Burnout, Depression, Anxiety, and Stress Among Family Physicians in Kansas: 18 Months into the COVID-19 Pandemic.

INTRODUCTION: Given the significant turmoil during the COVID-19 pandemic, the authors evaluated burnout and other types of emotional distress experienced by family physicians in Kansas during the second year of the pandemic. The authors compared findings of this study to a similar study conducted 3 months into the pandemic. METHODS: A cross-sectional online survey of 272 actively practicing family physicians in Kansas was conducted from September 15 to October 18, 2021. A 34-item questionnaire was used to measure the physicians' levels of burnout, personal depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, Mann-Whitney U test/independent samples t-test, χ2, adjusted odds ratio, and immersion-crystallization methods were used to analyze the data. RESULTS: The response rate was 48.9% (n = 133). In aggregate, 69.2% of respondents reported at least 1 manifestation of professional burnout in 2021 compared with 50.4% in 2020; P ≤ .01). The 2021 respondents were at higher odds of experiencing burnout compared with 2020 respondents (aOR = 1.86; 95% CI, 1.00 to 3.57; P = .046). The respondents who reported at least 1 manifestation of professional burnout were more likely to screen positive for depression (aOR = 1.87; 95% CI, 1.31-2.66; P ≤ .01), report higher levels of anxiety (aOR = 1.53; 95% CI, 1.04-2.24; P = .013), and higher levels of stress (aOR = 1.39; 95% CI, 1.17-1.66; P ≤ .001). CONCLUSION: As the COVID-19 pandemic continued, there are significant and worsening rates of professional burnout and other forms of emotional distress among family physicians. These findings suggest timely need for appropriate psychological supports.

Using the Residency Matched Method and Intent to Practice Method to Estimate Primary Care Workforce Production.

Introduction: Many medical schools overestimate the percentage of their graduates who enter the primary care workforce based on the "first-certificate" residency their graduates enter. To rectify this problem, Deutchman and colleagues proposed a new method of estimation. The objective of this study was to compare results from the traditional residency match and Deutchman methods to the actual percentage of University of Kansas School of Medicine (KUSM) graduates who practice primary care after completing medical school and all residency and subspeciality fellowship training. Methods: A retrospective study was conducted using a convenience sample of KUSM graduates from 2003-2014. Percentages of graduates classified as primary care by the traditional Residency Match Primary Care Method (RMPCM) and the percentages of graduates identified as primary care by Deutchman's Intent to Practice Primary Care Method (IPPCM) were compared with the actual percentage of graduates who eventually entered the primary care workforce. Results: Of the 1,944 KUSM graduates identified during the study period, the RMPCM predicted a 48.1% primary care output rate. The Deutchman's IPPCM predicted a 22.8% primary care output rate. The actual known percentage of graduates practicing primary care was 34.2%. Conclusions: Neither the RMPCM nor the Deutchman's IPPCM performed well in predicting the percentage or number of KUSM graduates who eventually practiced primary care. Due to predictions for the shortage of primary care physicians, there is a need to identify a method that more accurately predicts the medical schools' contribution to the primary care workforce.

Gastrointestinal Conditions: Occult Gastrointestinal Bleeding.

Occult gastrointestinal (GI) bleeding is bleeding from the GI tract that is not noticeable to patients or physicians. Patients with unexplained anemia (ie, not attributable to another cause such as menstrual bleeding), particularly iron deficiency anemia, should be evaluated for occult GI bleeding. Similarly, if fecal blood is detected during routine colorectal cancer screening, an evaluation for occult bleeding is indicated. Direct visualization with colonoscopy or esophagogastroduodenoscopy are the initial tests of choice; which one is conducted first depends on a patient's risk factors for upper versus lower GI bleeding. If initial endoscopy is negative, repeat endoscopy may identify the bleeding source. If still negative, other tests, typically capsule endoscopy, can be used to evaluate for small bowel bleeding. Management of identified lesions varies, but they often are amenable to endoscopic intervention or medical management. The need for transfusion is uncommon in occult GI bleeding. Rarely, a surgical approach to visualization and resection may be undertaken. If no bleeding source is identified, or even if it is identified and successfully treated, patients should be evaluated for conditions or treatments that might increase the risk of rebleeding (eg, nonsteroidal anti-inflammatory drug use, antiplatelet/anticoagulant therapy). Need for these treatments should be reevaluated.

Gastrointestinal Conditions: Colorectal Cancer Screening and Prevention.

Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. CRC screening reduces CRC deaths. Although the median age at diagnosis is 67 years, the incidence in younger individuals has been increasing, and younger patients are more likely to present with more advanced disease. In the past, guidelines recommended initiating screening at age 50 years. However, guidelines from multiple organizations now recommend initiating screening at age 45 years. Screening should start even earlier in individuals with genetic risks for CRC. Recommendations about when to discontinue screening vary, but all guidelines recommend continuing at least to age 75 years. After age 75 years, screening should be based on patients' life expectancy, medical status, and values and goals. Colonoscopy is considered the gold standard screening test, but many patients decline colonoscopy because of its invasive nature and associated bowel preparation. Other tests recommended in guidelines include guaiac-based fecal occult blood test, fecal immunochemical and DNA tests, flexible sigmoidoscopy, and computed tomography colonography. Recommended screening intervals vary for each of these tests. Two newer screening tests, not yet included in guidelines, are Epi proColon (methylated septin DNA) assay (which detects methylation of the SEPT9 gene associated with CRC) and capsule colonography. All patients also should be informed about lifestyle and diet-related interventions that can decrease CRC risk.

Gastrointestinal Conditions: Inflammatory Bowel Disease.

Inflammatory bowel diseases (IBDs) comprise a group of conditions thought to be caused by a dysregulated host immune response to the gut microbiome. IBDs, which affect 1.3% of Americans, include Crohn disease (CD), ulcerative colitis (UC), and microscopic colitis. UC and microscopic colitis are limited to the colon, but CD can occur anywhere along the gastrointestinal tract. Gastrointestinal symptoms typically predominate, including diarrhea and abdominal pain, along with systemic symptoms of weight loss, fatigue, night sweats, and fever. However, many patients have extraintestinal symptoms, often in the joints, skin, or eyes; extraintestinal symptoms can appear before gastrointestinal symptoms. Colonoscopy with biopsy is the test of choice for diagnosing UC and microscopic colitis. Diagnosing CD typically requires ileocolonoscopy and also may require esophagogastroduodenoscopy. Traditionally, therapy involved mesalamine for UC, thiopurines or methotrexate for CD, and budesonide for microscopic colitis. However, recently, biologic drugs targeting tumor necrosis factor alpha and other inflammatory drugs have revolutionized care of IBD. Surgery (complete resection of involved colon) can be curative in UC. In CD, surgery typically is only used for complications or refractory disease.

Gastrointestinal Conditions: Malabsorption Syndromes.

Malabsorption syndromes are a heterogenous group of conditions that can cause distressing gastrointestinal symptoms. Celiac disease is most common and is triggered by exposure to gluten. Tissue transglutaminase immunoglobulin A is the diagnostic test of choice; management is gluten avoidance. Lactose intolerance is caused by absence or declining levels of the enzyme lactase. Diagnosis typically is clinical, but breath tests can be helpful if diagnosis is uncertain. Management is lactose avoidance. Bile acid malabsorption results in unabsorbed bile acids in the colon, leading to diarrhea. The 75selenium homotaurocholic acid test is most accurate but is not widely available. Therefore, a trial of bile acid sequestrants (typically cholestyramine) is a reasonable alternative when the diagnosis is suspected. Exocrine pancreatic insufficiency is caused by decreased production of pancreatic enzymes, typically occurring in patients with preexisting pancreatic damage from alcohol, surgery, radiation, diabetes, or cystic fibrosis. Diagnosis involves fecal fat or fecal elastase-1 tests. Management is pancreatic enzyme replacement. Small intestinal bacterial overgrowth is caused by pathologic overgrowth of the small bowel microbiome. Diagnosis is by jejunal biopsy or, more commonly, breath tests. Antibiotics (typically rifaximin) are the initial management. Other options include dietary changes, probiotics, and prokinetic drugs.

Family physicians in kansas response to the COVID-19 pandemic.

Introduction The novel coronavirus infectious disease (COVID-19) has spread rapidly with vast global implications. This study assessed how family physicians in Kansas responded to COVID-19 and the effects of the pandemic on the physicians' well-being. Methods. The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 18-item survey assessing family physicians' concerns about being exposed to COVID-19, levels of personal depression, anxiety, stress, and burnout in addition to demographic information. Results. There was a 45.6% response rate, with 50.4% (n=57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared to those who did not, were more likely to report at least one manifestation of burnout (odds ratio[OR]=3.96; 95% confidence interval [CI], 1.38-11.36; P = .011), experience emotional exhaustion (OR=3.21; 95% CI, 1.01-10.10; P<.05), and feel a higher level of personal stress (OR=1.13; 95% CI, 1.01-1.27; P=.011). Conclusion. Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes such as burnout, depression, anxiety, and stress, to determine the need for interventions, and influence the implementation of programs to support physician wellness. These data can help drive wellness and mental health support initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians.

To Post or Not to Post: Does Applicants' Social Media Affect Family Medicine Resident Recruitment?

BACKGROUND AND OBJECTIVES: Current literature on review of applicant social media (SoMe) content for resident recruitment is scarce. With the recent increase in the use of privacy settings, and the cost of the recruitment process, the aim of this study was to describe the practice and outcomes of review of applicant SoMe in resident recruitment and its association with program director or program characteristics. METHODS: This study was part of the 2020 Council of Academic Family Medicine's Educational Research Alliance (CERA) annual survey of family medicine residency program directors (PDs) in the United States. RESULTS: The overall response rate for the survey was 39.8% (249/626). About 40% of PDs reported reviewing applicant SoMe content. The majority (88.9%) of programs did not inform applicants of their SoMe review practices. The most common findings of SoMe review were that the content raised no concerns (38/94; 40.4%) or was consistent with the application material (34/94; 36.2%). Forty PDs (17.0%) have ever moved an applicant up or down the rank list based on SoMe review. Review of applicant SoMe was not statistically associated with program size, program type, PD age, PD SoMe use, or program SoMe use. CONCLUSIONS: SoMe review has not become routine practice in family medicine resident recruitment. The outcome of SoMe review was mostly consistent with the applicant profile without any concerns and only very few changed the ranking order. This calls for more studies to explore the value of SoMe review for resident selection regarding its effect on future performance.

Family Physicians' Perception of the New mRNA COVID-19 Vaccines.

INTRODUCTION: This study was conducted to assess family physicians' perception of the US Food and Drug Administration-approved mRNA Coronavirus disease 2019 (COVID-19) vaccines, their plans to be vaccinated with an approved mRNA COVID-19 vaccine, and their support for vaccination of patients and family members. METHODS: The authors conducted a cross-sectional survey of 307 practicing family physicians, full-time faculty physicians, and resident physicians in Kansas from December 14, 2020, to December 31, 2020. The study participants completed an anonymous, 20-item survey assessing family physicians' concerns about exposure to COVID-19 and their perceptions of the mRNA COVID-19 vaccines to control SARS-CoV-2. A mixed-method approach was used to collect, analyze, and interpret the data. RESULTS: There was a 51.1% response rate. The proportion of family physicians who reported their intentions to be vaccinated for COVID-19 was significantly higher than those who were hesitant to receive the mRNA vaccines (90.6% vs 9.4%; χ2 [1, n = 307] = 201.9.1; P < .0001). Among those who were willing to be vaccinated with an approved mRNA COVID-19 vaccine, the main reasons were to prevent COVID-19 infection; protect self, family, and community; contribute to herd immunity; inspire confidence that the vaccines are safe and end the pandemic and bring life back to normal. CONCLUSION: Our findings suggest a significantly positive association between a physician's concerns and their willingness to be vaccinated with an approved mRNA COVID-19 vaccine. With the authorization of 2 new mRNA COVID-19 vaccines, future studies should investigate the number of physicians in our study who received the vaccine.

Burnout, Depression, Anxiety, and Stress Among Family Physicians in Kansas Responding to the COVID-19 Pandemic.

INTRODUCTION: COVID-19 has spread rapidly, with vast global implications. This study assessed how family physicians in Kansas were responding to COVID-19 and the effects of the pandemic on their well-being. METHODS: The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 36-item survey assessing their concerns about being exposed to COVID-19 and levels of personal depression, anxiety, stress, and burnout in addition to demographic information. RESULTS: There was a 45.6% response rate, with 50.4% (n = 57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared with those who did not, were more likely to report at least 1 manifestation of burnout, experience emotional exhaustion, and feel a higher level of personal stress. CONCLUSION: Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes. Data can help drive initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians.

Characteristics Sought When Hiring Faculty in Family Medicine Residency Programs.

BACKGROUND AND OBJECTIVES: Faculty shortages are a significant concern in family medicine education. Many family medicine residency programs need to recruit faculty in the coming years. As a result, family medicine faculty and resident physicians will be interviewing candidates to fill these vacancies. Little is known about the characteristics valued in a family medicine residency faculty candidate. METHODS: Using a cross-sectional survey of family medicine faculty and resident physicians in family medicine residency programs in Kansas, we attempted to define which characteristics are most valued by current faculty members and resident physicians in family medicine residency programs during the faculty hiring process. RESULTS: Of 187 invited respondents, 93 completed the survey (49.7% response rate). Twenty-five characteristics, grouped into five domains of relationship building, clinical, teaching, research and administrative skills, were rated as either not important, important, or very important. Building and maintaining healthy relationships was the most important characteristic for faculty, residents, males, and females. Administrative characteristics were the lowest ranked domain in our survey. DISCUSSION: These results provide an important snapshot of the characteristics valued in faculty candidates for family medicine residency programs. Understanding the paradigm used by existing faculty and resident physicians in family medicine residency programs when considering new faculty hires has an important impact on faculty recruitment and faculty development programs.

Changes in Family Physicians' Perceptions of Electronic Cigarettes in Tobacco Use Counseling Between 2016 and 2019.

INTRODUCTION: Given the recent reports of e-cigarette, or vaping, product use-associated lung injury (EVALI) and harm of e-cigarettes, the authors evaluated changes in the use and perception of e-cigarettes as tobacco use cessation tools in 2019 relative to 2016. The authors also evaluated the sources family physicians most commonly use to receive information regarding e-cigarettes. METHODS: A cross-sectional online survey of 248 community family physicians in Kansas was conducted from October 2019 to December 2019. An 11-item questionnaire measured the participants' perceptions of recommending e-cigarettes to patients for tobacco cessation. A mixed method approach was used to collect, analyze, and interpret the data. Standard descriptive statistics, Likelihood-Ratio/Fisher's exact tests, and immersion-crystallization methods were used to analyze the data. RESULTS: The response rate was 59.3% (147/248). The proportion of the family physicians who did not recommend e-cigarettes for tobacco use cessation was significantly higher in 2019 than in 2016 (86% vs. 82%; χ2 [1, n = 261] = 12.31; p < 0.01). Several reasons regarding respondents' perceptions of e-cigarettes as tobacco use cessation tools were reported. The medical literature and news media were the top sources where family physicians accessed e-cigarettes information. CONCLUSION: Most family physicians did not recommend e-cigarettes for tobacco cessation. Opinions regarding the efficacy and safety of e-cigarettes were influenced by information sources. Future, larger studies would be beneficial to further determine family physicians' beliefs and practices regarding e-cigarettes as tobacco use cessation products.

Assessing Loneliness and Other Types of Emotional Distress among Practicing Physicians.

INTRODUCTION: Loneliness has been linked to clinician burnout and other types of emotional distress. Research assessing the prevalence of loneliness among physicians is growing. Little is known, however, about how loneliness relates to other types of emotional distress among practicing physicians. The objectives of the study were to determine the prevalence of loneliness, and to explore the relationship between loneliness, burnout, depressive symptoms, and suicidal ideation among active member physicians of the Medical Society of Sedgwick County (MSSC). METHODS: The study involved a convenience sample of 197 practicing physicians who were active members of the MSSC. The 3-item University of California, Los Angeles Loneliness Scale, the Abbreviated Maslach Burnout Inventory, and 2-item Primary Care Evaluation of Mental Disorders Patient Health Questionnaire were used to measure prevalence of loneliness, manifestations of burnout, and symptoms of depression, respectively. RESULTS: Using an email survey, 442 practicing physicians received an invitation to participate; 197 (44%) completed the survey. The prevalence of loneliness was 43%. Loneliness prevalence was associated positively with age (p = 0.017) and more likely in those who reported manifestations of burnout (p < 0.01) or screened positive for depression (p < 0.01). Depression (OR = 2.24; 95% CI, 0.97-5.19) and emotional exhaustion (OR = 1.05; 95% CI, 0.39-2.84) were significantly associated with loneliness, including when adjusted for participants' sex, age, and duty hours. CONCLUSION: Loneliness is prevalent among active member physicians of the Medical Society of Sedgwick County. Given that loneliness is associated with burnout and other emotional distress, there is an important need to understand its implications better.

Why Patients Miss Scheduled Outpatient Appointments at Urban Academic Residency Clinics: A Qualitative Evaluation.

INTRODUCTION: Missed outpatient appointments are a common problem for academic residency clinics, and reducing their rate improves office efficiency, income, and resident education. Identifying specific reasons why some patients miss outpatient appointments may provide insight into developing targeted approaches to reducing their rates. This study sought to find reasons associated with patients' missed appointments at two family medicine residency clinics. METHODS: The study utilized a qualitative research design involving patients at two urban, university-affiliated family medicine residency outpatient clinics. Twenty-five randomly selected patients who were dismissed from the clinics for missing three or more scheduled appointments during a five-year span (July 2012 to July 2017) were interviewed over the phone about reasons they did not keep their scheduled clinic appointments. The authors, individually and as a group, used an immersion-crystalization approach to analyze the content of the interviews. RESULTS: Responses from 25 participants (21 females and four males) are presented. Fifty-two percent of patients were Caucasian, 32% Black, 12% Hispanic, and 4% Asian. Five themes emerged from the data analysis as major reasons the patients missed their scheduled outpatient appointments: forgetfulness, transportation issues, personal health issues, family and employer obligations, and other issues, such as anticipated long clinic wait times, bad weather, and financial problems. CONCLUSIONS: The findings showed there are several logistical, situational, and clinical reasons for patients' missed scheduled outpatient appointments.

Burnout and Quality of Life among Active Member Physicians of the Medical Society of Sedgwick County.

INTRODUCTION: The medical literature suggests disturbingly high rates of burnout among US physicians. The objective of this study was to determine the rates of burnout, other forms of distress, and overall quality of life among physicians in Sedgwick County. METHODS: The study involved a convenience sample of 197 physicians who were active member physicians of the Medical Society of Sedgwick County (MSSC). Between July and August 2018, we surveyed 872 physicians who were active members of the MSSC. The survey assessed manifestations of burnout, symptoms of depression and suicidal ideation, fatigue, and quality of life. The authors used standard descriptive summary statistics, Mann-Whitney U test/independent samples t-Test, Fisher's exact test, and correlations to analyze the data. RESULTS: The participation rate was 44.6%, with 49.5% of the respondents reporting manifestations of burnout. Although 85% of the participants rated their overall quality of life as good/very good, 45% screened positive for depression, 5% had thoughts of suicide during the past year, and 44% reported excessive fatigue during the past week. Those with manifestations of burnout were 2.13 (100% vs 46.9%, p < 0.01) times more likely to report thoughts of suicidal ideation, 2.43 (72.6% vs 30.4%; p < 0.001) times more likely to screen positive for depression, and 1.89 (67.5% vs 35.8%; p < 0.001) times more likely to have high degrees of fatigue. All of the participants who had suicidal ideation reported manifestations of burnout. CONCLUSIONS: Burnout was prevalent among active member physicians of the MSSC. Burnout among the participants was associated with symptoms of depression, fatigue, suicidal ideation, and intention of leaving the medical profession via early retirement and/or career change.

Assessing Work-Related Burnout and Job Satisfaction among Obstetrics and Gynecology Residency Program Coordinators.

INTRODUCTION: This study explored the prevalence of and the relationship between job satisfaction and burnout among obstetrics and gynecology residency program coordinators. METHODS: This cross-sectional study involved members of the American Program Managers of Obstetrics and Gynecology. The Copenhagen Burnout Inventory and Spector's Job Satisfaction Survey were used to measure the participants' burnout and job satisfaction rates respectively. Data were collected between August 2017 and December 2017. The authors used Fisher's exact tests, Spearman's r correlations, and multiple linear regression to analyze the data. RESULTS: There was an 83% (171/207) response rate. Thirteen percent of the coordinators reported high, 70% moderate, and 17% low job satisfaction scores. Thirty-nine percent of the coordinators reported high, 25% moderate, and 36% slight work-related burnout rates. Correlation coefficient showed a significantly negative relationship between job satisfaction and work-rated burnout, (r s [169] = -0.402, p < 0.01). Regression analysis showed co-workers (ß = -0.47) and supervision (ß = -0.16) domains of the job satisfaction scale were significant predictors of work-related burnout (R = 0.55; F[5, 195] = 11.05; p < .001). CONCLUSIONS: The findings highlight the importance of job satisfaction factors, such as support from coworkers and supervisors, in dealing with work-related burnout among residency coordinators.

Collaborating to Achieve the Optimal Family Medicine Workforce.

When the Family Medicine for America's Health (FMAHealth) Workforce Education and Development Tactic Team (WEDTT) began its work in December 2014, one of its charges from the FMAHealth Board was to increase family physician production to achieve the diverse primary care workforce the United States needs. The WEDTT created a multilevel interfunctional team to work on this priority initiative that included a focus on student, resident, and early-career physician involvement and leadership development. One major outcome was the adoption of a shared aim, known as 25 x 2030. Through a collaboration of the WEDTT and the eight leading family medicine sponsoring organizations, the 25 x 2030 aim is to increase the percentage of US allopathic and osteopathic medical students choosing family medicine from 12% to 25% by the year 2030. The WEDTT developed a package of change ideas based on its theory of what will drive the achievement of 25 x 2030, which led to specific projects completed by the WEDTT and key collaborators. The WEDTT offered recommendations for the future based on its 3-year effort, including policy efforts to improve the social accountability of US medical schools, strategy centered around younger generations' desires rather than past experiences, active involvement by students and residents, engagement of early-career physicians as role models, focus on simultaneously building and diversifying the family medicine workforce, and security of the scope future family physicians want to practice. The 25 x 2030 initiative, carried forward by the family medicine organizations, will use collective impact to adopt a truly collaborative approach toward achieving this much needed goal for family medicine.

Burnout and Other Types of Emotional Distress Among Medical Students.

BACKGROUND: The medical literature reports that many medical trainees experience burnout. The primary goal of this study was to determine how the prevalence of burnout and other forms of emotional distress among the University of Kansas School of Medicine (KUSM) medical students compared to the previously published data. METHODS: We conducted a cross-sectional survey of 379 medical students. Between July and September 2018, we surveyed 872 KUSM medical students on the three campuses (Kansas City, Salina, and Wichita) of KUSM. The survey included items on demographic information, burnout, symptoms of depression, fatigue, quality of life, and self-reported general health. The authors used standard descriptive summary statistics, Kruskal-Wallis test/one-way analysis of variance, chi-square test, correlation, and multivariate logistic regression model to analyze the data. RESULTS: The overall response rate was 43.5% with 48% of the students reporting manifestations of burnout. Burnout, depression, and fatigue were lowest during the first year of training and increased as year in training progressed. In multivariate models, only year in training was associated with increased odds of burnout, symptoms of depression, and fatigue. Nearly 46% of the students screened positive for depression, and 44.6% reported high levels of fatigue in the past week. CONCLUSION: Even though KUSM students have a lower prevalence of burnout than the national rate (48% vs. 55.9%), this prevalence is high enough to warrant new interventions. Because burnout and other emotional distress increase over the course of medical school no matter what campus the students attend, interventions should be both longitudinal and global across all campuses.