An analytical cross-sectional study was conducted at the College of Medicine, University of Kerbala, Kerbala, Iraq. The participants were medical students from all 6 stages.
Kerbala Medical College (KMC) included 1016 medical students from 6 years of study.
Due to the coronavirus COVID-2019 pandemic situation, most universities shifted to online classes around the world [16]. So, the data collection was conducted through an online approach using over the period from June 11 to July 3, 2020.
According to the following formula for determination of sample size n = Z2 P (1-p)/d2 , n = sample size, Z = 1.96 which is the corresponding value for the 95% confidence interval, P = prevalence of burnout among medical students, d = the degree of precision was at 0.05 at 95% confidence interval, and anticipated prevalence of burnout among medical students = 50%
$$\mathrm{Sample}\;\mathrm{size}=\frac{\left(1.96\right)^2\ast0.05\ast\left(1-0.5\right)}{\left(0.05\right)^2}=\frac{0.9515}{0.0025}=380$$
Supposing the non-response rate, 10% of the sample size was added, so, the minimum required sample size was 380+38 =418 students.
A convenient sample of 424 students from the total number of 1016 medical students at the year 2019–2020 (628 pre-clinical and 388 clinical) was approached in the study. Thus, the response rate was 42%.
A self-administered online questionnaire using Google form was developed. Then it was distributed as a link to the student representatives of each stage who shared it with all (1016) other students through the telegram groups which were already formed for each stage academic year and requesting their voluntary participation. Email survey took about 3 weeks to complete. The email survey took about 5–8 min for one participant to be completed.
Inclusion criteria
Inclusion criteria include all of the undergraduate medical students including both gender (male and female) and 18 years or above, who are willing to participate in the study and to complete all items of the MBI-SS.
The questionnaire consisted of 2 parts, the first part contains socio-demographic characteristics like gender, age, marital status, residency, academic stage, family income, smoking habit and type of smoking, exercise habit, daily sleep hours, regular use of legal substances (pain relieve drugs, sedatives, cough drugs, steroids, antidepressants, caffeine), and family history of psychological disorders. Where to maintain maximum health, adults should sleep 7 or more hours every night regularly (according to the American Academy of Sleep Medicine and Sleep Research Society). And regular exercise can improve anxiousness, tension, and a general sense of well-being [17, 18].
The second part of the questionnaire included Maslach Burnout Inventory -Student Survey (MBI-SS). The Arabic version was previously used and validated by other studies. It is a modified version of the Maslach Burnout Inventory-General Survey (MBI-GS), which had been adjusted for use on students and become the classically used tool to measure academic burnout syndrome [19, 20].
The MBI-SS includes 15 questions that conform to three scales: Emotional Exhaustion (5 questions), Cynicism (4 questions), and Professional Efficacy (6 questions). The MBI-SS questions are scored by students on a 7-point scale, based on their indicated frequency, ranging from 0 to 6, where 0, never; 1, a few times a year; 2, monthly; 3, a few times a month; 4, weekly; 5, a few times a week; and 6, every day [21].
The internal consistency for the MBI-SS total 15 questions was 0.76. The internal consistency for the subscales were 0.75 (Cronbach’s a = 0.75) for the emotional exhaustion 5 questions, 0.8 (Cronbach’s a = 0.8) for the cynicism 4 questions, and 0.73 (Cronbach’s a = 0.73) for the professional efficacy 6 questions.
The authors used a similar classification of other studies for burnout diagnosis. Students were identified as exhibiting burnout (high level) if their scores were more than 14 for emotional exhaustion and cynicism (score >6) while the low for professional efficacy (score < 23). These results matched the 66th percentile of exhaustion and cynicism, as well as the 33rd percentile of efficacy. Low burnout level indicated emotional exhaustion (< 10) cynicism (< 2), and efficacy (scores > 27). A moderate level of burnout was identified according to the following scores: emotional exhaustion (10–14), cynicism (2–6), and professional efficacy (23–27) [8, 22].
The study is a part of research that was approved by the Research Ethics Committee of the College of Medicine, University of Kerbala. The participation was entirely voluntary and anonymous, the participants were able to respond at their convenience, and the confidentiality of the answers was ensured.
Data analysis was done using the Statistical Package for Social Sciences (SPSS) version 24 computer software; categorical variables were presented as frequencies and percentages. Quantitative variables were expressed as mean and standard deviation (SD). Binary logistic regression had been used to evaluate the association between burnout and students̓ background variables. All predictor variables were tested in one block to assess their predictive ability. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) were measured. A p value of less than 0.05 was considered statistically significant.