Burnout is a psychological syndrome of emotional exhaustion, depersonalization, and impaired personal accomplishment induced by repeated workplace stressors. Current research suggests that physician burnout may have its origins in medical school. The consequences of medical student burnout include both personal and professional distress, loss of empathy, and poor health. We hypothesized that burnout occurs prior to the initiation of the clinical years of medical education. This was a cross-sectional survey administered to third-year medical students at the Mount Sinai School of Medicine (MSSM) in New York, New York (a traditional-style medical school with a marked division between pre-clinical and clinical training occurring at the beginning of the third year). Survey included an instrument used to measure job burnout, a sleep deprivation screen, and questions related to demographic information, current rotation, psychiatric history, time spent working/studying, participation in extracurricular activities, social support network, autonomy and isolation. Of the 86 medical students who participated, 71% met criteria for burnout. Burnt out students were significantly more likely to suffer from sleep deprivation (p = 0.0359). They were also more likely to disagree with the following statements: "I have control over my daily schedule" (p = 0.0286) and "I am confident that I will have the knowledge and skills necessary to become an intern when I graduate" (p = 0.0263). Our findings show that burnout is present at the beginning of the third year of medical school, prior to the initiation of the clinical years of medical training. Medical student burnout is quite common, and early efforts should be made to empower medical students to both build the knowledge and skills necessary to become capable physicians, as well as withstand the emotional, mental, and physical challenges inherent to medical school.

Introduction Internal medicine (IM) residents must be capable of performing ambulatory procedures required of a competent internist regardless of their career plans. Unfortunately, many IM residents may feel uncomfortable in the ambulatory setting and with ambulatory procedures as the bulk of residency training focuses on inpatient experiences. Methods The session described here is a 1.5-hour case-based, interactive module for residents of all training levels centered on key ambulatory procedures, featuring experienced faculty demonstrating said procedures on a realistic, full-body manikin patient care simulator followed by direct observation of resident competence by that faculty member. Four students per group is optimal. As clinician educators serve as facilitators, faculty training is limited to a walk-through of each session. The materials associated with this publication include the session protocol, cases, direct observation procedure checklists, preparticipation surveys, and postparticipation surveys. Results From July 2014 to June 2015, 66 residents of all training levels at Northwell Health-Lenox Hill Hospital in New York City, NY, completed this session. Upon completion, participant performance of breast and pelvic exams improved at every step of each procedure. Additionally, participant comfort, confidence, and intent to perform breast and pelvic exams increased. Discussion Given the success of this session, this educational experience was expanded to include modules on other key ambulatory procedures to promote the development of independent, competent, proficient, and professional IM practitioners who provide high-quality, patient-centered care while fulfilling the program requirements set forth by the ACGME.

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