Burnout – characterised by emotional exhaustion, depersonalisation and reduced personal accomplishmentReference Maslach, Jackson and Leiter1 – is increasingly prevalent among physicians internationally.Reference Rotenstein, Torre, Ramos, Rosales, Guille and Sen2 Consequences span diminished quality of life, suboptimal patient care and workforce attrition.Reference Dewa, Loong, Bonato, Thanh and Jacobs3 Although extensive research exists, critical evaluation reveals major limitations, including lack of longitudinal designs, over-reliance on the Maslach Burnout Inventory (MBI) and scarce cross-cultural assessments.Reference Bianchi, Verkuilen, Brisson, Schonfeld and Laurent4,Reference Melnick, Powsner and Shanafelt5 This brief communication analyses recent empirical studies focused on quantifying and characterising burnout specifically among physicians in Oman, an understudied non-Western cultural context. The investigation navigates through discovered outcomes, cultural impacts, constraints in methodology and prospects for future development. This collaborative exploration seeks to drive significant progress within the domain of research on physician burnout in the context of Oman.
Method
We adopted a narrative review methodology with a comprehensive search of PubMed and Google Scholar, employing different combinations of key terms such as ‘burnout’, ‘wellbeing’, ‘distress’, ‘physicians’, ‘doctors’, ‘residents’, ‘interns’ and ‘Oman’. Additional relevant articles were identified through the careful scrutiny of reference lists. Emphasis was placed on recent publications that specifically evaluated burnout levels within the Omani physician population, utilising standardised instruments.
Results
Prevalence
Recent Omani studies consistently report that burnout peaks during residency rather than in medical school or independent practice.Reference Rotenstein, Torre, Ramos, Rosales, Guille and Sen2,Reference Al-Alawi, Al-Sinawi, Al-Qubtan, Al-Lawati, Al-Habsi and Al-Shuraiqi6 Burnout is seen among Omani medical students at a rate of 7.4%, rising in interns to 15%, further rising in residents to 16.6% and affecting practising physicians at a rate of 6.3%.Reference Al-Alawi, Al-Sinawi, Al-Qubtan, Al-Lawati, Al-Habsi and Al-Shuraiqi6,Reference Al-Mahrouqi, Al-Sinawi, Al-Ghailani, Al-Balushi, Jose and Al-Alawi7 Overall, burnout rates appear lower among Omani compared with Western physicians.
Risk factors
Potential explanatory factors worldwide for burnout during residency training include high workload, long hours and inadequate preparedness at this early career stage.Reference Al Subhi, Al Lawati, Shafiq, Al Kindi, Al Subhi and Al Jahwari8 Available data suggest that Oman's unique sociocultural dynamics are also likely influencing the way burnout is experienced within this population.Reference Al-Alawi, Al-Sinawi, Al-Qubtan, Al-Lawati, Al-Habsi and Al-Shuraiqi6 For instance, the strong emphasis on collectivism in Oman might lead to the suppression of personal distress in order to preserve group harmony.Reference Al-Alawi, Al-Sinawi, Al-Qubtan, Al-Lawati, Al-Habsi and Al-Shuraiqi6,Reference Al-Mahrouqi, Al-Sinawi, Al-Ghailani, Al-Balushi, Jose and Al-Alawi7 The widespread stigma towards mental illness also hinders open acknowledgement of psychological struggles.Reference Al-Alawi, Al-Sinawi, Al-Qubtan, Al-Lawati, Al-Habsi and Al-Shuraiqi6 Furthermore, traditional gender expectations prescribing emotional strength for men may prevent disclosure of distress. Patients’ cultural beliefs about physicians as infallible healers further compound pressures.Reference Al-Adawi, Dorvlo, Al-Ismaily, Al-Ghafry, Al-Noobi and Al-Salmi9 However, quantitative research designs cannot capture the nuances of how these elements influence burnout, and cross-sectional designs using self-report surveys limit causal inferences about potential risk factors.
Discussion
Methodological limitations
Most Omani burnout studies employed cross-sectional self-report questionnaires such as the MBI. This allowed identification of predictors such as extended working hours.Reference Al-Alawi, Al-Sinawi, Al-Qubtan, Al-Lawati, Al-Habsi and Al-Shuraiqi6 However, longitudinal mixed-methods research is needed to elucidate the complex interrelationships between risk factors, burnout dimensions and outcomes. The MBI has also received criticism regarding its validity and overlap with depression.Reference Melnick, Powsner and Shanafelt5 Developing and validating context-specific burnout measures using qualitative insights and experimental approaches is critical.
Towards culturally valid assessments
The findings reveal how sociocultural forces uniquely shape burnout manifestations in Oman, necessitating in-depth qualitative exploration of physicians’ experiences. Experimental studies manipulating variables such as social support would further isolate cultural mechanisms. Integrating biomarkers such as cortisol, inflammatory markers, heart rate variability and electroencephalogram abnormalities as objective outcomes might also enhance validity.Reference Melamed, Shirom, Toker, Berliner and Shapira10 Despite limitations, these initial studies lay the foundation for developing robust, culturally calibrated burnout assessments tailored to Omani physicians.
Future directions
Although burnout is clearly a salient issue among Omani physicians, substantial knowledge gaps persist. Advancing this important research area will require meticulous qualitative inquiry into the cultural shaping of burnout, rigorous longitudinal tracking using culturally adapted metrics and focused measurement studies. The resultant insights could then powerfully inform interventions – spanning individual coping skills to institutional policies – carefully tailored to promote physician well-being within the Omani cultural context.
Data availability
The data that support the findings of this study are available on request from the corresponding author, M.A.A.
Author contributions
M.A.A. led the literature review and analysis. A.A.G. reviewed the materials used. Collaboratively, both authors wrote and proofread the manuscript.
Funding
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Declaration of interest
None.
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