Burnout Syndrome and associated factors among medical students: a cross-sectional study

Academic burnout syndrome among medical students in Serbia: prevalence of high risk and determinants

BACKGROUND

Although burnout syndrome has been described in numerous research studies, the data on burnout syndrome among medical students in developing countries is scanty. This study aimed to determine the prevalence of high-risk for burnout syndrome and its associated factors among university undergraduate medical students in Serbia.

METHODS

An observational, analytical, cross-sectional study was conducted using the Maslach Burnout Inventory-Student Survey and a survey on associated factors. The research was carried out from February to March 2014. Multivariate logistic regression was used to determine the adjusted odds ratio (Odds Ratio, OR) with 95% Confidence Interval (95%CI) in order to identify independent correlates of high risk of burnout syndrome.

RESULTS

A high risk for burnout syndrome was noted in 15.0% of respondents; that is, 114/760 medical students suffered from high emotional exhaustion, high cynicism, and low academic efficiency. According to the results of multivariate logistic regression, the main significant independent correlates of high risk for burnout syndrome in medical students were: age of students (for aged 22-24: adjusted OR = 5.64, 95%CI = 2.58-12.34, p < 0.001 for aged ≥ 25: adjusted OR = 5.65, 95%CI = 2.08-15.39, p = 0.001) with p for trend < 0.001, higher frequency of alcohol consumption (for habit 1-2 times a week: adjusted OR = 2.01, 95%CI = 1.01-4.03, p = 0.048) with p for trend = 0.025, and use of sedatives (adjusted OR = 3.44, 95%CI = 1.31-9.04; p = 0.012).

CONCLUSION

The present study identified several factors associated with burnout syndrome in Serbian medical students. Some factors associated with the high risk of burnout syndrome in medical students are modifiable. It is important to carry out similar research on burnout syndrome in the future, especially using longitudinal studies, in order to evaluate the associations found in this cross-sectional study.

Is the fire even bigger? Burnout in 800 medical and nursing students in a low middle income country

BACKGROUND

Burnout, characterized by emotional exhaustion (EX), depersonalization (DP), and a reduced sense of personal efficacy (PF) among medical and nursing students can lead to suicidal ideation, lack of empathy, and dropouts. Previous studies have used over-simplified definitions of burnout that fail to capture its complexity. We describe the prevalence of burnout profiles and its risk factors among medical and nursing students.

METHODS

A cross sectional study was conducted at a tertiary care University Hospital in Pakistan. The Maslach Burnout Inventory (MBI) survey was disseminated via SurveyMonkey over a period of 4 months (November 2019 to February 2020) to 482 Medical and 441 nursing students. The MBI tool measures the dimensions of EX, DP, and PF to describe seven burnout profiles. Multivariable regression was used to identify predictors of burnout.

RESULTS

The response rate was 92% in nursing and 87.3% in medical students. The prevalence of burnout in medical and nursing students was 16.9% and 6.7% respectively (p<0.001), with 55.7% (n = 427) suffering from at least one burnout profile. Only 32.5% (n = 250) students felt engaged, (42.3% medical, 22.7% nursing students, p<0.001). The most common profile was ineffective (32.5%, n = 250), characterized by a reduced sense of personal efficacy (35.6% medical, 29.4% nursing students; p = 0.065). Medical students were at higher risk of burnout compared to nursing students (OR = 2.49 [1.42, 4.38]; p<0.001) with highest risk observed in year 4 (OR = 2.47 [1.02, 5.99]; p = 0.046). Other risk factors for burnout included occasional drug use (OR = 1.83 [1.21, 8.49]; p = 0.017) and living in a hostel (OR = 1.64 [1.01,2.67]; p = 0.233).

CONCLUSION AND RELEVANCE

Two-thirds of our participants experienced at least one dimension of burnout with the highest prevalence of a reduced sense of PF. Drivers of burnout unique to a lower-middle-income country need to be understood for effective interventions. Faculty training on principles of student evaluation and feedback may be beneficial.

Design and validation of the general scale of academic engagement for Spanish adolescents (CAADE)

Academic engagement is considered one of the most essential elements to achieve educational success and decrease levels of school dropout. However, there is a need to develop reliable, practical and valid instruments that evaluate the academic engagement of adolescents taking into account their multidimensionality. The main aim of this research was to design and validate the General Scale of Academic Engagement for Spanish Adolescents that overcomes this limitation. The elaboration process began with the creation of items that are relying on the evaluation of existing literature, then the items were refined thanks to the reviews of the experts and discussion groups with adolescents. Data from 1158 students in compulsory secondary education were analyzed. The instrument's psychometric properties were determined by comprehension validity, analysis of content, reliability and construct validity. An Exploratory Factor Analysis was performed with the first sample (n = 356), while the second sample (n = 802) was used to verify the factor structure identified through Confirmatory Factor Analysis. Evidence of reliability and validity was provided for the instrument using SPSS Version 27 and SPSS AMOS. The results of the analyses resulted in a questionnaire of 17 items grouped into three factors (Cognitive, Affective-Emotional and Behavioral), and confirm that the General Scale of Academic Engagement for Spanish Adolescents (CAADE) has an adequate construct validity and reliability. In summary, this study has resulted in the development of a tool that can be utilized by educators or any institution concerned in evaluating student academic engagement, a construct that does not yet to have consensus.

Effects of the mental health promotion seminar 'Coping with stress' in the undergraduate medical curriculum of the Medical University of Vienna

BACKGROUND

High prevalence rates of distress and burnout in medical students are well-documented in mental health literature. Different types of interventions have been developed in the past in order to reduce stress in medical undergraduate students and promote better coping skills. There is, however, a paucity of studies that have tested the effectiveness of these interventions. This study aimed to examine the effect of different versions of the seminar 'Coping with stress', which was implemented in the first year of the undergraduate curriculum of the Medical University of Vienna in the summer semester of 2018, on students' mental health.

METHODS

Invitations to participate in the study were sent via email to six cohorts of students from the Medical University of Vienna. Two cohorts participated in the onsite version of the seminar 'Coping with stress', whereas two cohorts participated in the online version of the seminar, and two cohorts received no intervention (control group). Data on burnout risk, life satisfaction, stress, and knowledge about available help resources were collected via online questionnaires from n = 137 students before and after the curriculum module that contained the seminar.

RESULTS

Medical students who participated in the onsite seminar reported a reduction of some aspects of burnout, a decrease in stress, and an increase in knowledge about available help resources. No such effect was seen in the control group. Participants of the online seminar experienced a similar increase in knowledge about available help resources, but no changes in other outcomes.

CONCLUSIONS

The findings support the notion that the onsite seminar of 'Coping with stress' had a positive impact on medical students' mental health and is a useful addition to the medical curriculum by promoting mental health literacy.

TRIAL REGISTRATION

This research has been registered in the German Clinical Trial Registry with the registration number DRKS00018981 and the registration date 14/11/2019.

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).

Mindfulness and burnout among Chinese college students: mediation through sleep quality and perceived stress

College students often face challenges and obstacles which leads them vulnerable to burnout. Though numerous studies have supported an association between mindfulness and burnout, yet little is known about the potential mediating role of mindfulness exerts its effect in this link. This study aimed to explore the relationship between mindfulness and burnout among Chinese college students and investigated the sleep quality and perceived stress as two potential mediators of that relationship. A total of 536 college students (mean age = 21.93, 66.2% female) were investigated and completed the Five Facet of Mindfulness Questionnaire, Pittsburgh Sleep Quality Index, Perceived Stress Scale and Academic Burnout Scale of College Students. Path analyses were employed to examine the mediating effect. Results indicated that mindfulness had significant negative correlation with burnout (r=-.584, p < 0.001). Sleep quality and perceived stress were significant mediators of the observed relationship between mindfulness and burnout. These findings shed light upon the mediating role of sleep quality and perceived stress, and suggest that college students' mindfulness may facilitate their sleep quality and decrease perceived stress, which, in turn, may help prevent and reduce burnout.

Prevalence of burnout and its associated factors among medical students during COVID-19 pandemic in Indonesia: A cross-sectional study

Shifting learning process due to COVID-19 has led to increased burnout prevalence among medical students. Thus, this study aimed to assess burnout prevalence and its associated factors among Indonesian medical students during the COVID-19 pandemic. An online cross-sectional study was carried out among medical students in Malang, Indonesia. Burnout was assessed using the Maslach Burnout Inventory-Student Survey tool. Pearson's Chi-square was used to assess significant associations, and binary logistic regression was conducted to evaluate the relationships between the predictor variables and burnout. The difference of each subscale score was evaluated using an independent sample t test. This study analyzed 413 medical students with a mean age of 21.1 ± 1.4 years old. About 29.5% and 32.9% of students reported a high level of emotional exhaustion and depersonalization, respectively, resulting in 17.9% of burnout prevalence. Stage of study was the only sociodemographic factor independently associated with burnout prevalence (odds ratio = 0.180, 95% confidence interval = 0.079-0.410, p-values = 0.000). Preclinical students had significantly higher levels of emotional exhaustion (p-value = 0.004, d = 0.3) and depersonalization (p-value = 0.000, d = 1.1), and lower levels of personal accomplishment (p-value = 0.000, d = -0.5). Around one-sixth of the medical students experienced burnout during the COVID-19 pandemic, with preclinical students being more prone to have burnout. Future study with other adjusted confounding factors is needed to completely understand the issue and obtain immediate interventional strategies to reduce burnout among medical students.

Medicine as a career choice: a comprehensive study on factors influencing Sudanese students to opt in/out medical career

BACKGROUND

The medical profession is one of the most highly respected and desired professions among students worldwide, most likely because it provides opportunities for both a financially and socially rewarding career. However, while it has been quite established that factors such as self-interest, family pressure, friend pressure, and socioeconomic status do influence the choice of medicine among students worldwide, the exact reasons for an individual to join a medical school may actually vary worldwide. The aim of this study was to comprehensively explore factors influencing medical students to opt in/out medical careers in Sudan.

METHODS

An institutional based descriptive cross-sectional study was conducted at University of Khartoum in the year 2022 with a random sample of 330 students that was obtained from the medical students at the The University of Khartoum, Faculty of Medicine using stratified random sampling.

RESULTS

Self-interest was the most common factor influencing opting in (choosing) medical profession (70.6%) (n = 233), followed by getting a very high score in high-school that qualifies into the faculty (55.5%) (n = 183). Regarding the factors affecting medical students' choices, parental pressure was the main factor (37.0%) (n = 122), followed by other relatives' pressure (12.4%) (n = 41), and 4.2% (n = 14) chose Peer pressure. 59.7% (n = 197) of the participants stated that they were not affected by any of these factors. Most of the participants felt that the general perception of the medical profession by society is that it is prestigious and has good career opportunities, only 5.8% (n = 19) believed that it is "Not appreciated at all" by the society. A statistically significant association was found between the type of admission & parent pressure (p value 0.01). out of 330 participants, (56.1%) (n = 185) have opted out i.e. lost their interest or regretted their choice of medical career. Academic difficulties was the most common factor causing students to opt-out of the medical career (37%) (n = 122) followed by Multiple suspensions of education (35.2%) (n = 116), Current political & security conflicts in Sudan (29.7%) (n = 98), Poor quality of education (24.8%). The proportion of students having regrets for the medical profession was significantly higher among females. Over one third of the participants reported having depressive symptoms more than half days of the week. No statically significant correlation was established between the academic level and having these depressive symptoms and no statistically significant correlation was established between the decision to opt-out and the academic level (class) of the individuals (P = 0.105).

CONCLUSIONS

Over half of Sudanese medical students at the University of Khartoum have already lost their interest or regretted their choice of medical career choice. Whether these future doctor chose to drop out or continue their path in the medical career suggests that they are more prone to serious hardships in their future careers. A careful comprehensive approach should further explore and try to offer solutions for problems like "Academic difficulties", "multiple suspension of education", and "poor quality of education" for they were the most common factors that caused medical students to opt out of the medical career.

Prevalence of depression, anxiety and burnout in medical students at the University of Namibia

Background

There is an increased prevalence of depression, anxiety, and burnout among medical students worldwide with no information from Namibia.

Aim

This study aimed to determine the prevalence and factors associated with depression, anxiety, and burnout among medical students at the University of Namibia (UNAM).

Methods

A quantitative descriptive cross-sectional survey was conducted utilising a specially designed questionnaire for the study and standardised instruments to evaluate depression, anxiety, and burnout.

Results

Of the 229 students in this study, 71.6% were female and 28.4% were male. The prevalence of depression, anxiety, and burnout was 43.6%, 30.6%, and 36.2%, respectively. The prevalence of emotional exhaustion (EX), cynicism (CY), and professional efficacy (EF) was 68.1% (n = 156), 77.3% (n = 177) and 53.3% (n = 122), respectively. In the final regression model, participants with a current psychiatric illness were more likely to screen positive for depression (adjusted odds ratio [aOR] 4.06, confidence interval [CI] 1.28-12.91; p = 0.02) and anxiety (aOR: 3.63, CI: 1.17-11.23; p = 0.03). Emotional exhaustion and cynicism were significantly associated with female gender (EX: aOR, 0.40, CI: 0.20-0.79; p = 0.01) (CY: aOR, 0.42, CI: 0.20-0.91; p = 0.03).

Conclusion

More than one in three medical students at the UNAM were either depressed or burnt out.

Contribution

This is the first study to highlight the mental health needs of medical students at the University of Namibia.

Mediation analysis of circadian preferences and other behavioral and sociodemographic factors associated with subjective well-being in undergraduate students

Undergraduate students are usually subjected to a routine with constant pressure, stress, circadian misalignment, and sleep irregularity that impairs their subjective well-being. Recent evidence suggests that circadian preference is also a risk factor for impaired mental health and factors related to subjective well-being. This study aimed to identify the sociodemographic factors associated with subjective well-being and describe the mediating behavioral variables. Between September 2018 and March 2021, 615 Brazilian students enrolled in higher educational institutions completed an electronic form containing questionnaires on subjective well-being, sociodemographic, and behavioral-related factors (convenience sample). A statistical mediation model was applied to describe how these variables influence subjective well-being. We observed that Morningness (p < .001), identification with the male gender (p = .010), not working while studying (p = .048), and the practice of Pilates/yoga (p = .028) were associated with greater subjective well-being. Except for employment status, no direct effects were observed, which reinforces the need to consider a multidimensional approach. The relationship between subjective well-being and sociodemographic factors exists only in the presence of behavioral mediators, specifically perceived stress, daytime sleepiness, symptoms of depression, sleep quality, and positive and negative affects. Future work should investigate in more detail the impact of sleep, stress, and circadian preferences on this relationship.

Assessment of Medical Students Burnout during COVID-19 Pandemic

This study estimated the prevalence of burnout and its determinants among medical students at Jazan University during the COVID-19 pandemic. A total of 444 medical students completed an online survey containing the Maslach burnout inventory. The prevalence of burnout was 54.5%. Burnout reached its peak during the fourth year whereas it was the lowest in the internship year. Being a resident in mountain areas, being delayed in college-level, being divorced, and having divorced parents were all associated with an increased risk of burnout. During their time at medical school, students generally showed a trend of consistently high scores in the personal accomplishment subscale, a decreasing trend in the emotional exhaustion subscale, and an increasing trend in the depersonalization subscale. The most important predictive factor was having separated parents. Perceived study satisfaction appeared to be a significant protective factor in a dose-response manner. These findings suggest that burnout among medical students during the COVID-19 pandemic is a concern that should be monitored and prevented.

Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial

BACKGROUND

Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority.

OBJECTIVE

This study aimed to evaluate the effectiveness of a stand-alone app-delivered Acceptance and Commitment Training intervention for improving medical students' self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version.

METHODS

This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students' identified psychological flexibility training needs.

RESULTS

The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: -0.52, 95% CI -3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI -1.84 to 5.03, P=.37), cynicism (individualized: -1.26, 95% CI -4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI -2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI -0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI -0.92 to -0.04; P=.04), and reduced stress (-6.89, 95% CI -12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (-6.36, 95% CI -11.90 to -0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed.

CONCLUSIONS

This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/32992.

Prevalence of burnout in medical students: A systematic review and meta-analysis

BACKGROUND

Medical students are at a significant risk of experiencing psychological issues, such as burnout. Over the past few years, more studies have been conducted on this topic, producing different results.

AIMS

The purpose of this review was to determine the global pooled prevalence rate and risk factors associated with burnout and its components among undergraduate (pre-intern) medical students.

METHOD

From inception until 30 November 2021, nine electronic databases were used for an electronic search. Using random-effects meta-analysis, we pooled the estimates using the DerSimonian-Laird method. The prevalence of burnout in medical students was the primary outcome of interest. Data were analyzed globally, by country, by research measure. Age and sex were examined as confounders using meta-regression analysis.

RESULTS

A random-effects meta-analysis of 42 studies involving 26,824 evaluating the prevalence of burnout in medical students showed an overall prevalence rate 37.23% [32.66%; 42.05%], Q = 2,267.15(41), p < .0001, τ² = .42, τ = .65, I² = 98.2%; H = 7.5. Prevalence of emotional exhaustion, depersonalization, and personal accomplishment were 38.08% [30.67%; 46.10%], 35.07% [26.74%; 44.41%], and 37.23% [32.66%; 42.05%], respectively. Variations were observed between countries and research measures. Age (older) and sex (female) were both significant predictors of burnout.

CONCLUSION

The prevalence of burnout in medical students was estimated to be 37.23%. It is urgent that future studies serve as a basis for the development of prevention and treatment programs to prevent and treat burnout in students.

Assessing the Efficacy of an Individualized Psychological Flexibility Skills Training Intervention App for Medical Student Burnout and Well-being: Protocol for a Randomized Controlled Trial

BACKGROUND

Medical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of individual differences in burnout and PF by using individualized approaches.

OBJECTIVE

This study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an individualized version of the app versus those of a nonindividualized version will also be evaluated.

METHODS

In this 3-arm, parallel, randomized controlled study, a sample of medical students will be randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the individualized and nonindividualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either individualized to meet participants' identified PF training needs at each log-in or nonindividualized.

RESULTS

Burnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the individualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonindividualized group.

CONCLUSIONS

The findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train individuals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an individualized version of the app over a nonindividualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspx.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/32992.

The Prevalence of Stress Among Medical Students Studying an Integrative Curriculum During the COVID-19 Pandemic

PURPOSE

Stress is a psychological shift that negatively affects student achievement. We sought to investigate the extent of stress in the medical students at our university.

PATIENTS AND METHODS

A total of 337 medical students representing three program phases were represented. Stress was measured using a questionnaire divided into three main parts: 10-question Kessler instruments, 10-questions specific to identifying the causes of stress, and a qualitative component to report additional information. For the Kessler questionnaire, a score of less than 20 was considered negative for stress of any level (alert) and scores of 20-24 were considered mild stress (resistance phase), 25-29 moderate stress (near exhaustion), and 30-50 severe stress (exhaustion). Descriptive studies in the form of mean, standard deviation, and confidence interval (CI) were used in addition to the chi-squared test for estimate significant differences between variables. A P-value of <0.05 was considered significant.

RESULTS

The prevalence of stress was 85.5%, with a slight male predominance. The prevalence of stress was seen among the male students during Phase I (88.25%), followed by male students during Phase III (87.7%), female students during phase II (86.5%), male students during phase II (84.5%), female students during phase I (83.3%) and female students during phase III (80.4%). Stress was uniformly high during phase I (86.2%) followed by phase II (85.4%) and phase III (85.1%), and 85% of stress was obtained from the number and content of assessments.

CONCLUSION

There is a high level of stress throughout the curriculum. The number of assessments and the number of modules and their content are the primary sources of stress. Student mentorship, including academic, psychic, and social counseling, may help predict and manage stress and improve student performance. Detection of stress among the students is a major issue for program monitoring and development.

Burnout among medical students of the University of Kerbala and its correlates

Background

Burnout is prevalent among medical students. Throughout their training, medical students face many psychosocial stresses that, if not managed, might cause burnout syndrome. Burnout could negatively impact students’ life and their academic performance. This study aims to estimate the prevalence of burnout among medical students at the College of Medicine, University of Kerbala, and assess factors associated with it.

An analytic cross-sectional study. A sample of 424 students from all academic years from the College of Medicine, University of Kerbala, was approached. Data collection was conducted from June 11 to July 3, 2020, through a self-administered online questionnaire based on the Maslach Burnout Inventory Student Survey (MBI-SS). The MBI-SS included 15 questions with a 7-point rating ranging from 0 (never) to 6 (always). The tool measures three subscales: emotional exhaustion (5 questions), Cynicism (4 questions), and professional efficacy (6 questions). Statistical Package for the Social Sciences (SPSS) program version 24 was used for data analysis. Binary logistic regression was used to assess the association between burnout and students̓ variables, P value of a level < 0.05 considered statistically significant.

Results

The prevalence of burnout syndrome among medical students was 38.2%. About 85.6% of students had high emotional exhaustion, 77.8% had high cynicism, and 32.5% exhibited low professional efficacy. Female gender, regular use of legal substances, and family history of mental diseases were associated with significantly high rates of burnout.

Conclusions

Burnout is prevalent among medical students of the University of Kerbala with quite high levels of emotional exhaustion and cynicism and lower professional efficacy levels. Faculties of medicine need to consider burnout among their students and works to reduce unnecessary stresses by modifying and upgrading the educational and clinical environments.

Prevalence of burnout among university students in low- and middle-income countries: A systematic review and meta-analysis

BACKGROUND

Burnout is common among university students and may adversely affect academic performance. Little is known about the true burden of this preventable malady among university students in low-and-middle-income countries (LMICs).

OBJECTIVES

This study aimed to systematically estimate the prevalence of burnout among university students in LMICs.

METHODS

We searched PubMed, Google Scholar, CINAHL, Web of Science, African Journals Online, and Embase from the inception of each database until February 2021. Original studies were included. No study design or language restrictions were applied. A random-effects meta-analysis was performed using STATA version 16.0. Heterogeneity and publication bias were assessed using Q-statistics and funnel plots, respectively.

RESULTS

Fifty-five unique articles, including a total of 27,940 (Female: 16,215, 58.0%) university students from 24 LMICs were included. The Maslach Burnout Inventory (MBI) was used in 43 studies (78.2%). The pooled prevalence of burnout was 12.1% (95% Confidence Interval (CI) 11.9-12.3; I2 = 99.7%, Q = 21,464.1, p = < 0.001). The pooled prevalence of emotional exhaustion (feelings of energy depletion), cynicism (negativism), and reduced professional efficacy were, 27.8% (95% CI 27.4-28.3; I2 = 98.17%. p = <0.001), 32.6 (95% CI: 32.0-33.1; I2: 99.5%; p = < 0.001), and 29.9% (95% CI: 28.8-30.9; I2: 98.1%; p = < 0.001), respectively.

CONCLUSION

Nearly one-third of university students in LMICs experience burnout. More studies are needed to understand the causes of burnout in this key population. There is a need to validate freely available tools for use in these countries.

High risk of burnout in medical students in Serbia, by gender: A cross-sectional study

INTRODUCTION

Burnout syndrome is common among medical students, but findings about the gender differences in burnout are not consistent. The aim of this study was to assess high risk of burnout syndrome among medical students at one University in Serbia, by gender.

METHOD

A cross-sectional study was conducted at the Faculty of Medical Sciences, University of Kragujevac in 2014. The Maslach Burnout Inventory-Student Survey was used for assessment of burnout level. A questionnaire on basic socio-demographic characteristics (age, gender, marital status, habits, etc.) and academic performance (year of study, cumulative total average grade, length of study, housing, study financing, etc.) was used. The study included a total of 760 medical students (760/836 medical students; participation rate: 90.9%). Logistic regression analysis was used to determine odds ratios (OR) with 95% confidence intervals (95% CI).

RESULTS

Significant gender differences were detected in prevalence of high risk of burnout syndrome (male students- 19.0% vs. female students- 12.8%, p = 0.024). A significant independent predictor of high risk for burnout syndrome in male medical students was study year (p for trend = 0.011), while in female medical students-study year (p for trend = 0.002) and use of sedatives (adjusted OR = 5.74, 95% CI = 1.96-16.77, p = 0.001).

CONCLUSION

Our results indicate the need to assess the risk of burnout syndrome at the very beginning of medical studies, in order to more effectively control the modifiable risk factors.

Feeling the Burnout: Perceptions of Burnout, Anxiety, Depression, and Personal Achievement in US Podiatric Medical Students

Medical student burnout is a significant problem, which has led to the introduction of institutional intervention initiatives to combat the phenomenon. However, the incidence of burnout among podiatric medical students has not been previously assessed. The purpose of this cross-sectional study was to determine the perceptions of burnout, anxiety, depression, and personal achievement among podiatric medical students. A 50-question anonymous survey containing the Maslach Burnout Inventory-Human Services Survey and the Hospital Anxiety and Depression Scale was distributed to all students of eight US podiatric medical schools. Demographic and personal information regarding the student's free time, study time, family support, class or exam failures, loan debt, and previous work experience were recorded. Four hundred and eighty students completed the survey, and 479 responses were eligible for inclusion (response rate of 22.2%). Overall, 65.1% reported moderate or high self-perceived rates of burnout, a rate comparable to allopathic and osteopathic medical students. Respondents also reported high levels of emotional exhaustion and anxiety, but low levels of personal achievement. A predisposition for burnout was identified for third-year students between the ages of 26 to 35 years with borderline or abnormal levels of reported anxiety. The present study contributes to the growing body of literature regarding burnout with respect to the podiatric profession. Despite inherent limitations, the findings suggest institutional interventions for the promotion and development of protective factors may be warranted.

Epidemiology of Burnout and Its Association with Academic Performance Among Medical Students at Hail University, Saudi Arabia

Objectives

Burnout syndrome is a condition that is well-documented globally among medical students and affects their academic performance due to high levels of associated stress and psychiatric morbidities. This study aimed to assess burnout prevalence and predictors along with its association with academic performance among medical students at Hail University, Saudi Arabia.

Methods

A questionnaire-based cross-sectional survey of medical students was conducted between May and June 2019 at the Medical College at Hail University. The English version of the Maslach Burnout Inventory (MBI)-Student Survey was used to assess the three components of burnout syndrome—cynicism, emotional exhaustion and professional efficacy. A fixed-model multivariate logistic regression analysis was conducted for each of the three MBI components’ levels and for total burnout to identify factors significantly associated with burnout syndrome.

Results

A total of 218 students were included in this study (response rate: 53.8%). The majority of participants were female (n = 121; 55.5%) medical students ranging between 21–24 years of age. High emotional exhaustion, high cynicism and low professional efficacy was found among 79.4%, 61.0%, and 37.6%, respectively, of respondents. The overall prevalence of high burnout was 27.1% (n = 59). Female students were at almost double the risk for high emotional exhaustion compared to male students (adjusted odds ratio [AOR] = 2.14, 95% confidence interval [CI]: 1.06–4.34; P = 0.034). Students with grade point averages (GPA; on a four-point scale) ranging between 3.51–4.0 were considerably less prone (83% less risk) to experience burnout as compared to students with a GPA ≤2.0 (AOR = 0.17, 95% CI = 0.03–0.91, P = 0.039).

Conclusion

High levels of overall burnout were reported among Hail University medical students. Students with a higher GPA, however, were found to be less prone to burnout.

Burnout syndrome and resilience in medical students from a Brazilian public college in Salvador, Brazil

INTRODUCTION

Burnout syndrome is highly prevalent among medical students. Whereas burnout syndrome has been associated with negative outcomes, like suicidal ideation, protective factors are still unknown.

OBJECTIVE

To evaluate if there is an association between burnout syndrome and resilience in medical students, assessing covariates such as depressive symptoms, suicidal ideation, and religiosity.

METHOD

This cross-sectional study was carried out with a sample of 209 students from a medical school in Brazil. Burnout syndrome was assessed using the Maslach Burnout Inventory - Student Survey. Potential protective factors and aggravators to burnout syndrome were investigated using appropriate scales.

RESULTS

Fifty-nine students (28.2%) presented burnout. Multivariate analysis showed that resilience was a protective factor (p < 0.001), along with being older, married or having better academic performance. Depressive symptoms were positively associated with burnout. Religiosity was not a protective factor and suicidal ideation was not associated with burnout when adjusted for depressive symptoms.

CONCLUSION

Burnout is frequent among medical students, impacting mental health and academic performance. Resilience seems to be a protective factor, and the relationship between burnout and suicidal ideation is possibly mediated by depressive symptoms. Prospective studies are needed to further investigate the associations found in this study.

A journey through roses and thorns: becoming a physician by learning from patients with life-threatening illnesses. A qualitative study with international medical students

The medical students' well-being may be threatened by various stressors associated with providing care to different kinds of patients. This study aims to explore students' clinical experiences with patients who suffer from life-threatening illnesses, focusing on potential risk and protective factors. Audio-recorded and face-to-face interviews were conducted and transcribed verbatim. The "Interpretive Description" approach was used to analyse data. Overall, ten medical students with a mean age of 28 years old were interviewed. Well-being promoting factors were the following: therapeutic relationships, work-life balance, social support and communication, perception of improvement in knowledge and availability of advanced directives. Whilst factors that may reduce well-being included death exposure, managing emotions, communication difficulties, internal conflicts and disagreements, lack of knowledge and subjective concerns. These findings shed light on facets that are inherent parts of clinical experience with patients suffering from a life-threatening illness and that may turn in risk or protective factors for the medical students. Understanding the students' subjective experiences may aid in the improvement of the current educational programs, as well as in the development of tailored supportive and preventative interventions to promote well-being and professional competencies among this kind of students.

Psychological Capital Mediates the Relationship Between Problematic Smartphone Use and Learning Burnout in Chinese Medical Undergraduates and Postgraduates: A Cross-Sectional Study

Learning burnout is a pressing issue among Chinese medical undergraduates and Postgraduates and has drawn continuous attention worldwide. Studies have found that problematic smartphone use could affect learning burnout, but more research is needed in this direction. Furthermore, few studies focused on the mediating effect of psychological capital on the relationship between problematic smartphone use and learning burnout. The present study was a cross-sectional survey that recruited 1,800 participants from a medical university in Chongqing, China. A questionnaire based on the Mobile Phone Addiction Tendency Scale, Psychological Capital Questionnaire, Learning Burnout Scale, and demographic variables were administered to these students, and 1,475 provided valid responses (81.94%). 771 were undergraduates (52.3%) and 704 were postgraduates (47.7%). Hierarchical regression and the bootstrap method were used to examine the mediating effect of psychological capital. After controlling for demographic variables, problematic smartphone use positively predicted learning burnout in undergraduates (β = 0.328, p < 0.01) and in postgraduates (β = 0.342, p < 0.01). The partial mediating effect of psychological capital was 0.068 in undergraduates and 0.074 in postgraduates, accounting for 20.67 and 21.64%, respectively, of the total effect of problematic smartphone use on learning burnout. All the 95% confidence intervals (CI) did not contain 0. Problematic smartphone use can directly predict learning burnout and their relationship was mediated by psychological capital in Chinese medical undergraduates and postgraduates. Strategies to alleviating problematic smartphone use and enhance psychological capital in medical undergraduates and postgraduates may provide useful suggestions for future interventions on dealing with learning burnout in Chinese medical undergraduates and postgraduates.

Psycho-organizational and medical factors in burnout in French medical and surgery residents

Hospital residency is stressful, with a risk of burnout. To assess the prevalence of burnout in medical and surgical residents and identify psycho-organizational and medical risk factors with a view to prevention. A transverse study was conducted in France between September 2018 and November 2018, targeting 633 hospital residents. A self-administered questionnaire was delivered by e-mail. Burnout was assessed on the Maslach Burnout Inventory, anxiety/depression on the Hospital Anxiety and Depression Scale (HAD) and stress on a visual analogue scale (VAS). Two-hundred and sixteen of the targeted residents (34%) responded. Twenty-three (12%) showed severe burnout in all three dimensions, severe loss of empathy being the most frequent. Almost one-third showed symptoms of anxiety. Residents exposed to psycho-organizational constraints (stress, time pressure, intense work rhythm) and/or with symptoms of anxiety/depression more frequently showed burnout. Prevention of burnout requires reinforced medical monitoring and reduced psycho-organizational constraints.

Student burnout and engagement: Relationship with adolescent use of alcohol and attitudes towards authority

The burnout syndrome has been related to development of transgressive attitudes toward norms that facilitate risk behaviors in youth, such as drinking alcohol. On the contrary, academic engagement is related to positive attitudes toward authority which can slow down its use. The objective was analyze the relationships between burnout and academic engagement, attitudes toward authority and use of alcohol. Method: The sample included a total of 1,287 high school students who anonymously filled out the Maslach Burnout Inventory-Student Survey, the Utrecht Work Engagement Scale for Students and the Scale of Attitudes toward Institutional Authority in adolescents, along with questions on drinking alcohol. Results: It was observed that cynicism had a significant effect on positive attitude toward rule-breaking, and this in turn, on frequency of drinking. The engagement dedication factor was shown to have a significant direct effect on positive attitude toward institutional authority, and this on drinking frequency. Conclusions: Promoting measures for decreasing burnout in youth and stimulating academic engagement could have repercussions on attitudes toward rules and the presence of risk behavior.

Stress and burnout in chiropractic students of European chiropractic colleges

OBJECTIVE

High levels of stress and burnout are known to negatively impact academic success, quality of life, and well-being of students. The purpose of this study was to investigate the degrees of stress and burnout levels of students from several European chiropractic colleges.

METHODS

Stress and burnout were assessed using the Perceived Stress Scale (PSS-10) and the Maslach Burnout Inventory-Student Survey (MBI-SS). Surveys were delivered electronically in November 2017 to chiropractic students from 4 different chiropractic colleges. Data were analyzed using t test and 1-way ANOVA to determine differences between demographic data. Scores in perceived stress and burnout subscales were compared to the general, chiropractic, and medical student populations.

RESULTS

Both the MBI-SS and PSS had similar response rates (30%-34%) and demonstrated statistically significant differences between institutions, with C-3 demonstrating the highest levels of exhaustion (p < .001) and the highest levels of perceived stress (p = .012). MBI-SS results show that in the general chiropractic student population, 26.4% presented high emotional exhaustion, 18.2% high cynicism, and 43.8% low academic efficacy. Meanwhile, the PSS score indicated "moderate" levels of stress.

CONCLUSIONS

European chiropractic students experience higher levels of perceived stress than the general population and they may suffer levels of burnout similar to those of medical students. These results suggest that colleges should monitor stress and burnout levels in their students. This may help to establish student support systems in order to improve students' quality of life and academic performance, as well as help new graduates transition to their professional lives.

Burnout and Associated Factors Among Medical Students in a Public University in Uganda: A Cross-Sectional Study

BACKGROUND

Burnout is a well-recognized phenomenon that may manifest with feelings of stress, fatigue, or exhaustion. It is a common and emerging problem among healthcare workers. Medical students may be at increased risk of burnout given the rigorous nature of their training. However, there is a paucity of data on the burden of burnout among medical students in Africa.

AIM

This study aimed to determine the prevalence of burnout, as assessed using the Maslach Burnout Inventory - Student Survey (MBI-SS) as well as factors associated with the development of burnout among students pursuing Bachelor of Medicine and Bachelor of Surgery (MBChB) degrees at Mbarara University of Science and Technology (MUST), Uganda.

METHODS

A single-centre, cross-sectional, online survey was conducted among MBChB students of MUST. Burnout was assessed using the Maslach Burnout Inventory - Student Survey (MBI-SS) tool. Bivariate analysis and backward stepwise logistic regression analysis were performed to assess possible associations between variables related to participants' demography, socioeconomic, personal, learning environment, outside school environment aspects and burnout prevalence scores.

RESULTS

A total of 145 medical students, 102 (70.3%) male, with a median (range) age of 23 (18-40) years were studied. A total of 135 students (93.1%) presented with high levels of emotional exhaustion, 90 (62.1%) students had low levels of professional efficacy scores and 141 (97.2%) of the medical students had high levels of cynicism. Overall, 79 (54.5%) students had burnout, as defined by the MBI-SS tool. Choosing MBChB willingly appears to be an independent predictor of burnout (Adjusted odds ratio: 7.2; 95% CI: 1.4-36.9; p=0.018).

CONCLUSION

More than one-half of medical students questioned at MUST do experience a degree of burnout. Preventative and interventional measures should be considered in the development of the medical curriculum.

Risk Factors of Burnout among Egyptian Medical Students: A Cross-sectional Study

Background:

Burnout is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. It was initially investigated among employees and restricted to those who work in human services and educational institutions. However, this study aimed to evaluate the prevalence and associated risk factors of burnout among Egyptian medical students in Damietta Faculty of Medicine, Al-Azhar University.

Methods :

This cross-sectional study was conducted between December 2017 and March 2018, involved first to sixth-year medical students. The questioner consisted of four sections: 1) Sociodemographics and personal characteristics of participants such as age, gender, and academic year; 2) Burnout measurement: Burnout was measured by MBI-SS, a modified form of MBI-GS; 3) Related risk factors; 4) association between burnout and performance.

Results:

Out of 322 students, 222 students completed the questionnaire with a 67% response rate. The mean age was 21.1 ± 1.9, and 197 (88.7%) students were males. Our analysis demonstrated that the prevalence of burnout was 51.8%. In terms of subscales, 198 participants have high emotional exhaustion, 201 showed a high degree of depersonalization, and 110 participants have personal accomplishment. There was a significant difference between both groups in terms of gender (p=0.01) and marital status (p=0.005). Regression analysis demonstrated that high-risk factors related to studying burden, social burden, and future burden are associated with a higher risk of burnout with odd ratio (OR= 1.10, 95% CI (1.05-1.155), p<0.05), (OR= 1.05, 95% CI (1.01-1.09), p<0.05), and (OR= 1.15, 95% CI (1.05-1.26), p<0.05), respectively.

Conclusion:

This study found that the burnout prevalence was 52% with quite a high percentage of emotional exhaustion (EE) and depersonalization (DP), and a low level of personal accomplishment. Moreover, a significant association between gender, grade of medical school, marital status, and risk factors related to the study burden, future burden, and social burden.

Burnout syndrome in speech-language pathologists and audiologists: a review

Speech pathologists and audiologists work with the provision of health care, and as such, are susceptible to burnout syndrome. The objective of this study was to discuss scientific studies of burnout syndrome in speech pathologists and audiologists. A search was conducted across electronic databases using the following keywords: "burnout syndrome" and "speech pathologists/ audiologists." The search retrieved 11 articles addressing burnout in this occupational category. Prevalence estimates of burnout syndrome in speech pathologists varied widely across studies. The scarcity of the literature and high methodological variability prevented a deeper analysis of the topic. Future studies are encouraged to pay closer attention to occupational stress and mental health in speech pathologists and audiologists in order to provide these professionals with specialized care.

Burnout and its associated factors among medical students of Jazan University, Jazan, Saudi Arabia

Purpose

The purpose of this study is to assess the prevalence of burnout syndrome and its associated factors among medical students at Jazan University, Jazan, Kingdom of Saudi Arabia.

Design/methodology/approach

A cross-sectional survey was conducted among 440 randomly selected medical students at Jazan University. The questionnaire used for this study was based on the Copenhagen Burnout Inventory.

Findings

The overall prevalence of burnout was estimated at 60.2% (95% CI 55.6–64.8). The prevalence was higher for females (64.1%) than for males (56.2%) but without statistically significant differences (p > 0.05). On average, the students scored the highest averages in the personal burnout category, followed by the study-related and client-related burnout categories. In the multivariate analysis, a lower age (beta = −3.17, p = 0.026), female (beta = −0.896, p = 0.016), and having better burnout knowledge (beta = 0.710, p = 0.025) predict significantly higher personal burnout.

Practical implications

It is necessary to implement strategies to reduce the incidence of burnout among medical students for the sake of a better quality of life for future doctors.

Originality/value

There is a high prevalence of burnout among Jazan’s medical students.

Predictors of academic efficacy and dropout intention in university students: Can engagement suppress burnout?

In this study we modelled possible causes and consequences of student burnout and engagement on academic efficacy and dropout intention in university students. Further we asked, can student engagement protect against the effects of burnout? In total 4,061 university students from Portugal, Brazil, Mozambique, the United Kingdom, the United States of America, Finland, Serbia, and Macao SAR, Taiwan participated in this study. With the data collected we analyzed the influence of Social Support, Coping Strategies, and school/course related variables on student engagement and burnout using structural equation modeling. We also analyzed the effect of student engagement, student burnout, and their interaction, on Academic Performance and Dropout Intention. We found that both student engagement and burnout are good predictors of subjective academic performance and dropout intention. However, student burnout suppresses the effect of student engagement on these variables. This result has strong implications for practitioners and administrators. To prevent student dropout, it is not enough to promote student engagement-additionally, and importantly, levels of student burnout must be kept low. Other variables such as social support and coping strategies are also relevant predictors of student engagement and burnout and should be considered when implementing preventive actions, self-help and guided intervention programs for college students.

Stress among university students: the psychometric properties of the Italian version of the SBI-U 9 scale for Academic Burnout in university students

Several authors have highlighted the importance of creating a useful tool to evaluate academic Burnout through the construction and validation of specific scales to evaluate academic Burnout. Based on the literature, the aim of this study is to evaluate in Italian university the psychometric properties of the SBI-U 9 scale for Academic Burnout in university students in Italy developed by Boada-Grau and colleagues. Study 1 (N=609) examined the factor structure of the scale (Male=45.6%, Female=54.4%; Mage= 21.9; SD=2.92). Study 2 (N=412) advanced the previous SBI-U 9 validation by testing its measurement equivalence across gender (Male=48.8%, Female= 51.2%) and different type of course of study (Technical-Mathematical-Scientific=33.5%, Medical- Scientific=32.5%, Scientific-Humanistic=34%) through Multigroup Confirmatory Factor Analysis. Results confirmed a one higher-order factor structure with three first-order factors, the scale was found to be invariant across gender and different type of course of study. The findings advanced the general claim of SBI-U 9 showed an important tool for detecting the academic Burnout in university students in the Italian context, this is confirmed by the good psychometric properties of the scale.

Burnout in medical students

Only a small number of studies have examined the relationship between medical students and burnout syndrome. In Salzburg, Paracelsus Private Medical University (PMU) offers a 5‑year medical program instead of the regular 6 years of medical studies. Due to the tight schedule and heavy workload, the stress level of students is high. The purpose of this study was to determine whether PMU students show burnout symptoms. Three surveys were conducted: at the beginning of the academic year (T1, December 2009), at the end of the academic year (T2, June 2010), and at the beginning of the following academic year (T3, December 2010). For the assessment of burnout, the Maslach Burnout Inventory (emotional exhaustion, depersonalization or cynicism, and low personal accomplishment) was used, as well as the Six Factors Theory of Burnout (workload, control, reward, community, fairness, and values) and for comparison, the Austrian norms developed by Unterholzer. Burnout rate was calculated by a combined measure of the three components. The results show a significant difference from the norm means in emotional exhaustion, depersonalization/cynicism, and low personal accomplishment. With regard to areas of work life, all values are below the means, indicating high workload, high external control, low reward, low feeling of community, and low fairness—except values, i.e., motivation of the students. The mean overall burnout frequency turned out to be 47.8 ± 11.0%, whereas females have slightly higher burnout rates than males. An increasing linear trend with burnout rates was seen from the youngest to the oldest class. In addition, the estimated burnout rate increased within the academic term, as T2 had the highest rate, followed by T3, and the lowest rate was seen in T1. In conclusion, burnout in medical students is frequent and significantly related to heavy workload and other factors of worklife, necessitating changes of academic and organizational settings of medical curricula.

Prevalence of burnout among health sciences students and determination of its associated factors

Burnout is a major issue among healthcare students and a public health issue in general. Indeed, the consequences of student burnout are as complex as other mental distress factors, such as those concerned with smoking and alcohol consumption, or an unhealthy lifestyle.  This study aimed to determine the prevalence of burnout among health sciences students and to determine its associated factors. This is a cross-sectional descriptive study conducted among 368 students of a Tunisian institution using the French validated version of the MBI-SS. The prevalence of burnout was 64.4%. The presence of a diagnosed health problem, a diagnosed mental disorder or sleep problems were associated with burnout. Students who live alone are significantly the most emotionally exhausted (p=0.010) and the most cynical (p=0.033). Students who had a low socio-economic level are significantly more cynical than those who had a medium or high socio-economic level (p=0.032). Performing leisure activities and practicing physical activities were associated with emotional exhaustion (p=0.007, p= 0.008, respectively).In our study, burnout is prevalent among Tunisian health sciences students. Many factors were found to be associated with this syndrome. These findings reinforce the need to establish early preventive strategies to encounter this problem and its consequent risks.

Burnout in medical students of a tertiary care Indian medical center: How much protection does resilience confer?

CONTEXT

Medical profession continues to grapple with burnout; even medical students are not spared of this self-destructive psychological experience. Attempts are being made to control and contain burnout in medical students by the medical fraternity.

AIMS

We intend to study the prevalence and determinants of burnout in medical students in a tertiary medical center and also to study the relationship of resilience with the experience of burnout.

SETTINGS AND DESIGN

This was a cross-sectional anonymous survey method.

MATERIALS AND METHODS

Randomized stratified sampling method was used wherein roll numbers of MBBS students belonging to four different semesters were chosen using randomization software. Based on prevailing prevalence of burnout, sample size calculation was done, and 196 completed questionnaires were included in analysis. The Maslach Burnout Inventory (MBI) and the Resilience Scale for Adults (RSA) were used. Two-dimensional approach toward diagnosing burnout was used.

STATISTICAL ANALYSIS

Association tests were carried out to analyze the association between means, and Spearman's rho was used to assess the correlation of MBI subscales with RSA subscales. We also used binary logistic regression to assess the relationship of burnout with resilience.

RESULTS

The prevalence of burnout was 16.84%, and high scores on depersonalization (DP) subscale were seen in males. Personal accomplishment (PA) scores were lower in the fifth and seventh semesters. A statistically significant correlation was observed between MBI and RSA subscales. Binary regression analysis revealed higher resilience scores were significantly associated with decreased likelihood of burnout in emotional exhaustion (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.93-0.97), DP (OR = 0.95; 95% CI = 0.93-0.98), and PA (OR = 0.91; 95% CI = 0.84-0.98).

CONCLUSIONS

Burnout prevalence in our sample lies at the lower range of global prevalence rates. Resilience is protective from burnout.

Depression, anxiety, and burnout among medical students and residents of a medical school in Nepal: a cross-sectional study

BACKGROUND

Medical students and residents were found to have suffered from depression, anxiety, and burnout in various studies. However, these entities have not been adequately explored in the context of Nepal. We proposed to determine the prevalence of depression, anxiety, burnout, their associated factors, and identify their predictors in a sample of medical students and residents in a Nepalese medical school.

METHODS

It was a cross-sectional study with 651 medical students and residents chosen at random between December 2018 and February 2019. The validated Nepali version of Hospital Anxiety and Depression Scale, the Copenhagen Burnout Inventory, and Medical Students' Stressor Questionnaire were used to assess depression, anxiety, burnout, and stressors respectively. We used univariate and multivariable logistic regression analyses to identify the correlation of predictor variables with depression, anxiety, and burnout.

RESULTS

The overall prevalence of burnout (48.8%; 95% CI 44.9-52.7) and anxiety (45.3%; 95% CI 41.4-49.2) was more than that of depression (31%; 95% CI 27.5-34.7). Burnout and depression were more prevalent in residents than in medical students (burnout: 64.5% vs 37.6%, P-value < 0.0001; depression: 33.7% vs 29.1%, P-value 0.21). Whereas, medical students were found more anxious than residents (46.3% versus 43.96%, P-value 0.55). Academic related stressors caused high-grade stress to participants. Multivariable model for depression significantly showed anxiety, personal burnout, and work-related burnout as risk enhancing correlates; satisfaction with academic performance as a protective correlate. Similarly, the multivariate model for anxiety significantly identified female gender, depression, personal burnout, teaching and learning related stressors, and past history of mental illness as risk enhancing correlates; being satisfied with academic performance, getting adequate sleep, and being a second-year resident as protective correlates. The logistic model for burnout significantly showed being a first-year resident, depression, anxiety, and drive and desire related stressors as positive predictors. None of the variables were identified as significant negative predictors of burnout.

CONCLUSIONS

A high prevalence of depression, anxiety, and burnout was seen among medical students and residents. Most of them were stressed with academic-related factors. A strong correlation between teaching and learning-related stressors with depression and anxiety may be a call for an efficient and more student-friendly curriculum.

Prevalence of Burnout Syndrome Among Students of Health Care Colleges and its Correlation to Musculoskeletal Disorders in Saudi Arabia

Background

Burnout is a chronic stress-related syndrome with the three dimensions of exhaustion, cynicism, and inefficacy. Musculoskeletal disorders (MSDs) are defined as a musculoskeletal strain reported by an individual. Burnout is prevalent among Saudi medical students. Many studies have found that burnout is associated with a higher prevalence of MSDs. To the best of our knowledge, there is no study that has assessed the prevalence of burnout among students of health care colleges in Saudi Arabia and its correlation to MSDs and compared the results of each health care college to the other. Hence, this is the aim of this study.

Methods

A cross-sectional study of 392 students of health care colleges in Taif University was carried out from April 2019 to May 2019, using a predesigned questionnaire, including sociodemographic characteristics, the Copenhagen Burnout Inventory (CBI) Questionnaire to assess the degree of burnout, and Standardized Nordic Questionnaires for the analysis of musculoskeletal symptoms.

Results

48.7% of the students of health care colleges had burnout and 64.8% of them had MSDs. We did not detect a statistically significant association between burnout prevalence and sociodemographic characteristics. There was a significant association between burnout and the MSDs, as 34.2% of the students with a high degree of burnout had MSDs.

Conclusions

Burnout, as well as MSDs, are prevalent among students of health care colleges. Burnout seems to be a risk factor for MSDs. Social media campaigns and awareness campaigns about burnout should be promoted.

Burnout Prevalence and Associated Stressors in Medical Students of Traditional and Problem-Based Learning Curricula in a Saudi University

BACKGROUND

Medical students are prone to burnout, and several stressors have been associated with it. From the literature, it is yet unclear if type of curricula in medical schools plays a role in burnout among students.

AIMS

To assess the prevalence of burnout and its associated stressors in medical students in problem-based learning and traditional curricula at Imam Abdulrahman Bin Faisal University.

SUBJECTS AND METHODS

The analytical, cross-sectional study was conducted between February and May 2017 and included all third- to sixth-year medical students of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. In the 2016-2017 academic year, third- and fourth-year students were in problem-based learning, whereas fifth- and sixth-year students were in traditional learning. All eligible students were verbally invited to complete a 56-item questionnaire comprising three sections eliciting sociodemographic information, level of burnout (using a modified Copenhagen Burnout Inventory with personal, medical school- and faculty-related subsections) and stressors associated with burnout. Burnout was measured using a Likert-type scale, and scores of >50 were considered as high burnout. Chi-square and logistic regression analysis were used for statistical analysis.

RESULTS

Of 947 eligible students, 593 (62.6%) completed the questionnaire: 317 (53.5%) were in problem-based learning and 276 (46.5%) in traditional learning. Of these, 329 (55.5%) had high burnout, with no difference between type of curricula (problem-based learning = 178 [56.2%]; traditional = 151 [54.7%]; P = 0.73). All measured stressors were significantly associated with high burnout, including lack of sleep (odds ratio [OR] = 2.139, P = 0.005) and perceiving teaching staff as inflexible and unsupportive (OR = 2.995, P < 0.001).

CONCLUSIONS

This study found high prevalence of burnout among medical students in a university from Saudi Arabia, but no significant difference between students in problem-based learning and traditional curricula. A longitudinal study is recommended to better understand the long-term effect of type of curricula on burnout.

Burnout syndrome, extracurricular activities and social support among Brazilian internship medical students: a cross-sectional analysis

BACKGROUND

Burnout syndrome (BS) is highly prevalent among medical students and is associated with lower empathy and worsening of medical students ́ mental health. The aim of our study was to identify prevalence of BS during internship and its association with self-rated social support and participation in extracurricular activities in one medical school in Brazil.

METHODS

This was a cross-sectional study conducted in 2015, with 121 medical students on internship (56% response rate). They were evaluated using the Maslach Burnout Inventory - Human Services (MBI) and assessed about socio demographic data, social support and extracurricular activities.

RESULTS

The overall BS prevalence was 57.5% among medical interns. High emotional exhaustion was present in 33.1% (N = 38) of interns, high depersonalization was observed in 45.7% (N = 58) and 36.2% of participants (N = 46) had low personal accomplishment. Individuals with participation in community services had lower frequency of depersonalization (prevalence ratio 0.61 CI95% 0.42-0.88). BS was not associated with different types of extracurricular activities and no association was found among BS and the behaviour of seeking social support.

CONCLUSIONS

We found high prevalence of BS in medical interns, however the behaviour of seeking social support had no association with BS. The interns participating in community activities had lower frequency of high depersonalization.

Prevalence and Correlates of Burnout among Undergraduate Medical Students - A Cross-sectional Survey

BACKGROUND

Burnout among medical students is important for its prevalence, consequences, and modifiable risk factors. Although there are studies on the topic across the globe, Indian studies are few in number. A prevalence estimate of burnout and its determinants among Indian medical graduates will keep us informed about the emotional and motivational factors hindering their professional growth.

METHODS

From a total of 500 students spanning 5 professional years, data could be collected from 375 students. The study used a questionnaire primarily consisting of "personal burnout" domain of the Copenhagen Burnout Inventory (CBI), which is a validated instrument to assess the burnout at a cutoff score of 50. The questionnaire also included a set of potential personal correlates of burnout. In addition to summary statistics, both univariate and multivariate analyses were used for discerning the relationship of these correlates with burnout.

RESULTS

The prevalence of burnout among medical students in the college under study was 48.5% (95% confidence interval 43.4-53.7). The proportions of moderate, higher, and severe burnout were 44.8%, 3.2%, and 0.5% respectively. Univariate and multivariate analyses revealed that female gender and perceived stress were associated with burnout. Choosing medicine by one's own choice and maintaining hobbies and interests were associated with less chance for burnout.

CONCLUSION

Burnout is a prevalent phenomenon among medical students. There are modifiable risk factors for burnout and addressing them will help in training a medical student with high motivation and professionalism.

Stress, Burnout, and Associated Risk Factors in Medical Students

Objectives

To determine the prevalence of and the risk factors associated with burnout and stress for medical students in Saudi Arabia.

Methods

A cross-sectional, survey-based study was distributed between January and February 2018 among all 500 medical students from the first to fifth years in a medical college; 356 of the students responded (71.2% response rate). Burnout was measured using the Maslach Burnout Inventory-Student Survey (MBI-SS) while the stress level was measured using the 12-item General Health Questionnaire (GHQ-12). Socio-demographics, professional characteristics, and participation in extracurricular activities were also included as possible predictors of burnout and stress.

Results

The study revealed that the stress level was (51.7%, n= 184) and the rate of high burnout was (38.2%, n= 136), expressing high exhaustion (77.8%, n=277), high cynicism (65.7%, n=234), and low academic efficiency (45.5%, n=162). Half of the students (50%, n=178) participated in extracurricular activities and were involved in one or more activities such as organizing activities and medical volunteering (n = 52, 14.6%), research (n = 59, 16.6%), and physical exercise (n = 71, 10.4%). There was a statistically significant positive correlation between overall burnout and a lower grade point average (GPA) (OR = 0.581, p 0.004, 95% CI = 0.400 to 0.843). A statistically significant positive correlation was found between stress and students with a lower GPA (OR = 0.737, P = 0.0.23, 95% CI = 0.566 to 0.959); stress was also higher in students who were not involved in any extracurricular activities (OR 1.893, P = 0.004, 95% CI = 1.22 to 2.918).

Conclusion

Our study shows high burnout rates among medical students. Low GPA students in this study showed a higher overall burnout. Stress was high in our study participants and was higher in students with a low GPA and in students who were not involved in any extracurricular activities.

Burnout Syndrome in medical internship students and its prevention with Balint Group

BACKGROUND

We intend to estimate the Burnout Syndrome prevalence and its associated factors among medical internship students at a public university in northeastern Brasil, besides investigating the Balint Group (BG) contribution in its prevention.

METHODS

We conducted a cross-sectional study in February/2018 with Medical Internship Students at the University researched. We applied a structured questionnaire developed by the authors about socio-demographic data, educational process with BG participation, and current psycho-emotional experiences, in addition to the Maslach Burnout Inventory - Student Survey (MBI-SS), for Burnout Syndrome screening. We performed descriptive data analysis, logistic regression, and cluster analysis.

RESULTS

A total of 184 students (98%) participated in the study, with a mean age of 25.9±3.9 years, of which 54.9% were men. The prevalence of Burnout Syndrome was 10.3% based on the three-dimensional criterion and 35.9% on two-dimensional criterion (Exhaustion and Cynicism); it was higher in those who thought about quitting the program (OR=2.14), were dissatisfied with the teaching strategies (OR=2.67) and their performance (OR=2.64) and made use of licit drugs (OR=2.37). The variables associated with Burnout Syndrome allowed individuals to be discriminated, classifying them into three subgroups. Burnout Syndrome prevalence decreased, and vulnerability factors were attenuated when there was a higher frequency of students participating in BG.

CONCLUSIONS

The prevalence of two-dimensional Burnout Syndrome was high, with factors associated with the educational process. Participation in BG was associated with a lower Burnout rate prevalence. Longitudinal studies should be conducted.

Prevalence and associated factors of burnout among Debre Berhan University medical students: a cross-sectional study

BACKGROUND

Burnout, a measure of professional distress, is more common among medical professionals. About half of medical students have this problem. However, little is known about the burnout status of medical students in Ethiopia. Therefore, the aim of this study was to assess the prevalence and associated factors of burnout among medical students of Debre Berhan University (DBU).

METHODS

A cross-sectional study was conducted on randomly selected 151 medical students of DBU. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Participants were reported as having burnout if they scored ≥27 on Emotional Exhaustion (EE), ≥13 on Depersonalization (DP) sub-scales, and ≤ 31 on Personal Accomplishment (PA) sub-scale of the MBI-HSS. EpiData version 3.1 was used for data entry while SPSS version 20 and STATA version 13 for windows were used for data analysis. Both univariable and multivariable binary logistic regression analyses were conducted. The degree of association between variables was assessed using odds ratio (OR) with 95% confidence interval (CI) at two-tailed p-value of < 0.05.

RESULT

Of 144 medical students took part, 34.0% had symptoms of burnout. Regarding domains of burnout, 61.8% scored high on EE, 47.9% scored high on DP and 59.7% scored low on PA. Dissatisfaction with practice lecturer (AOR = 3.8, 95% CI (1.3, 11.6)), moderate social support (AOR = 0.2, 95% CI (0.1, 0.8)), and satisfaction with their education (AOR = 0.1 95% CI (0.0, 0.7)) were associated with burnout.

CONCLUSION

More than one-third of medical students at DBU had burnout. Individual and organizational level interventions targeting students who had poor social support, dissatisfied by their lecturer at the hospitals and their education are recommended.

Academic burnout as an educational complication and promotion barrier among undergraduate students: A cross-sectional study

BACKGROUND

Academic burnout is a worldwide problem that troubles students at all academic levels. Despite the significant effects of this problem on students' mental health and academic achievements, yet, it has not been adequately studied in Iranian system of academic education. Therefore, we aimed to explore the incidence of academic burnout status and its associated factors among the students at Guilan University of Medical Sciences.

SUBJECTS AND METHODS

This cross-sectional study was conducted over a number of 303 students at Guilan University of Medical Sciences during 2016. Study samples were selected through the stratified random sampling method, and a set of data including sociodemographic information, educational status, study habits, and burnout inventory status was collected for each sample. Items of burnout inventory status were based on the Maslach Burnout Inventory. Data were analyzed using descriptive and inferential statistics including t-test and linear regression.

RESULTS

The students in our study reported a mean of 2.53 ± 0.7 for academic burnout score. Along with related factors of academic burnout, marital status (P = 0.029), grade point average (P = 0.002), being interested in field of study (P = 0.000), and study time (P = 0.000) were significantly associated with academic burnout of students. Furthermore, the incidence of academic burnout did not differ between male and female students.

CONCLUSIONS

Regarding the considerable prevalence of academic burnout among students of medical sciences, it is needed that policymakers implement more effective educational programs considering the associated factors of academic burnout.

Sex Differences in the Relationship between Student School Burnout and Problematic Internet Use among Adolescents

BACKGROUND

The Internet has many positive sides, but it can also have a negative impact on human emotional-cognitive and behavioral functioning, especially during adolescence. To the most common consequences, the authors add addiction of the teenager to the Internet. This addiction is related to many negative physical and mental problems, including depression, substance abuse and social isolation.

METHODS

In the study, SSBS (Student School Burnout Scale) was used to measure the level of burnout, and the level of Internet addiction was measured using PUI (Internet Addiction Test). The research was carried out among 230 individuals aged 17-20 years.

RESULTS

The results of the research showed that higher level of school burnout is related to higher Internet addiction indicators, and connection was stronger in the male group. Gender significantly predicted Internet addiction and moderated the link between school burnout and Internet addiction. Hierarchical multiple regression analyses confirmed different predictors of Internet addiction for male and female students. However, for both groups, higher burnout due to parents was a significant predictor of Internet addiction (IA).

DISCUSSION

Internet addiction was predicted by school burnout, appearing as a result of parental pressure for high school achievements. In addition, school burnout and school-related characteristics have greater prediction power of Internet addiction and its indicators in a male group.