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      Burnout among medical students during the first years of undergraduate school: Prevalence and associated factors

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          Abstract

          Objective

          To evaluate the prevalence and possible factors associated with the development of burnout among medical students in the first years of undergraduate school.

          Method

          A cross-sectional study was conducted at the Barretos School of Health Sciences, Dr. Paulo Prata. A total of 330 students in the first four years of medical undergraduate school were invited to participate in responding to the sociodemographic and Maslach Burnout Inventory-Student Survey (MBI-SS) questionnaires. The first-year group consisted of 150 students, followed by the second-, third-, and fourth-year groups, with 60 students each.

          Results

          Data from 265 students who answered at least the sociodemographic questionnaire and the MBI-SS were analyzed (response rate = 80.3%). One (n = 1, 0.3%) potential participant viewed the Informed Consent Form but did not agree to participate in the study. A total of 187 students (187/265, 70.6%) presented high levels of emotional exhaustion, 140 (140/265, 52.8%) had high cynicism, and 129 (129/265, 48.7%) had low academic efficacy. The two-dimensional criterion indicated that 119 (44.9%) students experienced burnout. Based on the three-dimensional criterion, 70 students (26.4%) presented with burnout. The year with the highest frequency of affected students for both criteria was the first year (p = 0.001). Personal attributes were able to explain 11% (ΔR = 0.11) of the variability of burnout under the two-dimensional criterion and 14.4% (R 2 = 0.144) under the three-dimensional criterion.

          Conclusion

          This study showed a high prevalence of burnout among medical students in a private school using active teaching methodologies. In the first years of graduation, students’ personal attributes (optimism and self-perception of health) and school attributes (motivation and routine of the exhaustive study) were associated with higher levels of burnout. These findings reinforce the need to establish preventive measures focused on the personal attributes of first-year students, providing better performance, motivation, optimism, and empathy in the subsequent stages of the course.

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          Most cited references32

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          Prevalence of depression amongst medical students: a meta-analysis.

          Medical schools are known to be stressful environments for students and hence medical students have been believed to experience greater incidences of depression than others. We evaluated the global prevalence of depression amongst medical students, as well as epidemiological, psychological, educational and social factors in order to identify high-risk groups that may require targeted interventions.
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            MEASURING HAPPINESS WITH A SINGLE-ITEM SCALE

            This study examined the accuracy of measuring happiness by a single item (Do you feel happy in general?) answered on an 11-point scale (0–10). Its temporal stability was 0.86. The correlations between the single item and both the Oxford Happiness Inventory (OHI; Argyle, Martin, & Lu, 1995; Hills & Argyle, 1998) and the Satisfaction with Life Scale (Diener, Emmons, Larsen, & Griffin, 1985; Pavot & Diener, 1993) were highly significant and positive, denoting good concurrent validity. Moreover, the single item had a good convergent validity because it was highly and positively correlated with optimism, hope, self-esteem, positive affect, extraversion, and self-ratings of both physical and mental health. Furthermore, the divergent validity of the single item has been adequately demonstrated through its significant and negative correlations with anxiety, pessimism, negative affect, and insomnia. It was concluded that measuring happiness by a single item is reliable, valid, and viable in community surveys as well as in cross-cultural comparisons.
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              Personal life events and medical student burnout: a multicenter study.

              Burnout, a marker of professional distress prevalent among residents and physicians, has been speculated to originate in medical school. Little is known about burnout in medical students. The authors sought to identify the prevalence of burnout, variation of its prevalence during medical school, and the impact of personal life events on burnout and other types of student distress. All medical students (n = 1,098) attending the three medical schools in Minnesota were surveyed in spring 2004 using validated instruments to assess burnout, quality of life, depression, and alcohol use. Students were also asked about the prevalence of positive and negative personal life events in the previous 12 months. A total of 545 medical students (response rate 50%) completed the survey. Burnout was present in 239 (45%) of medical students. While the frequency of a positive depression screen and at-risk alcohol use decreased among more senior students, the frequency of burnout increased (all p < .03). The number of negative personal life events in the last 12 months also correlated with the risk of burnout (p = .0160). Personal life events demonstrated a stronger relationship to burnout than did year in training on multivariate analysis. Burnout appears common among U.S. medical students and may increase by year of schooling. Despite the notion that burnout is primarily linked to work-related stress, personal life events also demonstrated a strong relationship to professional burnout. The authors' findings suggest both personal and curricular factors are related to burnout among medical students. Efforts to decrease burnout must address both of these elements.
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                Author and article information

                Contributors
                Role: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 March 2018
                2018
                : 13
                : 3
                : e0191746
                Affiliations
                [1 ] Barretos School of Health Sciences, Dr. Paulo Prata, Barretos, São Paulo, Brazil
                [2 ] Research Group on Palliative Care and Health-Related Quality of Life (GPQual) –Barretos Cancer Hospital, Barretos, São Paulo, Brazil
                [3 ] Teaching and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
                [4 ] Department of Clinical Oncology – Breast and Gynecology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
                [5 ] School of Medicine, Federal University of Juiz de Fora, Minas Gerais, Brazil
                Universidade de Mogi das Cruzes, BRAZIL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-5111-0942
                Article
                PONE-D-17-25698
                10.1371/journal.pone.0191746
                5841647
                29513668
                416bb2c8-9291-4d16-a7d8-d6a0b1ee83d1
                © 2018 Boni et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 7 July 2017
                : 10 January 2018
                Page count
                Figures: 0, Tables: 5, Pages: 15
                Funding
                This project was supported by Barretos Cancer Hospital internal research funds (PAIP). The funder had no role in the design of the study, in the analysis or interpretation of data, or in the writing of the manuscript.
                Categories
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                Psychological Stress
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