Clinical Practice & Epidemiology in Mental Health




ISSN: 1745-0179 ― Volume 14, 2018
RESEARCH ARTICLE

Burnout Prevalence and Associated Factors Among Brazilian Medical Students



Mariana Linhares Barbosa1, Bárbara Lopes Rodrigues Ferreira1, Thaís Nunes Vargas1, George Martins Ney da Silva2, Antonio Egidio Nardi3, Sergio Machado3, 4, Leonardo Caixeta3, 5, *
1 Unit of Pedagogical Support - Unievangélica Faculty of Medicine, Anápolis, Brazil
2 Professor of Psychiatry – Unievangélica Faculty of Medicine, Anápolis, Brazil
3 Laboratory of Panic and Respiration (LABPR), Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
4 Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University, Niterói, Brazil
5 Associate Professor of Neurology, Internal Medicine Department, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil

Abstract

Objectives:

This study aims to identify the prevalence of burnout and associated factors in Brazilian medical students.

Methods:

In the largest medical school from Central Brazil, the Maslach Burnout Inventory-Student Survey and a socio-demographic questionnaire were adopted in this cross-sectional study. Correlations among the three dimensions of burnout were verified.

Results:

The evaluation of 399 students revealed a frequency of 12.0% of burnout. Women had a higher rate of burnout (8.0%) than men (4.0%). The fifth period had the higher frequency of burnout (27.1%), while the seventh grade had the lower frequency (2.1%). The students showed high scores only in emotional exhaustion (63.2%). Between the dimensions “emotional exhaustion” and “disbelief” found a significant correlation.

Conclusion:

The fifth period of the Medicine course and the female gender are the most affected by burnout syndrome and therefore, the preventive actions to reduce stress among medical students should be directed mainly at these higher risk categories. The low burnout rate found in our study can attest that the PBL methodology and medical schools strategically located to meet regional demand may represent strategies for the prevention of burnout among medical students.

Keywords: Burnout, Medical students, Mental health, Occupational health, Problem-based learning, Psychological responses.


Article Information


Identifiers and Pagination:

Year: 2018
Volume: 14
First Page: 188
Last Page: 195
Publisher Id: CPEMH-14-188
DOI: 10.2174/1745017901814010188

Article History:

Received Date: 3/2/2017
Revision Received Date: 22/6/2018
Acceptance Date: 24/7/2018
Electronic publication date: 31/08/2018
Collection year: 2018

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© 2018 Barbosa et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Laboratory of Panic and Respiration (LABPR), Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Tel: 55-(62)32047238; E-mail: leonardocaixeta1@gmail.com




1. INTRODUCTION

Psychological responses to stress including burnout represent an important issue in social neuroscience. Burnout is a syndrome constituted by the triad “emotional exhaustion”, “disbelief” and reduced “professional efficacy”. It is characterized as an inadequate response to chronic emotional stress; thus, it would be a way of adapting to difficult situations [1West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet 2016; 388(10057): 2272-81.[http://dx.doi.org/10.1016/S0140-6736(16)31279-X] [PMID: 27692469] -7Mori MO, Valente TCO, Nascimento LFC. Síndrome de Burnout e rendimento acadêmico em estudantes da primeira à quarta série de um curso de graduação em medicina. Rev Bras Educ Med 2012; 36(4): 536-40.[http://dx.doi.org/10.1590/S0100-55022012000600013] ]. The most accepted definition today is based on the socio-psychological perspective, which considers the syndrome as a reaction to chronic emotional tension by constantly and excessively dealing with people, as occurs in the case of health professionals, educators and caregivers [6Costa EFO, Santos SA, Santos ATRA, Melo EV, Andrade TM. Burnout syndrome and associated factors among medical students: A cross-sectional study. Clinics (São Paulo) 2012; 67(6): 573-80.[http://dx.doi.org/10.6061/clinics/2012(06)05] [PMID: 22760894] , 8Carlotto MS, Câmara SG. Análise da produção científica sobre a Síndrome de Burnout no Brasil. PSICO 2008; 39(2): 152-8., 9Backović D, Jevtić M. Burnout syndrome as a mental health problem among medical students. Med Pregl 2012; 65(3-4): 129-32.[http://dx.doi.org/10.2298/MPNS1204129B] [PMID: 22788061] ].

Some authors report that Burnout Syndrome affects 20 to 50% of health professionals [10Fernández-López JA, Siegrist J, Rödel A, Hernández-Mejía R. Stress at work: A new risk factor. What do we know and what can we do?. Aten Primaria 2003; 31(8): 524-6.[PMID: 12765592] ]. It can also be described in individuals who perform student activities or professional preparation, subject to physical, emotional and intellectual wear similar to that of the worker, as is the case of medical students [6Costa EFO, Santos SA, Santos ATRA, Melo EV, Andrade TM. Burnout syndrome and associated factors among medical students: A cross-sectional study. Clinics (São Paulo) 2012; 67(6): 573-80.[http://dx.doi.org/10.6061/clinics/2012(06)05] [PMID: 22760894] , 9Backović D, Jevtić M. Burnout syndrome as a mental health problem among medical students. Med Pregl 2012; 65(3-4): 129-32.[http://dx.doi.org/10.2298/MPNS1204129B] [PMID: 22788061] ].

The medical course is one of the most disputed among university selective processes, so the emotional impact of this choice comes even before graduation. However, many who choose to pursue a medical career do not have much knowledge about the routine experienced, both in the undergraduate and in the professional life itself [11Ramos-Cerqueira AT de A. Lima MCP. A formação da identidade do médico: Implicações para o ensino de graduação em Medicina. Interface Comunicacao Saude Educ 2002; 6(11): 107-16.[http://dx.doi.org/10.1590/S1414-32832002000200008] , 12Haddad AE, Morita MC, Pierantoni CR, Brenelli SL, Passarella T, Campos FE. Formação de profissionais de saúde no Brasil: uma análise no período de 1991 a 2008. Rev Saude Publica 2010; 44(3): 1482-90.[http://dx.doi.org/10.1590/S0034-89102010005000015] [PMID: 20499011] ]. When these students begin medical graduation, they become continuously exposed to stressors throughout their training, due to factors such as excessive study load, little time for leisure and for the family, difficult choice of a specialty; stressors that may be worsened by one's own personality traits - obsessive traits, self-willed, perfectionism - which, if persistent can trigger the syndrome. Thus, due to the high emotional exhaustion and possible mental disorders that may occur during training, there are several investigations studying the syndrome in the medical courses [4Benevides-Pereira AMT, Gonçalves MB. Transtornos emocionais e a formação em Medicina: Um estudo longitudinal. Rev Bras Educ Med 2009; 33(1): 10-23.[http://dx.doi.org/10.1590/S0100-55022009000100003] , 6Costa EFO, Santos SA, Santos ATRA, Melo EV, Andrade TM. Burnout syndrome and associated factors among medical students: A cross-sectional study. Clinics (São Paulo) 2012; 67(6): 573-80.[http://dx.doi.org/10.6061/clinics/2012(06)05] [PMID: 22760894] , 9Backović D, Jevtić M. Burnout syndrome as a mental health problem among medical students. Med Pregl 2012; 65(3-4): 129-32.[http://dx.doi.org/10.2298/MPNS1204129B] [PMID: 22788061] ]. These studies demonstrate the occurrence of stressful events during medical training, inducing “emotional exhaustion” and “disbelief” that may extend until after graduation, affecting the performance of the professional and his satisfaction with the work [4Benevides-Pereira AMT, Gonçalves MB. Transtornos emocionais e a formação em Medicina: Um estudo longitudinal. Rev Bras Educ Med 2009; 33(1): 10-23.[http://dx.doi.org/10.1590/S0100-55022009000100003] , 6Costa EFO, Santos SA, Santos ATRA, Melo EV, Andrade TM. Burnout syndrome and associated factors among medical students: A cross-sectional study. Clinics (São Paulo) 2012; 67(6): 573-80.[http://dx.doi.org/10.6061/clinics/2012(06)05] [PMID: 22760894] ].

Research carried out among undergraduates of the medical course revealed a prevalence of 10% to 45% of the syndrome, and in these studies, only two of their dimensions (“emotional exhaustion” and “disbelief”) were used as diagnostic criteria [6Costa EFO, Santos SA, Santos ATRA, Melo EV, Andrade TM. Burnout syndrome and associated factors among medical students: A cross-sectional study. Clinics (São Paulo) 2012; 67(6): 573-80.[http://dx.doi.org/10.6061/clinics/2012(06)05] [PMID: 22760894] ]. In the studies, that had a more rigid criterion, using the three dimensions, the values ​​were smaller. Costa et al. [6Costa EFO, Santos SA, Santos ATRA, Melo EV, Andrade TM. Burnout syndrome and associated factors among medical students: A cross-sectional study. Clinics (São Paulo) 2012; 67(6): 573-80.[http://dx.doi.org/10.6061/clinics/2012(06)05] [PMID: 22760894] ], for example, found a prevalence of 10.3% in a sample of 369 students (69.1% of the total students) using the three dimensions criterion. In a longitudinal study [4Benevides-Pereira AMT, Gonçalves MB. Transtornos emocionais e a formação em Medicina: Um estudo longitudinal. Rev Bras Educ Med 2009; 33(1): 10-23.[http://dx.doi.org/10.1590/S0100-55022009000100003] ] that followed a class during six years of training, it was shown that among the three dimensions of the syndrome, the score for “professional effectiveness” increased during the course, accompanied by an equal elevation of the score for “disbelief”. The elevation of the score in the dimension “professional effectiveness” is a sign of emotional health, the opposite occurring in the syndrome. Already the elevation of the score in “disbelief” points to greater wear and tear along the course. “Emotional exhaustion” at the end of the course decreased, thus reducing the score on the scale used in this study. It was also verified that the third and fourth-year undergraduate students presented the most emotional disorders.

Due to exposure to stressors that would be harmful to the mental health of medical students since the beginning of their academic training, and that may disrupt their professional performance, more research is needed in other Brazilian regions to better characterize the problem, and to find variables that to assist in future and necessary prevention and treatment attitudes for the benefit of these students. Thus, this work aimed to investigate the frequency of Burnout Syndrome in academics from the first to eighth periods of the major medical course of Central Brazil, as well as to relate the Burnout level with the sociodemographic data of the sample studied.

2. METHODOLOGY

2.1. Research Design and Data Collection

The study design was a cross-sectional one. The research was conducted at the largest medical school in Central Brazil, at the Centro Universitário de Anápolis (Unievangélica), State of Goiás, with the population consisting of medical students from the first to the eighth period during the second semester of 2015.

The Medicine course offered by the Centro Universitário de Anápolis (Unievangélica) is based on the teaching methodology called Problem-Based Learning (PBL). This new methodology presents to the students a question related to health care or the clinical picture of a patient, from which, and after initial analysis, the students define their learning objectives and search the necessary sources for the information that answers the problem found and then report what they found and what they learned. Thus, it differs from the traditional teaching methodology, since it stimulates the student to be an active agent in his/her own learning process.

Students were informed about the characteristics of the research and the voluntary nature of participation. Students who did not wish to participate in the study and who were less than 17 years of age were excluded.

2.2. Sample Size

Sampling was of the non-probabilistic and convenience type, calculated according to the formula for simple (random) representative sampling, where “N” represents the student population, “n” sample size, and ” n0” the first approximation of the sample size: n = N. n0 / N + n0 [13Andrade AL. Métodos de Investigação Epidemiológica em Doenças Transmissíveis 2nd ed. 2nd ed.1994; Vol. 1, 14Barbetta PA. Estatística Aplicada às Ciências Sociais 5th ed. 5th ed.2002; 41-66.]. The formula used to calculate ” n0 ” is as follows: n0 = 1 / E02. In this formula, E02 represents the tolerable sample error, with value, adopted in this research, equal to 5% (0.05). Therefore, the value of n0 adopted in the present study was 400 [13Andrade AL. Métodos de Investigação Epidemiológica em Doenças Transmissíveis 2nd ed. 2nd ed.1994; Vol. 1, 14Barbetta PA. Estatística Aplicada às Ciências Sociais 5th ed. 5th ed.2002; 41-66.].

2.3. Instruments

Data collection was carried out through the Maslach Burnout Inventory-Student Survey (MBI-SS), a form adapted by Carlotto & Câmara [15Carlotto MS, Câmara SG. Características psicométricas do Maslach Burnout Inventory-Student Survey (MBI-SS) em estudantes universitários brasileiros. Psico-USF 2006; 11(2): 167-73.[http://dx.doi.org/10.1590/S1413-82712006000200005] ], based on the version by Schaufeli et al. [16Schaufeli WB, Martínez IM, Pinto AM, Salanova M, Bakker AB. Burnout and engagement in university students: A cross-national study. J Cross Cult Psychol 2002; 33(5): 464-81.[http://dx.doi.org/10.1177/0022022102033005003] ]. Data were also collected in a supplementary questionnaire the socio-demographic data to characterize the sample - age, gender, marital status (single, married or equivalent, divorced, widowed), home state, nationality, skin color. The Maslach Burnout Inventory-Student Survey (MBI-SS) consists of 15 questions, addressing the three dimensions of Burnout Syndrome: “emotional exhaustion (5 questions),” “disbelief (4 questions),” and “professional efficacy (6 questions).” All items are evaluated on a seven-point Likert scale, ranging from zero (never) to six (always) [15Carlotto MS, Câmara SG. Características psicométricas do Maslach Burnout Inventory-Student Survey (MBI-SS) em estudantes universitários brasileiros. Psico-USF 2006; 11(2): 167-73.[http://dx.doi.org/10.1590/S1413-82712006000200005] ]. The inventory evaluates each dimension of the syndrome separately, according to the scores. High scores on “emotional exhaustion” and “disbelief” added to low scores for “professional effectiveness” indicate a high level of burnout. Studies on student burnout demonstrate that MBI-SS is an adequate and reliable scale [15Carlotto MS, Câmara SG. Características psicométricas do Maslach Burnout Inventory-Student Survey (MBI-SS) em estudantes universitários brasileiros. Psico-USF 2006; 11(2): 167-73.[http://dx.doi.org/10.1590/S1413-82712006000200005] ]. Maroco & Tecedeiro [17Maroco J, Tecedeiro MMV. Inventário de Burnout de Maslach para estudantes portugueses. Psicol Saude Doencas 2009; 10(2): 227-35.] suggest as a cut-off point for the questionnaire translated and validated for the Portuguese language the following values: score above 14 for “emotional exhaustion”, above 6 for “disbelief”, and below 23 for “professional efficacy”. The scale is reversed in the dimension of “professional effectiveness”, that is, the higher the score, the more satisfied the respondent is and the less likely he/she will be to develop burnout [18Chang E, Eddins-Folensbee F, Coverdale J. Survey of the prevalence of burnout, stress, depression, and the use of supports by medical students at one school. Acad Psychiatry 2012; 36(3): 177-82.[http://dx.doi.org/10.1176/appi.ap.11040079] [PMID: 22751817] ].

2.4. Data Analysis

The collected data was tabulated in Microsoft Excel 2010, version 3.0, and analyzed using SPSS software for Windows, version 20.018. The level of significance was set at p <0.05. The following variables were analyzed: a period of the course, age, gender, skin color, marital status, home state and nationality, and burnout indexes (“emotional exhaustion”, “disbelief” and “professional efficacy”).

The Kolmogorov-Smirnov normality test was performed, which presented a normal distribution of the variables indicative of Burnout Syndrome. A descriptive statistic was carried out in the form of simple frequency and percentage. Pearson's Chi-square test was used to compare the percentage distribution. A Pearson Correlation was performed with age and quantitative values for the syndrome indicators, and in addition, a Simple Linear Regression (Stepwise) verified how each dimension of Burnout influences the others, comparing them to each other.

2.5. Ethical Aspects

The students who accepted to participate signed the Free and Informed Consent Term (IC). This research was approved by the Research Ethics Committee of the Centro Universitário de Anápolis (Unievangélica) (CAAE 40789214.7.0000.5076).

3. RESULTS

This study included 399 students from the first to eighth grade, number above the minimum calculated for representative sampling. The age of the sample ranged from 17 to 52 years, with a mean of 21 years (SD = 3.6). Of the participants, 222 (55.6%) were women and 177 men (44.3%). Most of the sample came from Goiás State (85.9%). Almost all the students were single (98.0%) and most considered themselves as white color (54.1%). Considering the total sample (399 students), 12.0% had a positive burnout index, of which 32 (8.0%) were women and 16 (4.0%) were men.

The results are presented in Tables 1 to 3. Table 1 shows the frequency of positive burnout index, based on the criterion of the three dimensions (need to score for burnout in the three dimensions), in each period and according to sex. It was considered the cut-off points proposed by Maroco and Tecedeiro [17Maroco J, Tecedeiro MMV. Inventário de Burnout de Maslach para estudantes portugueses. Psicol Saude Doencas 2009; 10(2): 227-35.] for the Maslach Scale for Students (MBI-SS): Score above 14 in the dimension of “Emotional Exhaustion” (EE), above six in the dimension of “Disbelief” (DE), and below 23 in the third dimension, “Professional Efficacy” (PE). Table 2 estimates the positive frequency obtained in each dimension of burnout.

Table 1
Positive burnout indexes percentage in each period and according to gender, related to the total sample of medical students.


Table 2
Positive frequency of the three dimensions of burnout by period of Medical school.


The verification of how much each dimension influences the others, by comparisons of all of them to each other, is presented in Table 3. The dimensions EE, DE and PE in this Table are in numbers of students with “emotional exhaustion”, “disbelief” and low “professional effectiveness”, respectively. For the dimension “emotional exhaustion” it was obtained that the other two dimensions (“disbelief” and “professional effectiveness”) together are responsible for 26.2% of the positive cases, both with positive influence. In relation to the “disbelief” dimension, there is a negative influence of “professional effectiveness” and positive “emotional exhaustion”, totaling 36.1%. The dimensions “emotional exhaustion” (positive influence) and “disbelief” (negative influence) interfere in 15.1% of cases of low “professional efficacy”.

Table 3
Simple Linear Regression by Stepwise method to analyze the contribution of each dimension (EE, DE and PE) to each other.


Through the correlation of Pearson, presented in Table 4, it was possible to verify correlations between the three dimensions of burnout. Between the dimension “emotional exhaustion” and “disbelief” was found a significant correlation (r = 0.508; p = 0.001); Between “emotional exhaustion” and “professional efficacy”, there was a weak and negative correlation, that is, they were inversely proportional (r = -0.118; p = 0.018); The “disbelief” dimension also correlated negatively and moderately with “professional efficacy” dimension (r = -0.383; p = 0.001).

Table 4
Pearson's correlation among burnout domains (EE, DE and PE).


4. DISCUSSION

In our study, we have obtained 12.0% of the sample (n = 399) with a positive burnout syndrome index, using the three-dimensional criterion. This figure is considered a low rate of burnout. This value was very close to that found by Costa et al. [6Costa EFO, Santos SA, Santos ATRA, Melo EV, Andrade TM. Burnout syndrome and associated factors among medical students: A cross-sectional study. Clinics (São Paulo) 2012; 67(6): 573-80.[http://dx.doi.org/10.6061/clinics/2012(06)05] [PMID: 22760894] ] in his sample of 369 medical students from Northeastern Brazil, where he obtained a positive index of 10.3% using the same criteria. British authors also found low levels in British medical students [19Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: A five-year prospective longitudinal study. J R Soc Med 1998; 91(5): 237-43.[http://dx.doi.org/10.1177/014107689809100502] [PMID: 9764076] ]. On the other hand, the frequencies of positive burnout index in many studies are higher than those found in our sample. For instance, in an American study [5Santen SA, Holt DB, Kemp JD, Hemphill RR. Burnout in medical students: Examining the prevalence and associated factors. South Med J 2010; 103(8): 758-63.[http://dx.doi.org/10.1097/SMJ.0b013e3181e6d6d4] [PMID: 20622724] ], using the same methodology as ours, authors found moderate and high levels of burnout (varying from 21% in the first-year class, until 43% in the third-year class). Chang et al. found 55% of medical students with high burnout rates using the same methodology as ours. In another American study, using less conservative criteria, authors defined as many as 45% of American medical students in a multicenter study as burnt out [20Dyrbye LN, Thomas MR, Huntington JL, et al. Personal life events and medical student burnout: A multicenter study. Acad Med 2006; 81(4): 374-84.[http://dx.doi.org/10.1097/00001888-200604000-00010] [PMID: 16565189] ]. These differences can be attributed to differences in the methodology employed, cultural aspects and resilience factors in that particular culture, as well as the type of pedagogical management employed in each institution [21Baldassim S. Ansiedade e depressão no estudante de Medicina: Revisão de estudos brasileiros. Cadernos ABEM 2010; 6(1): 19-26.]. One of the factors that may contribute to the low burnout rates found in our study (compared to the high American rates, for example), may be the fact that most of our students come from nearby cities (85.9% are from Goiás) or even from Anápolis itself, that is, the students have an affective comfort generated by the proximity of their relatives. Medical schools strategically located to meet regional demand (avoiding the migration of young students away from their families) may represent a strategy for the prevention of burnout among medical students.

The students in the fifth period had the highest burnout rate compared to the other participating groups (27.1%). The fifth period also presented the highest proportion of positive emotional exhaustion index: 15.9%. Several studies point to the third year (or fifth period) as a period especially vulnerable to burnout [22Dahlin ME, Runeson B. Burnout and psychiatric morbidity among medical students entering clinical training: A three year prospective questionnaire and interview-based study. BMC Med Educ 2007; 7(1): 6.[http://dx.doi.org/10.1186/1472-6920-7-6] [PMID: 17430583] , 23Souza L. Prevalência de sintomas depressivos, ansiosos e estresse em acadêmicos de medicina these2011.[http://dx.doi.org/10.11606/T.5.2011.tde-01022011-181552] ]. In a longitudinal study developed at a medical school in Sweden [22Dahlin ME, Runeson B. Burnout and psychiatric morbidity among medical students entering clinical training: A three year prospective questionnaire and interview-based study. BMC Med Educ 2007; 7(1): 6.[http://dx.doi.org/10.1186/1472-6920-7-6] [PMID: 17430583] ] with students from the first to sixth periods of the course, it was pointed out that the problem of this stage would not be related to the quantity of subjects to be seen, but to the increase of the preoccupations with the future and professional competence. The authors also observed that tension, exhaustion and symptoms of depression are risk factors for the onset of the syndrome in the fifth period of the course [22Dahlin ME, Runeson B. Burnout and psychiatric morbidity among medical students entering clinical training: A three year prospective questionnaire and interview-based study. BMC Med Educ 2007; 7(1): 6.[http://dx.doi.org/10.1186/1472-6920-7-6] [PMID: 17430583] ].

Some researchers also show that it is around the fifth period that one perceives a problematic in relation to the process of disenchantment about what had previously been idealized in the first period of the course, or even before initiating it, being this disappointment precipitated by the more intense contact with patients [23Souza L. Prevalência de sintomas depressivos, ansiosos e estresse em acadêmicos de medicina these2011.[http://dx.doi.org/10.11606/T.5.2011.tde-01022011-181552] -25Colares M de FA. Reflexões e vivências de estudantes de medicina do ciclo básico através do Sociodrama Educacional these2004.[http://dx.doi.org/10.11606/T.59.2004.tde-13082008-103327] ]. Other studies have pointed out that when students engage in more direct contact with patients in the fifth and sixth periods, they are affected by anxious symptoms, in some cases because of fear of making mistakes, such as giving wrong diagnoses. This is also due to the difficulty of communication among medical students, teachers and clinicians [26Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety, depression and stressful life events among medical students: A prospective study in Antalya, Turkey. Med Educ 2001; 35(1): 12-7.[http://dx.doi.org/10.1046/j.1365-2923.2001.00726.x] [PMID: 11123589] -28Stewart RA, Hauge LS, Stewart RD, Rosen RL, Charnot-Katsikas A, Prinz RA. A CRASH course in procedural skills improves medical students’ self-assessment of proficiency, confidence, and anxiety. Am J Surg 2007; 193(6): 771-3.[http://dx.doi.org/10.1016/j.amjsurg.2007.01.019] [PMID: 17512294] ].

In the group of students surveyed, it is observed that the majority is female, a Brazilian trend of the last decade in medical schools and among new professionals registered in the Councils of Medicine [29Ávila RC. Women and medical schools. Rev Bras Educ Med 2014; 38(1): 142-9.]. Women also have a higher frequency of the syndrome compared to men. Despite the difference found between gender, this was not statistically significant (x2 = 2.521, p> 0.05). When assessing the dimensions of burnout syndrome individually, women also had a higher level of “emotional exhaustion” than men, a finding already seen in other studies. For instance, in the study by Paro et al. [30Paro HBMS, Silveira PSP, Perotta B, et al. Empathy among medical students: Is there a relation with quality of life and burnout? PLoS One 2014; 9(4): e94133.[http://dx.doi.org/10.1371/journal.pone.0094133] [PMID: 24705887] ], which encompassed 22 Brazilian colleges, women scored more “emotional exhaustion” than men, but scored less on the criterion of “disbelief.” In the present study, women represented 58.3% of the sample with a positive score in “emotional exhaustion” and 58.4% with a positive score in “disbelief”, following in part the trend observed in that study [30Paro HBMS, Silveira PSP, Perotta B, et al. Empathy among medical students: Is there a relation with quality of life and burnout? PLoS One 2014; 9(4): e94133.[http://dx.doi.org/10.1371/journal.pone.0094133] [PMID: 24705887] ].

Although some authors point out that the levels of “disbelief” increase during the course, the group considered in this study did not score above the value considered acceptable for this dimension of the syndrome, nor did it show an increase according to the passage of the periods, indicating that these students did not become insensitive or cynical and ironic in dealing with others. According to the literature, this behavior occurs, in particular, with professionals and internal medicine [21Baldassim S. Ansiedade e depressão no estudante de Medicina: Revisão de estudos brasileiros. Cadernos ABEM 2010; 6(1): 19-26.].

The university center in which the present research was carried out adopts a non-traditional methodology of teaching, called Problem-Based Learning (PBL). This is a method of active education that supposedly differs from traditional teaching by encouraging the student to develop self-seeking skills, making the teacher a facilitator of the whole process, and no longer the traditional owner of absolute truth. Gomes et al. [31Gomes R, de Faria Brino R, Aquilante AG. de Avó LR da S. Aprendizagem Baseada em Problemas na formação médica e o currículo tradicional de Medicina: uma revisão bibliográfica. Rev Bras Educ Med 2009; 33(3): 444-51.[http://dx.doi.org/10.1590/S0100-55022009000300014] ], in a bibliographic review covering articles from 1998 to 2008, showed some advantages acquired by students submitted to the PBL teaching method in relation to the traditional method, namely: better interpersonal communication, better team performance, and better relationship with the patient. In theory, all this would contribute positively to better preparation of the future professional, reducing their anxiety in relation to what awaits them. Following this line of thought, in a survey carried out among medical graduates of a private college in Rio de Janeiro (n = 703), there was a greater score of “emotional exhaustion” and lower “professional efficacy” among students submitted to the traditional curriculum (67.4%), when compared to those under the PBL method (32.5%) [32Dórea M. Burnout em estudantes de medicina: Um desafio pré-profissional.A Síndrome de Burnout em professores do ensino regular: pesquisa, reflexões e enfrentamento 2010; 73-97.]. The low burnout rate found in our study can attests that the PBL method may represent a strategy for the prevention of burnout among medical students.

In the sample studied, we obtained statistically significant correlations between the dimensions of burnout syndrome, according to Pearson's Correlation. Between the dimensions of “emotional exhaustion” and “disbelief” were found a significant and positive correlation; between “emotional exhaustion” and “professional efficacy”, was weak and negative; between “disbelief” and “professional efficacy” the correlation was moderate and negative. These findings may suggest a probable cause-effect relationship between “emotional exhaustion” and “disbelief.”

CONCLUSION

The major findings of this cross-sectional study of medical students from Central Brazil were that about 12.0% of the interviewed medical students had burnout and that the fifth period of the Medicine course and the female gender are the most affected by burnout syndrome, therefore, the pedagogical and preventive actions to reduce stress among medical students should be directed mainly at these higher risk categories. Besides that, the low burnout rate found in our study can attest that the PBL methodology and medical schools strategically located to meet regional demand (avoiding the migration of young students away from their families) may represent strategies for the prevention of burnout among medical students.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

This research was approved by the Research Ethics Committee of the Centro Universitário de Anápolis (Unievangélica) (CAAE 40789214.7.0000.5076).

HUMAN AND ANIMAL RIGHTS

No animals/humans were used for studies that are the basis of this research.

CONSENT FOR PUBLICATION

The students who accepted to participate signed the Free and Informed Consent Term (IC).

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Decleared none.

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