Burnout syndrome among medical students in Kazakhstan | BMC Psychology

The prevalence of burnout among medical students in Kazakhstan identified with CBI-S and OLBI-S was 28% and 31%, respectively. In a systematic review of 24 studies involving 17,431 pre-specialty medical students, the overall prevalence of burnout across the entire student population was estimated at 44.2% (33.4-55.0%). [4].

Our study found that while burnout prevalence was not dependent on gender, women had significantly higher personal burnout rates (p<0.05). Using the OLBI-S, we found that higher levels of withdrawal were found in male students (Table 2).

Burnout and decision to study medicine

This work found that if admission to a medical school is the student’s own decision, or he/she believes it was the case, the student is likely to report significantly lower levels of burnout (p<0.001) than during the study period fellow students who have chosen to pursue medical education for other reasons, including the urging of parents and close relatives. It has also been observed that students whose parents work in the health care system are more at risk of burnout if the decision to enter medical school was made by the parents. Thus, we found that a student's dependent decision to enter medical school was a strong predictor of burnout development.

Burnout was also associated with high parental expectations. Thus, students who indicated that they are haunted by high parental expectations are 1.7 times more likely to develop burnout, which is observed in all burnout dimensions except CRB. In addition, students who were dissatisfied with their chosen profession were 2.4 to 3.2 times more likely to experience burnout (Tables 1, 2). Broken down by course, there are significant differences between students in their 1st, 2nd and 5th year of study and interns. The obtained differences between students of the 1st and 2nd year can probably be explained by the fact that they come from the 1st year of medical studies and they adapt and realize their chosen profession. The 5th degree course in the Kazakh medical education system is special in that this is the last year before the bachelor’s degree in medicine and in the final courses the question is asked again: do a diploma and leave medicine or continue your education in an internship to become a practitioner. At the same time, a significant connection between burnout and satisfaction with the chosen job among interns can be interpreted as possible reasons: Firstly, the students receive more practical hours during the internship and have more contact with patients; and secondly, students who started the internship had already earlier chosen the direction (general practitioner, therapy, surgery, obstetrics and gynecology or pediatrics), but later, due to the development of primary health care in Kazakhstan, the internship began to be carried out only GP specialty , while a deeper specialization only began to obtain residency.

Burnout and academic life

According to Dyrbye et al. [43], medical students are likely to experience burnout as they progress in their medical education. In the current study, the prevalence of burnout among medical students also differed depending on the year of study; 2-5 undergraduate students, interns, and residents were more affected by burnout than 1-year-old students (Table 1, Fig. 1). This was particularly noticeable when using the OLBI-S.

In the current study, the authors wanted to examine the impact of extracurricular activities, such as participation in science clubs, student unions, and volunteering, on burnout. We found that students with extracurricular activity had lower personal burnout rates and were less engaged, but showed higher levels of collegial burnout compared to students without them (p<0.05). We also found an association between place of residence and academic burnout. Regardless of the measurement method, burnout was less common among students living in dormitories. Participation in extracurricular activities and living in the dormitory combine the fact that students can maintain communication in the circle of like-minded people; although they may tire of excessive such communication. It was found that participants who reported having relationship problems with family and friends were more prone to burnout. Strong relationships between stress and interpersonal relationship problems in medical students were previously reported by Salam et al. [44]Bhagate et al. [45].

Burnout is known to be associated with serious thoughts of quitting [46]. In the current study, we found the same connection: students who report having thoughts about dropping out of medical school have a significantly higher prevalence of burnout (RR = 3.3 (CBI-S), 3.9 (OLBI-S), p < 0.001). In addition, we found that students who are dissatisfied with their school performance have a more pronounced burnout syndrome (p < 0.001). According to Dyrbye et al. [47]thoughts of breaking off can be described as a manifestation of suffering.

Burnout and part-time job

Many students take on part-time work during their training for a variety of reasons: to earn some extra money or try to improve their practical skills as young medical professionals in clinics. Students doing additional work outside of the required curriculum made up 25% of our respondents. It was found that these students had a significantly higher prevalence of personal burnout (p<0.05) and high levels of disengagement (p<0.001) compared to students who did not have a job; This is independent of the place of work: in the medical or non-medical area. This can be explained by additional stress for students who combine study and work, and less time at university, which is attributed to lower satisfaction with academic life [48].

burnout and mental health

Our observations showed significant positive associations of burnout with somatic symptoms (headache, fatigue, and sleep disturbances), anxiety, and depression (p < 0.001).

Our study found that students with suicidal ideation exhibited higher levels of burnout overall and across all dimensions examined (p<0.05). In addition, students with suicidal ideation were almost 2.4 to 3.0 times more likely to develop burnout than students without suicidal ideation (p<0.001).

In the current study, 74 of 548 students (13.5%) reported smoking cigarettes, and smoking students had a higher prevalence of burnout (RR = 1.6–3.3, p<0.05). In addition, burnout was more common among students who started smoking after admission to medical school. In students who had started smoking before college, increased smoking was positively associated with personal burnout.

In this study, we found that a higher prevalence of burnout was found among students who drink alcohol (RR=1.9, p<0.001).

The resulting differences in the prevalence of burnout and the degree of association with certain factors when using CBI-S or OLBI-S can be explained by differences in the burnout components measured. Therefore, OLBI-S includes exhaustion and detachment dimensions, while CBI-S focuses only on exhaustion in different domains of life (PB, SRB, CRB and TRB).

Study Restrictions

Some limitations need to be considered in this study. First, this study is cross-sectional; further cohort studies are needed to determine more precise results. Secondly, it must be taken into account that the training system is different in different courses. Thus, junior students are trained in a linear model, while senior students are trained in a cyclical manner. Therefore, it is impossible to predict the influence of additional academic environment factors on the burnout level for a correct comparison of the results. Third, the sample presented in this study is not random since all students who received the mailing list were able to participate in the survey. It is assumed that students with high academic burnout rates have less interest in research participation, which can lead to a falsely reduced burnout rate in the population. Furthermore, the data were collected from students at only one university, and generalizing the results to all Kazakh medical students is unacceptable.

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