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Teaching and Academic Burnout

Feb 05, 2024 1:15 pm

RheumNow recently highlighted a publication that reported about a third of physicians in academia intend to leave.

To our colleagues in non-academic situations, this may seem incredibly high. Certainly, each practice situation has its benefits and challenges. Academic physicians have been relatively shielded from some of the forces faced more directly by our private practice colleagues, such as billing/collecting etc.

I think an important contributor to the intention to leave academics is that something that used to be a benefit has now become a challenge: namely, teaching.

Academic physicians used to relish teaching medical students, residents, and fellows. Indeed, not only did we promise to teach the next generation of physicians when we took the Hippocratic Oath, and of course it is a requirement for academic advancement, but more importantly it was something that physicians used to take great pleasure in.

What happened? 

To the old adage, “those who can – do; those who can’t – teach” I would add “those who are not really good at practicing medicine, and not great at teaching others medicine, become overlords in the academic medical education machine”. Lately, these detached bureaucrats have seemingly become obsessed with enforcing their own unproven largely ‘woke’ beliefs as to how medical education should be conducted.

Rather than putting a medical student on the spot with an affront such as “what are the potential causes of non-anion gap metabolic acidosis?”… we should rather say something like “..how do you feel about the anion gap.. and are there any ions that are not represented”. Trainees at all levels are also actively encouraged to report ‘bad behaviors’ by those teaching them (much like the Stasi did in the old East Germany). Make a grievous affront such as referring to someone as a “homeless person” (rather than “person experiencing homelessness”) and you should be written up for being unprofessional.

Over the course of the year, if you received 24 evaluations ranking you as a superlative teacher, with glowing remarks added…. But you also get 1 evaluation where it is implied you may be unprofessional… you can guarantee you will hear nothing about the former but be quickly reprimanded for the latter.

Ask any fellowship program director about the medical education apparatus. After looking over both shoulders, they will whisper agreement… teaching has become a contributor to burnout. 

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Disclosures
The author has no conflicts of interest to disclose related to this subject

Dr. Arthur Kavanaugh is Professor of Medicine at the University of California, San Diego School of Medicine. In addition, he is the Director of the Center for Innovative Therapy in the UCSD Division of Rheumatology, Allergy, and Immunology. Dr Kavanaugh has authored more than 500 publications. He is on the editorial board for several journals, and has served as peer reviewer for many scientific journals. Dr Kavanaugh’s main research interest is in clinical research, particularly translational aspects of rheumatology research. This has included work delineating the pathophysiology of rheumatic diseases as well as defining changes associated with novel immunomodulatory therapies. The focus of many clinical projects has been RA and psoriatic arthritis, but Dr Kavanaugh has conducted many studies in other autoimmune conditions, including SLE, ankylosing spondylitis, inflammatory bowel disease, and others. In addition, he has performed studies focusing on novel imaging methods and also clinical outcomes.