when reduced to quantifiable metrics, such as board scores and clinical evaluations. With this new insight and understanding into medical student burnout, I propose changes that address the root cause of student burnout – ontological insecurity caused by real-world micro- and macro-economic pressures.