Breaking the cycle of pain: practical steps to improve medical training

Medical training is hard for everyone, but faculty and administration influence trainee success—and have the power to drive change.

This article follows “The hidden cost of medical training: Debt, depression, and despair,” which left one crucial question unanswered: What can be done to improve medical training?

The answer is simple, but not easy: We must fix it.

Mending what’s broken

While mindfulness, meditation, and resilience are valuable tools, they’re too often used to deflect responsibility onto students instead of addressing institutional shortcomings. Medical students have already proven their determination and endurance, yet our schools and health care systems keep demanding more.

Debt relief

Financial stress erodes trainees’ focus and well-being. Kenneth and Elaine Langone’s transformative donation made tuition-free education a reality at NYU. Similarly, Professor Ruth Gottesman’s $1 billion gift to Albert Einstein College of Medicine confirms that eliminating debt is achievable—and essential for creating healthier, happier physicians.

Humane exams

NBME’s USMLE Step 1, 2, and 3 exams don’t need to be grueling 8-hour, $700 marathons packed with excessive information. Shorter, focused assessments could effectively evaluate knowledge and critical thinking without crushing trainees.

Leadership

Deans, department chairs, and program directors must go beyond setting policies. To nurture growth and success, treat students and trainees as academic family.

• Lead by example. A culture of respect, consistency, and humanity starts at the top; ignoring mistreatment allows it to spread.
• Listen actively to trainees, especially those struggling, and accept difficult truths without judgment or defensiveness.
• Take ownership. Connect overwhelmed individuals with a mentor or advisor who’s a good fit—even yourself if necessary.
• Act early. Regular check-ins, anonymous feedback systems, and genuine concern can be lifelines.
• Offer practical support. Don’t tell someone drowning what to do—throw them a life preserver and pull them out. Offer to send the email or make the call, and follow through.
• Prioritize health. Build protected time for ongoing mental and physical health care into rotations, residency, and fellowship. It may be challenging, but it’s solvable—and worth it.
• Train educators. Excellent teaching and mentoring skills can be developed with proper training. Incentivize through pay raises, promotions, and protected time—money speaks.

Attending physicians and faculty

Attendings set the standard for how trainees are treated daily.

• Acknowledge the grief. Justifying mistreatment as “character-building” only masks resentment or perpetuates harm. Strength comes from support, reflection, and meaningful challenges—not belittlement. Fixing the system starts with recognizing the pain we share.
• Be consistent. Trainees thrive on clear expectations. Ensure your team agrees on priorities.
• Practice respect. “Before you are anything, you are a human being.” Treat students, residents, fellows, nurses, techs, and administrative staff with dignity—make eye contact and say thank you.
• Let go of perfection—everyone is human. Mistakes are opportunities to teach, not humiliate. Most errors come from aligned flaws (Swiss cheese model), not individuals, and require structural fixes. Criticism only adds pressure in an already high-stakes setting.
• Cultivate supportive research environments. Toxic cultures impact everyone, including unpaid medical students. Principal investigators must actively tend their teams—neglect breeds mistreatment and unethical practices.
• Be courageous. Modeling honesty—by admitting mistakes or expressing vulnerability—creates a healthier environment and encourages trainees to do the same.

Practical changes you can make today

1. Recognize excellence. Students and trainees put in extraordinary effort. A kind word can carry someone through a tough week.
2. Ease the load. Helping a resident or fellow with a task can make a major difference.
3. Observe yourself objectively. Are you impatient? Does your voice get sharp when you’re stressed? Do you ignore the medical student trailing after you in clinic?
4. Appreciate others. Treat everyone as if their contributions matter—because they do.
5. Acknowledge reality. Medicine is deeply emotional. Every day brings the full range of human experience: suffering, fear, frustration, exhaustion, death, connection, miscommunication, honor, grief, joy, laughter—even insurance battles. We’re taught to compartmentalize, but numbness harms insidiously. We are meant to feel.

My story

For over a decade, I hid my pain—sparing others the burden of knowing felt like the one thing I could control. Eventually, the weight of it broke me. Watching the TEDMED talk “Why doctors kill themselves,” I heard a medical student’s suicide note that could have been mine. I sobbed, thinking: There has to be another way.

I felt trapped in my institution’s bureaucracy, ready to walk away from medicine. With nothing left to lose, I emailed the dean of medical education to request the support I needed to stay. He met with me that same day, and the interim dean of student affairs followed up soon after. She listened without judgment, and we co-created a three-month plan.

This dean’s rare leadership—texting me weekly, arriving to work early for our bimonthly walking meetings, and helping me keep the long-term in view while I take it one day at a time—built my trust. She’s working on broader changes to prevent others from falling through the cracks.

Sharing this feels vulnerable—yet I am not fragile. Most people see my joy, gratitude, and zest for life, but few know they stem from lifelong pain. My parents were heartbroken when I told them; I cringe imagining my mentors’ shock reading this article. Still, I promised myself I’m done hiding. I believe raw, courageous truth can break cycles—and it starts here.

Final thoughts

Some call medical students “soft”‘ and try to toughen us. Faculty and leadership, shaped by the same flawed system that harms trainees, can inflict mistreatment even with good intentions. We’re all connected; hurting anyone hurts everyone.

Anyone can make a difference, at any time. Vulnerability is painful, but it’s necessary. Only through honesty can we let grief breathe, heal, and stop the cycle of suffering.

If we treat trainees as human beings and remember the humanity at the core of medicine, we can create a system where no one is left behind. This change can only happen if we all come together and commit to it—before any more lives are lost.

Janet Constance Coleman-Belin is a medical student.