Burnout, Exhaustion, Experiences of Discrimination, and Stress Among Underrepresented and First-Generation College Students in Graduate Health Profession Education.

Objectives: Mental health disorders are increasing among health profession students. Compounding this, students from underrepresented backgrounds may face additional stressors and challenges. The aims of this study were to: (1) assess the extent to which burnout, exhaustion, experiences of discrimination, and stress exist among students in dentistry, nursing, occupational therapy, pharmacy, and physical therapist professional education programs; (2) determine if there are significant differences by key demographic characteristics (those who are first-generation college students [FGCSs], a member of an underrepresented minority [URM] group, or both); and (3) highlight strategies and solutions to alleviate these challenges identified by students.

Methods: Cross-sectional survey using a mix of question types of a sample of graduate students from dentistry, nursing, occupational therapy, pharmacy, and physical therapy programs from February to June 2020. Utilizing the Maslach Burnout Inventory Student Survey and campus climate and stress survey, mean subscale scores were calculated for the following outcomes of interest: MBI-SS burnout, dimensions of stress, and observed racism. Logistic regressions examined student factors that may help explain these outcomes. Content analysis examined participants' responses to open-ended questions.

Results: There were 611 individuals who completed all survey questions. FGCSs were significantly more likely than non-FGCSs to report exhaustion (adjusted odds ratio [aOR]: 1.50; 95% CI = 1.04-2.16), family stress (aOR: 3.11; 95% CI = 2.13-4.55), and financial stress (aOR: 1.74; 95% CI = 1.21-2.50). URM students reported not feeling supported in their program and mentioned needing additional support, particularly for well-being, from staff and faculty.

Conclusion: Findings from this study are consistent with literature that FGCSs experience additional stressors that may lead to burnout and exhaustion. URM students reported not feeling supported in their programs. This study's findings point to the need for leadership and faculty of health professional schools to implement or strengthen current policies, practices, and strategies that support URM students and FGCSs.

Impact: Research demonstrates that a diverse student body and faculty enhances the educational experience for health professional students, and that diversity strengthens the learning environment and improves learning outcomes, preparing students to care for an increasingly diverse population. However, this study finds that students from underrepresented backgrounds may still experience more burnout, exhaustion, discrimination, and stress than their peers. Programs and policies to support URM students and FGCSs throughout their academic careers can help improve graduation and retention rates, leading to improved workforce diversity.