Stress and burnout: exploring postgraduate physiotherapy students' experiences and coping strategies

Financial implications of unpaid clinical placements for allied health, dentistry, medical, and nursing students in Australia: a scoping review with recommendations for policy, research, and practice

BACKGROUND

Investing in allied health, dentistry, medical, and nursing undergraduate and postgraduate qualifying education is critical to meet a growing demand on global health care systems. Clinical placements are an integral component of qualifying training and are conventionally unpaid. Widespread economic challenges, attributed to a post-COVID-19 pandemic recovery era and global unrest, have led to growing economic hardship for populations, even in high-income countries like Australia. Allied health, dentistry, medical, and nursing undergraduate and postgraduate students undertaking unpaid clinical placements are not immune from these stressors, which has implications for education providers, ageing populations, the future health care system, and policy-makers. The purpose of this review was to better understand these stressors by scoping the financial implications of unpaid clinical placements for allied health, dentistry, medical, and nursing students in Australian research.

METHODS

The Joanna Briggs Institute's scoping review methodology was used. This involved a search of academic databases and an extensive search of grey literature sources. Literature published from 1 January 2014 was included. Citations were independently screened by two reviewers.

RESULTS

Thirty-three research studies were included. Most studies focused on allied health students (n = 12), followed by nursing (n = 11), and medical students (n = 5), with an additional five studies focused on multiple disciplines, including dentistry. One study had an interventional component. Findings were grouped around four concepts: reliance on self-reported measures of financial implications, costs of unpaid clinical placements for students, implications of costs for students, and an urgent need for targeted strategies to redress.

CONCLUSIONS

The financial implications of unpaid clinical placements for allied health, dentistry, medical, and nursing students in Australia are well-established in research. Impacts are significant for the future of Australia's health workforce and health system. Research findings have been consistent over the past decade in advocating for greater financial support for students undertaking unpaid clinical placements and flexibility of placement models to mitigate the indirect costs of placements. Collaboration between state and federal government, universities, peak professional bodies, and placement host organisations is imperative to implement a suite of strategies to redress the financial burden experienced by students and secure the future of Australia's health workforce.

Perceived stress and burnout syndrome in chiropractic students at a South African university during the COVID-19 pandemic: A cross-sectional study

OBJECTIVE

Higher stress levels may be associated with decreased academic success and physical and psychological well-being in chiropractic students. This study aimed to determine the perceived stress and burnout of chiropractic students at the University of Johannesburg during the COVID-19 pandemic.

METHODS

This was a quantitative, exploratory study utilizing a self-administered online questionnaire distributed to chiropractic students (n = 246) at the university. The questionnaire consisted of 3 main components: demographics, the Perceived Stress Scale (PSS-10), and the Maslach Burnout Inventory-Student Survey (MBI-SS). Data were analyzed utilizing exploratory factor analysis, Cronbach alpha for reliabilities, and descriptive statistics for mean scores being interpreted using subscales pertaining to the 2 survey tools.

RESULTS

The response rate was 63.82% (n = 157) with the PSS-10 indicating participants obtained a total mean score of 25.08 (average stress). For the MBI-SS categories, participants scored 18.96 out of 30 for exhaustion, 10.31 out of 30 for cynicism, and 22.46 out of 36 for professional efficiency; higher scores of exhaustion and cynicism and lower scores of professional efficiency are indicative of higher degrees of burnout. Statistically significant differences for both tools were noted in relation to age and academic year with higher values indicated with increased age and progression in the program.

CONCLUSION

The results indicate that chiropractic students experienced moderate levels of stress but higher burnout than other health sciences student populations when compared to current literature. Age and progression in the program appear to have a negative influence on both these factors.

Sources of stress and coping strategies among Chinese medical graduate students: a qualitative study

BACKGROUND

The incidence of mental health problems among medical graduate students is much higher than among students of other disciplines. This can have adverse consequences for the medical students themselves as well as their future patients. This study aims to understand the pressures faced by Chinese medical students and the current status of mental health education. It also propose recommendations for the current situation and prospects for the future.

METHOD

The authors conducted in-depth semi-structured interviews with 22 master's students from five medical schools during November 2023. All interview sessions were recorded and transcribed verbatim. The transcriptions were analyzed using the Colaizzi's seven-step method.

RESULT

Three main themes were extracted from the students' statements: sources of psychological stress, ways to cope with stress, and perspectives on mental health education. The study showed that current mental health education in China is mostly in the form of printed mental health education manuals and mental health lectures, and there is no active tiered intervention for students at different levels. It is suggested that reforms should be made to shift to a model where the school proactively identifies problems and intervenes based on feedback.

CONCLUSION

This study reveals the widespread psychological stress and shortcomings in current education methods. To address these challenges, institutions should develop tailored interventions, including tiered support systems, open dialogue promotion, and resilience training. Future research should focus on evaluating innovative interventions' effectiveness, ultimately fostering a supportive environment that enhances students' success and contributes to a healthier healthcare workforce.

The occupational burnout among medical staff with high workloads after the COVID-19 and its association with anxiety and depression

Objective

After the end of COVID-19, medical staff were immediately faced with a high workload, leading to widespread occupational burnout. This study aims to explore the level and influencing factors of burnout among medical staff during this period, as well as its relationship with anxiety and depression.

Methods

The participants' levels of burnout were assessed using Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the reliability and validity of the questionnaire were evaluated through Cronbach's α and Confirmatory Factor Analysis (CFA). Independent sample t-test, chi-square test, and Pearson analysis were employed to determine the correlation between two sets of variables. Univariate and multivariate logistic regression analyses were conducted to identify significant factors influencing burnout. Finally, nomograms were used to predict the probability of burnout occurrence.

Results

This study collected a total of 1,550 questionnaires, and after excluding 45 questionnaires that were duplicates or incomplete, a sample of 1,505 (97.1%) participants were included in the final statistical analysis. Both Cronbach's α and the fit indices of CFA demonstrated excellent adaptability of the Chinese version of MBI-HSS in this study. The overall prevalence rates for emotional exhaustion (EE), depersonalization (DP), and diminished personal accomplishment (PA) were 52.4, 55.3, and 30.6%, respectively. Obtaining psychological support, health condition, relationship with family members, and insufficient sleep were identified as common contributing factors to burnout among medical staff. Additionally, age and promotion pressure were also associated with burnout among doctors, and exceeding legal working hours was an important factor for nurse burnout. The C-index for the nomograms predicting burnout among doctors and nurses was 0.832 and 0.843, respectively. Furthermore, burnout exhibited a significant linear correlation with anxiety and depression.

Conclusion

After the end of COVID-19, medical staff in high workload environments were facing severe burnout, which might lead to anxiety and depression. The occupational burnout of medical staff needed to be taken seriously and actively intervened.

Clinical education-related stressors and emotional states during clinical education among physical therapy students

BACKGROUND

While clinical education-related stressors in other healthcare professions have been reported, clinical education stressors in physical therapy students are not yet clear.

PURPOSE

This study aimed to identify clusters of stressors associated with clinical education among Japanese physical therapy students and determine the association between these clusters and emotional states.

METHODS

Participants were physical therapy students who had completed five weeks of clinical education. In addition to demographic data, the survey included the Brief Job Stress Questionnaire (BJSQ) and the Stress Reaction Scale (SRS-18). Exploratory factor analysis was used to extract latent variables for sub-items of the BJSQ. Spearman's correlation coefficients between the extracted latent variables and the subscales of the SRS-18 were calculated.

RESULTS

Data from 114 individuals (median age 21 years, 68 men and 46 women) were analyzed. The variables identified as clusters of stressors were: 1) "adaptation to clinical education"; 2) "task burden"; and 3) "appropriate work environment." These three clusters of stressors were significantly but only weakly correlated with the subscales of the SRS-18 (|rs| ≤ |-.39|).

CONCLUSION

The stressors associated with physical therapy clinical education need to be understood in terms of the students' active attitude toward clinical education, the burden of practice tasks, and the physical environment during practice.

Relationship between Job Burnout, Depressive Symptoms, and Career Choice Regret among Chinese Postgraduates of Stomatology

A qualified Chinese dental postgraduate requires at least eight years of training. The huge academic burden, strict clinical requirements, and high workload increases the risk of job burnout, depression symptoms, and career choice regret of dental postgraduates, which may cause one to waver in their choice of a career as a doctor. Therefore, we aimed at assessing the relationship between job burnout, depressive symptoms, and career choice regret among Chinese dental postgraduates. The Chongqing Stomatological Association conducted an online cross-sectional study among 558 dental postgraduates in China, with an average age of 22.54 ± 2.44. Demographic information, the Maslach Burnout Inventory, the 2-item Primary Care Evaluation of Mental Disorders scale, and career choice regret scale were included in the questionnaire. About 41.0% of dental postgraduates experienced job burnout, 44.1% had depressive symptoms, and 41.6% reported career choice regret. Logistic regression analysis indicated the risk factors for job burnout were time worked/studied per week, depressive symptoms, and career choice regret. Job burnout and career choice regret was significantly related to depressive symptoms (p < 0.001). Risk factors for career choice regret were gender, postgraduate entrance examination score, daily hours of sleep, job burnout, and depressive symptoms. Such results suggest that job burnout, depressive symptoms, and career choice regrets are prevalent among dental postgraduates. Accurate measures should be taken to change this situation.

Burnout and Resilience among Respiratory Therapy (RT) Students during Clinical Training in Saudi Arabia: A Nationwide Cross-Sectional Study

BACKGROUND

The epidemic of burnout has been widely documented among health discipline students. However, there is limited information available on the prevalence of burnout and its association with resilience among clinical-level respiratory therapy (RT) students.

METHODS

Between March 2022 and May 2022, a descriptive, cross-sectional study using a convenience sample of RT students and interns was conducted. A total of 559 RT students and interns from 15 RT programs responded to socio-demographic questions and the Maslach Burnout Inventory (MBI) and the Brief Resilience Scale (BRS) questionnaires. The data were analyzed using descriptive, inferential, and correlation tests.

RESULTS

Of the 559 respondents, 78% reported a high level of burnout. Within the three subscales of burnout, 52% reported emotional exhaustion (EE), 59% reported depersonalization (DP), and 55% reported low personal achievement (PA). The prevalence of burnout increased as students proceeded to senior years (p = 0.006). In addition, participants with higher grade point averages (GPA) reported a higher level of burnout. Only 2% of the respondents reported a high level of resiliency. Further, there were negative correlations between resilience and EE (r = -41, p < 0.001) and DP (r = -32, p = 0.03), and a positive correlation with low PA (r = 0.56, p = 0.002).

CONCLUSION

The findings showed a high prevalence of burnout among RT students and interns during clinical training in Saudi Arabia. Resilience was associated with all domains of burnout and is likely to play a protective role. Therefore, there is a need for collaborative interventions to promote resiliency during clinical training to alleviate and overcome burnout symptoms.

Burnout and Online Medical Education: Romanian Students in Lockdown and Their Residency Choices

The primary aim of the study was to investigate the prevalence of burnout in Romanian medical students during the COVID-19 pandemic using the Maslach Burnout Inventory-General Survey for Students (MBI-GS(S)). The presence of burnout was assessed based on Exhaustion (EX), Cynicism (CY) and Professional Efficacy (PE) subscales. The secondary aim of the study was to identify the presence of intentional shift in medical specialty compared to their initial pursued choice within the population investigated. Data was collected online at the end of 2020 and beginning of 2021 through a licensed, customized MBI-GS(S) questionnaire from a sample of 126 Romanian medical students at the two leading medical schools in the country, Iasi (N = 56) and Cluj Napoca (N = 70). Descriptive statistics and bivariate correlations were also applied to describe the data set (age and gender of participants) and the relationship between variables (EX, CY, PE). Subsequently, the MBI-GS(S) group report revealed that 36.5% of the medical students in the sample (46) experienced burnout, with problematic results both in Exhaustion and Cynicism. Exhaustion and Cynicism, which contribute to burnout, showed high scores compared to the average scale (EX = 3.5/2.4; CY = 2.8/1.8), while the Professional Efficacy score was relatively high (PE = 3.8/4.4), showing a protective effect and burnout reduction. One of the main conclusions is that the consequences of burnout in medical students plays a significant role in shaping the future healthcare practitioners’ perception of the medical profession and of patients’ wellbeing. Exhaustion and Cynicism are mainly associated with depersonalization and disconnection from the patient. Another conclusion of the study is that about one third of the respondents (30% Cluj students and 37.5% Iasi students) considered changing residency options. The pandemic has also revealed the limitations of and challenges facing current medical education, and that further research is required to assess the trends in prevalence of burnout in medical students.