title: Sources of distress during medical training and clinical practice: Suggestions for reducing their impact.
abstract: BACKGROUND
  Medical students and doctors experience several types of professional distress. Their causes ("stressors") are commonly classified as exogenous (adapting to medical school or clinical practice) and endogenous (due to personality traits). Attempts to reduce distress have consisted of providing students with support and counseling, and improving doctors' management of work time and workload.
  
  
  OBJECTIVE
  To review the common professional stressors, suggest additional ones, and propose ways to reduce their impact.
  
  
  METHODS
  Narrative review of the literature.
  
  
  CONCLUSIONS
  We suggest adding two professional stressors to those already described in the literature. First, the incongruity between students' expectations and the realities of medical training and practice. Second, the inconsistencies between some aspects of medical education (e.g., its biomedical orientation) and clinical practice (e.g., high proportion of patients with psychosocial problems). The impact of these stressors may be reduced by two modifications in undergraduate medical programs. First, by identifying training-practice discrepancies, with a view of correcting them. Second, by informing medical students, both upon admission and throughout the curriculum, about the types and frequency of professional distress, with a view of creating realistic expectations, teaching students how to deal with stressors, and encouraging them to seek counseling when needed.
authors: Myers-JDC-Brookdale Institute, Jerusalem, Israel. benbasat@jdc.org.il
authors: Jochanan
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