A national survey published in 2014 revealed a disturbing finding. Compared to college graduates pursuing other professions, medical students, residents and early career physicians experienced a higher degree of burnout.
Citing that article, a group of researchers at University of California at Davis School of Medicine wondered whether medical students’ childhood adversity and resilience played a role in their burnout, said Dr. Andres Sciolla, an associate professor of psychiatry and behavioral sciences at the University of California at Davis Medical School. Sciolla is the lead author of a recent study in the journal Academic Psychiatry that investigated those questions.
Their query was based on the landmark CDC-Kaiser Permanente Adverse Childhood Experiences Studythat showed a remarkable link between 10 types of childhood trauma — such as witnessing a mother being hit, living with a family member who is addicted to alcohol or who is mentally ill, living with a parent who is emotionally abusive, experiencing divorce — and the adult onset of chronic disease, mental illness, being violent or a victim of violence, among many other consequences. The study found that two-thirds of the more than 17,000 participants had an ACE score of at least one, and 12 percent had an ACE score of four or more. (For more information, see ACEs Science 101.)
The ACE Study and subsequent research shows that people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic than someone with an ACE score of 0. Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1200 percent. An ACE score of 6 or higher is associated with a 20-year shorter lifespan than someone with an ACE score of 0. However, subsequent research has shown that social buffers, such as having just one caring adult in a child’s life, can mitigate the impact of ACEs.
For the UC Davis study, 86 third-year medical students completed an ACE survey. Of those, 49% had an ACE score of 0, 40 % had ACE scores between 1-3, and 12 % had ACE scores of 4 or more.
“Contrary to our expectations, the prevalence of ACEs in a class of third-year medical students was comparable to rates in the general population,” wrote the authors.
“You can assume that because physicians, in general, and medical students, come from more affluent backgrounds than the general population that those medical students would have a lower prevalence of ACEs than the general population and that was not the case,” explained Sciolla.
Also significant, said Sciolla, is that all of the students who had ACE scores of 4 or more were women. “When we’re talking about interpersonal violence — physical abuse, sexual abuse, emotional abuse — women are more likely than men to be victims,” he said. “The medical workforce is becoming increasingly female. And we know that female physicians are at a high risk for suicide and burning out, we can speculate that female physicians may be at increased risk for negative health and professional outcomes, so it needs to be looked at further.”