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      Burnout in medical students: a systematic review of experiences in Chinese medical schools

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          Abstract

          Background

          To identify the: extent to which medical students in China experience burnout; factors contributing to this; potential solutions to reduce and prevent burnout in this group; and the extent to which the experiences of Chinese students reflect the international literature.

          Methods

          Systematic review and narrative synthesis. Key words, synonyms and subject headings were used to search five electronic databases in addition to manual searching of relevant journals. Titles and abstracts of publications between 1st January 1989-31st July 2016 were screened by two reviewers and checked by a third. Full text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and synthesised.

          Results

          Thirty-three studies were eligible and included in the review. Greater levels of burnout were generally identified in males, more senior medical students, and those who already experienced poorer psychological functioning. Few studies explored social or contextual factors influencing burnout, but those that did suggest that factors such as the degree of social support or the living environment surrounding a student may be a determinant of burnout.

          Conclusions

          Greater understanding of the social and contextual determinants of burnout amongst medical students in China is essential towards identifying solutions to reduce and prevent burnout in this group.

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          Most cited references31

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          Early predictors of job burnout and engagement.

          A longitudinal study predicted changes in burnout or engagement a year later by identifying 2 types of early indicators at the initial assessment. Organizational employees (N = 466) completed measures of burnout and 6 areas of worklife at 2 times with a 1-year interval. Those people who showed an inconsistent pattern at Time 1 were more likely to change over the year than were those who did not. Among this group, those who also displayed a workplace incongruity in the area of fairness moved to burnout at Time 2, while those without this incongruity moved toward engagement. The implications of these 2 predictive indicators are discussed in terms of the enhanced ability to customize interventions for targeted groups within the workplace. PsycINFO Database Record (c) 2008 APA, all rights reserved.
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            A conceptual model of medical student well-being: promoting resilience and preventing burnout.

            This article proposes and illustrates a conceptual model of medical student well-being. The authors reviewed the literature on medical student stress, coping, and well-being and developed a model of medical student coping termed the "coping reservoir." The reservoir can be replenished or drained by various aspects of medical students' experiences. The reservoir itself has an internal structure, conceptualized as consisting of the individual's personal traits, temperament, and coping style. The coping reservoir metaphor is used to highlight the dynamic nature of students' experiences, with potential outcomes including enhanced resilience and mental health versus distress and burnout. Medical student well-being is affected by multiple stressors as well as positive aspects of medical training. Attention to individual students' coping reservoirs can help promote well-being and minimize burnout; formal and informal offerings within medical schools can help fill the reservoir. Helping students cultivate the skills to sustain their well-being throughout their careers has important payoffs for the overall medical education enterprise, for promotion of physician resilience and personal fulfillment, and for enhancement of professionalism and patient care. This and other models of coping should be empirically validated.
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              Burnout risk in medical students in Spain using the Maslach Burnout Inventory-Student Survey.

              It is questionable whether the Maslach Burnout is suitable for studying burnout prevalence in preclinical medical students because many questions are patient-centered and the students have little or no contact with patients. Among factors associated with burnout in medical students, the gender shows conflicting results. The first aim of this study was to investigate the prevalence of the risk of burnout in medical students in preclinical and clinical years of training, using the Maslach Burnout Inventory-Student Survey, specifically designed and validated to assess the burnout in university students, and secondly, to investigate the association between gender and burnout subscales. A cross-sectional study was carried out in a sample of 270 Spanish medical students-176 (65%) in the third year and 94 (35%) in the sixth year of training-using the Maslach Burnout Inventory-Student Survey questionnaire. Internal consistencies (Cronbach's alpha) for the three subscales on the whole sample were as follows: for exhaustion 0.78, cynicism 0.78, and efficacy 0.71. Moreover, the prevalence of burnout risk was significantly higher in sixth-year students 35 (37.5%) compared with students in third year of training 26 (14.8%) (χ(2) test, p < 0.0001). No significant association was found between gender and burnout subscales. The Maslach Burnout Inventory-Student Survey overcame difficulties encountered when students have little or no contact with patients. Our findings show that the risk of burnout prevalence doubled from the third year to sixth year of training and that gender was not significantly associated with any of the subscales of burnout.
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                Author and article information

                Contributors
                wangchunming@renji.com
                +61 2 93853324 , reema.harrison@unsw.edu.au
                r.macintyre@unsw.edu.au
                joanne.travaglia@uts.edu.au
                c.balasooriya@unsw.edu.au
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                16 November 2017
                16 November 2017
                2017
                : 17
                : 217
                Affiliations
                [1 ]ISNI 0000 0004 4902 0432, GRID grid.1005.4, School of Public Health, , University of New South Wales, ; Samuels Building, Sydney, NSW 2052 Australia
                [2 ]ISNI 0000 0004 1936 7611, GRID grid.117476.2, Centre for Health Services Management, , University of Technology Sydney, ; Sydney, Australia
                Article
                1064
                10.1186/s12909-017-1064-3
                5693445
                29145854
                f02000f3-5c66-44d9-bf50-0f0ccde9ddc6
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 April 2017
                : 7 November 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100008233, Shanghai Jiao Tong University School of Medicine;
                Award ID: 14XJ10061
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Education
                medical education,burnout,emotional exhaustion,depersonalisation
                Education
                medical education, burnout, emotional exhaustion, depersonalisation

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