| Under the background of the“Healthy China Strategy”,the sustainable development of higher medical education and the cultivation of medical postgraduate talents have been given higher requirements.As the reserve force of medical staff,the academic and scientific study status of medical postgraduates during their school years had a direct impact on the state of professionalism of the medical team and the quality of medical and health services in the future.Long-term academic burnout may lead to physical health problems such as physical exhaustion and chronic fatigue,and mental health problems such as anxiety and depression,and may even result in a waste of educational resources in colleges and universities and social cultivation resources.Paying attention to the academic burnout of medical postgraduates,effectively preventing and coping with the academic burnout of this population,and improving the health and well-being of this population has become one of the urgent subjects to be solved.ObjectivesThe study aimed to understand the status of academic burnout among medical postgraduates,explore the classification characteristics of academic burnout,analyze the influence of internal and external environmental factors on academic burnout,quantify the importance of each factor on academic burnout,and analyze the pathways between the associated factors.To understand the physical and mental health and subjective well-being of medical postgraduates,explore the effects of academic burnout on students’health,and verify the role of academic burnout in the pathway of the effects of postgraduate daily stressors on health.Based on the quantitative study,a qualitative study was conducted based on the dual perspectives of students and tutors to understand the understanding of different subjects on the problem of academic burnout,and to supplement the macro-social level factors of academic burnout that are not involved in the quantitative study.Based on the results of quantitative study and qualitative study,this study put forward systematic coping strategies to provide scientific reference for preventing or reducing academic burnout of medical postgraduates and improving their health and well-being.MethodsThis study adopted a mixed quantitative and qualitative methodology.(1)Quantitative study:Using the convenient sampling method,medical postgraduates who majored in medicine in colleges and universities and volunteered to participate in this study were selected as the study participants from April to June,2023,and questionnaires were distributed in the form of an online questionnaire platform.The questionnaire included information on sociodemographic characteristics,healthy lifestyle,family characteristics,academics,professional and career-related factors,tutor factors,interpersonal factors,academic burnout,postgraduate daily stressors,self-esteem,resilience,coping styles,perceived social support,self-rated physical health,sleep quality,anxiety symptoms,depressive symptoms,and subjective wellbeing.Descriptive analysis,χ~2 test,binary Logistic regression analysis,random forest model,latent profile analysis,mediation model and path analysis were performed using the IBM SPSS 24.0 software,AMOS 23.0 software,R 4.1.2 software and Mplus 8.3software.The two-sided P values were statistically significant when they were lower than 0.05.(2)Qualitative study:Semi-structured interview outlines were prepared for the two types of interviewees:medical postgraduates and tutors,and interviews were conducted with 15 medical postgraduates(interview duration 30～60 minutes)and 10 medical postgraduates’tutors(interview duration 20～60 minutes)during November2023～January 2024 according to the purposive sampling method by using face-to-face interviews and online interviews with Internet video calls.The Word document containing 25 interviews of the respondents was imported into NVivo 12.0 software,with the support of which sentence-by-sentence coding and extraction of categories were performed on the interview data.Based on the grounded theory,open coding,axical coding,and selective coding were used to conduct an in-depth study of academic burnout.ResultsStudy 1:The status,categories,associated factors and pathway of academic burnout among medical postgraduates(1)Of the 815 participants in the study,the academic burnout score was 2.64±0.59,and 23.8%of them had academic burnout,and the three dimensions of academic burnout from high to low were dejection 27.6%,reduced personal accomplishments26.3%,and improper behavior 21.8%,respectively.(2)The academic burnout of medical postgraduates was classified as positive type(33.6%),the low-achievement type(9.2%),the go-with-the-flow type(52.8%),and the complacent type(4.4%).(3)The results of multivariate analysis showed that work experience,marital status,healthy lifestyle,self-esteem,negative coping styles,motivation for choosing medical-related majors,professional satisfaction,satisfaction with academic guidance from tutors,and postgraduate daily stressors were the independently associated factors of academic burnout.Among the individual factors,the risk of academic burnout of those who have no work experience was 1.656 times(95%CI:1.016-2.700)higher than that of those who have work experience.The risk of academic burnout among non-singles was 2.143 times(95%CI:1.456-3.154)higher than that of singles.Healthy lifestyle(OR=0.573,95%CI:0.384-0.855)and high self-esteem level(OR=0.593,95%CI:0.370-0.948)reduced the risk of academic burnout.Negative coping styles increased the risk of academic burnout(OR=2.123,95%CI:1.539-2.930).Among the professional factors,the risk of academic burnout among those whose motivation for choosing medical-related majors was passive acceptance was 1.606 times(95%CI:1.091-2.363)higher than that of those who actively chose it.The risk of academic burnout for those whose professional satisfaction was dissatisfied was 5.987 times(95%CI:2.949-12.156)higher than that of those who were satisfied.Among the tutor factors,the risk of academic burnout for those with an unsatisfied tutor’s academic guidance was 1.680 times(95%CI:1.031-2.738)higher than that of those with a satisfied tutor’s academic guidance.Postgraduate daily stressors increased the risk of academic burnout(OR=1.652,95%CI:1.358-2.010).The results of the random forest model showed that the top five associated factors of academic burnout were healthy lifestyle,postgraduate daily stressors,negative coping styles,self-esteem,and professional satisfaction.(4)The pathway analysis of the associated factors of academic burnout showed that self-esteem/negative coping styles partially mediated the relationship between postgraduate daily stressors and academic burnout,with mediation effect values of0.066(95%CI:0.049-0.086)and 0.010(95%CI:0.002-0.021),respectively.Self-esteem partially mediated the relationship between professional satisfaction and academic burnout with a mediation effect value of-0.079(95%CI:-0.104-(-0.056)).Self-esteem partially mediated the relationship between healthy lifestyle and academic burnout with a mediation effect value of-0.157(95%CI:-0.203-(-0.119)).The overall model results showed that postgraduate daily stressors,professional satisfaction,and healthy lifestyle were all direct predictors of academic burnout,with effect values of0.270,-0.202,and-0.205,respectively.Postgraduate daily stressors indirectly influenced academic burnout through self-esteem and negative coping styles,with effect values of 0.049,and 0.027,respectively.Professional satisfaction had an indirect impact on academic burnout through self-esteem,with an effect value of-0.031.Healthy lifestyle had an indirect impact on academic burnout through self-esteem,with an effect value of-0.082.Study 2:The influence of academic burnout on the physical and mental health and subjective well-being of medical postgraduates(1)The self-rated physical health score of medical postgraduates was 3.69±0.90,and 58.4%had good self-rated physical health.The prevalence rates of poor sleep quality,anxiety symptoms,and depressive symptoms were 24.3%,24.3%,and 36.8%,respectively.High subjective well-being accounted for 68.0%.(2)Academic burnout and its potential categories were independently associated factors of mental health,and academic burnout had a negative impact on the mental health status.After adjusting the covariates,those with academic burnout had 1.929times(95%CI:1.276-2.915)the risk of developing poor sleep quality than those with non-academic burnout.The medical postgraduates who were in the go-with-the-flow type and the complacent type had 1.787 times(95%CI:1.051-3.039)and 3.372 times(95%CI:1.344-8.462)the risk of developing poor sleep quality as compared to those in the positive type,respectively.Those with academic burnout had 1.781 times(95%CI:1.128-2.812)the risk of developing anxiety symptoms than those with non-academic burnout.The medical postgraduates who were in the low-achievement type,the go-with-the-flow type and the complacent type had 5.477 times(95%CI:1.993-15.048),5.094 times(95%CI:2.361-10.992),and 7.689 times(95%CI:2.579-22.925)the risk of developing anxiety symptoms as compared to those in the positive type,respectively.Those with academic burnout had 1.723 times(95%CI:1.123-2.643)the risk of developing depressive symptoms than those with non-academic burnout.The medical postgraduates who were in the low-achievement type,the go-with-the-flow type and the complacent type had 13.607 times(95%CI:5.711-32.420),3.695 times(95%CI:2.050-6.658),and 13.822 times(95%CI:4.686-40.769)the risk of developing depressive symptoms as compared to those in the positive type,respectively.Study 3:The role of academic burnout in the path of the influence of postgraduate daily stressors on health(1)Postgraduate daily stressors had a direct negative effect on self-rated physical health and subjective well-being(P<0.001),and a direct positive effect on sleep quality,anxiety symptoms and depression symptoms(P<0.001),and can also have indirect effects on health status through mediator variables 1(self-esteem and resilience)and academic burnout,mediator variable 2(perceived social support)and academic burnout,mediator variables 3(positive coping styles/positive coping styles and negative coping styles)and academic burnout,respectively(P<0.01).(2)The role of academic burnout in the path of the influence of postgraduate daily stressors on health of medical postgraduates was discovered.Academic burnout played the simple and chain mediating role in the influence of postgraduate daily stressors on their health through mediator variables 1(self-esteem and resilience),mediator variable2(perceived social support)and mediator variables 3(positive coping styles/positive coping styles and negative coping styles)(P<0.01).Study 4:Qualitative study on academic burnout and its effect on health from different subjective perspectives(1)The results of the qualitative study showed that the 354 nodes in the student data were generalized into 67 categories,on such a basis,8 core categories were derived.These were the performance of outstanding problems in the academic study process,solutions,macro-social environmental factors of academic burnout,ranking the associated factors of academic burnout at various levels,the discrepancy between the study experience and expectations,academic burnout and the health status of medical postgraduates,the effect of the implementation of policies and measures to safeguard students’health in colleges and universities and the future initiatives for student health management,and the effective help and support in preventing or reducing academic burnout.(2)The results of the qualitative study showed that the 278 nodes in the tutor data were generalized into 37 categories,on such a basis,7 core categories were derived.These were the academic study performance of students,tutor’s countermeasure for relieving academic burnout,macro-social environmental factors of academic burnout,ranking the associated factors of academic burnout at various levels,academic burnout and the health status of medical postgraduates,suggestions and countermeasures to prevent or alleviate academic burnout,and the associated factors of academic study status of students.Conclusions(1)The phenomenon of academic burnout among medical postgraduates should not be ignored,and this group of academic burnout was prominently manifested in the dimensions of dejection and reduced personal accomplishments.There were four potential categories of academic burnout:the positive type,the low-achievement type,the go-with-the-flow type,and the complacent type.(2)Academic burnout among medical postgraduates was influenced by individual factors(work experience,marital status,healthy lifestyle,self-esteem,negative coping styles),professional factors(motivation for choosing medical-related majors,professional satisfaction),tutor factors(satisfaction with academic guidance from tutors),and postgraduate daily stressors.(3)The internal mechanism of the associated factors of academic burnout was verified.Self-esteem played a partial mediating role in the influence of postgraduate daily stressors,professional satisfaction and healthy lifestyle on academic burnout,while negative coping styles played a partial mediating role in the influence of postgraduate daily stressors on academic burnout.It was showed that reducing stress levels,improving professional satisfaction and adhering to a healthy lifestyle will help to enhance individual self-esteem and alleviate academic burnout,and reducing stress levels will help to reduce the use of negative coping styles and reduce the risk of academic burnout.(4)The physical health and subjective well-being level of medical postgraduates need to be improved,and the mental health status needs to be improved.Academic burnout had a negative correlation with the mental health.Postgraduate daily stressors produced stress response(academic burnout)through internal coping resources(self-esteem and resilience),external coping resources(perceived social support)and coping strategies(positive coping styles and negative coping styles),and then affected students’health to varying degrees.The role of academic burnout in the pathway of the influence of postgraduate daily stressors on students’health was clarified,suggesting that the health status can be improved by reducing the level of academic burnout.(5)The prominent academic distress of the current medical postgraduates included the quality of tutors,scientific study experiments,the internal aspects of the individual,academic achievements,and the direction of the project.The state of learning was manifested at the levels of behavioral characteristics,emotional characteristics,attitudinal characteristics,and ability characteristics.It was further clarified that the tough employment situation,social environment,students’yoke of career choice,clinical environment,and medical academic degree were the macro-social level associated factors of academic burnout.There were attributional differences in academic burnout associated factors in different perspectives.The student group was more inclined to external attribution.(6)To deal with the problem of academic burnout among medical postgraduates,we should make joint efforts through individuals,families,tutors,teams,schools and society,so as to improve the health and well-being of this population. |
