Socio-demographic and economic information
Of the 151 medical students invited, 95.3% (n = 144) students participated. The most common reason of non-participation was shortage of time.
As illustrated in the Table 1, 85.4% (n = 123) were male, 68.1% (n = 98) were from Amhara Ethnic background, 63.2% (n = 91) were single, and 27.1% (n = 39) were fourth year, students. In addition, 78.5% (n = 113) of the participants perceived that their income was not enough.
The mean age of the participants was 30 years, (standard deviation (SD)) ± 3 years). The mean Grade Point Average (GPA) of the study participants was 2.93 points, (SD ± 0.41) out of four points. Likewise, the mean monthly income of the participants was 1903, (SD ± 1251) Ethiopian Birr (ETB), (1 USD = 22.607 ETB, during the data collection period) (Table 2).
Academic and work-related factors
Most of the participants were not satisfied with the learning environment (83.3%) or the teaching-learning process (90.3%). Eighty-six percent (n = 86) of the participants respond that the distance between the University and the Hospital had an impact on their clerkship program. Majority of the study participants were also not satisfied with the class (79.9%) and practical lecturers, (72.9%). In addition, nearly all (98.6%) of the study participants had study overload, 38.2% (n = 55) of them complained about administrative problems, and only 15.3% (n = 11) were comfortable during night duties, most of the time.
Regarding the academic environment, 66.7% (n = 96) of the study participants were bothered by the education system, 81.3% (n = 117) had academic pressure, and 55.6% (n = 80) had fair relationships with the seniors. Additionally, majority of the participant believed that the curriculum of medical school at DBU is inflexible (84.0%) and lacks enough off-time (77.8%) (Table 3).
Social support and level of satisfaction in life
This study demonstrated that 40.3% (n = 58) of the study participants had strong social support. In the past month, nearly half (52.1%) of students had also good level life of satisfaction (Fig. 1 and Table 4).
Personal life experiences, leisure time and family-related factors
About two-third (n = 93) of the study participants had fair level of satisfaction with their education, 88.9% (n = 128) had no enough off-time for entertainment, and 63.9% (n = 92) afraid of failure. About two-thirds of (73.0%) the study participants had confidence in clinical skill, 77.1% (n = 111) had help from families, and 36.1% (n = 52) had added family responsibilities. Moreover, 35.4% (n = 51) of the study participants never perform regular exercise (Table 5).
Substance use habit
Concerning substance use habit, 27.8% (n = 40), 26.4% (n = 38), and 5.6% (n = 8) of the study participants used alcohol, khat and cigarettes, respectively. The study also showed that 25.4% (n = 37) of the study participants used coffee, tea, or shisha (Table 6).
Reliability of MBIHSS
The internal consistency of the instrument was very high: α = 0.90 for EE subscale, α = 0.86 for DP subscale and α = 0.90 for PA subscale. In any of the sub-scales, the α for correlated item-total correlation was not less than 0.4 and removing items does not significantly improve the overall internal consistency. In addition, two-way mixed-effects model and average consistency measure were used to measure the intra-class correlation of items. In all sub-scales, the intra-class correlation were significant with an intra-class correlation of 0.90 (95% CI = 0.88, 0.92) for EE sub-scale, 0.86 (95% CI = 0.82, 0.89) for DP sub-scale, and 0.90 (95% CI = 0.88, 0.93) for PA subscale.
Prevalence of burnout
Based on MBI-HSS definition, 34.0% (n = 49) of the study participants was found to have symptoms of burnout. The burnout prevalence incrementally increased with each additional year of school until 4th year and then starts to decline. Pertaining to sub-scales of MBI-HSS, 61.8% (n = 89) of the study participants scored high on EE sub-scale, 47.9% (n = 69) of the study participants scored high DP sub-scales, and 59.7% (n = 86) of the study participants scored low on PA sub-scale (Figs. 2, 3 and 4).
Factors associated with burnout
Female sex, being a 2nd year student, dissatisfaction with practical lecturers, not reporting administrative problem, perceiving paediatrics and emergency department as a stressful unit, being not comfortable with night duties, poor social support, very good overall life satisfaction, poor level of satisfaction on education, and not performing regular physical exercise were significantly associated with burnout in univariable model at p-value of < 0.05. However, perceiving paediatrics department as a stress full unit, being not comfortable with night duties, overall life satisfaction, and not performing regular physical exercise were removed from the multivariable model given that the observation per subgroup was less than five individuals.
All variables with a p-value of ≤0.05 in univariable model and with more than five observations per subgroup were included in the multivariable model. After controlling for the effects of potential confounding variables, dissatisfaction with practice lecturers, poor social support, and poor satisfaction on the education were significantly associated with burnout.
Students who were not satisfied by their practical lecturers were almost four times more likely to develop burnout than those who were satisfied (Adjusted Odds Ratio (AOR) = 3.8; 95% CI (1.3–11.6)). On the other hand, students who had moderate social support were 80% less likely to develop burnout than their counter parts (AOR = 0.2; 95% CI (0.1–0.8)). Additionally, students who had good levels of satisfaction on their education were 90% less likely to suffer from burnout than those who had poor satisfaction on their education (AOR = 0.1; 95% CI (0.0, 0.7)) (Table 7).