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Acad Med. 2014 Nov;89(11):1520-5. doi: 10.1097/ACM.0000000000000482.

Distress among matriculating medical students relative to the general population.

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Dr. Brazeau is professor of family medicine and psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey. Dr. Shanafelt is professor of medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Durning is professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Massie is professor of medicine, University of Alabama School of Medicine, Birmingham, Alabama. Dr. Eacker is associate professor of medicine, University of Washington School of Medicine, Seattle, Washington. Dr. Moutier was professor of psychiatry, University of California, San Diego, at the time of the study. She is now chief medical officer, American Foundation for Suicide Prevention, New York, New York. Mr. Satele is statistician, Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota. Dr. Sloan is professor of oncology, Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota. Dr. Dyrbye is professor of medicine and medical education, Department of Medicine, Mayo Clinic, Rochester, Minnesota.



Many medical students experience distress during medical school. If matriculating medical students (MMSs) begin training with similar or better mental health than age-similar controls, this would support existing concerns about the negative impact of training on student well-being. The authors compared mental health indicators of MMSs versus those of a probability-based sample of the general U.S. population.


In 2012 all MMSs at six U.S. medical schools were invited to participate in a survey during orientation. The research team surveyed a probability-based sample of U.S. individuals using the same questions in 2011. Individuals from the population sample who completed a four-year college degree and matched within the appropriate age strata (< 30, 31-35, 36-40, > 40) were compared with MMSs. Surveys included demographics and validated instruments to measure burnout; depression symptoms; and mental, emotional, physical, and overall of quality of life (QOL).


Demographic characteristics of the 582/938 (62%) responding MMSs were similar to U.S. MMSs. Relative to 546 age-similar college graduates, MMSs had lower rates of burnout (27.3% versus 37.3%, P < .001) and depression symptoms (26.2% versus 42.4%, P < .0001) and higher scores across the four QOL domains assessed relative to controls (all P < .0001). These findings persisted on multivariate analysis after adjusting for age, sex, relationship status, and race/ethnicity.


These findings, along with high rates of distress reported in medical students and residents, support concerns that the training process and environment contribute to the deterioration of mental health in developing physicians.

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