Education Research: Secondary Trauma in Third-Year Medical Students During a Neurology/Emergency Medicine Clerkship

Exposure to emotionally taxing patients can lead to secondary trauma that can result in burnout and emotional exhaustion in healthcare providers. Understanding whether secondary trauma is present in medical students could provide an opportunity to address the issue earlier in physician training. We sought to determine if secondary trauma characteristics exist in third-year medical students during a combined neurology/emergency medicine clerkship.

Six cohorts of third-year medical students at a MD-granting institution were invited to complete the Professional Quality of Life Survey, a widely used tool for assessing secondary trauma and its associated symptoms of compassion fatigue and burnout in healthcare workers. This was combined with supplemental questions and a standard postrotation survey to explore medical students' emotional experiences during the clerkship. The strength of the associations was measured with Cramér's V.

The survey had a 51% response rate (n = 100) with 11.3% reporting symptoms of secondary trauma. Of the respondents, 81% identified as White, 6% as Black/African American, 6% as Asian, and 2% as American Arab/Middle Eastern/North African; 60% identified as female and 37% as male. Contributors to secondary trauma could be grouped into 4 themes: 1, feeling helpless in the student role; 2, witnessing the physical consequences of patient diseases; 3, personal trauma history; and 4, empathy burden. Most students expected the level of emotional distress they experienced during the clerkship. Hobbies, wellness activities, talking to others, and avoidance were common reported coping strategies. Participation in hobbies was associated with less emotional exhaustion (Cramér's V = 0.372; p = 0.001). Feelings of increased preparedness were associated with less emotional exhaustion (Cramér's V = 0.395; p = 0.005).

Secondary trauma characteristics were identified in 11.3% of third-year medical students during a combined neurology/emergency medicine clerkship. This provides an opportunity to incorporate interventions that are effective in reducing secondary trauma characteristics in physicians during this early stage of training. Recognizing and proactively reducing secondary trauma during the clerkship experience may have longer-term benefits during later stages of medical training and practice.