Discussion

Occupational burnout has been explored in the Arabian Gulf countries, but limited studies have simultaneously examined whether there is a link to temperament. To fill the literature gap, this study aimed to quantify how first-year residents self-reported various indicators of occupational burnout and emotional intelligence, how specific dimensions of emotional intelligence are related to burnout and whether specific sociodemographic characteristics are associated with burnout.

Among the 120 first-year residents who consented to participate, the majority were female (76.7%). The recent modernisation in Oman increased women's empowerment and participation in the labour force. As a result, the healthcare infrastructure in Oman is predominantly female. The gender distribution in this study echoes this. Studies have indicated that occupational burnout takes a toll on all levels of the medical profession, and those who experience burnout are likely to continue to do so after qualifying as a physician.^{Reference Guthrie, Black, Bagalkote, Shaw, Campbell and Creed4} This study found that 25.8% of the participants had a high burnout status. The present rate appears to be in the lower range compared with the global prevalence of burnout, ranging from 7.0 to 75.2%.^{Reference Erschens, Keifenheim, Herrmann-Werner, Loda, Schwille-Kiuntke and Bugaj24}

It may be relevant here to speculate on a relatively lower rate of burnout prevalence found in this study compared with the global range. There may be specific cultural factors for Oman and the structure of the Omani residency programme that may have influenced the way burnout is reported among resident physicians. In traditional Omani society, psychological distress is often less openly acknowledged or supported, as revealing such feelings can be viewed as something that violates social modesty or constitutes culturally devalued conduct. Oman is a collective society where individuals may prioritise group harmony and adherence to social norms over personal emotional expression. This cultural tendency could contribute to the underreporting of burnout. Additionally, the OMSB programme, which fosters a structured and close-knit learning environment, can provide additional support systems to mitigate burnout, although the reluctance to disclose psychological distress remains a potential factor influencing the reported prevalence. Other factors that could contribute to the relaxed attitude are that medical education is universally free for Omani nationals, and jobs for graduating physicians in healthcare service literacy are guaranteed.

The present study showed that the mean emotional intelligence trait of all residents was 4.77 (±0.64), which is less than the average score reported by Al Huseini et al^{Reference Al Huseini, Al Alawi, Al Sinawi, Al-Balushi, Jose and Al-Adawi18} and other studies.^{Reference Abe, Niwa, Fujisaki and Suzuki19,Reference Lin, Kannappan and Lau25} There were no significant differences in the emotional intelligence of the trait and its subscales among residents who differed in specialties, age and socioeconomic status, similar to the findings of many international studies.^{Reference Lin, Kannappan and Lau25–Reference Miri, Kermani, Khoshbakht and Moodi28} Analysing the various correlates of occupational burnout could shed light on which factors could prevent high burnout among medical professionals. Data from the current study indicated a significant positive correlation between personal achievement and well-being: participants who reported a higher sense of personal achievement also reported increased well-being. However, there were no significant correlations between other indices of emotional intelligence and other subscales of occupational burnout. This partially supports the hypothesis of the study, as there is a significant correlation between occupational burnout and emotional intelligence. This confirms the impact of well-being on burnout, which was previously demonstrated in a study by Nastasa and Farcas.^{Reference Năstasă L-E and Fărcaş29} Several factors may explain the absence of a significant link between emotional exhaustion, depersonalisation and emotional intelligence in our study. One possible explanation is that our study was conducted among first-year medical residents at the beginning of their training, which may have influenced the outcome. Previous research suggests that residents in the early stages of their training experience less pressure compared with those who are further along in their residency training.^{Reference Bagatini, Bumaguin, Bagatini and Ardais30}

Furthermore, the higher proportion of women in our sample could explain the lack of connection between emotional exhaustion and depersonalisation with emotional intelligence, in terms of burnout experience and manifestation. Other unmeasured factors, such as resilience, perceived job control and social support, may act as mediators in the relationship between emotional exhaustion and burnout. Future research could explore these factors as potential moderators in the relationship between emotional intelligence and burnout dimensions, such as emotional exhaustion and depersonalisation.

There are likely to be some challenges in emotional intelligence as it pertains to burnout. Emotional intelligence refers to the ability to perceive, understand, manage and utilise emotions effectively in oneself and others.^{Reference Salovey and Mayer31} It encompasses skills such as emotional awareness, empathy, self-regulation and social skills. The construct of emotional intelligence has gained widespread acceptance since Daniel Goleman's influential book Emotional Intelligence, published in the mid-1990s. Research supports its validity, showing that emotional intelligence can influence various aspects of personal and professional life, including job performance, leadership and interpersonal relationships.^{Reference Goleman32} Several assessments have been developed to measure emotional intelligence, including the TEIQue-SF, which is currently used. However, there are ongoing debates and critiques regarding the definitions and measurement of emotional intelligence. Some argue that it overlaps with other psychological constructs or that current emotional intelligence measures may lack precision.^{Reference Murphy33}

Some covariates of burnout, including age, experience, specialisation, gender and marital status, have been suggested to play a role in the expression of occupational burnout.^{Reference Ishak, Lederer, Mandili, Nikravesh, Seligman and Vasa7,Reference Bria, Băban and Dumitraşcu8} The findings from this study demonstrate a significant correlation between age and the depersonalisation and personal achievement subscales. The older participants reported higher rates of depersonalisation and lower personal achievement, often leading to burnout. Previous research demonstrated similar findings, suggesting that older professionals with more work experience have higher chances of experiencing occupational burnout.^{Reference Chemali, Ezzeddine, Gelaye, Dossett, Salameh and Bizri34} However, other studies have found a bimodal relationship between age and burnout. A study by Marchand et al^{Reference Marchand, Blanc and Beauregard35} found that age was positively correlated with burnout until 30 years of age, negatively correlated up to 55 years of age and then again positively correlated above 55 years of age. This highlights a separate assumption and suggests that burnout syndrome is influenced by different stages of life rather than age alone. Previous studies have suggested that occupational stress tends to have a commutative pattern. Thus, there is an incremental increase in stress as one progresses in one's medical career.^{Reference Al-Alawi, Al-Sinawi, Al-Qubtan, Al-Lawati, Al-Habsi and Al-Shuraiqi36} This would imply that burnout is not a pre-existing disposition before entering medical school; instead, it is acquired during medical training. Studies in Oman have suggested that, compared with other specialties in art and science subjects, medical students are more prone to experience poor coping.^{Reference Al-Busaidi, Bhargava, Al-Ismaily, Al-Lawati, Al-Kindi and Al-Shafaee37}

This study also noted that marital status influences burnout, and married participants reported higher burnout rates, specifically in emotional exhaustion. This could be explained by work–family conflicts, especially since most of the sample was female. In particular, in many countries, including Oman, married women were often deemed responsible for housekeeping and caregiving, which therefore might increase the number of work–family conflicts and, as a result, increased levels of burnout, especially for women with highly demanding jobs. In other studies, marital status is often noted as a significant covariate in the trajectory of burnout^{Reference Rodrigues, Cobucci, Oliveira, Cabral, Medeiros and Gurgel6,Reference Ishak, Lederer, Mandili, Nikravesh, Seligman and Vasa7} and essential for work–life balance.^{Reference Al-Dubai and Rampal38} A study in Turkey suggested that married women working in emergency departments in Turkey appeared to be at high risk of poor coping.^{Reference Erdur, Ergin, Turkcuer, Parlak, Ergin and Boz39} In Oman, tradition dictated gender segregation, with women taking the role of homemakers.^{Reference Kemp and Madsen40} In recent years, female empowerment, mainly by including female students in education, has resulted in women entering the modern economy. However, tradition still means they have expected roles such as homemaking and motherhood. Such conflicting expectations are likely to mean that women in the labour force have to juggle their newly acquired role as a doctor and their traditional role as housewives.^{Reference Petek, Gajsek and Petek Ster41} This could explain why marriage may be a larger factor for burnout among Omani women doctors than their male counterparts,^{Reference Ma, Qiao, Qu, Wang, Huang and Cheng42} although not all studies share this view.^{Reference Abdulghani, Irshad, Al Zunitan, Al Sulihem, Al Dehaim and Al Esefir43}