Academic burnout (ABO) is a critical issue among medical students, marked by severe mental and physical exhaustion, cynicism, and a sense of inadequacy [1; 2]. This condition adversely affects students’ mental and physical health and academic performance, leading to poor outcomes and higher dropout rates [3; 4; 5]. The substantial academic and emotional demands placed on medical students can elevate stress and burnout levels. Therefore, identifying and implementing effective strategies to mitigate these effects is essential for fostering a healthier and more sustainable educational environment.
Building upon our previous findings [7], which demonstrated through ordinary one-way ANOVA that the latent variable CYIN produced a reduction in ABO among students participating in IPAL, this study employs mediation analysis to explore the underlying mechanisms of this relationship more deeply. Specifically, we aimed to examine the individual observed variables within the CYIN construct to pinpoint which specific aspects are most relevant to peer intervention. The detailed breakdown of CYIN into its observed variables (CY1, CY2, CY3, IN1, and IN2) offers targeted insights into these mechanisms.
The combined analysis of path coefficients, total and indirect effects, and percentage distributions provides a comprehensive understanding of how IPAL impacts ABO through observed variables. The significant negative indirect effects suggest that IPAL serves as a protective factor against ABO by reducing the levels of CY2, IN1, and IN2.
Our findings support the hypothesis that medical students engaged in IPAL experience a reduction in ABO, rather than those with reduced ABO being motivated to participate in IPAL. This aligns with previous studies that highlight the importance of social and collaborative learning environments in mitigating burnout [10; 11; 12]. The mediation analysis demonstrates that IPAL’s impact on ABO is mediated through indirect pathways involving the observed variables CY2 (loss of interest in academic work), IN1 (feelings of inadequacy), and IN2 (diminished academic expectations). These results provide evidence that IPAL influences ABO primarily through these mediating variables.
Although CY1 (lack of motivations and thoughts of leaving them) and CY3 (questioning the meaning of academic work) did not meet the mediation assumptions proposed by Baron and Kenny (1986) [24] because a significant effect from the independent variable was not found, the mediation analysis demonstrates that CY2 (loss of interest in academic work), IN1 (feelings of inadequacy), and IN2 (diminished academic expectations) significantly mediate the relationship between IPAL and ABO. This suggests that the reduction in ABO is mediated through specific behavioral changes within these observed variables, rather than through direct interactions with ABO, clearly indicating that it is IPAL that acts by reducing the ABO.
The present analysis reveals that the total effect of IPAL on ABO is significant and negative (Table 1), and that IPAL’s influence is predominantly exerted through indirect pathways facilitated by CY2, IN1 and IN2 (Fig. 2). The significant indirect and negative effect of IPAL on ABO aligns with theoretical propositions advocating for the enhancement of peer informal interactions to prevent or reduce ABO, emphasizing the mediated nature of IPAL's impact [17; 18].
Notably, our findings highlight the role CY2, as a significant mediator in the reduction of ABO influenced by IPAL. The negative correlation between IPAL and CY2, coupled with a significant positive correlation between CY2 and ABO, suggests that an increase in IPAL activities lead to a reduction in CY2, thus decreasing ABO (Table 1, 3; Fig. 2). This indicates that engagement in IPAL activities importantly helps students reduce their disinterest in academic work, thereby enhancing their engagement [35], which in turn reduces their level of ABO.
Furthermore, the observed variables within inadequacy, IN1 and IN2, emerge as significant mediators (Table 4; Fig. 2) in the reduction of ABO. IN1’s and IN2’s diminished expectations about academic work both highlights how peer interactions, particularly those involving teaching and support among peers, can effectively lessen feelings of inadequacy and adjust academic perceptions, reducing overall ABO.
These findings emphasize the importance of understanding and targeting specific observed variables within broader constructs to develop effective interventions. The role of peer interactions within a social context are crucial for enhancing academic collaboration and providing essential emotional and motivational support. Such interactions can help address aspects of burnout related to disinterest and detachment from academic tasks [36]. Moreover, these results indicate that IPAL appears particularly effective in re-engaging students with their studies, potentially by fostering a supportive community that alleviates feelings of disengagement and reinvigorates academic enthusiasm [37].
Importantly, while the direct effect of IPAL on ABO was found to be insignificant, its indirect effects through the observed variables CY2, IN1, and IN2 were statistically significant. This suggests that the reduction in ABO is mediated through specific behavioral changes encapsulated within these observed variables, rather than through direct interactions with ABO. The significant mediation obtained suggests that through these observed variables, IPAL could be particularly effective in addressing the cognitive and emotional components of burnout associated with academic self-perception. As students engage more with their peers in informal learning settings, they may experience a reduction in negative self-evaluations and a recalibration of their academic expectations, which are critical factors in the development and exacerbation of burnout [17, 18, 19, 20; 26].
Limitations
Our study has several limitations. First, due to its cross-sectional design, it lacks a control group, limiting our ability to make temporal comparisons concerning ABO rates and other aspects of medical students’ well-being throughout their careers. Future studies should consider longitudinal designs to enable more effective comparisons over time.
Second, our study encountered limited medical student participation, with only 49.19% (151 out of 307 medical students) of medical students responding. This introduces the potential for response rate bias, which may affect the results if, for example, students experiencing higher levels of distress were either less likely or more likely to participate, due to the subject matter's pertinence. However, such patterns were not evident in our analysis.
Third, our research was conducted at a single medical school, restricting the generalizability of our findings to the broader medical student population in Puerto Rico. Future studies should include multiple institutions to enhance generalizability.
Lastly, this mediation analysis did not account for confounding factors or measurement errors that could be addressed by introducing a more detailed inventory of observed variables conforming related factors not considered in this research.
The nature of our questionnaire limited our ability to collect comprehensive psychological and personal data from the students, thus narrowing the study’s overall depth. Future studies should consider exploring a broader array of factors, such as studying conditions and personal circumstances, to provide a more holistic understanding of the ABO experiences among medical students.