Burnout and active teaching-learning methodology among medical students at a university in a triple border region

Lima, Laís Carneiro Rezende; Tesche, Luciano Francisco; Araújo, Tiago Silva; Barbosa, Thiago Luis de Andrade; Andrade, Ludmila Mourão Xavier Gomes

doi:10.1590/1981-5271v46.4-20220163.ING

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Educação Médica

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. bras. educ. med. 46 (4) • 2022 • https://doi.org/10.1590/1981-5271v46.4-20220163.ING copy

Burnout and active teaching-learning methodology among medical students at a university in a triple border region

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

The teaching-learning methodology is an important factor in the training of medical students and may also be associated with the exposure to chronic stressors that culminate in mental suffering, as observed in the Burnout Syndrome (BS).

Objective:

To determine the prevalence of Burnout Syndrome and analyze its dimensions and the relationship with the active teaching-learning methodology in medical students at university located in a triple-border region.

Method:

Cross-sectional study with 279 medical students who answered questionnaires on sociodemographic data, life habits, aspects of the teaching-learning process and the Maslach Burnout Inventory (IBM). There was an association between the BS and sociodemographic variables, life habits and the teaching-learning process, using Pearson’s Chi-Square tests, Fisher’s exact test and Student’s T test. Descriptive data analysis, bivariate analysis and multivariate logistic regression were performed.

Result:

The prevalence of Burnout was 4.7%, with 26.2% of high Emotional Exhaustion, 37.6% of high Depersonalization and 20.4% of low Professional Achievement. The medical students evaluated in this study have low or moderate levels of BS. Dissatisfaction with the active methodology learning, the lack of understanding of the foundation of the active methodology and the perception that the minority/none of the teachers apply the active methodology adequately were important predictors associated with Burnout.

Conclusion:

This investigation can help medical schools to develop institutional strategies to face this reality aiming to reduce the risk of the development of BS among medical students.

Keywords:
Burnout; Active Learning; Medical students; Medical Education; Professional Exhaustion

Variables	N	%
Socioeconomic and demographic
Age	Mean 24.2 years ± 4.7
	Min = 18	Max = 48
Gender
Female	146	52.3
Male	133	47.7
Marital status
With partner	38	13.6
Without partner	241	86.4
Do you profess a religion
Yes	173	62.0
No	106	38.0
Nationality
Brazilian	165	59.1
Foreigner	114	40.9
Family income*
< 2 MW	45	16.2
2 to 4 MW	83	29.8
5 to 10 MW	88	31.7
>10 MW	62	22.3
Are you currently working
Yes	23	8.2
No	256	91.8
With whom do you live
With other people	200	71.7
Alone	79	28.3
Do you have a steady partner
Yes	128	45.9
No	151	54.1
Lifestyle
Hours of leisure activity
Less than 6 hours	141	50.5
06 to 10 hours	109	39.1
More than 10 hours	29	10.4
Hours of sleep
More than 09 hours	39	14.0
07 to 09 hours	84	30.1
Less than 07 hours	156	55.9
Regarding sleep time, most of the time you feel
Tired	185	66.3
Rested	94	33.7
Do you practice physical activity
Yes	166	59.5
No	113	40.5
Frequency of physical activity
01 to 02 times a week	64	22.9
03 to 04 times a week	64	22.9
05 to 06 times a week	22	7.9
Daily	17	6.1
Not applicable	112	40.1
Do you currently smoke
Yes	15	5.4
No	264	94.6
Alcohol consumption
Yes	124	44.4
No	155	55.6
Do you use illicit drugs
Yes	61	21.9
No	218	78.1
Academic profile and teaching-learning methodology
Year of the Course
1^st	46	16.5
2^nd	45	16.1
3^rd	60	21.5
4^th	58	20.8
5^th	70	25.1
Are you satisfied with the choice of medical career
Yes	243	87.1
No	2	0.7
I do not know	34	12.2
Would you make the same choice for a medical career*
Yes	234	84.2
No	8	2.9
I do not know	36	12.9

Have you ever thought about dropping out of medical school*
Yes	115	41.4
No	163	58.6

Do you feel overwhelmed by the semester’s extracurricular activities*
Yes	164	59.0
No	79	28.4
I don’t do them in this period	35	12.6
Are you satisfied with the teaching-learning strategy in the course*
Yes	67	24.1
No	211	75.9
Do you understand the fundamentals of the active teaching-learning methodology*
Yes	271	97.5
No	7	2.5
Do you find it important to learn the fundamentals of the active methodology before starting it in practice*
Yes	265	95.3
No	13	4.7
How do you feel about learning in the context of the active teaching-learning methodology **
Satisfied	51	18.4
Dissatisfied	212	76.5
I do not know	14	5.1
In your opinion, are the teachers able to apply the active teaching-learning methodology in practice*
All/the majority	142	51.1
A minority/none	136	48.9

Dimensions/Risk	n	%
Emotional exhaustion (EE)	Mean: 22.9 ± 6.1
Emotional exhaustion (EE)	Min= 9	Max= 45
≥ 27 (High)	73	26.2
< 27 (Moderate/Low)	206	73.8
Depersonalization (DE)	Mean: 8.6 ± 3.4
Depersonalization (DE)	Min= 5	Max= 22
≥ 11 (High)	77	27.6
< 11 (Moderate/Low)	202	72.4
Professional Achievement (PA)	Mean: 29.7 ± 4.9
Professional Achievement (PA)	Min= 8	Max= 40
≥ 27 (Moderate/High)	222	79.6
< 27 (Low)	57	20.4
Burnout Risk (Ebisui)
Reduced	146	52.3
Moderate	85	30.5
Elevated	35	12.5
Burnout
Grunfeld et al.	133	47.7
Ramirez et al.	13	4.7
Cronbach’s alpha for EE: 0.86
Cronbach’s Alpha for DE: 0.778
Cronbach’s alpha for PA: 0.827
Global Cronbach’s Alpha for MBI: 0.742

Variable	Emotional Exhaustion^a a Emotional Exhaustion: ≥ 27 (High); < 27 (Moderate/Low)				p	Depersonalization ^b b Depersonalization: ≥ 11 (High); < 11 (Moderate/Low)				p	Personal Achievement^c c Professional Achievement: ≥ 27 (Moderate/High); < 27 (Low)				p
	<27		>=27			<11		>=11			<27		>=27
	n	%	n	%		n	%	n	%		n	%	n	%
Socioeconomic and Demographic
Age*	204	73.7	73	26.3	0.791	201	72.6	76	27.4	0.638	56	20.2	221	79.8	0.139
Mean ±DP	24.2 ±4.9		24.0 ± 3.9			24.0 ±4.8		24.3 ±4.0			23.4 ±3.7		24.4 ± 4.9
Gender					0.134					0.003					0.237
Male	102	49.5	44	60.3		117	57.9	29	37.7		34	59.6	112	50.5
Female	104	50.5	29	39.7		85	42.1	48	62.3		23	40.4	110	49.5
Marital status					0.553					0.847					0.522
With partner	30	14.6	8	11.0		27	13.4	11	14.3		6	10.5	32	14.4
Without partner	176	85.4	65	89.0		175	86.6	66	85.7		51	89.5	190	85.6
Do you profess a religion					0.262					0.001					0.221
Yes	132	64.1	41	56.2		137	67.8	36	46.8		31	54.4	142	64.0
No	74	35.9	32	43.8		65	32.2	41	53.2		26	45.6	80	36.0
Nationality					0.685					0.056					0.764
Brazilian	120	58.3	45	61.7		112	55.5	53	68.9		35	61.4	130	58.6
Foreigner	86	41.7	28	38.4		90	44.6	24	31.2		22	38.6	92	41.4
Family income					0.544					0.308					0.062
< 2 MW	36	17.6	9	12.3		37	18.4	8	10.4		9	15.8	36	16.3
2 to 4 MW	61	29.8	22	30.1		61	30.3	22	28.6		15	26.3	68	30.8
5 to 10 MW	66	32.2	22	30.1		62	30.8	26	33.8		13	22.8	75	33.9
>10 MW	42	20.5	20	27.4		41	20.4	21	27.3		20	35.1	42	19.0
Are you currently working					0.144					0.808					1.000
Yes	14	6.8	9	12.3		16	7.9	7	9.1		4	7.0	19	8.6
No	192	93.2	64	87.7		186	92.1	70	90.9		53	93.0	203	91.4
With whom do you live					0.546					0.138					0.191
With other people	150	72.8	50	68.5		150	74.3	50	64.9		45	78.9	155	69.8
Alone	56	27.2	23	31.5		52	25.7	27	35.1		12	21.1	67	30.2
Do you have a steady partner					0.892					1.000					1.000
Yes	94	45.6	34	46.6		93	46.0	35	45.5		26	45.6	102	45.9
No	112	54.4	39	53.4		109	54.0	42	54.5		31	54.4	120	54.1
Lifestyle
Hours of leisure activity					0.369					0.893					0.845
Less than 6 hours	99	48.1	42	57.5		102	50.5	39	50.6		29	50.9	112	50.5
06 to 10 hours	84	40.8	25	34.2		80	39.6	29	37.7		21	36.8	88	39.6
More than 10 hours	23	11.2	6	8.2		20	9.9	9	11.7		7	12.3	22	9.9
Hours of sleep					0.224					0.831					0.999
More than 09 hours	30	14.6	9	12.3		27	13.4	12	15.6		8	14.1	31	14.0
07 to 09 hours	67	32.5	17	23.3		60	29.7	24	31.2		17	29.8	67	30.1
Less than 07 hours	109	52.9	47	64.4		115	56.9	41	53.2		32	56.1	124	55.9
Regarding sleep time, most of the time do you feel					0.014					0.987					0.875
Tired	128	62.1	57	78.1		134	66.3	51	66.2		37	64.9	148	66.7
Rested	78	37.9	16	21.9		68	33.7	26	33.8		20	35.1	74	33.3
Do you practice any physical activity					0.492					0.057					1.000
Yes	120	58.3	46	63.0		113	55.9	53	68.8		34	59.6	132	59.5
No	86	41.7	27	37.0		89	44.1	24	31.2		23	40.4	90	40.5
Frequency of physical activity					0.943					0.439					0.395
01 to 02 times a week	45	21.8	19	26.0		47	23.3	17	22.1		16	28.1	48	21.6
03 to 04 times a week	48	23.3	16	21.9		42	20.8	22	28.6		8	14.0	56	25.3
05 to 06 times a week	17	8.3	5	6.8		15	7.4	7	9.1		6	10.5	16	7.2
Daily	84	40.8	28	38.4		11	5.4	6	7.8		3	5.3	14	6.3
Not applicable	84	40.8	28	38.4		87	43.1	25	32.5		24	42.1	88	39.6
Do you currently smoke					1.000					1.000					0.320
Yes	11	5.3	4	5.5		11	5.4	4	5.2		14	6.3	1	1.8
No	195	94.7	69	94.5		191	94.6	73	94.8		208	93.7	56	98.2
Alcohol consumption					0.010					0.001					0.457
Yes	82	39.8	42	57.5		77	38.1	47	61.0		96	43.2	28	49.1
No	124	60.2	31	42.5		129	61.9	30	39.0		126	56.8	29	50.9
Do you use illicit drugs					0.002					0.005					0.592
Yes	35	17.0	26	35.6		35	17.3	26	33.8		47	21.2	14	24.6
No	172	83.0	47	64.4		167	82.7	51	66.2		175	78.8	43	75.4

Variable	Emotional Exhaustionl^a a Emotional Exhaustion: ≥ 27 (High); < 27 (Moderate/Low)				p	Depersonalization ^b b Depersonalization: ≥ 11 (High); < 11 (Moderate/Low)				p	Personal Achievement^c c Professional Achievement: ≥ 27 (Moderate/High); < 27 (Low)			p
	<27		>=27			<11		>=11			<27		>=27
	n	%	n	%		n	%	n	%		n	%	n	%
Year of the Course					0.036					<0.001					0.796
1^st	40	19.4	6	8.2		41	20.3	5	6.5		11	19.3	35	15.8
2^nd	38	18.4	7	9.6		35	17.3	10	13.0		10	17.5	35	15.8
3^rd	42	20.4	18	24.7		44	21.8	16	20.8		9	15.8	51	23.0
4^th	40	19.4	18	24.7		46	22.8	12	15.6		13	22.8	45	20.3
5^th	46	22.3	24	32.9		36	17.8	34	44.2		14	24.6	56	25.1
Are you satisfied with the choice of the medical career					0.003					0.006					<0.001
Yes	187	90.8	56	76.7		183	90.6	60	77.9		38	66.7	205	92.3
No	2	1.0	0	0.0		2	1.0	0	0.0		0	0.0	2	0.9
I do not know	17	8.3	17	23.3		17	8.4	17	22.1		19	33.3	15	6.8
Would you make the same choice for a medical career*					<0.001					0.006					<0.001
Yes	51	69.9	183	89.3		57	74.0	177	88.1		36	63.2	198	89.6
No	22	30.1	22	10.7		20	26.0	24	11.9		21	36.8	23	10.4
Have you ever thought about dropping out of medical school*					<0.001					0.175					0.131
Yes	71	34.6	44	60.3		78	38.8	37	48.1		29	50.9	86	38.9
No	134	65.4	29	39.7		123	61.2	40	51.9		28	49.1	135	61.1
Do you feel overwhelmed by the semester’s extracurricular activities					0.002					0.128					0.232
Yes	109	53.2	55	75.3		52	75.4	112	64.4		37	75.5	127	65.5
No	69	33.7	10	13.7		17	24.6	62	35.6		12	24.5	67	34.5
I don’t do them in this period	27	13.2	8	11.0
Are you satisfied with the teaching-learning strategy in the course*					0.081					1.000					0.056
Yes	55	26.8	12	16.4		49	24.4	18	23.4		8	14.0	59	26.7
No	150	73.2	61	83.6		152	75.6	59	76.6		49	86.0	162	73.3
Do you understand the fundamentals of the active teaching-learning methodology					1.000					0.400					0.635
Yes	200	97.6	71	97.3		197	98.0	74	96.1		55	96.5	216	97.7
No	5	2.4	2	2.7		4	2.0	3	3.9		2	3.5	5	2.3
Do you find it important to learn the fundamentals of the active methodology before starting it in practice					0.524					0.526					0.733
Yes	194	94.6	71	97.3		14	18.2	37	18.5		54	94.7	211	95.5
No	11	5.4	2	2.7		63	81.8	163	81.5		3	5.3	10	4.5
How do you feel about learning in the context of the active teaching-learning methodology					<0.001					0.502					0.192
Satisfied	48	23.5	3	4.1		37	18.5	14	18.2		6	10.5	45	20.5
Dissatisfied	143	70.1	69	94.5		151	75.5	61	79.2		47	82.5	165	75.0
I do not know	13	6.4	1	1.4		12	6.0	2	2.6		4	7.0	10	4.5
In your opinion, are the teachers able to apply the active teaching-learning methodology in practice					<0.001					<0.001					0.555
All/the majority	118	57.6	24	32.9		116	57.7	26	33.8		27	47.4	115	52.0
The minority/none	87	42.4	49	67.1		85	42.3	51	66.2		30	52.6	106	48.0

Variables: academic profile and use of active teaching-learning methodology / Domain	OR^a a For analysis purposes, the OR is related to the chance of high emotional exhaustion, high depersonalization and low professional achievement in the comparison of the categories of the variables analyzed above.	95%CI		p
		Lower Lim.	Upper Lim.	p
Emotional Exhaustion
Would you make the same choice for a medical career
Yes	1
No	3.28	1.42	7.59	0.005
Have you ever thought about dropping out of medical school
Yes	1.88	1.01	3.51	0.049
No	1
Do you feel overwhelmed by the semester’s extracurricular activities*
Yes	2.63	1.35	5.11	0.004
No	1
How do you feel about learning in the context of the active teaching-learning methodology
Satisfied	1
Unsatisfied	5.37	1.52	18.99	0.009
In your opinion, are teachers able to apply the active teaching-learning methodology in practice*
All/the majority	1
The minority/none	2.07	1.13	3.79	0.019
Depersonalization
Year of the Course
1^st	1
2^nd	2.81	0.85	9.23	0.088
3^rd	3.08	1.01	9.33	0.047
4^th	2.30	0.73	7.23	0.154
5^th	8.09	2.80	23.33	<0.001
Are you satisfied with the medical career
Yes	1
No	3.15	1.43	6.95	0.004
Professional Achievement
Are you satisfied with the medical career
Yes	1
No	3.88	1.50	10.04	0.005
Would you make the same choice for a medical career
Yes	1
No	2.99	1.19	7.48	0.019
Sociodemographic variables and lifestyle/Domain	OR*	95%CI		p
Sociodemographic variables and lifestyle/Domain	OR*	Lower Lim.	Upper Lim.	p
Emotional Exhaustion
Regarding sleeping time, most of the time do you feel
Tired	2.59	1.35	4.97	0.004
Rested	1
Alcohol consumption
Yes	1.93	1.06	3.38	0.029
No	1
Do you use illicit drugs
Yes	2.51	1.32	4.76	0.005
No	1
Depersonalization
Gender
Male	2.07	1.18	3.62	0.010
Female	1
Do you profess a religion				0.008
Yes	1
No	2.12	1.22	3.69
Alcohol consumption				0.005
Yes	2.21	1.27	3.85
No	1

Associação Brasileira de Educação Médica SCN - QD 02 - BL D - Torre A - Salas 1021 e 1023 | Asa Norte, Brasília | DF | CEP: 70712-903, Tel: (61) 3024-9978 / 3024-8013, Fax: +55 21 2260-6662 - Brasília - DF - Brazil
E-mail: rbem.abem@gmail.com

Acompanhe os números deste periódico no seu leitor de RSS

[1] Chief Editor: Rosiane Viana Zuza Diniz. Associate editor: Roberto Esteves.