Analysis of Emotional Burnout Amongst the USMLE Applicants Applying for NRMP Residency Match in the United States

By Santosh Rajaram Kale¹, Kamal Kant Sahu², Shamendra Anand Sahu³

Affiliations

1. Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
2. Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
3. Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

doi: 10.29271/jcpsp.2020.07.775

Sir,

Applying for residency in United States of America (USA) can be a stressful and an emotionally draining process. After spending approximately 4-6 years in medical school, every student has the goal of getting matched in a residency programme of choice. However, the fear of going unmatched can be nerve-racking and associated with stress and burnout and none of the studies in past have addressed it.¹ This study was done to highlight the impact of these emotional upsurges on the applicant’s mindset during the preparation of residency applications.

Figure 1: (A) How often did you felt like quitting your USMLE journey/application process due to emotional stress?
(B) How often you felt hurting yourself physically in any form during USMLE journey/application process due to emotional stress?
(C) Whom did you choose to confide your financial troubles or emotional stresses with?
(D) Did you seek any kind of medical counselling or were prescribed medication(s) by psychiatrist for this problem?

An online questionnaire was created using Google form programme. The questions focused on the emotional aspects of preparing and applying for residency. Survey was sent to the applicants successfully matched in national residency matching programme (NRMP) 2018. The questions included in the survey enquired about the level of stress, motivation, suicidal tendencies and psychiatric emergencies experienced during residency application.

The results were collected over a period of three months from April to June 2018. The total number of participants were 213 and the response rate was 56.80% (213/375). Only 7.04% (15/213) of the applicants were US citizens and rest 92.95% (198/213) were non-US applicants. The highest number of applicants were from India (61.97%, 132/213) followed by Pakistan (7.98%, 17/213) (Figure 1A). Accordingly, majority of the applicants (n=129, 60.56%) did their medical schooling from India. Majority, i.e. 52% of the applicants had B1/B2 visa. Most applicants accepted to discuss their financial issues or emotional stress with their family (37.25%, 133/357 responses) and friends (29.13%, 104/357 responses). Most, i.e. 89.67% (191/213) of responders, accepted to be emotionally stressed out at some point to more than 5 in a scale of 1-10 (Figure 1C). Similarly, nearly 64.78% (138/213) of candidates had low mood level of 5 or less in a scale of 1-10 at some point of time during the ERAS application process. A high proportion of responders (76.05%, 162/213) agreed to have thoughts of quitting the application process at least once (Figure 1A). More importantly, 67.6% (143/213) patients never thought; and 8.9% (20/213) patients rarely thought of hurting themselves at any point (Figure 1B). Despite huge emotional burden, very few candidates sought professional help (emergency consultation, psychiatry counselling or medications) for their problems (Figure 1C, D).

This survey results hold extreme importance for undergraduates especially from South East Asia Region (particulalry India, Pakistan, and Nepal) who apply for USMLE. It addresses the concern of emotional burn out during the lengthy process of application process and the interview season.^2-4 We hope this helps the future aspirants to be better prepared before embarking their journey to USMLE.

CONFLICT OF INTEREST:
No conflict of interest for all authors.

AUTHORS’ CONTRIBUTION:
KKS, SRS: Data collection, and manuscript writing.
SAS: Literature search.
SRS, KKS: Critical review, and comments

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