Why medical education needs to face the hidden curriculum now
When we talk about burnout in medicine, the focus often lands on residents. Long hours. Overnight shifts. The weight of clinical responsibility.
But here’s the truth: burnout doesn’t begin on Day 1 of residency.
For many, it begins years earlier in medical schoool.
The Hidden Curriculum of Stress
Long before Match Day, future physicians are navigating:
Debt loads that hang over every career decision.
Step 1 and Step 2 prep that can feel like a full-time job on top of school.
ERAS applications that reduce four years of training into checkbox scoring systems.
A hidden curriculum of perfectionism, competition, and fear of failure.
By the time residency begins, many learners are already running on fumes.
The Systemic Cost
This isn’t just about individual wellbeing.
When stress and disengagement start early, we see:
Residents arriving already depleted instead of energized.
Higher risk of attrition in GME programs.
Lower faculty morale, as they support trainees struggling before they’ve even entered the workforce pipeline.
In other words: burnout that begins upstream spills downstream into residency, into patient care, and into the culture of medicine itself.
What Can UME & GME Do Better ?
If we want to take burnout seriously, we can’t wait until residency. We need interventions in UME that focus on:
Transparent debt counseling & financial literacy from day one.
Reframing Step prep as a competency journey, not a sink-or-swim moment.
Holistic ERAS application review to reduce the “checkbox” race.
Coaching and mentorship that normalize vulnerability and imperfection.
Residency programs can also step in earlier, collaborating with medical schools to smooth transitions and build realistic expectations before learners arrive.
Final Thought
If we’re serious abut changing medicine’s culture, we can’t keep pretending burnout magically appears in residency. It starts earlier, it starts quieter, and it starts with the hidden pressures we often overlook.
The good news? By rethinking how UME and GME prepare and support learners, we can stop burnout before it takes root.
Because the goal isn’t just to train doctors who survive residents, its to prepare physicians who can thrive for a lifetime in medicine.
This couldn’t be more true!! Thank you so much for highlighting important factors for burnout.
As a senior resident myself, I can attest to how much debt has weighed on me and led to burn out from having to take extra shifts on top of an already 100h work week just to avoid bankruptcy from educational debt. Though for me I think it was more of a resource access issue, I do think more financial literacy education would be helpful for all trainees (medical students & residents… and even attendings alike).
Encouraging vulnerability and coaching in medical culture would be a huge win for everyone! It’s sad that this isn’t already the status quo, especially considering we already practice vulnerability every day with our patients. I wish we were better at practicing it with each other.