Mistreatment and Emotional Safety

National Voice, Advocacy, and Peer Stories

Mindfulness

Rest

Movement

Journaling and Reflection

When to Seek Help

On-Call Mental Health Kit

1. Before the Shift

Protect your baseline.

Quick 30-second check-in:

• Have I eaten?
• Do I have water?
• What kind of shift is this likely to be? What should I mentally prepare for?

Set one intention:

• “Steady, not perfect.”
• “One patient at a time.”
• “Ask for help early.”
• “I am a student, I am not expected to know everything.”

Pack:

• Water bottle
• 1–2 balanced protein and carb meals/snacks
• Small comfort item (tea bag, gum, photo, playlist)

2. During the Shift

Micro-Regulation Tools (1–2 minutes)

Breathing reset

• Box breathing: Inhale 4 seconds – hold 4 seconds – exhale 6 seconds
• Repeat 4 times before presentations or after pages

Grounding (“name 3”)

• 3 things you see
• 3 things you feel physically
• 3 things you hear

Cognitive reframe

• Instead of: “I’m behind. I’m terrible at this.”
• Try: “This is a heavy shift. I’m learning in real time.”

3. Emotional First Aid

Common on-call reactions:

• Self-doubt after feedback
• Emotional blunting
• Irritability or shutdown
• Guilt about not knowing enough

Stabilization techniques:

• Step outside for 2 minutes
• Splash cool water on your face
• Text a trusted peer
• Write one processing note to revisit later

You do not need to process everything mid-shift — just contain it.

4. Protect Your Energy

• Eat every 3–4 hours (even something small)
• Alternate caffeine with water
• Sit when charting if possible
• Cluster tasks to reduce mental switching

Fatigue amplifies negative thinking. Fueling supports cognition.

5. After the Shift

Close the loop. Before leaving, reflect on:

• One thing that went well
• One thing I learned
• One thing I am leaving here

Create a transition ritual:

• Change shoes
• Play one consistent “end of shift” song
• Take 5 slow breaths before driving
• Shower immediately on arriving home

Signal to your brain: the shift is over.

6. Know When to Reach Out

Seek support if you notice:

• Persistent dread before shifts
• Panic symptoms
• Sleep that does not recover post-call
• Intrusive replaying of cases
• Thoughts of self-harm

Consider contacting:

• Your school’s learner wellness office
• Confidential counseling services
• Provincial physician health programs
• Local crisis resources

Early support is protective — not a sign of weakness.

REMINDER

You are learning in a high-stakes system.

You will not know everything.

You are allowed to be new.

Steady > Perfect

Burnout Literature Review

Prevalence in Canadian Medical Students & Physicians

Burnout — typically defined as a syndrome encompassing emotional exhaustion, depersonalization, and reduced personal accomplishment — is consistently elevated across the medical training continuum. It has been measured using widely used tools such as the Maslach Burnout Inventory (MBI) in multiple Canadian studies.

Medical Students

Research indicates that burnout is highly prevalent among medical students in Canada. In a meta-analytic review that included Canadian cohorts, the pooled prevalence of burnout in medical students was approximately 27.6% in Canada, with overall estimates globally around 37% when measured using instruments such as the MBI and related inventories (e.g. emotional exhaustion, depersonalization, and reduced personal accomplishment) (Almutairi et al., 2022). A Canadian cross-sectional survey found that 37% of Canadian medical students met criteria for burnout, with clinically relevant levels of emotional exhaustion and other psychological distress noted (Lewis & Bhugra, 2022).

Residents

Burnout prevalence among Canadian residents is likewise high. A national survey of Royal College emergency medicine residents reported that 62% met established burnout criteria on the MBI, highlighting widespread symptoms even early in postgraduate training (Liu et al., 2020). Additional multi-specialty research has reported prevalence estimates in Canadian residents around 58%–69%, with emotional exhaustion and depersonalization particularly elevated, and associations with excessive work hours and work-life imbalance (Shalaby et al., 2023; L. Shalaby et al., 2023).

Physicians

Among practising Canadian physicians, burnout continues to be a significant concern. Surveys during the COVID-19 era found that ~60% of Canadian emergency physicians reported high burnout, including elevated emotional exhaustion and/or depersonalization (Chan et al., 2021). National physician health surveys indicate that over half of Canadian physicians report burnout symptoms, with higher rates observed among early-career clinicians (less than 20 years in practice) and across multiple specialties (Canadian Medical Association, 2021). A national study focused on Canadian physiatrists found that 42% met burnout criteria in a representative sample, with younger age and emotion-regulation difficulties linked to higher risk (Simpson et al., 2025).

References

Almutairi, H., Alsubaiei, A., Abduljawad, S., Alshatti, A., Fekih-Romdhane, F., Husni, M., … Jahrami, H. (2022). Prevalence of burnout in medical students: A systematic review and meta-analysis. International Journal of Social Psychiatry.

Canadian Medical Association. (2021). 2021 National Physician Health Survey: Burnout and workload reductions. Canadian Medical Association.

Chan, T., et al. (2021). Canadian emergency medicine physician burnout during the COVID-19 pandemic. Canadian Journal of Emergency Medicine.

Lewis, T., & Bhugra, D. (2022). Wellbeing and mental health amongst medical students in Canada.

Liu, R., Van Aarsen, K., Sedran, R., & Lim, R. (2020). A national survey of burnout amongst Canadian Royal College emergency medicine residents. Canadian Medical Education Journal, 11(5), 1–9. https://doi.org/10.36834/cmej.68602

Shalaby, L., Oluwasina, F., El Gindi, H., Eboreime, E., Nwachukwu, I., Hrabok, M., … Agyapong, V. (2023). Burnout among physicians: Prevalence and predictors among resident doctors in Canada. Abstract presented in European Psychiatry.

Simpson, R., Cohen, E., Kiss, A., Wasilewski, M., Hitzig, S., … Bayley, M. (2025). Burnout in Canadian physiatrists: A national cross-sectional survey. American Journal of Physical Medicine & Rehabilitation.

Compassion Fatigue in Medical Training

A brief evidence summary for medical students.

What Is Compassion Fatigue?

Compassion fatigue is often described as the emotional and physical exhaustion that can occur from repeated exposure to others’ suffering. It is closely related to secondary traumatic stress and shares features with burnout, but is conceptually distinct (Figley, 1995; Stamm, 2010).

Whereas burnout is primarily associated with chronic workplace stress and systemic overload, compassion fatigue is more directly linked to exposure to patients’ trauma, grief, and distress (Figley, 2002).

Core features may include:

• Emotional exhaustion
• Reduced capacity for empathy
• Irritability or emotional numbing
• Intrusive thoughts related to patient care
• Avoidance of emotionally charged cases

Compassion Fatigue in Medical Students & Physicians

Although compassion fatigue has been more extensively studied in nursing and trauma professionals, research increasingly demonstrates its relevance to physicians and trainees.

A systematic review of physicians found substantial rates of burnout and secondary traumatic stress across specialties, particularly in high-acuity environments (Rotenstein et al., 2018). While the review focused primarily on burnout and depression, many included studies identified emotional exhaustion linked to patient suffering exposure.

Emergency medicine physicians and residents report high levels of emotional exhaustion and depersonalization, particularly during periods of crisis (e.g. pandemics), suggesting vulnerability to compassion fatigue processes (Chan et al., 2021).

Among medical trainees, repeated exposure to death, critical illness, ethical tension, and high-stakes uncertainty during clerkship has been associated with emotional blunting and reduced empathy over time (Neumann et al., 2011).

The risk of compassion fatigue increases with:

• High patient acuity or trauma exposure
• Repeated exposure to death or moral distress
• Lack of debriefing opportunities
• Sleep deprivation
• Perfectionism and high self-expectations
• Limited psychological safety in clinical environments

Clerkship can be a particularly vulnerable period due to emotional exposure combined with low perceived control.

Distinguishing Burnout vs. Compassion Fatigue

Burnout

Exposure to chronic workplace stress

Gradual onset

Cynicism towards work

Workload/system driven

Compassion Fatigue

Exposure to patient suffering

Can have more acute emotional shifts

Emotional numbing toward patients

Trauma/empathy driven

They frequently co-occur but may require different prevention approaches.

Protective Factors

Evidence suggests protective factors include:

• Structured debriefing after difficult cases
• Peer support and normalization
• Reflective practice
• Emotion regulation skills
• Meaning-making and values alignment
• Mentorship relationships

Empathy can be preserved when trainees are supported rather than left to process difficult cases alone (West et al., 2016).

Why This Matters

Compassion fatigue is not a sign of weakness or lack of caring. It often occurs because someone cares deeply. When unrecognized, it may contribute to:

• Reduced well-being
• Depersonalization
• Increased medical errors
• Career dissatisfaction

Early recognition and supportive environments are key.

References

Chan, T. M., et al. (2021). Burnout and wellness in Canadian emergency physicians during the COVID-19 pandemic. Canadian Journal of Emergency Medicine, 23(4), 551–560.

Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner/Mazel.

Figley, C. R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self-care. Journal of Clinical Psychology, 58(11), 1433–1441.

Neumann, M., Edelhäuser, F., Tauschel, D., et al. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine, 86(8), 996–1009.

Rotenstein, L. S., Torre, M., Ramos, M. A., et al. (2018). Prevalence of burnout among physicians: A systematic review. JAMA, 320(11), 1131–1150.

Stamm, B. H. (2010). The concise ProQOL manual. ProQOL.org.

West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet, 388(10057), 2272–2281.