Burnout Prevalence Among Postgraduate Medical Trainees in the Eastern Health Cluster, Saudi Arabia: A Cross-Sectional Study

doi:10.21203/rs.3.rs-4997589/v1

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Research Article

Burnout Prevalence Among Postgraduate Medical Trainees in the Eastern Health Cluster, Saudi Arabia: A Cross-Sectional Study

https://doi.org/10.21203/rs.3.rs-4997589/v1

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Background: Burnout among medical professionals is recognized globally, with significant implications for mental health and patient care. This study evaluates the prevalence of burnout among postgraduate medical trainees in the Eastern Health Cluster of Saudi Arabia, aiming to fill the research gap in this region, where specific cultural and training factors may contribute uniquely to burnout.

Methods: A cross-sectional study was conducted from March to June 2024 across various healthcare facilities within the Eastern Health Cluster. A total of 422 postgraduate medical trainees participated, providing data through a Google Form survey, which included the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS(MP)).

Results: The study found a high prevalence of burnout symptoms among trainees: 30.3% reported high levels of emotional exhaustion, 24.9% reported high levels of depersonalization, and a significant 86.3% felt low levels of personal accomplishment. Burnout rates varied significantly across specialties and training levels, suggesting targeted interventions were needed.

Conclusions: The high prevalence of burnout underscores the critical need for tailored preventive strategies and interventions within the training environments to effectively address and mitigate burnout among medical trainees. Future research should explore longitudinal interventions to reduce burnout and enhance trainee well-being.

Burnout Syndrome

Postgraduate Medical Trainees

Eastern Health Cluster

Maslach Burnout Inventory

Emotional Exhaustion

Depersonalization

Personal Accomplishment

Saudi Arabia

Medical Education

Burnout, defined as a syndrome of emotional exhaustion, depersonalization, and diminished personal accomplishment, is increasingly recognized as a pervasive issue among medical professionals (1). Globally, a meta-analysis revealed that the pooled prevalence of burnout across 47 countries is approximately 48%, with variations ranging from 28–85% among postgraduate medical populations (2, 3). The rigorous nature of postgraduate medical training, marked by long hours, substantial workloads, and high-stress environments, considerably heightens the risk of burnout among trainees (4). Recent efforts to address this critical issue include the implementation of resilience curricula within medical education (5). Such curricula aim to equip medical trainees with coping skills, self-efficacy, goal-setting abilities, and emotional regulation skills, helping them manage stress and reduce the risk of burnout. Studies assessing the effectiveness of these interventions have shown promising results in enhancing the well-being of medical students and residents, fostering a healthier educational environment (6).

Shifting the focus to local observations in Saudi Arabia, a detailed study conducted at King Abdulaziz Medical City and two other healthcare facilities in Buraidah, Qassim Province, reported an 81% burnout rate among residents in medical and surgical programs (7). This study highlighted significant levels of emotional exhaustion and depersonalization, which are core aspects of burnout. Notably, no significant correlation was found between the number of working hours and the prevalence of burnout, suggesting the influence of other factors. During the COVID-19 pandemic, healthcare workers, including medical trainees, reported a substantial level of burnout and stress, with 60.5% of individuals aged 22–35 experiencing notable stress (8). The research also detailed various coping strategies adopted by healthcare professionals during this challenging period. Furthermore, a comprehensive systematic review of nine studies on burnout among medical residents, primarily using the Maslach Burnout Inventory (MBI) or its variations, revealed that burnout prevalence ranged from 24.1–85.5% (9). This significant variation, comparable to global levels, could be explained by methodologies, sample sizes, assessment tools, and medical specialties. Furthermore, unique cultural factors such as the hierarchical structure of the healthcare system, gender segregation in the workplace, and limited social support systems also contribute to these disparities in burnout rates (10).

This study aims to address a notable void in existing research by examining burnout prevalence among postgraduate medical trainees in the Eastern Province of Saudi Arabia, where data on this subject are particularly scarce. The distinctiveness of the Saudi educational environment, predominantly characterized by a consultant-driven approach in governmental settings, potentially introduces unique stressors affecting trainee well-being. By conducting a meticulous analysis of burnout and its contributory factors within this unique context, this research is poised to offer pivotal insights into the experiences of postgraduate trainees in the region. The results illuminate the scope of burnout and inform the development of targeted interventions to enhance well-being and mitigate burnout among medical trainees.

Ethical approval

This study complied with the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of the Erada Complex and Mental Health Hospital in Dammam, with approval number MED008.

Study Design

This cross-sectional study, conducted from March 31, 2024, to June 30, 2024, involved various healthcare facilities across the Eastern Health Cluster (EHC) in the Eastern Province of Saudi Arabia. Enrolled participants were Postgraduate Medical Trainees (PGMTs) who had been active in residency, fellowship, or diploma programs accredited by the Saudi Commission for Health Specialties (SCFHS) for at least six months and provided informed written consent. The study sites encompassed diverse healthcare settings, including King Fahad Specialist Hospital-Dammam, a tertiary care facility; specialized hospitals like Maternity and Children Hospital–Dammam, Erada Complex for Mental Health–Dammam, and Eye Specialist Hospital–Dhahran; secondary care providers such as Dammam Medical Complex and Qatif Central Hospital; and the Family Medicine Academy, a primary healthcare center. It targeted a specific cohort of 920 PGMTs from residency programs and 153 from fellowship and diploma programs, as detailed in the 2023-2024 annual academic report.

Participants were selected via convenience sampling due to logistical and time constraints, allowing for the expedient selection of readily available trainees from each facility. While this method does not ensure a representative sample of all trainees within the cluster, it facilitates efficient data collection within the operational confines of the study. Data was collected using a tailored Google Form, which captured sociodemographic information, detailed elements of the training programs, and responses to the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS(MP)). The form was distributed electronically through email and official communication channels within the Eastern Health Cluster, ensuring broad accessibility for all participants. It was designed to ensure anonymous and confidential survey data submission, protecting participant privacy.

Study Variables and Data Collection

The survey consisted of three parts. The first part covered demographic variables, including age, sex, marital status, hometown, and smoking habits. The second part focused on specific aspects of the training programs, such as type of training program—residency, fellowship, or diploma; training level—junior, senior, or fellowship; specialty; type of on-call duty—in-house or home call; number of on-call hours; and training center. The last part of the survey incorporated the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS (MP)), which assessed burnout across three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). The emotional exhaustion subscale consisted of 9 items that measured feelings of being emotionally overextended and exhausted, where higher scores indicated greater experienced burnout. The depersonalization subscale included 5 items assessing an unfeeling and impersonal response toward patients, with higher scores suggesting more severe burnout. Finally, the 8-item personal accomplishment subscale evaluated feelings of competence and achievement in one’s work, with lower scores indicating greater experienced burnout. These scales have been referenced in the literature to provide empirical support for their application and interpretation (11–13).

Statistical analyses

We received 816 initial responses to the online form, achieving a response rate of 76.1%. After excluding incomplete submissions, the study successfully included 422 participants, yielding a completion rate of 39.3%. This cohort consisted of 177 males (41.9%) and 245 females (58.1%).

Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 25 for Windows. Descriptive statistics were applied to summarize the data, presenting results as mean ± standard deviation for continuous variables and as frequencies and percentages for categorical variables, all accompanied by 95% confidence intervals (CIs). Inferential statistics were employed to probe the relationships between variables, with a significance threshold established at p<0.05. A linear-by-linear association test was used to assess relationships between two qualitative variables, at least one of which was ordinal.

Characteristics of Medical Trainees in the Eastern Health Cluster

The study included 422 participants, with an average age of 28.75 years (SD = 3.58, range: 24–58 years). Of these, 41.9% (n=177) were male and 58.1% (n=245) were female. Regarding marital status, 46.7% (n=197) were single, 52.8% (n=223) were married, and the remainder were either divorced or separated (0.2% each, n=1 for both). Most participants resided within the Eastern province (80.8%, n=341), while 19.2% (n=81) came from outside the Eastern province.

Participants were primarily enrolled in residency programs (89.1%, n=376), with smaller numbers in fellowship (4.7%, n=20) and diploma programs (6.2%, n=26). The training levels were categorized as junior (61.4%, n=259) and senior (38.6%, n=163). Most participants were non-smokers (86.0%, n=363), and 14.0% (n=59) reported smoking habits.

Regarding on-call duties, 74.4% (n=314) had in-house calls, whereas 25.6% (n=108) had home calls. The number of on-call hours varied, with 14.2% (n=60) not performing any on-call duties, 12.6% (n=53) on 8-hour calls, 21.1% (n=89) on 12-hour calls, 19.0% (n=80) on 16-hour calls, 29.1% (n=123) on 24-hour calls, and 4.0% (n=17) exceeding 24-hour calls.

Participants were distributed across various specialties, with the most common being family medicine (24.4%, n=103), internal medicine (19.7%, n=83), and pediatrics (8.3%, n=35). The training centers with the highest number of participants included the Family Medicine Academy (21.1%, n=89), Qatif Central Hospital (22.0%, n=93), and King Fahad Specialist Hospital (19.7%, n=83).

Table 1. Demographic and Professional Characteristics of Postgraduate Medical Trainees in the Eastern Health Cluster

Age		Mean ± SD	Range
Age		28.75 ± 3.58	24 – 58
		Number	%
Sex	Male	177	41.9%
Sex	Female	245	58.1%
Marital Status	Single	197	46.7%
	Married	223	52.8%
	Divorced	1	0.2%
	Separated	1	0.2%
Hometown	Within Eastern Province	341	80.8%
Hometown	Outside Eastern Province	81	19.2%
Type of Training Program	Residency	376	89.1%
	Fellowship	20	4.7%
	Diploma	26	6.2%
Training Level	Junior	259	61.4%
Training Level	Senior	163	38.6%
Smoking Habit	No	363	86.0%
Smoking Habit	Yes	59	14.0%
Type of On-Call	In-House	314	74.4%
Type of On-Call	Home	108	25.6%
Number of Hours of On-Call	None	60	14.2%
	8 hrs	53	12.6%
	12 hrs	89	21.1%
	16 hrs	80	19.0%
	24 hrs	123	29.1%
	>24 hrs	17	4.0%
Training Program Specialty	Dentistry	26	6.2%
	Radiology	9	2.1%
	General Surgery	23	5.5%
	Dermatology	9	2.1%
	Anesthesiology	11	2.6%
	Clinical Pharmacy	4	0.9%
	Psychiatry	16	3.8%
	Oncology	4	0.9%
	Nursing	24	5.7%
	Internal Medicine	83	19.7%
	Hematology	5	1.2%
	Emergency Medicine	6	1.4%
	Gastroenterology	1	0.2%
	Epilepsy	1	0.2%
	Obstetrics and Gynecology	20	4.7%
	Family Medicine	103	24.4%
	Colorectal Surgery	1	0.2%
	Pediatrics	35	8.3%
	Otorhinolaryngology (ENT)	4	0.9%
	Orthopedics	5	1.2%
	Cardiology	1	0.2%
	Anatomical Pathology	1	0.2%
	Nephrology	1	0.2%
	Ophthalmology	16	3.8%
	Endocrinology	1	0.2%
	Midwifery	2	0.5%
	Neurology	1	0.2%
	Urology	9	2.1%
Training Center	King Fahad Specialist Hospital - Dammam	83	19.7%
	Maternity And Children Hospital – Dammam	29	6.9%
	Erada Complex for Mental Health – Dammam	9	2.1%
	Eye Specialist Hospital – Dhahran	12	2.8%
	Dammam Medical Complex	79	18.7%
	Family Medicine Academy	89	21.1%
	Qatif Central Hospital	93	22.0%
	Other	28	6.6%

Prevalence of Burnout Syndrome Among Postgraduate Medical Trainees in the Eastern Health Cluster

The study analyzed responses from 422 trainees, focusing on emotional exhaustion, depersonalization, and personal accomplishment. For emotional exhaustion, the mean score was 20.7 (SD = 15.01, range 0-54), with results showing 30.3% (n = 128) of trainees experiencing high levels, 20.4% (n = 86) moderate levels, and 49.3% (n = 208) low levels. This indicates a significant spread in the extent of exhaustion among trainees.

In the dimension of depersonalization, the mean score stood at 7.61 (SD = 6.85, range 0–30). Here, 24.9% (n = 105) of trainees reported high levels, suggesting a substantial degree of emotional detachment, while 27.3% (n = 115) experienced moderate levels, and 47.9% (n = 202) reported low levels.

Regarding personal accomplishment, the mean score was 18.63 (SD = 11.71, range 0-48). A vast majority, 86.3% (n = 364), felt low levels of achievement, highlighting a pervasive sense of inefficacy within the cohort. Moderate and high levels of personal accomplishment were less common, reported by 9.0% (n = 38) and 4.7% (n = 20) of trainees, respectively, underscoring concerns about trainees’ perceptions of their professional success.

Furthermore, the distribution of burnout symptoms varied across specialties and levels of training, revealing that specific disciplines and more senior trainees exhibited higher levels of emotional exhaustion and depersonalization. These findings highlight the need for targeted interventions to mitigate burnout and support the well-being of medical trainees in this region.

Table 2. Distribution of Burnout Levels Among Postgraduate Medical Trainees in the Eastern Health Cluster as Assessed by the Maslach Burnout Inventory

		N	%
MBI-Emotional Exhaustion	Low	208	49.3%
	Moderate	86	20.4%
	High	128	30.3%
MBI-Depersonalization	Low	202	47.9%
	Moderate	115	27.3%
	High	105	24.9%
MBI- Personal Accomplishment	Low	364	86.3%
	Moderate	38	9.0%
	High	20	4.7%

Specialty-Specific Burnout Patterns Among Postgraduate Medical Trainees: Insights from the Maslach Burnout Inventory

The analysis of burnout levels using the Maslach Burnout Inventory (MBI) among postgraduate medical trainees across various specialties highlighted substantial disparities in burnout symptoms, as outlined in Table 3. The highest levels of emotional exhaustion were observed in diagnostic radiology, where 55.56% of trainees reported high levels, followed closely by internal medicine with 43.37% and general surgery with 26.09%. Diagnostic Radiology again showed the most significant impact in depersonalization, with 55.56% of trainees experiencing high levels; general surgery also demonstrated substantial depersonalization, with 30.43% reporting high levels. These findings indicate a pronounced risk of burnout in these intense clinical settings.

On the spectrum of personal accomplishment, several specialties indicated alarmingly low levels of personal achievement, notably nursing, where 95.83% of trainees felt a low sense of accomplishment, and internal medicine, with 91.57%. Such results indicate a critical area of concern, as a diminished sense of accomplishment can adversely affect trainees’ personal well-being and professional efficacy.

Interestingly, some specialties like dentistry and clinical pharmacy reported significantly lower levels of emotional exhaustion and depersonalization, suggesting variations in the work environment or possibly more effective coping mechanisms. For example, only 11.54% of dentistry trainees reported high emotional exhaustion, and none in clinical pharmacy reported high depersonalization.

Overall, the data suggest that while certain specialties are at higher risk of severe burnout symptoms, there is a general trend across all fields indicating significant levels of distress among trainees. These insights underscore the urgency for targeted mental health support and burnout prevention strategies tailored to the unique demands of each specialty, enhancing the resilience and well-being of our future healthcare providers.

Table 3. Distribution of Maslach Burnout Inventory (MBI) Scores Across Medical Specialties in Postgraduate Trainees

MBI-Emotional Exhaustion

MBI-Depersonalization

MBI-Personal Accomplishment

Low

Moderate

High

low

moderate

High

Low

moderate

high

N (%)

Dentistry

(73.08%)

4 (15.38%)

(11.54%)

(80.77%)

(15.38%)

(3.85%)

20 (76.92%)

(11.54%)

Diagnostic Radiology

(11.11%)

3 (33.33%)

(55.56%)

(11.11%)

(33.33%)

(55.56%)

(88.89%)

(11.11%)

(0%)

General Surgery

(47.83%)

6 (26.09%)

(26.09%)

(34.78%)

(30.43%)

(91.3%)

(4.35%)

Dermatology

(55.56%)

2 (22.22%)

(22.22%)

(77.78%)

(0%)

(22.22%)

(66.67%)

(22.22%)

(11.11%)

Anesthesiology

(18.18%)

5 (45.45%)

(36.36%)

(45.45%)

(18.18%)

(36.36%)

(63.64%)

(36.36%)

(0%)

Clinical Pharmacy

(50%)

(0%)

(75%)

(25%)

(0%)

(100%)

(0%)

Psychiatry

(56.25%)

(12.5%)

(31.25%)

(62.5%)

(18.75%)

(75%)

(12.5%)

Oncology

(50%)

(25%)

(50%)

(25%)

(50%)

(0%)

(50%)

Nursing

(70.83%)

(4.17%)

(25%)

(54.17%)

(33.33%)

(12.5%)

23 (95.83%)

(0%)

(4.17%)

Internal Medicine

(38.55%)

15 (18.07%)

(43.37%)

(36.14%)

(31.33%)

27 (32.53%)

76 (91.57%)

(7.23%)

(1.2%)

Hematology

(80%)

(0%)

(20%)

4 (80%)

1 (20%)

0 (0%)

4 (80%)

(20%)

(0%)

Emergency Medicine

4 (66.67%)

(0%)

2 (33.33%)

4 (66.67%)

2 (33.33%)

0 (0%)

5 (83.33%)

1 (16.67%)

(0%)

Gastroenterology

(0%)

(100%)

0 (0%)

1 (100%)

(0%)

Epilepsy

(0%)

(100%)

(0%)

0 (0%)

1 (100%)

0 (0%)

1 (100%)

(0%)

Obstetrics and Gynecology

(25%)

(45%)

(30%)

8 (40%)

9 (45%)

3 (15%)

15 (75%)

(25%)

(0%)

Family Medicine

54 (52.43%)

18 (17.48%)

31 (30.1%)

48 (46.6%)

28 (27.18%)

27 (26.21%)

91 (88.35%)

5 (4.85%)

(6.8%)

Colorectal Surgery

(100%)

(0%)

1 (100%)

0 (0%)

1 (100%)

(0%)

Pediatrics

12 (34.29%)

11 (31.43%)

12 (34.29%)

11 (31.43%)

13 (37.14%)

30 (85.71%)

3 (8.57%)

(5.71%)

Otorhinolaryngology (ENT)

(25%)

(0%)

(75%)

1 (25%)

2 (50%)

4 (100%)

(0%)

Orthopedics

(80%)

(20%)

(0%)

3 (60%)

1 (20%)

5 (100%)

(0%)

Cardiology

(0%)

(100%)

(0%)

0 (0%)

1 (100%)

0 (0%)

1 (100%)

(0%)

Anatomical Pathology

(100%)

(0%)

1 (100%)

0 (0%)

1 (100%)

(0%)

Nephrology

(0%)

(100%)

(0%)

0 (0%)

1 (100%)

(0%)

Ophthalmology

13 (81.25%)

(6.25%)

2 (12.5%)

13 (81.25%)

1 (6.25%)

2 (12.5%)

14 (87.5%)

2 (12.5%)

(0%)

Endocrinology

(100%)

(0%)

0 (0%)

1 (100%)

0 (0%)

1 (100%)

(0%)

Midwifery

(100%)

(0%)

2 (100%)

0 (0%)

2 (100%)

(0%)

Neurology

(0%)

(100%)

1 (100%)

0 (0%)

1 (100%)

(0%)

Urology

6 (66.67%)

2 (22.22%)

1 (11.11%)

5 (55.56%)

2 (22.22%)

7 (77.78%)

2 (22.22%)

(0%)

Burnout Variability Across Training Centers in the Eastern Health Cluster: Insights from the Maslach Burnout Inventory

The study assessed burnout among PGMTs across several training centers in the Eastern Health Cluster using the Maslach Burnout Inventory (MBI). King Fahad Specialist Hospital – Dammam reported a relatively balanced distribution of emotional exhaustion, with 53.01% of trainees experiencing low levels, 21.69% moderate, and 25.3% high levels. Similarly, depersonalization was reported by 50.6% of trainees at low levels, 27.71% at moderate, and 21.69% at high. A significant 91.57% of these trainees felt low personal accomplishment.

In contrast, Erada Complex for Mental Health in Dammam showed a concerning 55.56% of trainees reporting high emotional exhaustion, a notably higher rate compared to other centers. Depersonalization and personal accomplishment followed similar patterns, with one-third experiencing high levels of depersonalization and 77.78% reporting low personal accomplishment.

The Eye Specialist Hospital in Dhahran was noteworthy, where emotional exhaustion and depersonalization were predominantly low (83.33% each), suggesting better burnout management or less stressful working conditions than other centers. Regarding personal accomplishment, all but two trainees felt low levels, indicating a pervasive feeling of inefficacy despite lower levels of exhaustion and depersonalization.

These results highlight significant variability in burnout levels across different medical specialties and training centers, underscoring the need for tailored interventions to address trainees’ specific challenges in high-stress environments.

Table 4. Burnout Levels by Training Center in the Eastern Health Cluster According to the Maslach Burnout Inventory

	MBI-Emotional Exhaustion			MBI-Depersonalization			MBI-Personal Accomplishment
	Low	Moderate	High	low	Moderate	High	Low	Moderate	High
	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)
King Fahad Specialist Hospital - Dammam	44 (53.01%)	18 (21.69%)	21 (25.3%)	42 (50.6%)	23 (27.71%)	18 (21.69%)	76 (91.57%)	4 (4.82%)	3 (3.61%)
Maternity And Children Hospital - Dammam	10 (34.48%)	10 (34.48%)	9 (31.03%)	11 (37.93%)	10 (34.48%)	8 (27.59%)	23 (79.31%)	4 (13.79%)	2 (6.9%)
Erada Complex for Mental Health - Dammam	3 (33.33%)	1 (11.11%)	5 (55.56%)	3 (33.33%)	3 (33.33%)	3 (33.33%)	7 (77.78%)	1 (11.11%)	1 (11.11%)
Eye Specialist Hospital - Dhahran	10 (83.33%)	1 (8.33%)	1 (8.33%)	10 (83.33%)	1 (8.33%)	1 (8.33%)	10 (83.33%)	2 (16.67%)	0 (0%)
Dammam Medical Complex	41 (51.9%)	14 (17.72%)	24 (30.38%)	41 (51.9%)	18 (22.78%)	20 (25.32%)	66 (83.54%)	7 (8.86%)	6 (7.59%)
Family Medicine Academy	46 (51.69%)	17 (19.1%)	26 (29.21%)	40 (44.94%)	26 (29.21%)	23 (25.84%)	80 (89.89%)	5 (5.62%)	4 (4.49%)
Qatif Central Hospital	39 (41.94%)	21 (22.58%)	33 (35.48%)	38 (40.86%)	30 (32.26%)	25 (26.88%)	77 (82.8%)	13 (13.98%)	3 (3.23%)
Other	15 (53.57%)	4 (14.29%)	9 (32.14%)	17 (60.71%)	4 (14.29%)	7 (25%)	25 (89.29%)	2 (7.14%)	1 (3.57%)

Factors Influencing Burnout Among Healthcare Professionals: Insights from the Maslach Burnout Inventory

The study quantitatively analyzed burnout among healthcare professionals using the Maslach Burnout Inventory (MBI), focusing on Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). Results indicated significant associations with several demographic and occupational variables. For Emotional Exhaustion, a significant linear-by-linear association was observed for sex, with males displaying lower high exhaustion levels (23.73%) compared to females (35.10%), p=0.008. Training program type also showed significant associations, notably residency programs, where 31.65% reported high exhaustion, compared to a lower 15% in fellowships, p=0.015. The type of on-call duty was another critical factor, with in-house on-call staff experiencing higher exhaustion (33.44% high) versus those on home calls (21.3% high), p=0.003.

Depersonalization outcomes were less uniformly distributed but still significant in residency training programs, with 26.6% of residents experiencing high depersonalization, p=0.025. Similarly, the type of on-call was significantly associated with depersonalization rates; in-house staff reported higher depersonalization (27.71%) compared to home call staff (16.67%), p<0.001. In contrast, marital status and hometown variables showed no significant associations across burnout dimensions, indicating potential resilience factors or lesser impact on burnout levels.

These findings illustrate the complex interplay between work environment, personal demographics, and burnout levels, highlighting specific areas within healthcare settings that may benefit from targeted interventions to reduce burnout rates and improve overall well-being and job satisfaction among professionals.

Further analysis of the burnout dimensions showed that those in high-stress specialties and positions, such as emergency services and critical care, reported higher Emotional Exhaustion and Depersonalization levels. For instance, the number of on-call hours significantly influenced burnout levels, with those reporting over 24 hours of on-call duty demonstrating notably higher levels of Emotional Exhaustion (41.18% high) and Depersonalization (35.29% high), p=0.009 for EE and p=0.013 for DP. This trend suggests extended work hours, particularly those beyond standard shifts, significantly exacerbate stress and burnout symptoms.

The findings also suggest that younger, less experienced (junior level) professionals tend to experience higher rates of depersonalization (26.64% high) compared to their senior counterparts, although this difference was not statistically significant (p=0.066). This indicates a possible vulnerability among less experienced staff, who may require additional support and mentoring to cope with the psychological demands of the healthcare profession.

Regarding Personal Accomplishment, most participants across almost all categories reported low levels of accomplishment, which may reflect broader issues related to job satisfaction and recognition within the healthcare sector. Notably, even among those with less demanding on-call responsibilities, the perception of personal accomplishment was predominantly low, suggesting that factors beyond mere workload contribute to this sentiment.

These patterns underscore the importance of considering both organizational and personal factors when addressing burnout in healthcare settings. Interventions such as adjusting on-call schedules, enhancing support systems, and acknowledging the accomplishments of healthcare professionals could be beneficial. Moreover, these results advocate for policy changes and leadership actions to improve work conditions, which may mitigate burnout and foster a more supportive and productive work environment.

Table 5. Associations Between Demographic and Occupational Variables with Burnout Dimensions Using the Maslach Burnout Inventory

		MBI- Emotional exhaustion				Linear by Linear Association
		Low	Moderate		High
		N (%)	N (%)		N (%)
Sex	Male	99 (55.93%)	36 (20.34%)		42 (23.73%)	χ² = 7.02, p= 0.008
	Female	109 (44.49%)	50 (20.41%)		86 (35.1%)
Marital Status	Single	100 (50.76%)	41 (20.81%)		56 (28.43%)	χ² = 0.69, p=0.406
	Married	106 (47.53%)	45 (20.18%)		72 (32.29%)
Hometown	Within Eastern Province	165 (48.39%)	68 (19.94%)		108 (31.67%)	χ² = 1.17, p=0.279
	Outside Eastern Province	43 (53.09%)	18 (22.22%)		20 (24.69%)
Type of Training Program	Residency	176 (46.81%)	81 (21.54%)		119 (31.65%)	χ² = 5.87, p=0.015
	Fellowship	13 (65%)	4 (20%)		3 (15%)
	Diploma	19 (73.08%)	1 (3.85%)		6 (23.08%)
Training Level	Junior	119 (45.95%)	63 (24.32%)		77 (29.73%)	χ² = 1.37, p=0.241
	Senior	80 (49.08%)	28 (17.18%)		55 (33.74%)
Smoking Habit	No	176 (48.48%)	73 (20.11%)		114 (31.4%)	χ² = 1.20, p=0.273
	Yes	32 (54.24%)	13 (22.03%)		14 (23.73%)
Number of Hours of On-Call	None	37 (61.67%)	10 (16.67%)		13 (21.67%)	χ² = 6.73, p= 0.009
	8 hrs	32 (60.38%)	5 (9.43%)		16 (30.19%)
	12 hrs	52 (58.43%)	15 (16.85%)		22 (24.72%)
	16 hrs	23 (28.75%)	22 (27.5%)		35 (43.75%)
	24 hrs	55 (44.72%)	33 (26.83%)		35 (28.46%)
	>24 hrs	9 (52.94%)	1 (5.88%)		7 (41.18%)
Type of On-Call	In-House	141 (44.9%)	68 (21.66%)		105 (33.44%)	χ² = 9.04, p= 0.003
	Home	67 (62.04%)	18 (16.67%)		23 (21.3%)
		MBI- depersonalization				Linear By linear Association
		Low	Moderate		High
		N (%)	N (%)		N (%)
Sex	Male	85 (48.02%)	54 (30.51%)		38 (21.47%)	χ² = 0.57,p=0.449
	Female	117 (47.76%)	61 (24.9%)		67 (27.35%)
Marital Status	Single	103 (52.28%)	45 (22.84%)		49 (24.87%)	χ² = 1.26,p=0.262
	Married	97 (43.5%)	70 (31.39%)		56 (25.11%)
Hometown	Within Eastern Province	158 (46.33%)	98 (28.74%)		85 (24.93%)	χ² = 1.70,p=0.419
	Outside Eastern Province	44 (54.32%)	17 (20.99%)		20 (24.69%)
Type of Training Program	Residency	174 (46.28%)	102 (27.13%)		100 (26.6%)	χ² =5.87, p=0.015
	Fellowship	12 (60%)	6 (30%)		2 (10%)
	Diploma	16 (61.54%)	7 (26.92%)		3 (11.54%)
Training Level	Junior	115 (44.4%)	75 (28.96%)		69 (26.64%)	χ² = 3.39,p=0.066
	Senior	78 (47.85%)	42 (25.77%)		43 (26.38%)
Smoking Habit	No	176 (48.48%)	99 (27.27%)		88 (24.24%)	χ² = 0.61,p=0.436
	Yes	26 (44.07%)	16 (27.12%)		17 (28.81%)
Number of Hours of On-Call	None	35 (58.33%)	16 (26.67%)		9 (15%)	χ² = 6.16,p=0.013
	8 hrs	27 (50.94%)	12 (22.64%)		14 (26.42%)
	12 hrs	49 (55.06%)	22 (24.72%)		18 (20.22%)
	16 hrs	30 (37.5%)	24 (30%)		26 (32.5%)
	24 hrs	55 (44.72%)	36 (29.27%)		32 (26.02%)
	>24 hrs	6 (35.29%)	5 (29.41%)		6 (35.29%)
Type of On-Call	In-House	133 (42.36%)	94 (29.94%)		87 (27.71%)	χ² = 12.61,p=0.001
	Home	69 (63.89%)	21 (19.44%)		18 (16.67%)
		MBI- personal accomplishment				Linear By linear Association
		Low		Moderate	High
		N (%)		N (%)	N (%)
Sex	Male	149 (84.18%)		19 (10.73%)	9 (5.08%)	χ² = 0.73,p=0.394
	Female	215 (87.76%)		19 (7.76%)	11 (4.49%)
Marital Status	Single	167 (84.77%)		21 (10.66%)	9 (4.57%)	χ² = 0.23,p=0.394
	Married	195 (87.44%)		17 (7.62%)	11 (4.93%)
Hometown	Within Eastern Province	296 (86.8%)		29 (8.5%)	16 (4.69%)	χ² = 0.26,p=0.613
	Outside Eastern Province	68 (83.95%)		9 (11.11%)	4 (4.94%)
Type of Training Program	Residency	321 (85.37%)		37 (9.84%)	18 (4.79%)	χ² = 1.45,p=0.229
	Fellowship	18 (90%)		1 (5%)	1 (5%)
	Diploma	25 (96.15%)		0 (0%)	1 (3.85%)
Training Level	Junior	224 (86.48%)		21 (8.11%)	14 (5.41%)	χ² = 0.34,p=0.559
	Senior	124 (76.07%)		25 (15.34%)	14 (8.59%)
Smoking Habit	No	314 (86.5%)		32 (8.82%)	17 (4.68%)	χ² = 0.10,p=0.757
	Yes	50 (84.75%)		6 (10.17%)	3 (5.08%)
Number of Hours of On-Call	None	52 (86.67%)		5 (8.33%)	3 (5%)	χ² = 0.98,p=0.768
	8 hrs	44 (83.02%)		5 (9.43%)	4 (7.55%)
	12 hrs	80 (89.89%)		3 (3.37%)	6 (6.74%)
	16 hrs	68 (85%)		11 (13.75%)	1 (1.25%)
	24 hrs	105 (85.37%)		13 (10.57%)	5 (4.07%)
	>24 hrs	15 (88.24%)		1 (5.88%)	1 (5.88%)
Type of On-Call	In-House	274 (87.26%)		29 (9.24%)	11 (3.5%)	χ² = 2.51,p=0.113
	Home	90 (83.33%)		9 (8.33%)	9 (8.33%)

The prevalence of burnout among postgraduate medical trainees in the Eastern Health Cluster of Saudi Arabia, with significant levels of emotional exhaustion (30.3%) and depersonalization (24.9%), mirrors global concerns about the mental health of medical professionals. The review by Shanafelt et al. indicates that 45.8% of US physicians experienced at least one symptom of burnout, which emphasizes the pervasive nature of this issue across different healthcare systems (14).

This study’s findings are consistent with the narrative review by Lin et al., which documented that reforms in resident duty hours generally improve resident well-being without negatively impacting their educational outcomes. In our study, no direct correlation was found between the number of on-call hours and the level of burnout, suggesting that the quality of the working environment and the inherent stress of medical training significantly influence burnout rates (15).

Further comparison is drawn with the study by Fahrenkopf et al., where depressed residents made 6.2 times as many medication errors per resident per month compared to their non-depressed peers. This statistic is alarming and highlights the critical impact of mental health on patient safety, paralleling our findings where high levels of burnout could potentially compromise patient care (16).

Our research also aligns with findings from Temple et al., who discuss the global variability in duty-hour policies. The lack of consensus on optimal duty hour configurations suggests that each region may need to develop customized solutions that reflect local training conditions and cultural factors (17).

Moreover, the specific burnout rates across various specialties in our study indicate that some disciplines, such as family medicine (24.4% high emotional exhaustion) and internal medicine (19.7% high emotional exhaustion), are more affected than others. These figures can be compared to those in other studies, such as the national survey by Aldrees et al., which found high burnout rates, particularly among surgical specialties, underscoring the need for specialty-specific interventions (18).

Additionally, the impact of burnout on specific clinical skills and cognitive performance, a critical concern highlighted by Fletcher et al., provides an essential context for our findings. They documented that resident well-being significantly improves following duty-hour reforms, aligning with our high emotional exhaustion and depersonalization observations. Their study underlines the potential cognitive repercussions of burnout, which could compromise clinical decision-making and patient care, reinforcing the need for a structured reform in duty hours and support systems within the Saudi medical education system (19). The study by Martini et al. further elucidates the relationship between burnout and the educational environment by assessing the impact of work-hour limits on burnout prevalence among medical residents. Their findings, showing a decrease in burnout prevalence, particularly among junior residents after implementing work-hour restrictions, underscore the potential benefits of similar policy changes in our region. This study supports the notion that structured modifications to the training schedule can mitigate burnout, thereby enhancing the overall training experience and potentially improving patient care outcomes (20).

The findings from the Eastern Health Cluster indicate a critical need for interventions to reduce burnout among medical trainees, similar to efforts documented in international studies. The substantial prevalence of emotional exhaustion (30.3%) and depersonalization (24.9%) reported in our study highlights the urgency of implementing effective measures to improve the training environment and promote better mental health outcomes for trainees. Future research should focus on longitudinal studies to assess the effectiveness of targeted interventions in reducing burnout and improving educational outcomes and patient care.

Funding: Not applicable

Ethics approval: This was approved by the Institutional Review Board (IRB) of the Erada Complex and Mental Health Hospital in Dammam, Saudi Arabia, with approval number MED008. Clinical trial number: not applicable.

Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

Data Availability Statement: Data is available upon request. Please contact Dr.Fahad Almsned at [email protected].

Acknowledgments: We sincerely thank Ms. Rehab Almanasef for her invaluable contributions to this study. Her diligent efforts in writing and reviewing the survey in Google Forms were instrumental to its success.

Conflicts of Interest: The authors declare no conflict of interest.

Authors’ contributions:

NA designed the study, authored the IRB submission, and developed the methodology.

FA assisted in the study design, reviewed the article, and evaluated the statistical analysis.

NB designed and created the online survey and reviewed the article.

FA reviewed the article and distributed the survey.

MA reviewed the article and distributed the survey.

MY conducted the statistical analysis.

MA helped design the study, recruited participants, and reviewed the article.

Consent for publication: Not applicable
Competing interests: Not applicable

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No competing interests reported.

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Burnout Prevalence Among Postgraduate Medical Trainees in the Eastern Health Cluster, Saudi Arabia: A Cross-Sectional Study

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