A Scoping Review of Research into the Origins of Cynicism Among Medical Trainees

There is a perception that medical trainees begin their training idealistic and full of excitement. Yet, there is growing recognition in scholarly literature that this idealism is replaced by cynicism as a result of the training process itself. The ultimate goal of this study was to review the current literature on cynicism during medical training in order to identify factors that engendered its development. Equipped with this information, medical education can expand data collection regarding cynicism in order to further inform the development of solutions to combat it. This scoping review was conducted with a broad search for published articles across three medical education databases using search terms "cynicism in medical students." Additional relevant articles were added from reference lists of included articles. Articles on cynicism in practicing professionals were excluded as were articles that focused on burnout. The search identified 161 unique articles; 30 articles merited full reading and 19 ultimately met inclusion criteria. Emergent themes comprised three categories: causes of cynicism, variations of cynicism among populations, and outcomes of cynicism. Within these 3 categories, 9 sub-categories were also extracted. From Kopelman's perspective (Kopelman in JAMA 250(15):2006-10, [11]), the presence of cynicism verifies that students' ideals are still alive because they recognize that things could be better and are disappointed that they are not; cynicism may be preferable to despair. This review revealed that trainees have not suffered a death of their ideals, but a burial. Corrective action may be able to excavate what was lost-an idealistic approach to medical training.