“This generation, they just lack resilience. Why, back in my day….”

I cringe at the pontificating on the “demise” of medical education at the hands of “this generation.” Often this remark is tossed around in response to raised concerns regarding systemic challenges and failures, concerns that are dismissed because “we have always done it this way.” The propagation of the I-Have-Suffered-So-You-Must-Suffer-Too model of medical education is sadly prevalent.

It is exhausting to listen to misguided conversations around “resilience”—a term I have grown increasingly wary of, as many use it to shift the onus of responsibility and blame to individuals in health care, rather than formulating meaningful action plans that recognize the fundamental transformation of our medical system. In this era of rapidly evolving medical advances, there is simply no comparison between the volume and complexity of patient care provided today as compared to decades ago. For instance, one study estimated that “the doubling time of medical knowledge in 1950 was 50 years; in 1980, 7 years; and in 2010, 3.5 years. In 2020 it is projected to be just 73 days.” This shocking statistic meant that “what was learned in the first 3 years of medical school will be just 6% of what is known at the end of the decade from 2010 to 2020.”¹

While empowering individuals to prioritize time off to recharge and focus on life outside medicine is important, we cannot self-care our way out of the current structural failures. Dithering over whether the term should be work-life balance or work-life integration skates over the crux of the problem and wastes time on semantics. With 24/7/365 access to the electronic medical records and work email through mobile phone apps, there is a mounting expectation for constant availability and troubleshooting of any and all work-related issues—there is no longer a division between the workday and home life. And frankly, any discussion of the “back in my day” model of work-life balance that refers to a time when women weren’t even allowed in medical schools is ludicrous.

Medical burnout is well documented. Rather than continuing to invest in surveys and publications on its prevalence, we should shift our focus to meaningful, actionable steps that institutions commit to implementing. Those steps should not be centered around mandatory wellness and resilience modules. We don’t need to click through slides of data regarding how driving while sleep-deprived is equivalent to driving while intoxicated during a precious hour that could be spent catching up on that sleep.

There are no easy or obvious solutions to the current situation. To start, we must strive to reclaim some order amidst all the chaos and to hold leaders and institutions accountable as we attempt to rebuild. We need to retire the “back in my day” speeches once and for all. Rather than a nostalgic glorification of days past, it is imperative that we focus on effective restructuring of the system and providing meaningful support to the current workforce and the new challenges they face.

Simply stated: “Systems don’t change easily. Systems try to maintain themselves and seek equilibrium. To change a system, you need to shake it up, disrupt the equilibrium. That often requires conflict.”

In order to disrupt our broken system and make the progress we want to see in our profession, we need to advocate for:

• Diverse and inclusive leadership. The people making decisions at the very top of our institutions, agencies, and professional societies should be representative of the current workforce.
• Strict systemic measures to prevent the over-reliance on working off-hours to ensure appropriate patient care and to meet academic obligations. The onus of work-life balance should not rest on the individual.
• Inclusive workplace policies that support family, medical, and bereavement leaves. We need to build and invest in a supportive workplace community that recognizes that a job in health care is a privilege but that self-sacrifice of the individuals in that workforce is not a badge of honor to tout.

I don’t see a lack of resilience. What I see is a generation demanding reform rather than succumbing to an archaic medical education system, work policies, and professionalism standards set decades ago. I see a generation that believes we can and must do better for our learners and for our workforce.

Reference

1. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.