Study design and setting
We conducted a cross-sectional study between 2-3-2020 and 23-3-2020 at the College of Medicine at Qassim University in the Qassim region, Saudi Arabia. Qassim University has two medical colleges. The leading medical college, located at Al-Mulayda, began its 5-year Bachelor of Medicine and Surgery (MBBS) program in the academic year 2000–2001. It is the first college in Saudi Arabia to adopt problem-based learning (PBL) and implement an integrated curriculum. Unayzah Medical College was established in 2011. It is the first college in Saudi Arabia to adopt the team-based learning (TBL) style as an essential foundation for medical curricula.
Participants, sampling method, and sample size
Undergraduate students at the Medical College of Qassim University were invited to participate in a Web-based survey. We provided an incentive (iPad) for one of the study participants selected randomly at the end of the sample collection to encourage participation. A total of 409 participants responded to the questionnaire out of 393 medical students in Unayzah Medical College and 726 medical students in Al-Mulayda Medical College. Students who neither complete all items of the MBI-SS or the demographic information were excluded, leaving a total of 336 participants to include in the analysis: first-year (n = 42), second-year (n = 91), third-year (n = 61), fourth-year (n = 68), fifth-year (n = 56), and internship (n = 18) undergraduate medical students. The sample size of 287 medical students from Buraidah and Unayzah Medical College was determined using Cochran’s formula with a 5% margin of error and a 95% confidence level.
Ethical approval was obtained from the Institutional Review Board at Qassim University. A study confidentiality information sheet was included on the first web page of the questionnaire. It indicated that students’ participation was voluntary, and information would be used only for research purposes. A click on “agree” on the consent web page was required from each student before filling out the survey.
Data collection instrument and procedure
The medical students were asked to complete a structured questionnaire that had been designed and formulated based on the information provided by the Maslach Burnout Inventory – Student Survey (MBI-SS) , which calculates a burnout score using 16 items for three categories of burnout symptoms EE, DP, and PA . Additionally, the questionnaire had been modified to include demographic data (age, gender, medical college, and school year).
The questionnaire consisted of two parts. Part 1 identified sociodemographics and personal characteristics of the participants, such as age, gender, academic year, and medical college. Part 2, MBI-SS, was used to determine burnout among the respondents. Schaufeli validated it, showing acceptable reliability among students in Spanish, Portuguese, and Dutch . Among Chinese students, the MBI-SS has been found to have sufficient reliability and factorial validity . The survey contains 16 items that focus on the triad of exhaustion (five items), cynicism (five items), and professional efficacy (six items). Exhaustion refers to the student’s exhaustion induced by academic demands, cynicism refers to the student’s detachment from lessons, and professional effectiveness refers to the student’s academic achievement. All items on the survey were graded on a 7-point Likert scale ranging from 0 (Never) to 6 (Always). Scores were categorized into high, moderate, or low scores in each of the three components. High scores on cynicism and exhaustion and low scores on professional efficacy indicate high burnout . In this study, Cronbach’s alpha for the MBI-SS was 0.77 for professional efficacy, 0.87 for exhaustion, and 0.75 for cynicism.
An analysis of variance was used to compare groups and test interactions. Components of the MBI-SS subscores for emotional exhaustion, cynicism, and personal efficacy were analyzed for gender, age, school year, and college.