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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 8
| Issue : 2 | Page : 81-87 |
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A cross-sectional and comparative study of burnout among medical students of urban government medical college
Hamza Hussain, Sireesha Srinivasa Rao
Department of Psychiatry, Osmania Medical College, Hyderabad, Telangana, India
| Date of Submission | 01-Nov-2022 |
| Date of Decision | 09-Nov-2022 |
| Date of Acceptance | 11-Nov-2022 |
| Date of Web Publication | 16-Dec-2022 |
Correspondence Address:
Dr. Hamza Hussain
11-5-90, Bazaar Ghat, Hyderabad - 500 004, Telangana
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/tjp.tjp_43_22
Background: Burnout syndromes are becoming more prevalent in medical students of late due to multiple reasons that can negatively impact their lives and academic performances.
Aims and Objectives: This study aims to estimate and compare the prevalence of burnout across first- and final-year medical students and assess sociodemographic factors associated with it.
Materials and Methods: A cross-sectional study on 375 students of a government medical college was carried out through an online questionnaire based on the Copenhagen Burnout inventory (personal domain). The data were analyzed using SPSS version 26.
Results: The prevalence of burnout among the first year was 40% and the final year was 54%. Burnout was more prevalent among female gender, and in students who did not have any hobbies or were uncomfortable seeking support from teachers and parents.
Conclusions: To reduce these effects, focus must be on reducing stress, the inclusion of sports, and improving resiliency and the study environment.
Keywords: Burnout, Copenhagen Burnout Inventory, medical students
How to cite this article:
Hussain H, Rao SS. A cross-sectional and comparative study of burnout among medical students of urban government medical college. Telangana J Psychiatry 2022;8:81-7 |
How to cite this URL:
Hussain H, Rao SS. A cross-sectional and comparative study of burnout among medical students of urban government medical college. Telangana J Psychiatry [serial online] 2022 [cited 2023 Jun 5];8:81-7. Available from: https://tjpipstsb.org/text.asp?2022/8/2/81/363977 |
| Introduction | |  |
Depersonalization (i.e., feeling distant from or callous toward patients) and a low sense of personal accomplishment are three characteristics of the phenomenon known as burnout.[1] Herbert Freudenberg first used the term “Burnout” to describe the emotional issues that social workers experience. He asserts that the loss of drive or incentive is the main sign of burnout, particularly when one's commitment to a person or relationship does not yield the intended results.[2] The term “Burnout” is commonly used to describe the effects of extreme stress on those in “helping” professions, such as doctors and nurses, as well as the high standards expected of them.
The fact that medical students experience a great deal of stress while studying medicine is well supported.[3],[4] Academic, social, economic, and personal issues can all be sources of stress. Being a medical student requires significant adjustments in one's personal life, free time, and social commitments, whereas academic stress involves coping with death/suffering and relating to teachers. The overwhelming wealth of knowledge, a demanding workload, financial constraints, personal problems, and examination pressure all serve to increase stress. An individual who was previously dedicated, hardworking, and motivated may become increasingly dissatisfied or disillusioned with different areas of work and life under pressure to perform in medical education.[5]
Evidence suggests that mental illness during medical school may foreshadow future problems with personal suffering or patient care. Burnout among medical students lowers academic performance, has an impact on how doctors care for their patients and lead to suicidal ideation, anxiety, and depression. Medical students do not seek professional assistance for themselves that they would otherwise provide to their patients in similar circumstances.[6]
The findings that medical students' mental health at matriculation is comparable to or even better than that of age-matched college graduates pursuing other careers and that while in medical school, their mental health deteriorates to a level worse than that of the age-matched college graduates, suggest that the reasons of burnout are anchored in the curriculum and learning environment.[7] Many researchers have previously questioned whether the demands of medical education or the inherent disposition of the individual causes the problem to arise. This has remained impossible to distinguish clearly till date.[6],[8],[9] More mental distress results from a higher perception of stress. Burnout though a measure of induced distress, has also been associated with neuroticism and Type A behavior.[10]
Researchers have found burnout as high as 45% in multi-centric studies on medical students.[3] Preclinical training and clinical training are increasingly being integrated into curricula at an early stage of education recently. Although medical students have a more negative attitude toward traditional curricula, there is no evidence that either model attracts more vulnerability.[11] However, the transition from preclinical training to clinical training in traditional curricula has been recognized as crucial to stress.[12] Little is known about the prevalence of mental distress in medical students; some have been extrapolation from the medical fraternity of various hierarchies, most of them have been from questionnaire data or qualitative group interviews, and only a few studies have reported on medical students' burnout; hence, we intend to study the prevalence of burnouts among medical students in Telangana India.
Aims and objectives
Aim
To determine and compare the prevalence of burnout among medical students studying in government medical colleges of Telangana state.
Objectives
- To assess the prevalence of burnout among first- and final-year MBBS students of government medical colleges of Telangana state
- To compare burnout rates between first- and final-year students
- To study the effect of sociodemographic profile and other variables on burnout rates.
| Materials and Methods | | |
A cross-sectional study was conducted on 375 medical students belonging to the first and final years of government medical colleges of Telangana state. Data were collected online through Google forms over a period of 2 months, from February to March 2022. Considering an anticipated prevalence of burnout among medical students as 44.2% as published in a recent meta-analysis[13] and according to the formula, N = Z2P (1 − p)/d2, a convenient sample of 375 medical students out of 700 total medical students belonging to the first and final years of 2020–2021 batch of two government medical colleges in Hyderabad was taken. The response rate was 90% among the first years and 25% among the final years.
Inclusion criteria were all students belonging to either the first or final year of government medical colleges in Telangana and are willing to give consent.
Those who were belonging to other study years or were students of private medical colleges or did not consent for the study were excluded from the study.
A self-administered online questionnaire was developed using Google Forms and was distributed as a link to student representatives who shared it with their respective batches through WhatsApp groups which were already formed for each academic year.
The questionnaire consisted of the following:
- Sociodemographic data sheet which collected data about gender, age, domicile, type of current accommodation, year of studying, family income, and substance abuse in students and parents
- Another sheet that included variables such as hobbies, perception of teaching, and their own academic performance by the students, any stressful life events if they have experienced within the past 6 months were included
- Third sheet consisting of items from the personal domain of Copenhagen Burnout Inventory[14] was used.
- The inventory actually consists of three domains (personal burnout, client-related burnout, and work-related burnout) however as client-related and work-related burnout are not applicable for a student, only the personal domain was used similarly to that used before in a study in Pakistan and India[15],[16]
- The instrument has been validated and extensively used for various caring and noncaring professions. The internal consistency reliability of the instrument was 0.85 for the personal domain of the questionnaire
- A cut off of 50 on the summary score, which is the mean of individual item scores, was taken; 50–74 was considered moderate burnout and 75–100 was considered severe burnout
- The original instrument in English was used for the study.
- The study was approved by the Osmania Medical College institutional ethics committee
- Data analysis was performed using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.
| Results | | |
Descriptive stats was represented using mean, percentages, and standard deviation (SD). [Table 1] and [Figure 1] The prevalence of burnout among medical students in the first years, as measured by Copenhagen Burnout Inventory (personal burnout domain), was 40% and that of final years was found to be 53.5%. The mean copenhagen burnout inventory (CBI) score was found to be 45.29 ± 15.6 (SD); for first years, it was found to be 43.7 ± 15 (SD), and for final years, it was found to be 48.9 ± 16.4 (SD).
35.2% of first years were found to have moderate burnout and 3.8% were found to have severe burnout, whereas 43.9% of final years were found to have moderate burnout and 9.6 of them were found to have severe burnout in total, 54% of respondents among final year group were found to have burnout, whereas only 38% among first-year groups had burnout. This was statistically significant at 0.009703 [Table 2].
Comparison of sociodemographic factors with burnout was made using the Chi-square test with a P value set at 0.05. Females had a significantly higher rate of burnout than males in the sample population [Table 3]. | Table 3: Comparing burnout rates among males and female of sample population
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Other factors which may influence burnout were also compared with burnout using the Chi-square test with a P value set at 0.05. When respondents were asked are you comfortable seeking support from your parents whenever stressed? Respondents who were comfortable seeking support from family were less likely to suffer from burnout (P = 0.001) [Table 4]. | Table 4: Burnout among participants who were or were not comfortable seeking support from their parents when stressed
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Similarly, those who were comfortable seeking support from teachers suffered from less burnout P = 0.000 [Table 5]. | Table 5: Burnout among participants who were or were not comfortable seeking support from their teachers when stressed
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It was also found that students who had hobbies were less likely to suffer from burnout than those who did not (P = 0.010) [Table 6]. | Table 6: Burnout rates among individual who did or did not have any hobbies
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It was also found that respondents who experienced stressful life events in the past 6 months suffered from more burnout than those who did not [Table 7]. | Table 7: Burnout in students who had experienced stressful event in the past 6 months
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Out of 375 students, 18 had only one parent at the time of study and 13 did not prefer to answer the question. On doing the Chi-square test, no significant difference in burnout was found between those with single or both parents.
Similarly, the use of substances, either by students or their father did not impact their burnout rates.
| Discussion | | |
For medical students to successfully complete their courses, good emotional and other forms of support are crucial. Since the start of this demanding course, medical students frequently experience emotional exhaustion and loss of balance. The current study assessed the prevalence of burnout among medical students and its possible relationship with predictor variables. This study showed that the mean age of the participants was 20 ± 1.5 years. Overall, 163 students of the 375 (43.5%) interviewed had scores correlating with burnout. The proportion of burnout seen among medical students in this study was slightly lower than the estimated prevalence of 44.2% burnout in a recently published meta-analysis.[13] Burnout was more prevalent in the final years than first years in the study population. The prevalence of burnout increases over the initial years, indicating the development of burnout from preclinical medical education and continuing into clinical years. According to studies, even one symptom of burnout can negatively impact medical students learning process. It may cause fatigue, depression, drowsiness, inattention, eating disorders, migraine, emotional instability, and drug use. One of the reasons could be pedagogical teaching in the first couple of years of medical school.[17],[18],[19],[20] Burnout has been described as a form of depression.[17] The etiology of burnout and depression is linked to repeated and unresolved stress. In a recent UK study, 16% of medical students had psychiatric morbidity.[17] According to self-reports, depression has a prevalence rate of 14%–24%.[18],[19]
The current study shows a burnout prevalence was higher among Brazilian, British, Pakistan, Romanian, and Saudi Arabian medical students.[18],[21],[22],[23],[24] Burnout rates reported in Brazilian medical students varied from 10.3% to 12%.[21] 18.2% of the medical students in Karachi reported burnout.[22] The burnout prevalence was 13.4% among medical students of Riyadh.[24] Burnout rates reported from Chinese and US medical schools were 50%, which is much higher than our population.[25],[26]
The current study also shows a higher prevalence compared to another study done in India based on the Maslach Burnout Inventory, which showed a prevalence of burnout as per two-dimensional definition was 16.84%, whereas as per three-dimensional conceptualization, it was 15.31%.[27] However, according to a study done in Kerala, India, the overall prevalence among medical students was 48.52%.[15]
Predictors of Burnout
The current study found that the female gender was more prone to burnout than the male gender, which is consistent with findings in other countries like Isaac et al. 2018, reported higher Burnout rates in female medical students in Australia.[28] Asghar et al. reported high Burnout rates in all three Maslach Burnout Inventory domains in females.[29] Female medical students of Riyadh, Saudi Arabia, also showed higher burnout rates.[24]
Though most of the studies showed a higher burnout rate in females as mentioned above, a few studies found males to have more burnout than females like Pharasi et al., in 2020[30] and Chunming et al. in chinese patients.[25]
Our study also found that those who have hobbies tend to had lesser burnout rates than others. In this regard, we feel it is necessary to summarize certain data from prior studies. According to a study done by Youssef, students who routinely exercised and had time to relax had decreased rates of burnout.[31] A survey of Saudi Arabian medical students, however, revealed no correlation between burnout levels and the frequency of participation in extracurricular activities.[24] In contrast with our findings, Muzafar et al. discovered that students who participated in extracurricular activities less frequently experienced lower burnout in a study in Pakistan.[22] It is possible that those students who were experiencing burnout might have used extracurricular involvement as a coping mechanism to lighten their feeling of burnout.
Choice of medicine, whether made by self or influenced by others, did not differentiate the Copenhagen Burnout Inventory scores in our participants, which is contrary to that found by Vidhukumar and Hamza, 2020,[15] who reported that choosing medical discipline based on one's own interest was found to have less burnout as compared to it being an enforced choice. Neither did the future decision to continue with medicine nor opt-out could influence burnout rates which were similar to that found by Shaurya et al., 2020.[30]
Similarly, living with or without family did not have much effect on burnout among medical students, which was found to be similar to some past studies.[15]
The learning environment- and curriculum-related variables, as measured by perception about the quality of teaching, perception about academic performance, and failure in the professional examination, were not found to be associated with burnout which is consistent with previous findings.[15] It could be because the students are uniformly exposed to such factors, and the measurements were not sensitive enough to pick up the subtleties [Figure 2] and [Figure 3]. | Figure 2: Histogram showing perception of teaching quality by students of sample population when rated on a 1–5 Likert scale
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 | Figure 3: Histogram showing perception of their own academic performance by the students of sample population
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Limitations
This study is constrained by several factors. One of the major problems was response bias. This bias further increased because the questionnaire was circulated through WhatsApp and convenient sampling methods were used. Students with burnout might be more or less likely to respond to the survey.
Since this study is cross-sectional rather than longitudinal, additional research that is interview-based and done in two different setups (government and private) can help to identify additional factors and also help us better understand the effects of the learning environment and curriculum variables that contribute to the differences in burnout and may be able to identify the root causes of burnout and provide solutions for them.
Personality traits and previous history of psychiatric illness have a considerable impact on burnout; however, none of them were accessed.
Although hosteller status was not linked to burnout, the study did not assess the true effects of cultural adaptation and homesickness.
| Conclusions and Future Directions | | |
Burnout affects nearly half of medical students, which has both short-term and long-term effects. Medical student burnout has been linked to a number of factors, including feminine gender, the presence of stressors, lack of hobbies, and the inability to seek support from parents and teachers when under stress. Reduced stress, shorter workdays, improved resiliency, and a positive work environment must be the main focus to lessen these consequences. There may be a number of methods medical colleges might use to reduce stressors and aid prevent burnout. This involves regularly including sports and extracurricular activities to promote student interaction and stress relief. Another strategy might be to minimize summative tests and lessen the emphasis on grades. Counseling programs could benefit students with the uncertainty of future plans, as well as helping support their decision in their choice of specialties.
According to experts, stress, when managed better, could help provide motivation without negative effects. This might be done with the help of counseling in the pre- and para-clinical years in medical colleges
Interventions addressing the mental health of medical students might be directed towards those revealing depressive symptoms already during their first year of medical school. Interventions on the part of the faculty and organizations could help prevent burnout among medical students.
The undergraduate curriculum in India is being modified to more of a competency-based one. Emotional factors, stress, and burnout among medical graduates need to be addressed in the above curriculum. Salient curricular changes, such as electives, programs to improve communication skills, and foundational courses, could shield students from stress and exhaustion. The study serves to highlight the importance of including the aforementioned elements in undergraduate curricula.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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