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Burnout is common among medical students [1, 2] and tends to strengthen as physicians graduate and progress into residency training [3, 4]. The cardinal symptoms of burnout are emotional exhaustion, depersonalization, and impaired sense of personal accomplishment induced by repeated stressors and may develop during undergraduate medical school training [5]. This phenomenon has been widely reported and linked to high rates of depression among physicians [6], deteriorating job performance and a loss of empathy for patients [5]. Although traditional stress management activities (i.e., meditation, journaling) to promote wellness among medical trainees are effective in reducing stress, Ziegelstein and colleagues suggest medical schools and residency programs address burnout by facilitating social engagement through structured opportunities to establish meaningful connections [7]. This was reinforced in a publication by chief medical residents recommending a shift in focus “from addressing burnout to fostering meaning within residency” [8]. Further, an inverse relationship was reported in a recent study between engagement and burnout/perceived stress among medical students [9]. One approach to engaging trainees and cultivating meaning may be through formal support of creative outlets and hobbies [10, 11]. Musical expression, such as singing, is one option to establish connections, build resilience, and decrease burnout. A multi-institutional study of U.S. medical students revealed that exposure to literature, music, theater, and visual arts reduces symptoms of burnout in medical students and increases empathy, resilience, and tolerance of ambiguity [12]. The therapeutic and anxiolytic impact of the humanities may be driven by physiological changes. There is evidence that music engages the neurochemical systems for reward, motivation, pleasure, stress, immunity, and social affiliation [13]. For example, studies show that serum concentrations of both salivary IgA, a marker of immune function, and oxytocin, a hormone involved in human connection, increase after singing lessons [14, 15]. Several studies also report decreases in cortisol, a hormone integral to the stress response, for subjects during the act of singing and other creative activities [13, 14, 16-20]. Group singing in particular has also been shown to reduce stress and arousal, measured by serum levels of ACTH, a precursor to cortisol [21]. To address burnout among health sciences students, the University of Nebraska Medical Center (UNMC) created Doc’Apella, a volunteer student vocal performance group designed to provide a creative outlet through music. The purpose of this study was to assess the students’ motivation for joining Doc’Apella and the impact on student burnout.

Doc’Apella: A Vocal Performance Group Designed to Reduce Stress And Prevent Burnout Among Medical and Health Sciences Students