Syntax Literate: Jurnal Ilmiah Indonesia p–ISSN: 2541-0849 e-ISSN: 2548-1398

Vol. 9, No. 5, Mei 2024

BURNOUT IN MEDICAL STUDENT: LITERATURE REVIEW

Joulanda A. M. Rawis^1*, ⁠Andriessanto C. Lengkong², Inggrid C. Mahama³, ⁠Christopher Lampah⁴, ⁠Iddo Posangi⁵

Universitas Negeri Manado, Manado, Indonesia^1,2,3,4,5

Email: [email protected]¹, [email protected]²,

[email protected]³, [email protected]⁴,

[email protected]⁵

Abstract

Burnout is a condition of emotional exhaustion, depersonalization, and reduced work performance caused by chronic stress. Burnout can occur in various people, including medical students. The purpose of this study was to review the literature on burnout in medical students. This study used a literature research method. Research data were collected using literature search techniques. Research data were obtained from various sources, namely journal articles, books, and research reports. The research data were analyzed using qualitative analysis techniques. The results showed that burnout in medical students is a serious problem. Burnout can occur in medical students at various levels of education, ranging from early semester students to final semester students. Factors that can cause burnout in medical students include high academic loads, demands to be perfect doctors, and stressful working conditions. The negative impacts of burnout on medical students include impaired physical and mental health, decreased academic performance and lower chances of getting a job.

Keywords: Burnout, Medical, Student

Introduction

Burnout is a condition in which a person experiences high levels of emotional exhaustion, depersonalization, and decreased work performance as a result of continuous exposure to chronic stress. In this state, individuals can feel emotionally drained, lose a sense of attachment to their work or surroundings, and experience decreased performance or achievement in their tasks. Burnout is often associated with excessive demands, constant pressure, and an imbalance between workload and the ability to cope with the stress experienced (Maslach & Leiter, 2006).

There are a variety of different instruments to measure burnout symptoms including: Work-Related Behavior Scale and Patterns of Experience Scale, Oldenburg Burnout Inventory, Burnout symptoms scale, Hamburg Burnout Inventory Copenhagen Burnout Inventory and Maslach Burnout Inventory (MBI) with its specific versions: Maslach Burnout Inventory-Human Services Survey (MBI-HSS) (Erschens et al., 2019).

Burnout can occur in various groups, including medical students. Symptoms of burnout generally appear early in medical education, and based on research from several institutions, at least 50% of medical students may experience burnout during their studies (Chigerwe et al., 2014). Although medical school institutions make every effort to provide support to students during their education and aim to produce doctors who are knowledgeable, highly skilled, and professionally ethical, scientific studies show that medical students face very high levels of personal stress (Fares et al., 2016).

Burnout that occurs in the medical school environment has the potential to negatively impact students' academic performance and overall well-being. Burnout has also been identified as a significant predictive factor for suicidal ideation and leaving medical education (Chunming et al., 2017). Therefore, burnout in medical students deserves more attention in research and more consideration as a target for prevention and intervention efforts in the school environment.

Previous research by (Ishak et al., 2013) showed that burnout is prevalent during medical school, with a large multi-institutional study in the US estimating that at least half of all medical students may be affected by burnout during their medical education. Studies show that burnout can continue after graduating from medical school, and is sometimes associated with psychiatric disorders and suicidal ideation. Various personal and professional characteristics correlate with burnout. Potential interventions include school-based and individual-based activities to improve students' overall well-being.

Another study by (Jennings, 2009) showed that cultural factors also facilitate burnout in medical students who are immersed in clinical environments that foster excessive detachment from patients and self, undermine self-care, undermine self-confidence, and hinder the development of a mature and well-integrated professional identity. The ethical implications of medical student burnout are also discussed. The purpose of this study was to review the literature on burnout in medical students.

Research Methods

This research uses the literature research method. Literature review is a systematic process in a research that involves the identification, collection, evaluation, and synthesis of relevant text sources related to a particular research topic or problem. This process involves an in-depth review of literature or published works, such as books, scientific journals, articles, theses, research reports, and other sources relevant to the subject or topic of research (Van Lange et al., 2015). Research data were collected using literature search techniques obtained from Google Schoolar. The type of data in this study is secondary data. Research data were obtained from various sources, namely journal articles, books, and research reports. The research data were analyzed using qualitative analysis techniques.

Results and Discussion

The medical study program is a study program that aims to produce professional doctors. Medicine is one of the favorite majors in demand in Indonesia. The strict selection carried out in the admission of new prospective students is based on efforts to select new prospective students who have high academic ability to follow and complete education in higher education in accordance with the predetermined time limit. The high educational load and process as well as the high learning outcomes that are adjusted to the competency standards of doctors that must be achieved affect the readiness of students in undergoing the educational process (Trisnasari & Sulthany, 2023).

Medical education is not easy and requires strong motivation to complete (Dewi et al, 2015). Although the doctor's study program is a major that is in demand. However, the medical study program is also one of the most difficult majors in the world. The long and arduous learning process and high competition make the medical study program a challenging study program with various exams that must be passed (Gibran, 2023).

Individual failure to make adjustments in the field of education can cause individuals to experience psychological disorders, one of which is feeling stress (Maulina & Sari, 2018). The American College Health Association (2013) states that in the field of education, the problem often faced by students is stress. Students experience stress as a demand for academic life that must be lived. Stress is a universal phenomenon that occurs in daily life and will be experienced by everyone. Stress has a total impact on individuals such as physical, social, intellectual, psychological and spiritual impacts. Stress can come from individuals, family environment, residential environment, work environment and education (Hediaty et al, 2022).

Stress can reduce concentration, decrease attention, hinder the decision-making process, and reduce students' ability to build good relationships with patients, which can result in incompetence and patient dissatisfaction with clinical practice in the future (Rahmayani et al, 2019). A form of stress that is often found in the field of education is academic stress. Academic stress also includes students' perceptions of the amount of knowledge that must be mastered. Another factor that can cause academic stress in students is confidence. Belief in one's ability to complete academic tasks can increase efforts to achieve goals but can also be an obstacle in achieving goals. Self-efficacy is an ability to organize and carry out part of the activities needed to achieve the desired goals (Avianti et al, 2021).

Academic stress over a long period of time results in physical and psychological burnout in students. Burnout appears accompanied by feelings of fatigue, frustration, helplessness, and cynicism (Firdaus et al, 2021). This unaddressed and ongoing stress can have a negative impact and can lead to burnout (Aliftitah, 2015). Burnout is a condition of a person who experiences physical and psychological fatigue due to work and emotional demands. If burnout continues to occur, it can have a negative impact on life satisfaction among students and health professionals (Lutfia et al, 2021). Burnout can interfere with the professional development of medical students in training, put patients at risk, and result in a variety of personal consequences, including suicidal thoughts. (Shanafelt et al., 2016).

Burnout syndrome is a syndrome that includes three dimensions, namely emotional exhaustion, depersonalization, and reduced satisfaction with personal achievement. The main component is emotional exhaustion which is synonymous with the experience of fatigue and loss of interest in work.

Emotional exhaustion, also known as emotional exhaustion, comes from burnout, which is an emotional condition in which a person feels mentally or physically tired and saturated as a result of increased work demands and feels exhausted, loses passion for work and is indifferent (Ahsyari, 2014). Emotional exhaustion arises due to excessive stress, and is difficult to overcome which can lead individuals to a worse state where apathy, cynicism, and frustration appear. Sources of emotional exhaustion can arise in individuals who have perfectionist personality tendencies or want perfection in every job (Santika & Sudibia, 2017). Emotional exhaustion affects learning achievement, so that to be able to attend lectures sometimes less able to understand lecture material and tired physical conditions make them less able to concentrate properly (Putri & Budiani, 2012).

Depersonalization is defined as an attempt to create distance between oneself and the service recipient by ignoring their own special qualities and neglecting to please others. This dimension is considered the defensive element of the syndrome. It is characterized by a negative and uncaring attitude towards the patient (Sutoyo et al, 2018). Cynicism (depersonalization) indicates the appearance of tension with other individuals and loss of motivation. This component shows a loss of cognitive and emotional engagement and a negative response to work. Decreased achievement is another component of burnout that shows the self-evaluation of burnout sufferers (Islami, 2019).

Burnout syndrome is a special type of tension that reflects a belief that several sources for coping with stressful conditions will cause a person to experience hopelessness, fatigue and cognitive fatigue (Putri et al, 2023). According to Korunka et al in Santi et al (2019), the general characteristics of burnout, namely:

1) Physical pain is characterized as headaches, fever, back pain, tension in the neck and shoulder muscles, frequent colds, insomnia, chronic fatigue.

2) Emotional exhaustion is characterized as boredom, irritability, cynicism, anger, anxiety, despair, sadness, depression, helplessness.

3) Mental fatigue is characterized as indifference to the environment, negative attitude towards others, low self-concept, hopelessness with life path, feeling worthless.

Christy et al (2020) revealed an alarming, yet unsurprising, prevalence rate of burnout among medical students. Burnout in medical students has several negative effects on their mental health, with increased rates of depression, poor sleep, suicidal ideation, and substance abuse. Burnout in this special population can also have far-reaching effects on learning, causing career regret and thoughts of quitting, as well as impacting future patient care as medical students enter the workforce. We suggest the need for consensus on the definition and measurement of burnout to allow for better international comparisons of burnout prevalence rates in different settings (Almutairi et al, 2022).

The incidence of burnout in students can be related to academic problems and poor stress coping in students in dealing with these problems (7,13,14), so interventions need to be made to increase student resilience in dealing with stress during medical education (Putri et al, 2019). Burnout that is not properly addressed can also affect the professionalism of medical graduates when they become doctors (Wolf & Rosenstock, 2016). Prolonged burnout has been shown to impair performance and decrease an individual's interest in further education (Walburg, 2014). Thus, health-related study programs have a long and strenuous education time. This is what causes burnout in medical students. Especially in medical students burnout is a common thing to experience.

Conclusion

Burnout in medical students is a serious problem that requires deep attention. Burnout can arise at various stages of education, including early semester students to the final stage. There are several factors that trigger burnout in medical students, including a very high academic load, pressure to achieve standards of perfection as a doctor, and a work environment that tends to cause stress. The negative impact of burnout on medical students is significant. These include impaired physical and mental health, decreased academic performance, and decreased chances of getting a better job in the future. Overburdening and constant pressure can have a serious impact on the overall well-being of medical students. Therefore, the need for concrete and appropriate measures to prevent and address burnout among medical students is urgent.

BIBLIOGRAPHY

Ahsyari, E. (2014). Kelelahan Emosional Dan Strategi Coping Pada Wanita Single Parent (Studi Kasus Single Parent Di Kabupaten Paser). Psikoborneo. 2(3), 170-176.

Aliftitah, S. (2015). Pengaruh Solution Focused Brief Counselling dalam mencegah Burnout Syndrome pada Mahasiswa Keperawatan. Jurnal Kesehatan Wirajaya Medika. 6(2), 68–77.

Almutairi, H., Alsubaiei, A., Abduljawad, S., Alshatti, A., Romdhane, F., Husni, M., & Jahrami, H. (2022). Prevalence of burnout in medical students: A systematic review and meta-analysis. International Journal of Social Psychiatry. 1-14.

Avianti, D., Setiawati, O., Lutfianawati, D., & Putri, A. (2021). Hubungan Efikasi Diri Dengan Stres Akademik Pada Mahasiswa Fakultas Kedokteran Universitas Malahayati. Psyche: Jurnal Psikologi Universitas Muhammadiyah Lampung. 3(1), 83-93.

Chigerwe, M., Boudreaux, K. A., & Ilkiw, J. E. (2014). Assessment of burnout in veterinary medical students using the Maslach Burnout Inventory-Educational Survey: a survey during two semesters. BMC medical education, 14, 1-7.

Christy. Sahrani, R., & Heng, P. (2020). Kemampuan Mengontrol Diri Mahasiswa Kedokteran Dalam Belajar, Pengerjaan Tugas, Dan Penggunaan Gawai. Jurnal Muara Ilmu Sosial, Humaniora, dan Seni. 4(1), 204-212.

Chunming, W. M., Harrison, R., MacIntyre, R., Travaglia, J., & Balasooriya, C. (2017). Burnout in medical students: a systematic review of experiences in Chinese medical schools. BMC medical education, 17(1), 1-11.

Dewi, S., Arya, I., Achadiyani, & Achmad, T. (2015). Gambaran Motivasi Menjadi Dokter pada Mahasiswa Tahun Pertama Fakultas Kedokteran Universitas Padjadjaran. JSK. 1(1), 24-29.

Erschens, R., Keifenheim, K. E., Herrmann-Werner, A., Loda, T., Schwille-Kiuntke, J., Bugaj, T. J., ... & Junne, F. (2019). Professional burnout among medical students: systematic literature review and meta-analysis. Medical teacher, 41(2), 172-183.

Fares, J., Al Tabosh, H., Saadeddin, Z., El Mouhayyar, C., & Aridi, H. (2016). Stress, burnout and coping strategies in preclinical medical students. North American journal of medical sciences, 8(2), 75.

Firdaus, A., Yuliyanasari, N., Djalillah, G., & Utama, M. (2021). Potensi Kejadian Burnout pada Mahasiswa Kedokteran di Masa Pandemi Covid-19. Huang Tuah Medical Journal. 18(2), 114-135.

Gibran, D. (2023). 15 Jurusan Kuliah Paling Sulit di Dunia, Sanggup Sampe Lulus?. CNBC Indonesia. https://www.cnbcindonesia.com/lifestyle/20230711145845-33-453274/15-jurusan-kuliah-paling-sulit-di-dunia-sanggup-sampe-lulus#:~:text=Jurusan%20Kedokteran%20sering%20kali%20dianggap,fisiologi%2C%20farmakologi%2C%20dan%20patologi. Diakses pada 14 Desember 2023.

Hediaty, S., Herlambang, Shafira, N. (2022). Gambaran Tingkat Stres Mahasiswa Kedokteran Berdasarkan Medical Student Stresor Questionnaire Di Fakultas Kedokteran Dan Ilmu Kesehatan Universitas Jambi. JOMS. 2(2), 61-71.

Ishak, W., Nikravesh, R., Lederer, S., Perry, R., Ogunyemi, D., & Bernstein, C. (2013). Burnout in medical students: a systematic review. The clinical teacher, 10(4), 242-245.

Islami, S. (2010). Fenomena Burnout pada Mahasiswa Kedokteran Tingkat Satu: Studi Kasus di Fakultas Kedokteran Universitas Sebelas Maret. Universitas Sebelas Maret.

Jennings, M. L. (2009). Medical student burnout: Interdisciplinary exploration and analysis. Journal of Medical Humanities, 30(4), 253-269.

Lutfia, A., Riezky, A., & Andriaty, S. (2021). Faktor Penyebab Terjadinya Burnoutpada Mahasiswa Program Studi Pendidikan Dokter Universitas Abulyatama. Jurnal Ilmu Kedokteran dan Kesehatan. 8(2), 88-95.

Maslach, C., & Leiter, M. P. (2006). Burnout. Stress and quality of working life: current perspectives in occupational health, 37, 42-49.

Maulina, B., & Sari, D. (2018). Derajat Stres Mahasiswa Baru Fakultas Kedokteran Ditinjau Dari Tingkat Penyesuaian Diri Terhadap Tuntutan Akademik. Jurnal Psikologi Pendidikan & Konseling: Jurnal Kajian Psikologi Pendidikan dan Bimbingan Konseling. 4(1), 1-5.

Putri, A., & Budiani, M. (2019). Pengaruh Kelelahan Emosional Terhadap Perilaku Belajar Pada Mahasiswa Yang Bekerja. Universitas Negeri Surabaya.

Putri, B., Amalia, E., & Sari, D. (2023). Hubungan Antara Burnout Dan Kualitas Tidur Dengan Prestasi Akademik Mahasiswa Kedokteran Universitas Mataram. Prosiding SAINTEK LPPM Universitas Mataram. 3, 282-292.

Putri, R., Oktaria, D., & Rahmayani, F. (2023). Korelasi Kecerdasan Emosional Terhadap Kejadian Burnout Pada Mahasiswa Tingkat Akhir Fakultas Kedokteran Universitas Lampung. Medula. 13(2), 207-214.

Rahmayani, R., Liza, R., & Syah, N. (2019). Gambaran Tingkat Stres Berdasarkan Stressor pada Mahasiswa Kedokteran Tahun Pertama Program Studi Profesi Dokter Fakultas Kedokteran Universitas Andalas Angkatan 2017. Jurnal Kesehatan Andalas. 8(1), 103-111.

Santi, K. (2019). Pengaruh Big Five Personality dengan Kejadian Burnout pada Mahasiswa Pendidikan Kedokteran. JIMKI. 8(1), 64-70.

Santika, P., & Sudibia, G. (2017). Pengaruh Kelelahan Emosional Terhadap Kepuasan Kerja Dan Komitmen Organisasional. E-Jurnal Manajemen Unud. 6(2), 634-662.

Shanafelt, T. D., Dyrbye, L. N., West, C. P., & Sinsky, C. A. (2016). Potential impact of burnout on the US physician workforce. Mayo Clinic Proceedings, 91(11), 1667–1668.

Sutoyo, D., Kurniadi, R., & Fuadi, I. (2018). Sindrom Burnout pada Peserta Program Pendidikan Dokter Spesialis Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran. Jurnal Anestesi Perioperatif. 6(3), 153-161.

Trisnasari, E., & Sulthany, A. (2023). Faktor-Faktor Mempengaruhi Pemilihan Jurusan Mahasiswa Program Studi Kedokteran Universitas Sultan Ageng Tirtayasa. Tirtayasa Medical Journal. 2(2), 49-53.

Van Lange Paul, A. M., Liebrand, W. B., & AM, W. H. (2015). Introduction and literature review. Social dilemmas, 3-28.

Walburg, V. (2014). Burnout among high school students: A literature review. Children and Youth Services Review, 42, 28-33.

Wolf, M. R., & Rosenstock, J. B. (2016). Inadequate sleep and exercise associated with burnout and depression among medical students. Academic Psychiatry, 41(2). 174-179.

Copyright holder:

Joulanda A. M. Rawis, ⁠Andriessanto C. Lengkong, Inggrid C. Mahama, ⁠Christopher Lampah, ⁠Iddo Posangi (2024)

First publication right:

Syntax Literate: Jurnal Ilmiah Indonesia

This article is licensed under: