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

[en] Objectives Prior research has found a high prevalence of academic burnout among medical students (33–55%), and medical education institutions have begun to address the issue. In this research, we hypothesized an increase in academic burnout during medical education, as supported by previous findings. The second purpose was to identify the significant predictors (among perceived stress, empathy, and perceived social support) of academic burnout and determine their respective importance. Study design The study design was a cross-sectional online and anonymous survey. Methods We recruited medical students (N = 342) from four education year-groups (i.e. Bachelor 1 and 3; Master 1 and 3). All participants voluntarily responded to our anonymous study and filled in four questionnaires assessing academic burnout, perceived stress, empathy, and perceived social support. We performed a multivariate analysis of variance on academic burnout and hierarchical regression analyses to determine the respective importance of risk and protective factors of academic burnout. Results We found that two academic burnout domains (i.e. emotional exhaustion and cynicism) significantly changed according to the study year. Cynicism increased as the academic years progressed (F(3,334) = 9.50; P < 0.001), and emotional exhaustion was highest at critical graduation moments during the academic curriculum (i.e. Bachelor 3 and Master 3; F(3,334) = 11.2; P < 0.001). Overall, women presented higher academic burnout traits than men (ᴧ = 0.963; F(3,332) = 4.26; P = 0.006), but univariate analysis revealed that they especially displayed higher emotional exhaustion (F(1,334) = 12.1; P < 0.001). Hierarchical regression analyses showed that perceived stress, cognitive empathy, and perceived social support were significant predictors of academic burnout. We found that perceived stress was a major predictor of academic burnout (from 10% to 28% of the part of variance) in comparison to other factors such as empathy (around 5%) and perceived social support (around 6%). Conclusions We found that emotional exhaustion and cynicism significantly changed over medical education and that women presented greater vulnerability than men for emotional exhaustion. Furthermore, risk and protective factors of academic burnout were identified: (1) perceived stress was a decisive risk factor; (2) paradoxically, cognitive empathy had a double edge nature (the two cognitive empathy domains had opposite effects); and (3) perceived social support was identified as a protective factor. Thus, a novel dimension of this research was to investigate and describe the importance of several predictors of academic burnout. The implications are crucial for education, and several recommendations are discussed to prevent academic burnout.

Disciplines :

Public health, health care sciences & services

Author, co-author :

Kilic, Rana

Nasello, Julian ; Université de Liège - ULiège > RUC

Melchior, Valerie ; Université de Liège - ULiège > Master spéc. psych.

Triffaux, Jean-Marc ; Université de Liège - ULiège > Département des sciences cliniques > Psychologie médicale

Language :

English

Title :

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

Publication date :

01 September 2021

Journal title :

Public Health

ISSN :

0033-3506

eISSN :

1476-5616

Publisher :

Elsevier

Volume :

198

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://doi.org/10.1016/j.puhe.2021.07.025

Available on ORBi :

since 02 September 2021

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Bibliography

Maslach, C., Schaufeli, W.B., Leiter, M.P., Job burnout. Annu Rev Psychol 52 (2001), 397–422, 10.1146/annurev.psych.52.1.397.
Maslach, C., Jackson, S., Leiter, M.P., The Maslach burnout inventory manual. 3rd ed., 1996, CPP, Palo Alto, California.
von Harscher, H., Desmarais, N., Dollinger, R., et al. The impact of empathy on burnout in medical students: new findings. Psychol, Health Med 23 (2018), 295–303, 10.1080/13548506.2017.1374545.
West, C., Dyrbye, L., Erwin, P.J., Shanafelt, T., Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 388 (2016), 2272–2281, 10.1016/s0140-6736(16)31279-x.
Van Bogaert, P., Clarke, S., Roelant, E., et al. Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: a multilevel modeling approach. J Clin Nurs 19 (2010), 1664–1674, 10.1111/j.1365-2702.2009.03128.x.
Hojat, M., Vergare, M., Isenberg, G., et al. Underlying construct of empathy, optimism, and burnout in medical students. Int J Med Educ 6 (2015), 12–16, 10.5116/ijme.54c3.60cd.
Ríos-Risquez, M.I., García-Izquierdo, M., Sabuco-Tebar, E.L., et al. An exploratory study of the relationship between resilience, academic burnout and psychological health in nursing students. Contemp Nurse 52 (2016), 430–439, 10.1080/10376178.2016.1213648.
Goehring, C., Bouvier Gallacchi, M., Künzi, B., et al. Psychosocial and professional characteristics of burnout in Swiss primary care practitioners: a cross-sectional survey. Swiss Med Wkly 135 (2005), 101–108, 10.4414/smw.2005.10841.
Panagopoulou, E., Montgomery, A., Benos, A., Burnout in internal medicine physicians: differences between residents and specialists. Eur J Intern Med 17 (2006), 195–200, 10.1016/j.ejim.2005.11.013.
Goitein, L., Shanafelt, T.D., Wipf, J.E., et al. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med 165 (2005), 2601–2606, 10.1001/archinte.165.22.2601.
Renzi, C., Tabolli, S., Ianni, A., et al. Burnout and job satisfaction comparing healthcare staff of a dermatological hospital and a general hospital. J Eur Acad Dermatol Venereol 19 (2005), 153–157, 10.1111/j.1468-3083.2005.01029.x.
Shanafelt, T.D., Bradley, K.A., Wipf, J.E., et al. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 136 (2002), 358–367, 10.7326/0003-4819-136-5-200203050-00008.
Fahrenkopf, A.M., Sectish, T.C., Barger, L.K., et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ 336 (2008), 488–491, 10.1136/bmj.39469.763218.be.
Frajerman, A., Morvan, Y., Krebs, M.-O., et al. Burnout in medical students before residency: a systematic review and meta-analysis. Eur Psychiatr 55 (2019), 36–42, 10.1016/j.eurpsy.2018.08.006.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., 2013, American Psychiatric Publishing, Washington DSM-5.
World Health Organization. ICD-10: international statistical classification of Diseases and related health problems. 2nd ed., 2004, WHO.
ICD-10-CM Code Z73.0 Occupational burnout. Available from: https://icd.codes/icd10cm/Z730.
Institut national d'assurance maladie-invalidité. Incapacité de travail de longue durée – Statistiques sur les invalides qui souffrent de burn-out et de dépression. 2019, INAMI [Internet] [cited 2019 Dec 16]. Available from: https://www.inami.fgov.be/fr/nouvelles/Pages/statistiques-invalides-burn-out depression.aspx#.XVMpr3s682w.
West, C.P., Dyrbye, L.N., Erwin, P.J., Shanafelt, T.D., Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 388 (2016), 2272–2281, 10.1016/S0140-6736(16)31279-X.
Dyrbye, L.N., Lipscomb, W., Thibault, G., Redesigning the learning environment to promote learner well-being and professional development. Acad Med 95 (2020), 674–678, 10.1097/ACM.0000000000003094.
Dyrbye, L.N., Thomas, M.R., Massie, F.S., et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med 149 (2008), 334–341, 10.7326/0003-4819-149-5-200809020-00008.
Deeb, G.R., Braun, S., Carrico, C., et al. Burnout, depression and suicidal ideation in dental and dental hygiene students. Eur J Dent Educ 22 (2018), e70–e74, 10.1111/eje.12259.
Schaufeli, W.B., Taris, T.W., The conceptualization and measurement of burnout: common ground and worlds apart. Work Stress 19 (2005), 256–262, 10.1080/02678370500385913.
Campos, J.A.D.B., Maroco, J., Adaptação transcultural Portugal-Brasil do Inventário de Burnout de Maslach para estudantes. Rev Saude Publica 46 (2012), 816–824, 10.1590/s0034-89102012000500008.
Schaufeli, W.B., Martínez, I.M., Pinto, A.M., et al. Burnout and engagement in university students. J Cross Cult Psychol 33 (2002), 464–481, 10.1177/0022022102033005003.
West, C.P., Tan, A., Habermann, T., et al. Association of resident fatigue and distress with perceived medical errors. JAMA, 302(1294), 2009, 10.1001/jama.2009.1389.
Dyrbye, L.N., Massie, F.S., Eacker, A., et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA, 304(1173), 2010, 10.1001/jama.2010.1318.
Duru, E., Duru, S., Balkis, M., Analysis of relationships among burnout, academic achievement, and self-regulation. Educ Sci Theor Pract 14 (2014), 1–11, 10.12738/estp.2014.4.2050.
Almeida, G.C., Souza, H.R., Almeida, P.C., et al. The prevalence of burnout syndrome in medical students. Arch Clin Psychiat 43 (2016), 6–10, 10.1590/0101-60830000000072.
Cecil, J., McHale, C., Hart, J., et al. Behaviour and burnout in medical students. Med Educ Online, 25209, 2014, 19, 10.3402/meo.v19.25209.
Jackson, E.R., Shanafelt, T.D., Hasan, O., et al. Burnout and alcohol abuse/dependence among U.S. medical students. Acad Med 91 (2016), 1251–1256, 10.1097/acm.0000000000001138.
Mbanga, C.M., Efie, D.T., Aroke, D., et al. Prevalence and predictors of recreational drug use among medical and nursing students in Cameroon: a cross-sectional analysis. BMC Res Notes 11 (2018), 1–7, 10.1186/s13104-018-3631-z.
Njim, T., Makebe, H., Toukam, L., et al. Burnout syndrome amongst medical students in Cameroon: a cross-sectional analysis of the determinants in preclinical and clinical students. Psychiat J, 2019, 1–7, 10.1155/2019/4157574.
Dyrbye, L.N., Eacker, A., Durning, S.J., et al. The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Acad Med 90 (2015), 961–969, 10.1097/acm.0000000000000655.
Maslach, C., Jackson, S.E., The measurement of experienced burnout. J Organ Behav 2 (1981), 99–113, 10.1002/job.4030020205.
Santen, S.A., Holt, D.B., Kemp, J.D., et al. Burnout in medical students: examining the prevalence and associated factors. South Med J 103 (2010), 758–763, 10.1097/smj.0b013e3181e6d6d4.
Maslach, C., Leiter, M.P., Burnout. Fink, G., (eds.) Stress: concepts, cognition, emotion, and behavior, 2016, Elsevier Academic Press, 351–357, 10.1016/b978-0-12-800951-2.00044-3.
Fares, J., Al Tabosh, H., Saadeddin, Z., et al. Stress, burnout and coping strategies in preclinical medical students. N Am J Med Sci 8 (2016), 75–81, 10.4103/1947-2714.177299.
Lazarus, R.S., Folkman, S., Stress, appraisal, and coping. 1st ed., 1984, Springer Publishing Company, New York.
Dahlin, M., Joneborg, N., Runeson, B., Stress and depression among medical students: a cross-sectional study. Med Educ 39 (2005), 594–604, 10.1111/j.1365-2929.2005.02176.x.
Moerk, K., Klein, D., The development of major depressive episodes during the course of dysthymic and episodic major depressive disorders: a retrospective examination of life events. J Affect Disord 58 (2000), 117–123, 10.1016/s0165-0327(99)00102-0.
Honkalampi, K., Koivumaa-Honkanen, H., Hintikka, J., et al. Do stressful life-events or sociodemographic variables associate with depression and alexithymia among a general population? A 3-year follow-up study. Compr Psychiatr 45 (2004), 254–260, 10.1016/j.comppsych.2004.03.014.
Dyrbye, L.N., West, C.P., Satele, D., et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med 89 (2014), 443–451, 10.1097/acm.0000000000000134.
Talih, F., Warakian, R., Ajaltouni, J., et al. Correlates of depression and burnout among residents in a lebanese academic medical center: a cross-sectional study. Acad Psychiatr 40 (2016), 38–45, 10.1007/s40596-015-0400-3.
Worly, B., Verbeck, N., Walker, C., et al. Burnout, perceived stress, and empathic concern: differences in female and male Millennial medical students. Psychol Health Med 24 (2019), 429–438, 10.1080/13548506.2018.1529329.
Paro, H.B.M.S., Silveira, P.S.P., Perotta, B., et al. Empathy among medical students: is there a relation with quality of life and burnout?. PloS One, 9, 2014, e94133, 10.1371/journal.pone.0094133.
Lapinski, J., Yost, M., Sexton, P., et al. Factors modifying burnout in osteopathic medical students. Acad Psychiatr 40 (2016), 55–62, 10.1007/s40596-015-0375-0.
Galán, F., Sanmartín, A., Polo, J., et al. Burnout risk in medical students in Spain using the Maslach burnout inventory-student survey. Int Arch Occup Environ Health 84 (2011), 453–459, 10.1007/s00420-011-0623-x.
Decety, J., Lamm, C., Human empathy through the lens of social neuroscience. Sci World J 6 (2006), 1146–1163, 10.1100/tsw.2006.221.
Decety, J., The neural pathways, development and functions of empathy. Curr Opin Behav Sci. 3 (2015), 1–6, 10.1016/j.cobeha.2014.12.001.
Hojat, M., Gonnella, J.S., Mangione, S., et al. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ 36 (2002), 522–527, 10.1046/j.1365-2923.2002.01234.x.
Triffaux, J.-M., Tisseron, S., Nasello, J.A., Decline of empathy among medical students: dehumanization or useful coping process?. Encephale 45 (2019), 3–8, 10.1016/j.encep.2018.05.003.
Halpern, J., From detached concern to empathy: humanizing medical practice. 1st ed., 2001, Oxford University Press, Oxford.
Larson, E.B., Yao, X., Clinical empathy as emotional labor in the patient-physician relationship. JAMA 293 (2005), 1100–1106, 10.1001/jama.293.9.1100.
Nasello, J.A., Triffaux, M.-S., Triffaux, J.-M., The intergroup empathy bias among incoming medical students. Med Educ Online, 23(1527625), 2018, 10.1080/10872981.2018.1527625.
Nasello, J.A., Triffaux, J.-M., Focusing: a new challenger for improving the empathy skills of medical students. Compl Ther Med, 53, 2020, 102536, 10.1016/j.ctim.2020.102536.
Lamothe, M., Boujut, E., Zenasni, F., et al. To be or not to be empathic: the combined role of empathic concern and perspective-taking in understanding burnout in general practice. BMC Fam Pract, 2014, 15, 10.1186/1471-2296-15-15.
Hojat, M., Mangione, S., Nasca, T.J., et al. An empirical study of decline in empathy in medical school. Med Educ 38 (2004), 934–941, 10.1111/j.1365-2929.2004.01911.x.
Chen, D., Lew, R., Hershman, W., et al. A cross-sectional measurement of medical student empathy. J Gen Intern Med 22 (2007), 1434–1438, 10.1007/s11606-007-0298-x.
Hojat, M., Vergare, M.J., Maxwell, K., et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med 84 (2009), 1182–1191, 10.1097/acm.0b013e3181b17e55.
Riess, H., Empathy in medicine—a neurobiological perspective. JAMA 304 (2010), 1604–1605, 10.1001/jama.2010.1455.
Nunes, P., Williams, S., Sa, B., et al. A study of empathy decline in students from five health disciplines during their first year of training. Int J Med Educ 2 (2011), 12–17, 10.5116/ijme.4d47.ddb0.
Caron, J., Guay, S., Soutien social et santé mentale: concept, mesures, recherches récentes et implications pour les cliniciens. Sante Ment Quebec 30 (2006), 15–41, 10.7202/012137ar.
Triffaux, J.-M., Nasello, J.A., Luminet, O., Servais, C., Close, M., Quertemont, E., Blavier, A., Relative stability of alexithymia and openness to emotions in one psychiatric day hospital setting. Clin Psychol Psychother 27 (2020), 714–726, 10.1002/cpp.2456.
Wang, J., Mann, F., Lloyd-Evans, B., et al. Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatr, 2018, 18, 10.1186/s12888-018-1736-5.
Bruchon-Schweitzer, M., Psychologie de la santé: Modèles, concepts et méthodes. 2002, Dunod, Paris.
Procidano, M.E., Heller, K., Measures of perceived social support from friends and from family: three validation studies. Am J Community Psychol 11 (1983), 1–24, 10.1007/bf00898416.
Boren, J.P., Co-rumination partially mediates the relationship between social support and emotional exhaustion among graduate students. Commun Quart 61 (2013), 253–267, 10.1080/01463373.2012.751436.
Jacobs, S.R., Dodd, D., Student burnout as a function of personality, social support, and workload. J Coll Student Dev 44 (2003), 291–303, 10.1353/csd.2003.0028.
Faye-Dumanget, C., Carré, J., Le Borgne, M., et al. French validation of the Maslach burnout inventory-student survey (MBI-SS). J Eval Clin Pract 23 (2017), 1247–1251, 10.1111/jep.12771.
Davis, M.H., A multidimensional approach to individual differences in empathy. JSAS Cat Sel Doc Psychol, 10, 1980, 85.
Davis, M.H., Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol 44 (1983), 113–126, 10.1037/0022-3514.44.1.113.
Gilet, A.-L., Mella, N., Studer, J., et al. Assessing dispositional empathy in adults: a French validation of the Interpersonal Reactivity Index (IRI). Can J Behav Sci 45 (2013), 42–48, 10.1037/a0030425.
Zimet, G.D., Dahlem, N.W., Zimet, S.G., et al. The multidimensional scale of perceived social support. J Pers Assess 52 (1988), 30–41, 10.1207/s15327752jpa5201_2.
Denis, A., Callahan, S., Bouvard, M., Evaluation of the French version of the multidimensional scale of perceived social support during the postpartum period. Matern Child Health J 19 (2015), 1245–1251, 10.1007/s10995-014-1630-9.
ReleasedIBM Corp. IBM SPSS statistics for windows. Version 27.0, 2020, IBM Corp, Armonk, NY.
The Jamovi Project. Jamovi, version 1.1.9.0. Computer software. 2019, Jamovi Retrieved from: https://www.jamovi.org.
Dahlin, M., Runeson, B., Burnout and psychiatric morbidity among medical students entering clinical training: a three-year prospective questionnaire and interview-based study. BMC Med Educ, 7, 2007, 10.1186/1472-6920-7-6.
Mion, G., Libert, N., Journois, D., The prevalence of burnout. Intensive Care Med 44 (2018), 1192–1194, 10.1007/s00134-018-5200-2.
Pascoe, M.C., Hetrick, S.E., Parker, G.A., The impact of stress on students in secondary school and higher education. Int J Adolesc Youth 25 (2020), 104–112, 10.1080/02673843.2019.1596823.
Thomas, M.R., Dyrbye, L.N., Huntington, J.L., Lawson, K.L., Novotny, P.J., Sloan, J.A., Shanafelt, T.D., How do distress and well-being relate to medical student empathy? A multicenter study. Soc Gen Intern Med 22 (2007), 177–183, 10.1007/s11606-006-0039-6.
Hicks, M., Hanes, D., Naturopathic medical student empathy and burnout: a preliminary study. Adv Integr Med 6 (2019), 151–158, 10.1016/j.aimed.2018.07.001.
Decety, J., Yang, C.-Y., Cheng, Y., Physicians down-regulate their pain empathy response: an event-related brain potential study. NeuroImage 50 (2010), 1676–1682, 10.1016/j.neuroimage.2010.01.025.
Yang, H.-J., Factors affecting student burnout and academic achievement in multiple enrollment programs in Taiwan's technical-vocational colleges. Int J Educ Dev 24 (2004), 283–301, 10.1016/j.ijedudev.2003.12.001.
Chunming, W.M., Harrison, R., MacIntyre, R., et al. Burnout in medical students: a systematic review of experiences in Chinese medical schools. BMC Med Educ, 2017, 17, 10.1186/s12909-017-1064-3.
Lee, S., Chung, J.E., Park, N., Network environments and well-being: an examination of personal network structure, social capital, and perceived social support. Health Commun 33 (2016), 22–31, 10.1080/10410236.2016.1242032.
Karasek, R., Theorell, T., Healthy work: stress, productivity, and the reconstruction of working life. 1990, Basic Books, New York, NY.
Alarcon, G.M., Edwards, J.M., Menke, L.E., Student burnout and engagement: a test of the conservation of resources theory. J Psychol 145 (2011), 211–227, 10.1080/00223980.2011.555432.
Hammen, C., Kim, E.Y., Eberhart, N.K., Brennan, P.A., Chronic and acute stress and the prediction of major depression in women. Depress Anxiety 26 (2009), 718–723, 10.1002/da.20571.
McGonagle, K.A., Kessler, R.C., Chronic stress, acute stress, and depressive symptoms. Am J Community Psychol 18 (1990), 681–706.
Ritsma, A., Forrest, L., Causes of chronic stress and impact on physician health. Hategan, A., Saperson, K., Harms, S., Waters, H., (eds.) Humanism and resilience in residency training, 2020, Springer Cham, 10.1007/978-3-030-45627-6_8.
Bonvicini, K.A., Perlin, M.J., Bylund, C.L., et al. Impact of communication training on physician expression of empathy in patient encounters. Patient Educ Counsel 75 (2009), 3–10, 10.1016/j.pec.2008.09.007.