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The field of medicine is academically overwhelming, spans the entire gamut of human experiences, and is all together unique (need a Williams Osler quote). At every stage of graduation through academic medical training, the physician-in-training experiences overwhelm. Statistically, the largest attrition rates occur during the first half of medical school, but mid-career burnout has economic and national implications as well.

The emotional impact of learning life-saving information that is too vast to memorize affects everyone differently, I suspect. Further adding to this “shock stage” of maturation is one’s own internalization of mortality, ethical dilemmas, and personal inadequacies, which rise to the surface under such pressure.

Our literature does provide specific insights into sub-populations of future physicians that ultimately point to the social isolation that results from reconciling participation in an imperfect education system. For example, gays and lesbians, students with learning disabilities and physical handicaps have adequately demonstrated trouble adapting to condescending messages that dominate the “hidden curriculum”, and sometimes not so hidden.

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