Dr. Josh Webb On Spearheading Anti-Burnout Programs for Medical Students

It’s “THE” Grey’s Anatomy Nightmare – late nights studying, lots of coffee, and textbook overload. Medical students across the country are experiencing burnout. In fact, recent data show that physician burnout affects more than 50% of doctors in the United States.

The national burnout crisis takes a toll on not only the practicing clinician, but can negatively impact patient experience and outcomes. Western Atlantic University (WAUSM) is getting to the “root” cause – spearheading anti-burnout programs by addressing and amending curriculum development, and teaching skills and techniques to cope with high pressure of medicine, in order to set up their students for success.

Dr. Josh Webb, assistant professor of clinical medicine department of medical education at WAUSM, spoke with DocWire News on how this upstream approach can help provide coping skills and tools to medical students for the high-pressure environment to come.

DocWire News: Please give us some background on yourself, and your specialty.

Dr. Josh Webb: So, I’m a rural general practitioner. So, I was trained to practice in a very rural and remote setting to provide essentially every level of healthcare to whatever comes through the door. So, from basic family medicine to emergency medicine, to dealing with more complex issues, as well as counseling. Really whatever walks through the door, that was what I was trained in and that’s what my training program was designed to do.

How many medical students and health care workers suffer from burnout? What are some of the root causes?

It’s been increasing year over year, especially the pandemic exacerbated the incidents and the frequency of burnout. A lot of people chose to retire early, putting increased demand on their staff. Also, the overall healthcare demand increased. Lot of services were lost and shut down or switched over to distance, so via video services or phone. So, that’s really increased the rate of burnout. I think we’re pushing 60, 70% now that staff, nurses, doctors are experiencing as far as burnout goes.

How is the Western Atlantic University School of Medicine addressing the problem of burnout? What programs are being spearheaded?

So, traditionally in healthcare, almost had that military bootcamp mentality. It was hard for me, it was difficult for me, so we’re going to make it difficult for you. And unfortunately, the landscape has changed. The amount of knowledge, of medical knowledge that exists, doubles, I believe every two years now. It’s really, really increasing. So, to have someone who is trained in the late ’70s or the late ’80s, expects students to have everything memorized or expect them to be able to keep on top of their workload. Well, things are different. Maybe you had a paging service that would call you, but now works with students and residents and medical professionals or even yourself. You’re expected to be available by email and by text, by video chat 24 hours a day. So, well, that kind of military bootcamp, I did it, you did it mentality exists.

The world, the dynamic in which it exists has changed so much that you can’t just do that to people anymore, because of the demands are so much higher than it’s ever been before. So, what we’re trying to do is we’re trying to build resilience into our curriculum. And there’s a couple things that we were doing for that, is one, we’re using a flipped classroom model. So, no longer do we expect students to come. When I trained, you went to class from 8:00 in the morning until 5:00 at night, and you were lectured the whole way through. You had an hour break for lunch, and then you went home and studied. And you’re expected to pay attention and take notes and do those things. And some things come very easy to some students. And I remember sitting through lectures and being like, well, I already know this, but not being able to do other things or study on other issues because you had to pay attention, you had to focus.

And what we’ve done with that flip classroom model is we say, “Here’s your learning objectives. Here are your goals. Here are what we want you to cover and prepare.” And we expect the students to do that out of the classroom. And then as opposed to coming in and sitting in the classroom for eight hours and listening to someone lecture and go through 100 slides, we have a multi faculty discussion where myself as a clinician will come in and I’ll pair with our physiologists and I’ll pair with our biochemists or pathologists or our pharmacologists, and we’ll have a discussion with the students based on the concepts that they’ve already gone over to really answer those questions, to solidify the knowledge that they’ve covered on their own. And then also to address any shortcomings. And as anyone that’s gone to university, some things come easy for you and then some things don’t come easy.

And to kind of have a one size fits all approach to a curriculum, it doesn’t serve anyone. The students that have the ability to excel, don’t get the extra attention they need. And the students that are struggling, don’t get the attention they need. So, the education’s not tailored to everyone. It’s just kind of, well, this is the lowest common denominator. So, by doing this flip classroom is we have these really engaging conversations where everyone participates. We’ve got multiple faculty in the room. We’re not clicking through PowerPoints and just kind of reading off traditional style. We’re really having an engaging discussion. And then also, it opens up more opportunity for the students to come after class, because they’re only in class for really at most a four hours on a busy day and some days an hour or two hours.

But it allows them to come seek out faculty. Maybe they’re struggling with the physiology of it, or maybe they’re struggling with the clinical applications of it. They can come and see me, or they can come and see one of my colleagues who’s a physiologist and they can break it down. So, it really has that individual tailored learning plan, which is fantastic. We also have additional sessions, voluntary sessions built in if you want to come in and work on certain topics. We have faculty present that you can come in and ask questions. We can go through and do some exam preparations or work through some difficult concepts if the students want to come in and do that. And then we also have fantastic activities for the students. We’ve just established our student government. So, really building in resilience is also community.

When you’re stressed, when you’re anxious, when you’re having trouble, if you can go to a colleague or a peer and say, “Hey, I’m just having a rough go.” So, building in social activities, things like having bonfires or snorkeling trips or really enjoying the beauty and the nature that Grand Bahama has to offer. And also, helping the students build a lifelong community. So, when they’re off in residency in Colorado, they can call someone they spent four years studying with, who’s working in Fort Lauderdale and say, “Hey, I’ve got this really tough preceptor and I don’t know how to deal with this. How are you doing? Can you help me out here?” So, we’re really trying to build that community part of the resilience. We provide a lot of physical activity programs here at the school, exercise opportunities for exercise, opportunities for community engagement, beach cleanups, community service.

And also with this flip curriculum, it allows the students, say that if it’s 10:00 in the morning, you stayed up all night studying for an exam, you’re not tethered to go into class eight hours. You can go and catch up on some sleep or get some groceries or really address those personal needs that a lot of us find when we get into 8, 10, 12 hour work days. You’re just like, I don’t even have time to do my laundry and take care of myself.

What are the optimal tools health care workers need to thrive in a high-pressure environment?

The optimal tools, I think really being able to have community, connection, being able to self-reflect and realize… Big thing about burnout is being able to realize it when it starts, when you’re starting to feel burnt out, and then having the tools to address that. So, I think recognizing it, because the old way was bury your head and work, work, work, work, work, work. And then all of a sudden, people find that they’re anxious and they’re depressed and they’re burnt out, but that it’s so far down the line.

The engine’s on fire, as opposed to seeing the check engine light that came on six months ago, and really teaching them to find that check engine light and recognize what they need to do. And addressing burnout is social, it’s sleep, it’s stress management, anxiety management, it’s personal care, adequate nutrition, all things that typically in medicine is like, oh, I haven’t slept in two days and I haven’t eaten in three weeks. And all of these things that were old things that we carry through in medicine and then realized this is not healthy. And the demands are more, so the ability to cope with those stresses are so much higher. So, we’re trying to get students to be able to early recognize those signs of burnouts, those signs of stress, and being able to reach out and recognize what they need before it becomes kind of mission-critical.

Any closing thoughts?

And then I think the other thing is just also having really open door policies. We’ve got fantastic counseling and fantastic student services here that are kind of overseeing, keeping an eye on the students. They’re there to help and reach out if that help is needed. And really just create that sense of community that you’re not all on your own and you’re not invincible and you’re not expected to be the old, perfect, flawless, the physician that doesn’t have any problems, to recognize that we all have issues. And you think about your classic TV doctors, Dr. House or the staff of Grey’s Anatomy, they don’t address any of their issues, which makes the shows entertaining, because someone’s got a drug problem or someone’s mean to other staff, or someone’s doing something outside of the hospital that they shouldn’t be doing. And it makes for great TV, but it doesn’t make for great physicians in the real world.