Burnout, perceived stress, and empathic concern: differences in female and male Millennial medical students

High risk of burnout syndrome and associated factors in medical students: A cross-sectional analytical study

INTRODUCTION

Although research on burnout syndrome in medical students has increased in recent years, results are inconsistent about which factors are associated with a high risk for burnout syndrome. The aim of this study was to assess the prevalence of high risk of burnout syndrome and to identify factors associated with burnout in medical students in preclinical and clinical training.

METHOD

A cross-sectional study was conducted at the University of Kragujevac, Serbia. The Maslach Burnout Inventory Student Survey and an epidemiological questionnaire on basic socio-demographic and academic characteristics were used. Statistical evaluation was performed through logistic regression analysis, using Odds Ratio (OR) and 95% Confidence Interval (CI).

RESULTS

Among medical students, no statistically significant differences were found in the prevalence of high risk of burnout syndrome in preclinical (14.8%) and clinical grade (15.1%), p > 0.05. High risk for burnout syndrome in preclinical study years was independently associated with the female sex (adjusted OR = 0.41, 95%CI = 0.19-0.91, p = 0.028), and cigarette smoking (adjusted OR = 2.47, 95%CI = 1.05-5.78, p = 0.038). The high risk of burnout syndrome was associated with sedatives use (adjusted OR = 4.03, 95%CI = 1.27-12.73; p = 0.018) only in clinical years medical students. The frequency of alcohol consumption was correlated with the high risk of burnout syndrome in medical students in both preclinical and clinical training, but without statistical significance (both p for trend < 0.1).

CONCLUSION

There was a significant prevalence of burnout among medical students, with some modifiable associated factors revealed.

Relations of Lifetime Perceived Stress and Basal Cortisol With Hippocampal Volume Among Healthy Adolescents and Those at Clinical High Risk for Psychosis: A Structural Equation Modeling Approach

BACKGROUND

Hippocampal volume (HV) is sensitive to environmental influences. Under normative conditions in humans, HV increases linearly into childhood and asymptotes in early adulthood. Studies of humans and nonhuman animals have provided evidence of inverse relationships between several measures of stress and HV.

METHODS

Using structural equation modeling, this study aimed to characterize the relationships of age, basal cortisol, biological sex, and lifetime perceived stress with bilateral HV in a sample of healthy adolescents and adolescents at clinical high risk for psychosis (CHR-P) (N = 571, 43% female; age range = 12-19.9 years). This sample included 469 individuals at CHR-P and 102 healthy comparison participants from the combined baseline cohorts of the second and third NAPLS (North American Prodrome Longitudinal Study).

RESULTS

A structural model that constrained the individual effects of basal cortisol and perceived stress to single path coefficients, and freely estimated the effects of age and biological sex in group models, optimized model fit and parsimony relative to other candidate models. Significant inverse relationships between basal cortisol and bilateral HV were observed in adolescents at CHR-P and healthy comparison participants. Significant sex differences in bilateral HV were also observed, with females demonstrating smaller HV than males in both groups.

CONCLUSIONS

Multigroup structural equation modeling revealed heterogeneity in the relationships of age and biological sex with basal cortisol, lifetime perceived stress, and bilateral HV in individuals at CHR-P and healthy comparison participants. Moreover, the findings support previous literature indicating that elevated basal cortisol is a nonspecific risk factor for reduced HV.

Reduced burnout in medical and health science students during the pandemic COVID-19 - a follow-up study of a single institution in Hungary

BACKGROUND

The coronavirus pandemic has significantly impacted lives worldwide, especially of medical and health science students. In Hungary, education has been relegated to the online space, with a substantial proportion of students having to attend medical secondments. Increased stress, uncertainty, and the presence of medical secondments can have an impact on students' premature burnout.

METHODS

In 2021, we conducted a follow-up survey among students of the University of Pécs studying medicine and health sciences in two data collection periods (from March to May and September to November). Our online questionnaire consisted of the Maslach Burnout Inventory General Survey for Students and our self-designed questionnaire. We used descriptive and paired two-sample t-tests for data analysis at a 95% confidence interval (p ≤ 0.05).

RESULTS

We excluded from our survey respondents whose data we could not follow-up; finally, 183 students' responses were analyzed. The majority of students were female (n = 148; 80.9%). Overall, there was a significant decrease in both exhaustion (EX) and cynicism (CY) scores (p = 0.001; p = 0.004). Female respondents had higher EX scores, but a significant decrease was observed for both genders (p ≤ 0.05). Excluding paramedic students, a significant decrease in EX scores was observed for the specialties we studied (p ≤ 0.05). General medicine students' CY scores decreased; physiotherapy students' profesisonal efficacy (PE) scores increased significantly (p ≤ 0.05). Students who were on medical secondments (n = 127; 69. 4%) were found to be more affected by burnout, but in all cases, these scores significantly improved (p ≤ 0.05). Students serving in the National Ambulance Service (n = 76; 41.5%), Hospitals (n = 44; 24.0%), or both (n = 7; 3.8%) had a significant decrease in their burnout score (p ≤ 0.05). Students who served in either a hospital or a hospital and National Ambulance Service had significantly improved CY and PE scores (p ≤ 0.05). Students concerned about their health had elevated EX and CY scores, which also improved (p ≤ 0.05).

CONCLUSIONS

In conclusion, medical secondments positively affected student burnout scores for medicine and health sciences students at our institution. This fact implies that it is necessary to have more internships in real-life settings during the training.

TRIAL REGISTRATION

Our survey has been approved by the Medical Research Council (Case No IV/4573-1/2021/ECU).

Physical activity, problematic smartphone use, and burnout among Chinese college students

The aim of this study was to investigate the association between physical activity (PA), problematic smartphone use (PSU), and burnout, as well as to identify whether there is a mediating role for PSU. We recruited 823 college students (Mage = 18.55, SD = 0.83) from Wuhan, China, in December 2022, including 499 males and 324 females. Demographic information, the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Smartphone Addiction Scale-Short Version (SAS-SV), and the Maslach Burnout Inventory-Student Survey (MBI-SS) were used for assessments. Pearson correlation analysis showed that PA was significantly associated with PSU (r = -0.151, p < 0.001), PSU was significantly associated with burnout (r = 0.421, p < 0.001), and the association between PA and burnout was not statistically significant (r = -0.046, p > 0.05). The results of the mediation model test showed that PA could not predict burnout directly; it instead predicted burnout entirely indirectly through PSU. Furthermore, PSU mediated the predictive effect of PA on exhaustion and cynicism. In conclusion, there is no direct connection between PA levels and burnout. PA indirectly affects burnout through PSU, but does not fully apply to the three different dimensions of exhaustion, cynicism, and professional efficacy.

Medical student flourishing before and during the COVID-19 pandemic at one U.S. institution

Introduction: Medical education research often focuses on measuring negative mental states like burnout, rather than focusing on positive states like well-being. Flourishing - a state that includes domains of happiness and mental health - is a way of thinking about well-being that may be relevant to education and research. The purpose of this prospective, observational study was to compare the relationship among flourishing, other well-being measures, and burnout in medical students via a survey administered at two time points.    Methods: We surveyed medical students at one U.S. institution about their flourishing, satisfaction with work-life balance, quality of life, empathic concern, and burnout (emotional exhaustion and depersonalization) before and after the onset of the COVID-19 pandemic. Flourishing was measured using two scores, the Flourish Index (FI) and Secure Flourish Index (SFI), with higher scores indicating greater flourishing. Pre- and post-scores for both measures were compared. Results: 107/585 (18%) medical students responded to the survey and 78/107 (73%) participated in the post survey. At the first time point, respondents reported both a mean FI and SFI 6.7 (SD=1.3); higher levels of flourishing correlated with higher satisfaction with work-life balance (p<.001), higher quality of life (p<.001), and lower levels of burnout (emotional exhaustion p<.001; depersonalization p=.021). SFI scores were higher at the second time point (M=7.1, SD=1.2) than the first (M=6.7, SD=1.3, p=.026). FI, satisfaction with work-life balance, quality of life, empathic concern, and burnout were unchanged at the second time point. Discussion: Like past findings in medical residents, we found medical students' flourishing-as measured by FI and SFI scores-correlated with greater satisfaction with work-life balance, higher quality of life, and lower burnout. In this limited sample, we found flourishing remained largely unchanged after the COVID-19 pandemic onset.

Academic burnout, self-esteem, coping with stress and gratitude among Polish medical students – a cross sectional study

Introduction: Academic burnout is emerging as an essential obstacle in education process. Students of the most challenging fields of study with high degrees of stress are thought to be at the highest risk. Medical studies are considered one of them. The aim of the study was to measure the levels of academic burnout, stress and gratitude among Polish medical students of Medical University of Lublin, and determine their styles of coping with stress.

Materials and methods: A cross-sectional study was conducted using a questionnaire comprised of the following: Maslach Burnout Inventory – Student Survey (MBI-SS), Rosenberg Self-Esteem Scale (SES), a Coping Inventory for Stressful Situations (CISS) and a Gratitude Questionnaire Six-Item form (GQ-6). The data was obtained from 773 medical students.

Results: Total number of 169 students (21.86%) met criteria for academic burnout. When it comes to 354 participants, they displayed signs of low self-esteem (45.8%). The number of 18 students showed low level of gratitude, while gratitude level of the majority of them – 496 (64.17%) was high. The most common style of coping with stress was emotions-oriented style – 354 students (48.29%), followed by task-oriented style – 345 students (47.07%). Burnout subscales turned out to be associated with age, year of study, self-esteem, gratitude and different styles of coping with stress to the various extent.

Conclusions: The prevalence of academic burnout among Polish medical students is high compared with general population across various occupations. Utilisation of protective characteristics of high self-esteem, gratitude and healthy coping methods can result in development of efficient anti-burnout prevention strategies and intervention tools.

Study-related wellbeing, behavior, and attitudes of university students in the Netherlands during emergency remote teaching in the context of COVID-19: A longitudinal study

Introduction

During the COVID-19 pandemic, emergency remote teaching was implemented at all conventional Dutch universities; however, the degree of limitations in on-campus teaching and learning varied during the pandemic dependent on the strictness of the measures. In the present study, it will be investigated how study-related experiences of university students changed in the face of varying limitations in on-campus teaching and learning.

Methods

The study had a longitudinal natural experiment design with three points of measurement during the academic year 2020-2021: November-December 2020 (t1; campuses partially open), March 2021 (t2; campuses fully closed) and June-July 2021 (t3; campuses partially open). In total, 680 Dutch university students (65.9% female; age: M = 21 years, SD = 2.06) filled in online surveys measuring study-related wellbeing (academic burnout and study-engagement), study-related behavior (study effort), and study-related attitudes (education satisfaction, online self-efficacy, and attitudes toward online education).

Results

Overall, students reported moderate levels of academic burnout, study engagement, study effort, education satisfaction, and online self-efficacy; their attitudes toward online education were rather negative. Students' study-related wellbeing and education satisfaction decreased in the period when on-campus teaching and learning was impossible (t2) compared to periods in which on-campus teaching and learning was possible at a low level with several restrictions (t1 and t3). Students' attitudes toward online education and online self-efficacy slightly increased at the end of the academic year (t3); however, the attitudes toward online education remained negative.

Discussion

The findings indicate that students' academic burnout, study engagement, and education satisfaction varied over the course of the academic year in the context of changing limitations in on-campus teaching and learning. To facilitate positive study-related experiences, universities are advised to offer as much on-campus education as possible in times of pandemics.

The relationship between burnout and empathy in physiotherapists: a cross-sectional study

BACKGROUND

There have been few studies carried out into empathy in physiotherapists. Burnout can debilitate the quality of care and the efficacy of treatment as the empathetic capacity of the professional diminishes.

OBJECTIVE

The objective of the study was to examine the association between the construct burnout, empathy and sociodemographic aspects in Spanish physiotherapists.

METHODS

A cross-sectional electronic survey including the Maslach Burnout Inventory (for burnout assessment), the Interpersonal Reactivity Index (for empathy assessment) and sociodemographic data was answered by 461 Spanish physical therapists. A descriptive, bivariate and lineal regression analysis was performed.

RESULTS

There was an association between burnout and empathy. Specifically, higher levels of burnout are associated with lower levels of empathy, whilst years of work experience is associated with lower levels of burnout.

CONCLUSIONS

The results of this study contribute to a greater understanding of the relationship between the level of burnout and the dimensions of empathy in physiotherapists. The influence of burnout, which causes difficulties in the mobilization of the professional towards the establishment of a quality therapeutic relationship, is highlighted.KEY MESSAGESEmotional exhaustion is associated to greater personal discomfort and less empathy.The depersonalization is associated to personal discomfort and less empathy.Depersonalization is negatively associated to the lack of perspective.

Burnout and resilience during the COVID-19 outbreak: differences between male and female students

This research aims to determine the burnout levels of male and female students on the three subscales of Exhaustion (EX), Cynicism (CY), and Professional Efficacy (PE) and their resilience during the COVID-19 pandemic. This is a non-experimental quantitative, descriptive, and cross-sectional research conducted on students of Riau University. The snowball sampling method was used to obtain data from 131 students consisting of 69 female and 62 male through the distribution of an online questionnaire and analyzed using the independent sample t-test and Pearson Product Moment Correlation. The data distribution showed that burnout on the PE, EX, CY, and resilience is in the high, moderate, and low categories, respectively.

The data analysis showed that the burnout variable for the PE and EX indicators in female was higher than for men. Meanwhile, male's CY and resilience indicators were higher than female. This indicates significant differences in burnout and resilience between male and female during the pandemic. The results also showed that there is no correlation between PE and resilience as well as CY and resilience, while EX and resilience show a correlation. This finding shows the psychological condition of students in using distance learning during the pandemic. There is a need for strategies to be implemented to reduce the impact of the pandemic on students for better mental health.

An initial preparation for human cadaveric dissection ameliorates the associated mental distress in students

It is universally recognized that cadaveric dissection is an essential part of anatomy training. However, it has been reported to induce mental distress in some students and impair their intrinsic motivation (IM) to study. One of the postulated reasons for this behavior is the lack of adequate information and preparation of students for cadaveric dissection. Therefore, it is hypothesized that providing relevant information prior to cadaveric dissection will ameliorate the mental distress, enhance the IM of students, and improve their academic performance. A cohort of occupational therapy students enrolled in an anatomy course were psychologically prepared for cadaveric dissection. Students were provided with a curated list of YouTube videos and peer-reviewed journal articles related to cadaveric dissection prior to the commencement of the anatomy course. All students were also required to attend an oral presentation immediately before commencing dissection. The control group included students who had not been provided with any resources in preparation for cadaveric dissection. Compared to the control group, students who had been prepared demonstrated better quality of cadaveric dissection, improved academic performance, reported less mental distress and greater IM. Moreover, students reported the oral presentation to be most relevant and journal articles to be least useful in their preparation. Therefore, this is an effective approach in the amelioration of mental distress and improvement of performance in anatomy students. Consequently, this study represents a paradigm shift in the pedagogy of anatomy, and could represent a vital element in the evolution of a revitalized anatomy curriculum.

Relationship Between Family Socioeconomic Status and Learning Burnout of College Students: The Mediating Role of Subjective Well-Being and the Moderating Role of Resilience

Objective

Learning burnout affects the positive development of college students. The present study aimed to investigate the relationship between family socioeconomic status (FSES) and learning burnout, as well as the mediation effect of subjective well-being and the moderation effect of resilience in this relation.

Methods

A total of 550 Chinese college students from Yunnan completed a questionnaire measuring the research variables in this study.

Results

(1) After controlling for participants' gender and age, FSES negatively, and significantly predicted learning burnout; (2) subjective well-being partially mediated the relationship between FSES and learning burnout; and (3) the direct effect of FSES on learning burnout and the mediation effect of subjective well-being was moderated by resilience. The level of learning burnout of individuals with low resilience increased significantly with the decrease of FSES, and the level of learning burnout of individuals with high resilience decreased significantly with the increase in subjective well-being.

Conclusion

The present findings support the moderated mediation model underlying the relationship between FSES and learning burnout. This also has significant implications for formulating prevention and intervention measures on learning burnout among college students.

Limitations

First of all, this study used the cross-sectional study design, which cannot make a causal inference. In addition, the sample in this study is university students from Kunming, which may affect the popularity of the results.

Medical student flourishing before and during the COVID-19 pandemic at one U.S. institution

Introduction: Medical education research often focuses on measuring negative mental states like burnout, rather than focusing on positive states like well-being. Flourishing – a state that includes domains of happiness and mental health - is a way of thinking about well-being that may be relevant to education and research. The purpose of this prospective, observational study was to compare the relationship among flourishing, other well-being measures, and burnout in medical students via a survey administered at two time points.    Methods: We surveyed medical students at one U.S. institution about their flourishing, satisfaction with work-life balance, quality of life, empathic concern, and burnout (emotional exhaustion and depersonalization) before and after the onset of the COVID-19 pandemic. Flourishing was measured using two scores, the Flourish Index (FI) and Secure Flourish Index (SFI), with higher scores indicating greater flourishing. Pre- and post-scores for both measures were compared. Results: 107/585 (18%) medical students responded to the survey and 78/107 (73%) participated in the post survey. SFI scores were higher at the second time point (M=7.1, SD=1.2) than the first (M=6.7, SD=1.3, p=.026). FI, satisfaction with work-life balance, quality of life, empathic concern, and burnout were unchanged at the second time point. Discussion: COVID-19 has disrupted medical students and their education in multiple ways – some of them positive – which may explain the increase in SFI score and the lack of change in FI and other measures, at the post-survey.

An Italian Adaptation of the Burnout Assessment Tool-Core Symptoms (BAT-C) for Students

Burnout is psychological, physical, and emotional suffering that may affect students with low or inadequate resources to face stressful events at school. Although the existing instruments are used worldwide to assess school burnout risk, they show several flaws and mainly focus on the emotional facets of the syndrome. No previous studies have developed a multi-component tool to reveal students’ burnout by simultaneously analyzing cognitive, behavioral, and emotional problems. The central core of the current study is to adapt the Burnout Assessment Tool-Core symptoms (BAT-C; Schaufeli et al., 2020), comprising four subscales, exhaustion, mental distance, cognitive impairment, and emotional impairment, for a sample of Italian students. The factor structure, the reliability, and the validity of the scale are investigated. The participants are 745 middle school students (male, 52.2%; aged 9–13, M = 11.84, and SD = 1.21). Confirmatory factor analyses confirmed the best fit of the second-order model (four first-order factors and one second-order factor). Specifically, four factors were loaded onto a main high-order factor, which constitutes the BAT-C. Our findings support the Italian adaptation of the BAT-C for students’ samples as a valid instrument for measuring the core symptoms of school burnout.

Analysis of the Emotional Exhaustion Derived From Techno-Stress in the Next Generation of Qualified Employees

This study analyses the emotional exhaustion of students inhigher education, derived from the extremely technology-relatedstrain associated to the current COVID-19 pandemic in a conservation of resources' approach. Technostress, as source of emotional exhaustion, was investigated in a sample of 333 students in a medium size public university in Spain. Data was collected in May 2020, during the COVID lockdown. After literature review, a structural model was developed, linking technostress with emotional exhaustion. Results confirm the expected cause-effect relationships. In addition, the study reveals two mediator variables that must be considered when managing students' suffering, perceived stress and intrapersonal conflicts. This study contributes to the academic literature in the field of managing and mitigating suffering. They do so by providing both new knowledge and empirical evidence on the effects of technostress in the new generations that will soon join the working life.

The relationship between medical students' empathy and burnout levels by gender and study years

OBJECTIVE

To investigate the multifaceted factors affecting empathy in medical students.

METHODS

1293 medical students from 15 South Korean medical schools participated in an online survey. Affective empathy was measured with the 'empathy concern' and 'personal distress' dimensions from the Interpersonal Reactivity Index for Medical Students (IRI-MS). Cognitive empathy was assessed with IRI-MS' 'perspective taking' and Jefferson Scales for Physician Empathy for Student (JSPE-S). Maslach Burnout Inventory for Medical Students (MBI-MS) assessed the burnout levels of the participants.

RESULTS

A significant gender difference in affective and cognitive empathy was found using JSPE-S. Different patterns were seen in the empathy dimensions between the study years and genders. Burnout scores showed no gender differences, while exhaustion and cynicism increased, and academic efficacy decreased with seniority. Academic efficacy was a consistently influential factor for both affective and cognitive empathy in both genders, all study years and the three domains of burnout.

CONCLUSION

Academic efficacy was a significant factor influencing both affective and cognitive empathy.

PRACTICAL IMPLICATIONS

The comprehensive nature of empathy in medical students may be better investigated by applying multi-dimensional empathy measurement tools and by analyzing multiple factors such as gender, study year and burnout.

An Abrupt Transition to Digital Teaching—Norwegian Medical Students and Their Experiences of Learning Output during the Initial Phase of the COVID-19 Lockdown

Norwegian universities closed almost all on-campus activities on the 12 March 2020 following a lockdown decision of the Norwegian government in response to the COVID-19 pandemic. Online and digital teaching became the primary method of teaching. The goal of this study was to investigate how the transition to digital education impacted on medical students enrolled at the University of Bergen (UiB). Key points were motivation, experience of learning outcomes, and fear of missing out on important learning. Using an online questionnaire, students were asked to evaluate the quality of both lectures and taught clinical skills and to elaborate on their experience of learning output, examination, and digital teaching. Answers from 230 students were included in the study. Opinions on the quality and quantity of lectures offered and their experience of learning output varied based on gender, seniority and the amount of time spent on part time jobs. Students at UiB were generally unhappy with the quality of teaching, especially lessons on clinical skills, although both positive and negative experiences were reported. Securing a satisfying offer of clinical teaching will be important to ensure and increase the student experience of learning output in the time ahead.

Medical students' perceptions and coping strategies during the first wave of the COVID-19 pandemic: studies, clinical implication, and professional identity

BACKGROUND

The unfolding of the COVID-19 pandemic during spring 2020 has disrupted medical education worldwide. The University of Geneva decided to shift on-site classwork to online learning; many exams were transformed from summative to formative evaluations and most clinical activities were suspended. We aimed to investigate the perceived impact of those adaptations by the students at the Faculty of Medicine.

METHODS

We sent an online self-administered survey to medical students from years 2 to 6 of the University of Geneva, three months after the beginning of the pandemic. The survey explored students' main activities during the first three months of the pandemic, the impact of the crisis on their personal life, on their training and on their professional identity, the level of stress they experienced and which coping strategies they developed. The survey consisted of open-ended and closed questions and was administered in French.

RESULTS

A total of 58.8% of students responded (n = 467) and were homogeneously distributed across gender. At the time of the survey, two thirds of the participants were involved in COVID-19-related activities; 72.5% voluntarily participated, mainly fueled by a desire to help and feel useful. Many participants (58.8%) reported a feeling of isolation encountered since the start of the pandemic. Main coping strategies reported were physical activity and increased telecommunications with their loved ones. Most students described a negative impact of the imposed restrictions on their training, reporting decreased motivation and concentration in an unusual or distraction-prone study environment at home and missing interactions with peers and teachers. Students recruited to help at the hospital in the context of increasing staff needs reported a positive impact due to the enriched clinical exposure. Perceived stress levels were manageable across the surveyed population. If changed, the crisis had a largely positive impact on students' professional identity; most highlighted the importance of the health care profession for society and confirmed their career choice.

CONCLUSION

Through this comprehensive picture, our study describes the perceived impact of the pandemic on University of Geneva medical students, their training and their professional identity three months after the start of the pandemic. These results allowed us to gain valuable insight that reinforced the relevance of assessing the evolution of the situation in the long run and the importance of developing institutional support tools for medical students throughout their studies.

The role of difficulties in emotion regulation in predicting empathy and patient-centeredness in pre-clinical medical students: a cross-sectional study

While empathy and patient-centeredness (PC) are considered core variables in high-quality healthcare education and care, research suggests that empathy and PC decrease during the clinical years of study and that impairments in empathy and PC may be related to difficulties in emotion regulation. There is a growing interest in identifying the psycho-social variables that sustain and foster empathy and PC in medical students throughout their education. This study explored whether and to what extent emotion dysregulation predicted empathy and PC in medical students controlling for gender. Three hundred ninety-eight pre-clinical medical students enrolled at a university in northern Italy completed the Difficulties in Emotion Regulation Scale (DERS), the Interpersonal Reactivity Index (IRI) and the Patient-Practitioner Orientation Scale - 8 Items - Italian version (PPOS-8-IT). All statistically significant correlation coefficients between DERS, IRI and PPOS-8-IT scores were negative (rs from -.130 to -.336, ps ≤ 01), except for IRI Personal Distress and IRI Fantasy Scale that were mainly positively related to DERS scores (rs from .130 to .305, ps ≤ .01). Hierarchical multiple-regression analyses showed that DERS scores accounted for a significant amount of additional variance in both IRI and PPOS-8-IT components above and beyond gender. Emotion dysregulation was positively associated with Personal Distress (βs from .135 to .250, ps ≤ .007), whereas Empathic Concern, Perspective Taking, and the PC components were negatively predicted by emotion regulation difficulties (βs from -.131 to -.309, ps ≤ .005). Female students showed higher levels of all empathy and PC measures than males (ts from -3.49 to -5.54, ps ≤ 001) except for Perspective Taking. Tailored educational approaches that provide medical students with emotion regulation strategies implemented along the pre-clinical curriculum may sustain empathy and PC and equip students to appropriately and functionally face the emotional and interpersonal aspects of the clinical internship experience.

Low health literacy and perceived stress in adults: is there a link?

OBJECTIVES

Mental stress, low health literacy (HL) and nutrition literacy (NL) are associated with serious negative health outcomes. The aim of this study was to investigate HL and NL levels, in relation to levels of perceived stress, in adults.

METHODS

This cross-sectional study was conducted in the urban area of the Attica region, Greece. The sample consisted of 1,281 individuals, aged ≥ 18 years. The European Health Literacy Questionnaire 47, the Greek version of the Nutrition Literacy Scale and the Perceived Stress Scale 14 were used. Socio-demographic characteristics were also assessed. Nonparametric Mann-Whitney U and Kruskal-Wallis tests, Pearson chi-square and multiple linear regression models were used.

RESULTS

The sample's perceived stress mean value (SD) was 26.47 (7.27) with women scoring statistically significantly higher than men. The mean HL and NL scores were 32.28 (8.28) and 22.11 (5.67), respectively. Linear regression analysis has shown that perceived stress was significantly negatively associated with HL (p < 0.001) but not with NL levels (p = 0.675) after adjusting for a series of confounding variables.

CONCLUSIONS

Low health literacy seems to be very significantly associated with high levels of perceived stress. The reasons behind this association require further investigation.

Frequency and Association of Stress Levels with Modes of Commuting Among Medical Students of a Developing Country

Introduction

This study aimed at determining the frequency and association of stress levels with modes of transportation and was likely to reveal the contributing transportation-related factors for stress in medical students.

Methods

This was a questionnaire-based, cross-sectional study that included undergraduate medical students of a public sector medical university in Karachi, Pakistan. A total of 573 students participated voluntarily, of which 300 were provided a manual questionnaire and 273 filled it online. The reliability of the questionnaire was assessed using Cronbach’s alpha at 0.791. The collected data were analysed using IBM SPSS Statistics for Windows, version 21.0.

Results

Out of 573 participants, 99.3% (n = 298) of students filled the questionnaire manually, whereas 100% of students filled the questionnaire online. Almost two-thirds of students used university transport; more than 90% lived more than 5 km from the university and 56% had a traveling time of more than an hour. Approximately 15.4% of students reported physical trauma and some form of harassment. Sheldon Cohen’s stress scale surprisingly revealed 90% of students to be within the moderate-to-high stress category. Risk factors were associated with stress levels and significant associations were observed with noise exposure (P = 0.023) and sleep quality (P = 0.001). The most common reported stressors associated with commuting included overcrowding, long travel, and air and noise pollution. Noise pollution was the main predictor of stress among commuters.

Conclusion

Poor transportation has adverse effects on health and academic performance. Administration in their respective jurisdictions is needed to investigate this matter to make commuting a routine rather than a hassle.

Academic burnout among medical students: respective importance of risk and protective factors

OBJECTIVES

Prior research has found a high prevalence of academic burnout among medical students (33-55%), and medical education institutions have begun to address the issue. In this research, we hypothesized an increase in academic burnout during medical education, as supported by previous findings. The second purpose was to identify the significant predictors (among perceived stress, empathy, and perceived social support) of academic burnout and determine their respective importance.

STUDY DESIGN

The study design was a cross-sectional online and anonymous survey.

METHODS

We recruited medical students (N = 342) from four education year-groups (i.e. Bachelor 1 and 3; Master 1 and 3). All participants voluntarily responded to our anonymous study and filled in four questionnaires assessing academic burnout, perceived stress, empathy, and perceived social support. We performed a multivariate analysis of variance on academic burnout and hierarchical regression analyses to determine the respective importance of risk and protective factors of academic burnout.

RESULTS

We found that two academic burnout domains (i.e. emotional exhaustion and cynicism) significantly changed according to the study year. Cynicism increased as the academic years progressed (F_(3,334) = 9.50; P < 0.001), and emotional exhaustion was highest at critical graduation moments during the academic curriculum (i.e. Bachelor 3 and Master 3; F_(3,334) = 11.2; P < 0.001). Overall, women presented higher academic burnout traits than men (ᴧ = 0.963; F_(3,332) = 4.26; P = 0.006), but univariate analysis revealed that they especially displayed higher emotional exhaustion (F_(1,334) = 12.1; P < 0.001). Hierarchical regression analyses showed that perceived stress, cognitive empathy, and perceived social support were significant predictors of academic burnout. We found that perceived stress was a major predictor of academic burnout (from 10% to 28% of the part of variance) in comparison to other factors such as empathy (around 5%) and perceived social support (around 6%).

CONCLUSIONS

We found that emotional exhaustion and cynicism significantly changed over medical education and that women presented greater vulnerability than men for emotional exhaustion. Furthermore, risk and protective factors of academic burnout were identified: (1) perceived stress was a decisive risk factor; (2) paradoxically, cognitive empathy had a double edge nature (the two cognitive empathy domains had opposite effects); and (3) perceived social support was identified as a protective factor. Thus, a novel dimension of this research was to investigate and describe the importance of several predictors of academic burnout. The implications are crucial for education, and several recommendations are discussed to prevent academic burnout.

A Scoping Review of Research into the Origins of Cynicism Among Medical Trainees

There is a perception that medical trainees begin their training idealistic and full of excitement. Yet, there is growing recognition in scholarly literature that this idealism is replaced by cynicism as a result of the training process itself. The ultimate goal of this study was to review the current literature on cynicism during medical training in order to identify factors that engendered its development. Equipped with this information, medical education can expand data collection regarding cynicism in order to further inform the development of solutions to combat it. This scoping review was conducted with a broad search for published articles across three medical education databases using search terms "cynicism in medical students." Additional relevant articles were added from reference lists of included articles. Articles on cynicism in practicing professionals were excluded as were articles that focused on burnout. The search identified 161 unique articles; 30 articles merited full reading and 19 ultimately met inclusion criteria. Emergent themes comprised three categories: causes of cynicism, variations of cynicism among populations, and outcomes of cynicism. Within these 3 categories, 9 sub-categories were also extracted. From Kopelman's perspective (Kopelman in JAMA 250(15):2006-10, [11]), the presence of cynicism verifies that students' ideals are still alive because they recognize that things could be better and are disappointed that they are not; cynicism may be preferable to despair. This review revealed that trainees have not suffered a death of their ideals, but a burial. Corrective action may be able to excavate what was lost-an idealistic approach to medical training.

The role of extracurricular activities and lectures in mitigating medical student burnout

CONTEXT

Strong evidence throughout the literature highlights burnout as a significant and increasing problem among medical students, impacting students' ability to effectively care for and empathize with patients.

OBJECTIVES

To examine how involvement in extracurricular activities and attendance at burnout lectures can impact burnout among medical students.

METHODS

An anonymous digital survey including the Maslach Burnout Inventory (MBI) was sent to all students (n=765) at Rowan University School of Osteopathic Medicine. The survey included questions regarding the number of burnout/wellness lectures respondents had attended, the number of clubs in which the respondents participated, the number of hours spent in these clubs, and any leadership positions held by the respondents.

RESULTS

Of the 765 students enrolled, 597 completed the survey. Results indicated that women participated in significantly more clubs than men (t[456]=-4.30; p<0.001). Men had higher scores on the depersonalization subscale of the MBI than women (t[463)=2.98; p<0.01]. There were no gender differences in emotional exhaustion or personal accomplishment. Linear regression analyses including gender and club participation as predictors of each of the burnout subscales indicated a significant interaction between gender and number of clubs (β=0.34; p<0.05), in that more club participation was associated with higher depersonalization scores for women, but lower depersonalization scores for men. The number of wellness/burnout prevention lectures attended was not predictive of scores on any of the burnout subscales.

CONCLUSIONS

Our results indicate the importance of understanding what drives burnout on the individual level and adapting interventions to suit the needs of individual students, rather than the student body as a whole.

Empathy and attitude toward communication skill learning as a predictor of patient-centered attitude: a cross-sectional study of dental students in Korea

BACKGROUND

Enhancing medical students' practice of patient-centered care is a goal of medical schools. In addition to exploring the demographic and academic factors of the students, it is necessary to identify other attitudes and perceptions that may influence the student's patient-centered attitude and inclination toward communication skill learning. This study aimed to assess patient-centered attitudes among dental students in Korea and identify the association between the students' characteristics and empathy, communication skill learning attitude, and patient-centered attitude.

METHODS

Data were collected via a cross-sectional online survey, and 312 dental students were included in the analyses. The study participants completed the Patient-Practitioner Orientation Scale (PPOS), the Interpersonal Reactivity Index (IRI), and the Communication Skills Attitude Scale (CSAS). Analyses were performed using independent samples' t-tests, hierarchical multi-variable regression, and ANOVA with a post-hoc Tukey test.

RESULTS

The students tend to be moderately patient-oriented toward the sharing subscale of PPOS score (M = 3.78, standard deviation [SD] = 0.54) and slightly more patient-centered toward the caring subscale of PPOS score (M = 4.41, SD = 0.52) of patient-centered attitudes. Being a female and a shorter academic period in dentistry were associated with attitudes toward patient-centered care. Empathy and positive attitude toward learning communication skills were also related to a patient-centered attitude, and among aspects of empathy, "empathic concern" had the greatest significant impact on patient-centered attitude.

CONCLUSIONS

Gender, academic period, empathy, and attitudes on learning communication skills were important influencing factors of patient-centered attitudes. Patient-centered attitude can and must be taught. Education programs should focus on enhancing empathy, emphasizing positive attitudes on learning communication skills, and conducting follow-up educational sessions to prevent students from becoming less patient-centered with an increase in duration of their academic period.

Quality and Safety in Healthcare, Part LXVIII: Consequences and More Solutions Regarding Poor Well-Being in Medical Students

ABSTRACT

Suggestions to improve the well-being in medical students include establishing learning communities, having pass-fail grading at least in the freshman and sophomore years, giving the students some control over their learning environment (such as with evaluations and serving on the curriculum committee), encouraging more protected time and more money for faculty teaching and mentoring, and eliminating mistreatment of medical students. Also, the Medical Student and Physician Well-Being Index should be freely available to the medical students and staff for both self-evaluation and for evaluating the learning environment. Burnout in medical school may continue in residency and not only causes misery to the individual, but adversely affects professionalism and patient care.

Relationships among perceived stress, emotional eating, and dietary intake in college students: Eating self-regulation as a mediator

This study aimed to examine the relationships among perceived stress, eating self-regulation, emotional eating, and dietary intake among undergraduate college students. This cross-sectional study was conducted with 523 students recruited from Amazon Mechanical Turk. All participants completed an online survey that assessed perceived stress, eating self-regulation, emotional eating, dietary intake, and demographics. The study sample was 47% female, 30% Hispanic, 8% Black, and 33% Asian. The overweight and obesity rate was 33%. Nearly 83% reported having moderate to high levels of stress, and over 80% had low to medium levels of eating self-regulation skills. On average, students consumed fruits and vegetables 2.42 times per day and sweets and soft drinks about once every other day. Perceived stress was positively correlated with emotional eating (β = 0.12, p = .005), and negatively correlated with eating self-regulation (β = -0.40, p < .001). Eating self-regulation partially mediated the relationship between perceived stress and emotional eating (β = 0.11, p < .001). Emotional eating was positively related to intake of sweets and soft drinks. Eating self-regulation was negatively related to sweet intake (β = -0.19, p < .001). Eating self-regulation and emotional eating fully mediated the relationship between perceived stress and sweet intake (β = 0.09, p < .001). Although warranting further investigation, this study's results emphasize the significant protective role of eating self-regulation for controlling college students' intake of sweets and soft drinks, and the negative effects of perceived stress and emotional eating on their dietary intake. Future interventions could consider strategies focusing on stress management and eating self-regulation to improve dietary intake among this young population.

Quality and Safety in Healthcare, Part LXVII: Counseling, Mental Health Services, and Wellness Curricula for Medical Students

ABSTRACT

There are many approaches to improving the well-being of medical students such as having a wellness curriculum including emphasizing the importance of keeping a balance in life between work and other activities, encouraging mindfulness and other stress reduction techniques, getting adequate sleep and exercise, and learning about the signs of burnout and depression. It is also important to have mentoring services and discussion groups available and to offer counseling for monetary management. Mental health services must be made available, and the students should be advised that seeking treatment will not adversely affect their ability to get a license or a good residency. The students should be counseled that being employed while in medical school is associated with a greater chance of burnout.

Measures of empathy and the capacity for self-reflection in dental and medical students

BACKGROUND

Empathy and self-reflection have been studied among medical students, but fewer studies have examined the presence of these attributes among dental students and investigated the correlation between empathy and self-reflection.

METHODS

First-year dental and medical students (n = 198) beginning their studies at the University of Oulu, Finland in August 2017 participated in this study, which was conducted via an internet-based questionnaire. Data were collected on personal characteristics and scores on Davis's Interpersonal Reactivity Index (IRI) and Roberts's Self Reflection and Insight Scale (SRIS).

RESULTS

Differences in IRI scores between dental and medical students were significant only in male students and in two IRI domains. Mean (SD) scores for male dental and medical students were personal distress, 8.2 (4.0) and 10.7 (3.1) (p = 0.022); empathic concern, 15.0 (4.0) and 16.9 (3.5) (p = 0.054). Mean SRIS scores did not differ between sexes or training programs. Positive correlations (r = - 0.3-0.65) were observed between some empathy and self-reflection subscales.

CONCLUSIONS

A lower degree of empathy was observed among male dental students than in male medical students. A positive correlation between empathy and self-reflection was demonstrated in both study groups and sexes. However, more research in this field is warranted.

Quality and Safety in Healthcare, Part LXVI: Contributing Causes of Poor Well-being in Medical Students

ABSTRACT

Problems in the learning environment are the main contributing factors to medical student burnout. These issues include stresses from mistreatment, poor support, cynical supervisors, pressure to get good grades and learn a huge amount of information quickly, fatigue, lack of control, and so on. Personal risk factors include having been seriously ill recently, having a low grit score, being in debt, and having a job.

Developing Emotional Intelligence Through a Longitudinal Leadership Curriculum in UME: Combating the Decline in Medical Student Empathy

We report on a novel curriculum (Scholarly Excellence, Leadership Experiences, Collaborative Training [SELECT]) in an allopathic medical school designed to prepare students to be physician leaders while remaining empathetic by combating burnout. SELECT students were surveyed annually. The survey contained the Jefferson Scale of Empathy (JSE) and Maslach Burnout Inventory (MBI). In this cohort, empathy did not decrease, as measured by the JSE, and SELECT students' MBI Depersonalization burnout scores decreased after year 3. In summary, in this allopathic US medical school utilizing a novel curriculum, there was no significant decline in empathy after the third year of medical school. The SELECT program appears to mitigate the decline in empathy and increased Depersonalization burnout levels often seen at the end of the third year of medical school.

Empathy and COVID-19: Study in Professionals and Students of the Social Health Field in Ecuador

Empathy plays a fundamental role in health related occupations. In this study, we analysed empathy levels in professionals (117) and students (170) from various healthcare fields in Ecuador during the COVID-19 pandemic. The Interpersonal Reactivity Index was used in an online survey. The results show high levels of empathy in both groups, influenced by age and gender. The students presented higher levels of personal distress, and their age was negatively correlated to empathy. Additionally, professionals working in physical health scored higher levels of personal distress compared to those in the field of emotional health. COVID-19 has placed social health systems in great stress. Despite this, the personal capacities for empathy of both students and health professionals have not been diminished.

Quality and Safety in Healthcare, Part LXV: Prevalence of Burnout, Suicidal Ideation, and Evidence of Depression in Medical Students

Matriculating medical students have a low degree of psychological distress. Yet, over time burnout, suicidal ideation, and evidence of depression become quite prevalent among medical students. Often, approximately 50% of the students and sometimes more suffer from burnout. The prevalence of depression in different studies varied but was often approximately 20%. Suicidal ideation in medical students in various articles had a prevalence of approximately 6% to 11%.

Burnout among medical students in Cyprus: A cross-sectional study

OBJECTIVES

The primary aim was to estimate the burnout prevalence among all medical students at the Medical School of the University of Cyprus. Secondary aims were to ascertain the predictors of burnout and its relationship with lifestyle habits, sleep quality and mental health.

BACKGROUND

Burnout in the healthcare sector has drawn significant scientific attention over the last few years. Recent research underscored the large burden of profession-related burnout among medical students.

MATERIALS AND METHODS

An anonymous questionnaire was administered to all 189 eligible candidates. This included demographic and lifestyle characteristics. Sleep quality was assessed via the Pittsburg Sleep Quality Index, mental health was assessed via the mental health (MH) domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory-Student Survey (MBI-SS).

RESULTS

Overall response rate was 96.3%. The burnout prevalence was 18.1%. There was a significant linear effect of between the year of studies and the burnout frequency [F(1) = 5.09, p = 0.024], implying that with increasing academic year there were more students with burnout, especially after the 4th year of education which signifies the beginning of clinical education. Students with burnout were more likely to have poor sleep quality (90.9% vs. 60.8%, odds ratio 4.33, p = 0.023) and worse mental health (MH score 40.2 ± 17.7 vs 62.9 ± 20.3, p<0.001). Alcohol consumers had more symptoms of cynicism and less feelings of efficacy than non-alcohol consumers. Moreover, less feelings of efficacy were significantly associated with more alcohol consumption among alcohol consumers.

CONCLUSIONS

Burnout is prevalent in medical students and increases significantly during the clinical years. Students with burnout have worse sleep and mental health and might use alcohol as a coping mechanism. Implementing prevention strategies of burnout may be beneficial.

Effect of Aggression Management Training on Perceived Stress Levels of Nurses Working in Mental Health Care Settings in Jordan

The current study investigated the effect of an aggression management training course on reducing perceived stress levels of nurses working in mental health care settings in Jordan. This quasi-experimental pre/post study included 83 nurses (44 male, 39 female; mean age = 33 years) who completed a sociodemographic characteristics questionnaire and the Arabic Version of the Perceived Stress Scale 10-Items Questionnaire. Participants attended 32 hours of an aggression management training course and then answered the questionnaires for a second time. Female nurses reported significantly higher stress levels than male nurses before and after the training course. Paired-samples t test showed a significant decrease in the mean total score of perceived stress of all nurses after attending the training course. The results of this study highlight the need to design and implement aggression management courses, as such training can improve nurses' mental health and perceived stress levels. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 32-38.].

Función de la empatía en el trabajo de psicólogos y psicoterapeutas

La empatía es una habilidad importante en el trabajo de un psicólogo y psicoterapeuta puesto que permite entrar en el mundo del otro y ponerse en su lugar. En este sentido, Davis (1983): crea el Índice de Reactividad Interpersonal bajo este concepto. Se pretende en este estudio evaluar las características específicas de la empatía en psicólogos ecuatorianos y compararla entre hombres y mujeres. Se realizó un estudio descriptivo de campo con una muestra de 64 psicólogos ecuatorianos. Se utilizó para el análisis de datos el software estadístico IBM SPSS Statistics 20.0 y el test de significación estadística U de Mann-Whitney para el análisis de género y nivel de empatía. Para la recolección de datos se utilizó la subescala de preocupación empática del Índice de Reactividad Interpersonal de Davis adaptado a la versión española. La mayoría de los psicólogos y psicoterapeutas presentan un nivel de empatía media alta, no obstante, en esta investigación no se vio resultados significativos en cuanto a la diferencia de género y nivel de empatía por lo que, se requiere mayor investigación.

Measuring Flourishing Among Internal Medicine and Psychiatry Residents

BACKGROUND

Many residents experience burnout, prompting national attention to well-being; however, well-being is not merely the absence of burnout. A recently developed measure of flourishing may provide insight on this important topic.

OBJECTIVE

We investigated flourishing in a sample of medical residents.

METHODS

Internal medicine residents and psychiatry residents at 2 residency programs responded to a cross-sectional online survey (December 2017-February 2018), which focused on the Flourish Index (FI) and Secure Flourish Index (SFI). Both measures generate scores ranging from a low of 0 to a high of 10. Participants were queried about quality of life, burnout, work-life balance, empathic concern, and sociodemographic characteristics. Simple and multiple linear regressions were performed to examine the relationship between FI/SFI and other variables.

RESULTS

The response rate was 92% (92 of 101). Participants were found to have a mean FI score of 6.8 (SD = 1.6) and mean SFI score of 6.9 (SD = 1.6). Low quality of life, low work-life balance satisfaction, high emotional exhaustion, lower empathic concern, and having a pet were all significantly associated with lower FI scores (R² = 0.59; F[14, 69] = 7.10; P < .0001), indicating lesser flourishing, controlling for other variables. Similarly, low quality of life, high emotional exhaustion, lower empathic concern, and having a pet were all significantly associated with lower SFI scores (R² = 0.55; F[14, 69] = 6.06; P < .0001), controlling for other variables.

CONCLUSIONS

In this sample, the flourishing indices were associated with well-being and burnout metrics.

The Role of Active Coping in the Relationship Between Learning Burnout and Sleep Quality Among College Students in China

Learning burnout negatively influences students' learning and well-being. Sleep quality is directly related to students' health and learning outcomes. Research indicates that sleep quality and coping style may be associated with learning burnout. However, the interrelationship among learning burnout, sleep quality, and coping style has not yet been fully studied. This study aimed to explore the relationship between sleep quality and learning burnout and examine whether coping mediates this relationship in Chinese university students. A total of 228 undergraduate students were recruited to participate in this research. The Simplified Coping Style Questionnaire (SCSQ), Learning Burnout Questionnaire (LBQ), and Pittsburgh Sleep Quality Index-Chinese (PSQI-C) were employed to collect data. The results showed the following: (1) poor sleep quality had a positive association with learning burnout, and (2) active coping style mediated the effects of poor sleep quality on learning burnout and the dimensions of learning burnout (depression and low sense of achievement). The findings of the current study contribute to knowledge of learning burnout and provide theoretical evidence for further educational interventions.

Emotional exhaustion, burnout, and perceived stress in dental students

Objective

As in other health sciences, a career in dentistry is associated with numerous stressors in practitioners. The main objective of this research was to examine the prevalence of emotional exhaustion, burnout, and perceived stress among dental students in Mexico.

Methods

A cross-sectional study was conducted among 73 dental students attending a private university in Northern Mexico. Three scales were administered to students to identify emotional exhaustion, burnout, and perceived stress, and parametric data analysis was performed.

Results

Among participants (mean age 19.7 years), the proportion with emotional exhaustion, perceived high stress, and burnout was 52.0%, 42.3%, and 17.8%, respectively. All students with perceived stress also had burnout.

Conclusions

We found that emotional exhaustion and perceived stress are experienced by a large proportion of dentistry students enrolled in the third semester at this private university in Northern Mexico. The proportions were independent of age and sex.

Burnout in OB/GYN Students and Residents

In this article we address the concept of burnout, first in the medical student setting, and then in the residency setting. We will review the prevalence followed by a discussion of risk factors, consequences, and finally thoughts on prevention and intervention.