By Shannon Firth

A majority of medical and nursing students said they view their studies as a "stepping-stone" to a broader non-patient-facing healthcare career, according to a global survey from Elsevier Health.

Of a total of 2,212 medical and nursing students surveyed, 61% in the U.S. said they plan to work in roles that do not involve direct patient care, such as public health, research, or business consulting, according to a report of the survey findings.

Perhaps even more striking, 25% of medical students and 21% of nursing students in the U.S. reported that they have thought about quitting their studies, and more than one in 10 plan to leave healthcare entirely.

"As much as we would like to think that our students are maybe a little bit protected by being students, they're really not," Candice Chen, MD, MPH, of George Washington University's Fitzhugh Mullan Institute for Health Workforce Equity in Washington, DC.

According to the report, 54% of U.S. students said they are worried about their mental well-being, 57% said they anticipate that they will suffer from clinician burnout, and 65% said they worry about the impact that clinician shortages will have on their future career.

Students face a range of "high-stakes" pressures, including the financial burden of school, their first exposure to the clinical setting, and the current "dysfunction" in those settings, Chen said. "A really, really key part of training medical students and nursing students is the immersion that they have in clinical settings and the real-life experience ... that they get in those settings."

"As long as those ... clinical settings are dysfunctional and the workers themselves are working in environments that are driving burnout and driving moral injury, medical and nursing students are going to start feeling it," she added.

Gary Price, MD, an attending surgeon at Yale-New Haven Hospital in Connecticut and president of the Physicians Foundation, noted that the survey results on mental health mirror what the foundation learned from its 2023 survey, which showed that medical students have higher rates of burnout than physicians and residents.

However, he added, "I think the report missed the boat as far as what to do about well-being."

"We aren't going to fix this problem by noting that canaries are dying in the coal mine and ... sending out for tougher canaries," he said.

The survey also asked about artificial intelligence (AI), with 57% of medical students and 53% of nursing students in the U.S. stating that they were "excited" about the use of generative AI, and 64% of both groups saying that they believe it will "aid in diagnoses, treatment and patient outcomes."

On the other hand, 56% of all medical and nursing students globally worry about the "negative effects of GenAI [generative AI] on the healthcare community."

The findings on the use of AI reflect students' understanding of technology as a "double-edged sword," Price said, acknowledging his own cynicism about AI as a reflection of the "failure" of the current electronic health record, which is now a chief contributor to burnout.

"I think it's important that we don't let our hopes for artificial intelligence take our eyes off the ball, as far as making systems we do have actually help take care of our patients," he noted.

He also pointed out one limitation to the report -- it lumps medical and nursing students together.

"I think each one of them has complicated work and education environments, and efforts to help relieve the stress of burnout and dissatisfaction with their careers are going to have to be tailored to the needs of each group," he said.

The report included findings from the online survey, which was distributed across 91 countries in April and May, as well as two roundtable sessions with stakeholders and faculty in the U.S. and the U.K.