Skip to main content Accessibility help
×
Home

Burnout in medical students before residency: A systematic review and meta-analysis

  • Ariel Frajerman (a1) (a2), Yannick Morvan (a2) (a3) (a4), Marie-Odile Krebs (a1) (a2) (a4), Philip Gorwood (a2) and Boris Chaumette (a2) (a4) (a5)...

Abstract

Background:

Applying the concept of burnout to medical students before residency is relatively recent. Its estimated prevalence varies significantly between studies. Our objective was to estimate the prevalence of burnout in medical students worldwide.

Methods:

We systematically searched Medline for English-language articles published between January 1, 2010 and December 31, 2017. We selected all the original studies about the prevalence of burnout in medical students before residency, using validated questionnaires for burnout. Statistical analyses were conducted using the OpenMetaAnalyst software.

Results:

Prevalence of current burnout was extracted from 24 studies encompassing 17,431 medical students. Among them, 8060 suffered from burnout and we estimated the prevalence to be 44.2% [33.4%–55.0%]. The information about the prevalence of each subset of burnout dimensions was given in nine studies including 7588 students. Current prevalence was estimated to be 40.8% for ‘emotional exhaustion’ [32.8%–48.9%], 35.1% [27.2%–43.0%] for ‘depersonalization’ and 27.4% [20.5%–34.3%] for ‘personal accomplishment’. There is no significant gender difference in burnout. The prevalence of burnout is slightly different across countries with a higher prevalence in Oceania and the Middle East than in other continents.

Conclusions:

The results of this meta-analysis suggest that one student out of two is suffering from burnout, even before residency. Again, our findings highlight the high level of distress in the medical population. These results should encourage the development of preventive strategies.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Burnout in medical students before residency: A systematic review and meta-analysis
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Burnout in medical students before residency: A systematic review and meta-analysis
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Burnout in medical students before residency: A systematic review and meta-analysis
      Available formats
      ×

Copyright

Corresponding author

*Corresponding author at: Ludmer Building, 1033 Pine Avenue, H3A 1A1, Montreal, QC, Canada. E-mail address: boris.chaumette@mcgill.ca

References

Hide All
[1]Suicides of physicians and the reasons. J Am Med Assoc XLI 1903; 263–4.
[2]Schernhammer, ESColditz, GASuicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004; 161:2295–302.
[3]Swanson, JWBonnie, RJAppelbaum, PSGetting serious about reducing suicide: more ‘How’ and less ‘Why’. JAMA 2015; 314:2229–30.
[4]Mata, DA et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA 2015; 314:2373.
[5]Rotenstein, LS et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA 2016; 316:2214–36.
[6]Kessler, RCUstün, TBThe world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 2004; 13:93121.
[7]The ESEMeD/MHEDEA 2000 Investigators et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 2004; 109:21–7.
[8]Kessler, RC et al. The Epidemiology of Major Depressive Disorder: Results From the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289:3095–105.
[9]Steptoe, ATsuda, ATanaka, YWardle, JDepressive symptoms, socio-economic background, sense of control, and cultural factors in university students from 23 countries. Int J Behav Med 2007; 14:97107.
[10]Dahlin, MFjell, JRuneson, BFactors at medical school and work related to exhaustion among physicians in their first postgraduate year. Nord J Psychiatry 2010; 64:402–8.
[11]Brazeau, CMLR et al. Distress among matriculating medical students relative to the general population. Acad Med J Assoc Am Med Coll 2014; 89:1520–5.
[12]Dyrbye, LN et al. Burnout among U.S. Medical students, residents, and early career physicians relative to the general U.S. Population. Acad Med J Assoc Am Med Coll 2014; 89:443–51.
[13]Freudenberger, HJStaff burn-out. J Soc Issues 1974; 30:159–65.
[14]Maslach, CJackson, SEThe measurement of experienced burnout. J Organ Behav 1981; 2:99113.
[15]Friberg, TBurnout: from popular culture to psychiatric diagnosis in Sweden. Cult Med Psychiatry 2009; 33:538–58.
[16]ICD-10-CM Code Z73.0 - Burn-out. Available at: https://icd.codes/icd10cm/Z730. (Accessed 27 November 2017).
[17]Schaufeli, WBMartinez, IMPinto, AMSalanova, MBakker, ABBurnout and engagement in university students: a cross-national study. J Cross-Cult Psychol 2002; 33:464–81.
[18]Demerouti, EBakker, ABVardakou, IKantas, AThe convergent validity of two burnout instruments: A multitrait-multimethod analysis. Eur J Psychol Assess 2003; 19:12.
[19]Kristensen, TSBorritz, MVilladsen, EChristensen, KBThe Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work Stress 2005; 19:192207.
[20]Maslach, CJackson, SESchwab, RLMaslach burnout inventory: manual 1986, Consulting Psychologists Press.
[21]Maslach, CJackson, SLeiter, MThe maslach burnout inventory manual 3 1997.
[22]Maroco, JCampos, JADBDefining the student burnout construct: a structural analysis from three burnout inventories. Psychol Rep 2012; 111:814–30.
[23]Ishak, W et al. Burnout in medical students: a systematic review. Clin Teach 2013; 10:242–5.
[24]Fares, JAl Tabosh, HSaadeddin, ZEl Mouhayyar, C et al. Burnout and coping strategies in preclinical medical students. North Am J Med Sci 2016; 8:7581.
[25]Wallace, BCSchmid, CHLau, JTrikalinos, TAMeta-Analyst: software for meta-analysis of binary, continuous and diagnostic data. BMC Med Res Methodol 2009; 9:80.
[26]Viechtbauer, WConducting Meta-Analyses in R with the metafor Package. J Stat Softw 2010; 36:.
[27]Cecil, JMcHale, CHart, JLaidlaw, ABehaviour and burnout in medical students. Med Educ Online 2014; 19:25209.
[28]Cook, AFArora, VMRasinski, KACurlin, FAYoon, JDThe prevalence of medical student mistreatment and its association with burnout. Acad Med J Assoc Am Med Coll 2014; 89:749–54.
[29]Dyrbye, LN et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA 2010; 304:1173–80.
[30]Dyrbye, LN et al. Patterns of distress in US medical students. Med Teach 2011; 33:834–9.
[31]Enoch, LChibnall, JTSchindler, DLSlavin, SJAssociation of medical student burnout with residency specialty choice. Med Educ 2013; 47:173–81.
[32]Fares, J et al. Extracurricular activities associated with stress and burnout in preclinical medical students. J Epidemiol Glob Health 2016; 6:177–85.
[33]Mazurkiewicz, RKorenstein, DFallar, RRipp, JThe prevalence and correlations of medical student burnout in the pre-clinical years: a cross-sectional study. Psychol Health Med 2012; 17:188–95.
[34]de Costa, EFOSantos, SA et al. Burnout Syndrome and associated factors among medical stu dents: a cross-sectional study. Clin São Paulo Braz. 2012; 67:573–80.
[35]van Venrooij, LTBarnhoorn, PCGiltay, EJvan Noorden, MSBurnout, depression and anxiety in preclinical medical students: a cross-sectional survey. Int J Adolesc Med Health 2015 10.1515/ijamh-2015-0077.
[36]Galán, FSanmartín, APolo, JGiner, LBurnout risk in medical students in Spain using the Maslach Burnout Inventory-Student Survey. Int Arch Occup Environ Health 2011; 84:453–9.
[37]Muzafar, Y et al. Burnout and its associated factors in medical students of Lahore, Pakistan. Cureus 2015; 7: e390.
[38]Seo, J-HKim, HJKim, B-JLee, S-JBae, H-OEducational and relational stressors associated with burnout in korean medical students. Psychiatry Investig 2015; 12:451–8.
[39]Almalki, SAAlmojali, AIAlothman, ASMasuadi, EMAlaqeel, MKBurnout and its association with extracurricular activities among medical students in Saudi Arabia. Int J Med Educ 2017; 8:144–50.
[40]de Almeida, GC et al. The prevalence of burnout syndrome in medical students. Arch Clin Psychiatry São Paulo 2016; 43:610.
[41]Asencio-López, L et al. Burnout syndrome in first to sixth-year medical students at a private university in the north of Mexico: descriptive cross-sectional study. Medwave 2016; 16: e6432.
[42]DeWitt, DCanny, BJNitzberg, MChoudri, JPorter, SMedical student satisfaction, coping and burnout in direct-entry versus graduate-entry programmes. Med Educ 2016; 50:637–45.
[43]Dyrbye, LN et al. The Impact of Stigma and Personal Experiences on the Help-Seeking Behaviors of Medical Students With Burnout. Acad Med J Assoc Am Med Coll 2015; 90:961–9.
[44]Lyndon, MP et al. Burnout, quality of life, motivation, and academic achievement among medical students: a person-oriented approach. Perspect Med Educ 2017; 6:108–14.
[45]Popa-Velea, ODiaconescu, LMihăilescu, AJidveian Popescu, M et al. Burnout and its relationships with Alexithymia, stress, and social support among romanian medical students: a cross-sectional study. Int J Environ Res Public Health 2017; 14:.
[46]Wolf, MRRosenstock, JBInadequate sleep and exercise associated with burnout and depression among medical students. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry 2017; 41:174–9.
[47]Youssef, FFMedical student stress, burnout and depression in Trinidad and Tobago. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry 2016; 40:6975.
[48]Al-Alawi, M et al. Prevalence and determinants of burnout Syndrome and Depression among medical students at Sultan Qaboos University: A cross-sectional analytical study from Oman. Arch Environ Occup Health 1–10 2017 http://dx.doi.org/10.1080/19338244.2017.1400941.
[49]Asencio-López, L et al. Burnout syndrome in first to sixth-year medical students at a private university in the north of Mexico: descriptive cross-sectional study. Medwave 2016; 16:.
[50]Dyrbye, LNThomas, MRShanafelt, TDSystematic review of depression, anxiety, and other indicators of psychological distress among U.S. And Canadian medical students. Acad Med J Assoc Am Med Coll 2006; 81:354–73.
[51]Prins, JT et al. Burnout in medical residents: a review. Med Educ 2007; 41:788800.
[52]Bianchi, RSchonfeld, ISLaurent, EBurnout-depression overlap: a review. Clin Psychol Rev 2015; 36:2841.
[53]Armon, GMelamed, SToker, SBerliner, SShapira, IJoint effect of chronic medical illness and burnout on depressive symptoms among employed adults. Health Psychol Off J Div Health Psychol Am Psychol Assoc 2014; 33:264–72.
[54]Hakanen, JJSchaufeli, WBDo burnout and work engagement predict depressive symptoms and life satisfaction? A three-wave seven-year prospective study. J Affect Disord 2012; 141:415–24.
[55]Shin, HNoh, HJang, YPark, YMLee, SMA longitudinal examination of the relationship between teacher burnout and depression. J Employ Couns 2013; 50:124–37.
[56]Campbell, JProchazka, AVYamashita, TGopal, RPredictors of persistent burnout in internal medicine residents: a prospective cohort study. Acad Med J Assoc Am Med Coll 2010; 85:1630–4.
[57]Salmela-Aro, KAunola, KNurmi, J-ETrajectories of depressive symptoms during emerging adulthood: antecedents and consequences. Eur J Dev Psychol 2008; 5:439–65.
[58]Salmela-Aro, KSavolainen, HHolopainen, LDepressive symptoms and school burnout during adolescence: evidence from two cross-lagged longitudinal studies. J Youth Adolesc 2009; 38:1316–27.
[59]Toker, SBiron, MJob burnout and depression: unraveling their temporal relationship and considering the role of physical activity. J Appl Psychol 2012; 97:699710.
[60]Molina-Canales, GLe Barbier, MBrunel, SLasfargues, GÉpuisement professionnel : étude descriptive de cas recensés dans le Réseau national de vigilance et de prévention des pathologies professionnelles. Arch Mal Prof Environ 2016; 77:440.
[61]Toker, SShirom, AShapira, IBerliner, SMelamed, SThe association between burnout, depression, anxiety, and inflammation biomarkers: C-reactive protein and fibrinogen in men and women. J Occup Health Psychol 2005; 10:344–62.
[62]Pereira-Lima, KLoureiro, SRBurnout, anxiety, depression, and social skills in medical residents. Psychol Health Med 2015; 20:353–62.
[63]Soler, JK et al. Burnout in European family doctors: the EGPRN study. Fam Pract 2008; 25:245–65.
[64]Galam, EKomly, VLe Tourneur, AJund, JBurnout among French GPs in training: a cross-sectional study. Br J Gen Pract J R Coll Gen Pract 2013; 63:e21724.
[65]Olie, J-PLegeron, PLe burn-out 2016, Académie nationale de médecine 349–65.
[66]Rapport du Dr Donata Marra sur la Qualité de vie des étudiants en santé. Ministère des Solidarités et de la Santé 2018 Available at: http://solidarites-sante.gouv.fr/ministere/documentation-et-publications-officielles/rapports/sante/article/rapport-du-dr-donata-marra-sur-la-qualite-de-vie-des-etudiants-en-sante (Accessed 17 June 2018).
[67]Barrack, RLMiller, LSSotile, WMSotile, MORubash, HEEffect of duty hour standards on burnout among orthopaedic surgery residents. Clin Orthop 2006; 449:134–7.
[68]Gopal, RGlasheen, JJMiyoshi, TJProchazka, AVBurnout and Internal Medicine Resident Work-Hour Restrictions. Arch Intern Med 2005; 165:2595–600.
[69]Jovanović, N et al. Burnout syndrome among psychiatric trainees in 22 countries: risk increased by long working hours, lack of supervision, and psychiatry not being first career choice. Eur Psychiatry 2016; 32:3441.
[70]Ferrari, S et al. Young and burnt? Italian contribution to the international BurnOut Syndrome Study (BOSS) among residents in psychiatry. Med Lav 2015; 106:172–85.
[71]West, CPDyrbye, LNErwin, PJShanafelt, TDInterventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 2016; 388:2272–81.
[72]Williams, DTricomi, GGupta, JJanise, AEfficacy of burnout interventions in the medical education pipeline. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry 2014 http://dx.doi.org/10.1007/s40596-014-0197-5.
[73]Slavin, SJChibnall, JTFinding the why, changing the how: improving the mental health of medical students, residents, and physicians. Acad Med J Assoc Am Med Coll 2016; 91:1194–6.
[74]van Vendeloo, SNBrand, PLPVerheyen, CCPMBurnout and quality of life among orthopaedic trainees in a modern educational programme: importance of the learning climate. Bone Jt. J. 96–B 2014; 1133–8.
[75]Wasson, LT et al. Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review. JAMA 2016; 316:2237–52.
[76]Auslender, VOmerta à l’hôpital: le livre noir des maltraitances faites aux étudiants en santé 2017, Editions Michalon.
[77]Shanafelt, TDNoseworthy, JHExecutive Leadership and Physician Well-being:Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc 2017; 92:129–46.
[78]Shoji, K et al. Associations between job burnout and self-efficacy: a meta-analysis. Anxiety Stress Coping 2016; 29:367–86.
[79]Schaufeli, WBLeiter, MPMaslach, CBurnout: 35 years of research and practice. Career Dev Int. 2009; 14:204–20.
[80]Schaufeli, WBVan Dierendonck, DA cautionary note about the cross-national and clinical validity of cut-off points for the Maslach Burnout Inventory. Psychol Rep 1995; 76:1083–90.
[81]Gil-Monte, PRPeiró, JMUn estudio comparativo sobre criterios normativos y diferenciales para el diagnóstico del síndrome de quemarse por el trabajo (burnout) según el MBI-HSS en España. Rev Psicol Trab Las Organ 2000; 16:135–49.
[82]Dion, GTessier, RValidation de la traduction de l’Inventaire d’épuisement professionnel de Maslach et Jackson. Can J Behav Sci Can Sci Comport 1994; 26:210.
[83]Enzmann, DSchaufeli, WBGirault, NThe validity of the Maslach Burnout Inventory in three national samples. Health Work. Aids Res Interv Curr Issues Burn Response 1995; 131–50.
[84]Schaufeli, WBJanczur, BBurnout among nurses: a polish-dutch comparison. Afr J Cross-cultural Psychol Sport Facil 1994.
[85]Schutte, NToppinen, SKalimo, RSchaufeli, WThe factorial validity of the Maslach Burnout Inventory-General Survey (MBI-GS) across occupational groups and nations. J Occup Organ Psychol 2000; 73:5366.
[86]Langballe, EMFalkum, EInnstrand, STAasland, OGThe factorial validity of the Maslach Burnout Inventory–General Survey in representative samples of eight different occupational groups. J Career Assess 2006; 14:370–84.
[87]Bakker, ABLe Blanc, PMSchaufeli, WBBurnout contagion among intensive care nurses. J Adv Nurs 2005; 51:276–87.
[88]Kalafati, MHow Greek healthcare services are affected by the Euro crisis. Emerg Nurse J RCN Accid Emerg Nurs Assoc 2012; 20:2627.
[89]Rachiotis, G et al. Medical supplies shortages and burnout among greek health care workers during economic crisis: a pilot study. Int J Med Sci 2014; 11:442–7.

Keywords

Type Description Title
WORD
Supplementary Material

Frajerman et al. Supplementary Material
Frajerman et al. Supplementary Material

 Word (225 KB)
225 KB

Burnout in medical students before residency: A systematic review and meta-analysis

  • Ariel Frajerman (a1) (a2), Yannick Morvan (a2) (a3) (a4), Marie-Odile Krebs (a1) (a2) (a4), Philip Gorwood (a2) and Boris Chaumette (a2) (a4) (a5)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Burnout in medical students before residency: A systematic review and meta-analysis

  • Ariel Frajerman (a1) (a2), Yannick Morvan (a2) (a3) (a4), Marie-Odile Krebs (a1) (a2) (a4), Philip Gorwood (a2) and Boris Chaumette (a2) (a4) (a5)...
Submit a response

Comments

No Comments have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *