Burnout and predictive factors among medical students: a cross-sectional survey.
Burnout
Medical education
Medicine
Mental health
Survey
Journal
BMC medical education
ISSN: 1472-6920
Titre abrégé: BMC Med Educ
Pays: England
ID NLM: 101088679
Informations de publication
Date de publication:
29 Jul 2024
29 Jul 2024
Historique:
received:
26
01
2024
accepted:
17
07
2024
medline:
30
7
2024
pubmed:
30
7
2024
entrez:
29
7
2024
Statut:
epublish
Résumé
Burnout is a growing problem in medical education, and is usually characterised by three dimensions: emotional exhaustion, cynicism, and reduced professional efficacy. Currently, the majority of burnout studies have been conducted in western high-income countries, overshadowing findings from low- and middle-income countries. Our objective is to investigate burnout and its associated predictive factors in Morocco, aiming to guide intervention strategies, while also assessing differences between the preclinical and clinical years. A cross-sectional, self-administered online survey assessing burnout dimensions and its main determinants was distributed among medical students at Université Mohammed VI des Sciences et de la Santé (UM6SS, Casablanca, Morocco). Descriptive analyses involved computing mean scores, standard deviations and Pearson correlations. Further, t-tests were performed to check for significant differences in burnout dimensions across the preclinical and clinical learning phase, and stepwise linear regression analyses were conducted using a backward elimination method to estimate the effects of the selected variables on the three burnout dimensions. A t-test assessing the difference in cynicism found a significant difference between students at the preclinical phase and the clinical phase, t(90) = -2.5, p = 0.01. For emotional exhaustion and reduced professional efficacy no significant difference was observed. A linear regression analysis showed that emotional exhaustion was significantly predicted by workload, work-home conflict, social support from peers and neuroticism. Cynicism was predicted by the learning phase, workload, meaningfulness and neuroticism; and reduced professional efficacy by neuroticism only. Our findings suggest a potential gradual increase in cynicism during medical education in Morocco. Conducting this study in a low- and middle income country has enhanced the scientific understanding of burnout in these regions. Given the identified predictive factors for burnout, such as workload, work-home conflict, support from peers, neuroticism, and meaningfulness, it is necessary to focus on these elements when developing burnout interventions.
Sections du résumé
BACKGROUND
BACKGROUND
Burnout is a growing problem in medical education, and is usually characterised by three dimensions: emotional exhaustion, cynicism, and reduced professional efficacy. Currently, the majority of burnout studies have been conducted in western high-income countries, overshadowing findings from low- and middle-income countries. Our objective is to investigate burnout and its associated predictive factors in Morocco, aiming to guide intervention strategies, while also assessing differences between the preclinical and clinical years.
METHODS
METHODS
A cross-sectional, self-administered online survey assessing burnout dimensions and its main determinants was distributed among medical students at Université Mohammed VI des Sciences et de la Santé (UM6SS, Casablanca, Morocco). Descriptive analyses involved computing mean scores, standard deviations and Pearson correlations. Further, t-tests were performed to check for significant differences in burnout dimensions across the preclinical and clinical learning phase, and stepwise linear regression analyses were conducted using a backward elimination method to estimate the effects of the selected variables on the three burnout dimensions.
RESULTS
RESULTS
A t-test assessing the difference in cynicism found a significant difference between students at the preclinical phase and the clinical phase, t(90) = -2.5, p = 0.01. For emotional exhaustion and reduced professional efficacy no significant difference was observed. A linear regression analysis showed that emotional exhaustion was significantly predicted by workload, work-home conflict, social support from peers and neuroticism. Cynicism was predicted by the learning phase, workload, meaningfulness and neuroticism; and reduced professional efficacy by neuroticism only.
CONCLUSIONS
CONCLUSIONS
Our findings suggest a potential gradual increase in cynicism during medical education in Morocco. Conducting this study in a low- and middle income country has enhanced the scientific understanding of burnout in these regions. Given the identified predictive factors for burnout, such as workload, work-home conflict, support from peers, neuroticism, and meaningfulness, it is necessary to focus on these elements when developing burnout interventions.
Identifiants
pubmed: 39075396
doi: 10.1186/s12909-024-05792-6
pii: 10.1186/s12909-024-05792-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
812Informations de copyright
© 2024. The Author(s).
Références
Abreu Alves S, Sinval J, Lucas Neto L, Marôco J, Gonçalves Ferreira A, Oliveira P. Burnout and dropout intention in medical students: the protective role of academic engagement. BMC Med Educ. 2022;22(1):1–11. https://doi.org/10.1186/s12909-021-03094-9 .
doi: 10.1186/s12909-021-03094-9
Al-Alawi AI, Alkhodari HJ. Cross-cultural Differences in Managing Businesses: Applying Hofstede Cultural Analysis in Germany, Canada, South Korea and Morocco. Elixir Int Bus Manage. 2016;95(June):40855–61.
Almutairi H, Alsubaiei A, Abduljawad S, Alshatti A, Fekih-Romdhane F, Husni M, Jahrami H. Prevalence of burnout in medical students: A systematic review and meta-analysis. Int J Soc Psychiatry. 2022. https://doi.org/10.1177/00207640221106691 .
doi: 10.1177/00207640221106691
Angelini G. Big five model personality traits and job burnout: a systematic literature review. BMC Psychol. 2023;11(1). https://doi.org/10.1186/s40359-023-01056-y .
Bakker AB, Demerouti E. The Job Demands-Resources model: State of the art. J Manag Psychol. 2007;22(3):309–28. https://doi.org/10.1108/02683940710733115 .
doi: 10.1108/02683940710733115
Bakker AB, Demerouti E. Towards a model of work engagement. Career Dev Int. 2008;13(3):209–23. https://doi.org/10.1108/13620430810870476 .
doi: 10.1108/13620430810870476
Bang H, Reio TG. Examining the role of cynicism in the relationships between burnout and employee behavior. Revista de Psicologia Del Trabajo y de Las Organizaciones. 2017;33(3):217–27. https://doi.org/10.1016/j.rpto.2017.07.002 .
doi: 10.1016/j.rpto.2017.07.002
Belayachi J, Rkain I, Rkain H, Madani N, Amlaiky F, Zekraoui A, Dendane T, Abidi K, Zeggwagh AA, Abouqal R. Burnout syndrome in Moroccan Training Residents: Impact on Quality of Life. Iran J Public Health. 2016;45(2):260–1.
Bianchi R. Burnout is more strongly linked to neuroticism than to work-contextualized factors. Psychiatry Res. 2018;270(May):901–5. https://doi.org/10.1016/j.psychres.2018.11.015 .
doi: 10.1016/j.psychres.2018.11.015
Brazeau CMLR, Shanafelt T, Durning SJ, Massie FS, Eacker A, Moutier C, Satele DV, Sloan JA, Dyrbye LN. Distress among matriculating medical students relative to the general population. Acad Med. 2014;89(11):1520–5. https://doi.org/10.1097/ACM.0000000000000482 .
Burgess AM, Frost RO, DiBartolo PM. Development and Validation of the Frost Multidimensional Perfectionism Scale-Brief. J Psychoeduc Assess. 2016;34(7):620–33. https://doi.org/10.1177/0734282916651359 .
doi: 10.1177/0734282916651359
Burr H, Berthelsen H, Moncada S, Nübling M, Dupret E, Demiral Y, Oudyk J, Kristensen TS, Llorens C, Navarro A, Lincke HJ, Bocéréan C, Sahan C, Smith P, Pohrt A. The Third Version of the Copenhagen Psychosocial Questionnaire. Saf Health Work. 2019;10(4):482–503. https://doi.org/10.1016/j.shaw.2019.10.002 .
doi: 10.1016/j.shaw.2019.10.002
Cecil J, McHale C, Hart J, Laidlaw A. Behaviour and burnout in medical students. Med Educ Online. 2014;19:25209. https://doi.org/10.3402/meo.v19.25209 .
doi: 10.3402/meo.v19.25209
Demerouti E, Nachreiner F, Bakker AB, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol. 2001;86(3):499–512. https://doi.org/10.1037/0021-9010.86.3.499 .
doi: 10.1037/0021-9010.86.3.499
Dyrbye LN, Satele D, West CP. Association of Characteristics of the Learning Environment and US Medical Student Burnout, Empathy, and Career Regret. JAMA Netw Open. 2021;1–13. https://doi.org/10.1001/jamanetworkopen.2021.19110 .
Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, Shanafelt TD. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443–51. https://doi.org/10.1097/ACM.0000000000000134 .
doi: 10.1097/ACM.0000000000000134
Elbarazi I, Loney T, Yousef S, Elias A. Prevalence of and factors associated with burnout among health care professionals in Arab countries: A systematic review. BMC Health Serv Res. 2017;17(1):1–10. https://doi.org/10.1186/s12913-017-2319-8 .
doi: 10.1186/s12913-017-2319-8
Erschens R, Keifenheim KE, Herrmann-Werner A, Loda T, Schwille-Kiuntke J, Bugaj TJ, Nikendei C, Huhn D, Zipfel S, Junne F. Professional burnout among medical students: Systematic literature review and meta-analysis. Med Teach. 2019;41(2):172–83. https://doi.org/10.1080/0142159X.2018.1457213 .
doi: 10.1080/0142159X.2018.1457213
Faye-Dumanget C, Carré J, Le Borgne M, Boudoukha PAH. French validation of the Maslach Burnout Inventory-Student Survey (MBI-SS). J Eval Clin Pract. 2017;23(6):1247–51. https://doi.org/10.1111/jep.12771 .
doi: 10.1111/jep.12771
Frajerman A, Morvan Y, Krebs MO, Gorwood P, Chaumette B. Burnout in medical students before residency: A systematic review and meta-analysis. Eur Psychiatry. 2019;55:36–42. https://doi.org/10.1016/j.eurpsy.2018.08.006 .
doi: 10.1016/j.eurpsy.2018.08.006
Hill AP, Curran T. Multidimensional Perfectionism and Burnout: A Meta-Analysis. Pers Soc Psychol Rev. 2016;20(3):269–88. https://doi.org/10.1177/1088868315596286 .
doi: 10.1177/1088868315596286
Jagodics B, Szabó É. Student Burnout in Higher Education: A Demand-Resource Model Approach. Trends Psychol. 2022;0123456789. https://doi.org/10.1007/s43076-021-00137-4 .
Kaggwa MM, Kajjimu J, Sserunkuma J, Najjuka SM, Atim LM, Olum R, Tagg A, Bongomin F. Prevalence of burnout among university students in low- And middle-income countries: a systematic review and meta-analysis. PLoS One. 2021;16(8 August):1–21. https://doi.org/10.1371/journal.pone.0256402 .
doi: 10.1371/journal.pone.0256402
Kapasa RL, Hannoun A, Rachidi S, Ilunga MK, Toirambe SE, Tady C, Diamou MT, Khalis M. Evaluation of burn-out among health professionals working at public health surveillance units COVID-19 in Morocco. Archives Des Maladies Professionnelles et de l’Environnement. 2021;82(5):524–34. https://doi.org/10.1016/j.admp.2021.06.001 .
doi: 10.1016/j.admp.2021.06.001
Keith TZ. Multiple Regression and Beyond. An Introduction to Multiple Regression and Structural Equation Modeling. (2nd Editio). Routlegde; 2014. https://doi.org/10.4324/9781315749099 .
Kilic R, Nasello JA, Melchior V, Triffaux JM. Academic burnout among medical students: respective importance of risk and protective factors. Public Health. 2021;198:187–95. https://doi.org/10.1016/j.puhe.2021.07.025 .
doi: 10.1016/j.puhe.2021.07.025
Lahlou L, Benhamza S, Karim N, Obtel M, Razine R. Stress and Burnout Syndrome Among Moroccan Medical Students: a cross-sectional study. Int J Adv Res. 2021;9(12):610–8. https://doi.org/10.21474/ijar01/13949 .
doi: 10.21474/ijar01/13949
Lesener T, Gusy B, Wolter C. The job demands-resources model: A meta-analytic review of longitudinal studies. Work Stress. 2019;33(1):76–103. https://doi.org/10.1080/02678373.2018.1529065 .
doi: 10.1080/02678373.2018.1529065
Lesener T, Pleiss LS, Gusy B, Wolter C. The study demands-resources framework: An empirical introduction. Int J Environ Res Public Health. 2020;17(14):1–13. https://doi.org/10.3390/ijerph17145183 .
doi: 10.3390/ijerph17145183
Loubir D. Ben, Serhier Z, Diouny S, Battas O, Agoub M, Othmani MB. Prevalence of stress in casablanca medical students: a cross-sectional study. Pan African Med J. 2014;19:1–10. https://doi.org/10.11604/pamj.2014.19.149.4010 .
doi: 10.11604/pamj.2014.19.149.4010
Madigan DJ, Kim LE, Glandorf HL. Interventions to reduce burnout in students: A systematic review and meta-analysis. European J Psychol Educ. 2023;0123456789. https://doi.org/10.1007/s10212-023-00731-3 .
Malach Pines A. Occupational burnout: A cross-cultural Israeli Jewish-Arab perspective and its implications for career counselling. Career Dev Int. 2003;8(2):97–106. https://doi.org/10.1108/13620430310465516 .
doi: 10.1108/13620430310465516
Maneesriwongul W, Dixon JK. Instrument translation process: a methods review. J Adv Nursing. 2004;48(2):175–86. https://doi.org/10.1111/j.1365-2648.2004.03185.x .
doi: 10.1111/j.1365-2648.2004.03185.x
Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 4th ed. Mindgarden Inc; 2018.
Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422.
doi: 10.1146/annurev.psych.52.1.397
Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69–71.
Nteveros A, Kyprianou M, Artemiadis A, Charalampous A, Christoforaki K, Cheilidis S, Germanos O, Bargiotas P, Chatzittofis A, Zis P. Burnout among medical students in Cyprus: a cross-sectional study. PLoS One. 2020;15(11 November):1–10. https://doi.org/10.1371/journal.pone.0241335 .
doi: 10.1371/journal.pone.0241335
Prins DJ, van Vendeloo SN, Brand PLP, Van der Velpen I, de Jong K, van den Heijkant F, Van der Heijden FMMA, Prins JT. The relationship between burnout, personality traits, and medical specialty. A national study among Dutch residents. Med Teacher. 2019;41(5):584–90. https://doi.org/10.1080/0142159X.2018.1514459 .
doi: 10.1080/0142159X.2018.1514459
Prins JT, Gazendam-Donofrio SM, Tubben BJ, Van Der Heijden FMMA, Van De Wiel HBM, Hoekstra-Weebers JEHM. Burnout in medical residents: A review. Med Educ. 2007;41(8):788–800. https://doi.org/10.1111/j.1365-2923.2007.02797.x .
doi: 10.1111/j.1365-2923.2007.02797.x
Qualtrics. Qualtrics (April 2023). 2023. https://www.qualtrics.com .
R Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; 2023.
Rattrie LTB, Kittler MG, Paul KI. Culture, Burnout, and Engagement: A Meta-Analysis on National Cultural Values as Moderators in JD-R Theory. Appl Psychol. 2020;69(1):176–220. https://doi.org/10.1111/apps.12209 .
doi: 10.1111/apps.12209
Robins TG, Roberts RM, Sarris A. The role of student burnout in predicting future burnout: exploring the transition from university to the workplace. High Educ Res Dev. 2018;37(1):115–30. https://doi.org/10.1080/07294360.2017.1344827 .
doi: 10.1080/07294360.2017.1344827
Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, West CP. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General US Working Population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–13. https://doi.org/10.1016/j.mayocp.2015.08.023 .
doi: 10.1016/j.mayocp.2015.08.023
Shanafelt TD, Raymond M, Kosty M, Satele D, Horn L, Pippen J, Chu Q, Chew H, Clark WB, Hanley AE, Sloan J, Gradishar WJ. Satisfaction with work-life balance and the career and retirement plans of US oncologists. J Clin Oncol. 2014;32(11):1127–35. https://doi.org/10.1200/JCO.2013.53.4560 .
doi: 10.1200/JCO.2013.53.4560
Sosnowska J, De Fruyt F, Hofmans J. Relating neuroticism to emotional exhaustion: a dynamic approach to personality. Front Psychol. 2019;10(October). https://doi.org/10.3389/fpsyg.2019.02264 .
Soto CJ, John OP. Short and extra-short forms of the big five inventory–2: The BFI-2-S and BFI-2-XS. J Res Pers. 2017;68:69–81. https://doi.org/10.1016/j.jrp.2017.02.004 .
doi: 10.1016/j.jrp.2017.02.004
The World Bank. Morocco. 2023. https://data.worldbank.org/country/morocco .
Thun-Hohenstein L, Höbinger-Ablasser C, Geyerhofer S, Lampert K, Schreuer M, Fritz C. Burnout in medical students. Neuropsychiatrie. 2021;35(1):17–27. https://doi.org/10.1007/s40211-020-00359-5 .
doi: 10.1007/s40211-020-00359-5
World Health Organization. Global strategy on human resources for health: Workforce 2030. 2016.
Wright T, Mughal F, Babatunde OO, Dikomitis L, Mallen CD, Helliwell T. Burnout among primary health-care professionals in low-and middle-income countries: systematic review and meta-analysis. Bull World Health Organ. 2022;100(6):385-401A. https://doi.org/10.2471/BLT.22.288300 .
doi: 10.2471/BLT.22.288300
Yusoff MSB, Hadie SNH, Yasin MAM. The roles of emotional intelligence, neuroticism, and academic stress on the relationship between psychological distress and burnout in medical students. BMC Med Educ. 2021;21(1):1–10. https://doi.org/10.1186/s12909-021-02733-5 .
doi: 10.1186/s12909-021-02733-5