| Abstract|| |
Background: Burnout syndrome is characterized by emotional exhaustion, depersonalization and decreased personal accomplishment.
Objective: To investigate the level of burnout syndrome among fourth and fifth year clinical dental students in Sudan.
Materials and Methods: A total of 259 selected males and females of fourth and fifth years, using stratified random sampling technique from 10 universities and Medical Colleges in Sudan. Burnout was assessed by Maslach burnout inventory scale. 22 items concerning the measurement of the three burnout components: Emotional exhaustion (EE) (9 items), depersonalization (D) (5 items) and personal accomplishment (PA) (8 items). A high risk of burnout was considered present, when the respondent scored high in both (EE) and (D) and low in (PA).
Results: Revealed that 57.1% of the students suffering from high levels of emotional exhaustion, only 3.1% had severe lack of personal accomplishment and 8.9% had severe depersonalization. Students from private universities showed significant higher levels in personal accomplishment than their counterparts in the public ones (P = 0.003). There was no significant difference between the means scored of EE, PA and D among males and females, fourth and fifth years students.
Conclusion: Emotional exhaustion was the main component affecting Sudanese dental students. Burnout components affected the students in a same manner regarding male and female, fifth and fourth year students. Selection of dentistry as first career did not affect the level of burnout.
Keywords: Burnout syndrome, dental students, maslach burnout inventory
|How to cite this article:|
Ghali SM, Awooda AM. Burnout syndrome among undergraduate clinical dental students in Sudan. J Educ Ethics Dent 2013;3:71-5
|How to cite this URL:|
Ghali SM, Awooda AM. Burnout syndrome among undergraduate clinical dental students in Sudan. J Educ Ethics Dent [serial online] 2013 [cited 2020 Mar 30];3:71-5. Available from: http://www.jeed.in/text.asp?2013/3/2/71/136049
| Introduction|| |
Dentists suffer a lot as their profession demands, physical and mental effort as well as personal contact which can result in condition known as burnout. It is a syndrome of being burned or nervous breakdown. Burnout syndrome is defined as "a syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do ''people-work'' of some kind.  It is a psychological term for the experience of long-term exhaustion and diminished interest. It is characterized by three key aspects: Emotional exhaustion (mental fatigue), depersonalization or dehumanization (psychological distancing from others) and reduced personal accomplishment. ,
Interest in this topic emerged from the work of the psychologist Cristian Maslach  in 1976 and the most acceptable definition of the "burnout syndrome" was written by Maslash and Jackson  in 1981. Dental students or Dentists who experience burnout are unable to continue working, find the interaction with patients unbearable and withdraw from contact with staff and colleagues.  Stressful work or too many requirements are not merely contributing factors to burnout, but lifestyle and certain personality traits could have an effect. Burnout is accumulative and gradual process that occurs over an extended period of time. It does not happen overnight, but it can creep up on the individual if he or she is not paying attention to the warning signals. There are physical, emotional and behavioral signs and symptoms of burnout which are subtle at first, but they get worse and worse as time goes on.  Many researches had investigated the existence of burnout, its rate and its effects on the lives among dental students. ,, It was found that, female students had higher degrees of emotional exhaustion than their male counterparts, while no significant differences were found between males and females neither in depersonalization nor in personal achievement.  Sources of stress affecting dental students could be examinations and grades, full working day, receiving criticism from supervisors,  lack of time to do assigned work,  financial resources, and fear of employment after graduation or facing parents after failure. 
In the Sudan, during the last two decades more than ten public and private dental schools were established. No previous data were available tackling this issue. The objectives of this study were to determine the level of burnout among fourth and fifth year dental students in Sudan, to compare the level of burnout between male and female students and between the students from public and private dental schools. Also to assess the association between selecting dentistry as first line career and the level of burnout.
| Materials and Methods|| |
A descriptive cross-sectional study among males and females, fourth and fifth year clinical dental students from ten dental schools in Sudan (four public and six private), during the period March-May 2011. Total population of the dental students from the 10 schools as follows = 535 4 th year +429 5 th year = 964.
The sample size was calculated according to the following formula:
Where n' = Sample size with finite population correction, N = Population size. Z = Z statistics for the level of confidence, P = Expected proportion. D = precision. The size was resulted as 275 students. The ten dental schools were stratified and according to the total number of students in fourth and fifth years from each, the sample size was determined and the students were selected randomly. The selected students were asked to complete the inventory scale during the day at each of the school. The questions were explained thoroughly to the students. Personal information about gender, name of university, year of study and the choice of dentistry as a first line career were set in the questionnaire. Burnout was assessed by the Maslach burnout inventory (MBI) of Maslach and Jackson  1981. It consists of 22 items concerning the measurement of the three burnout components: Emotional exhaustion (EE) (9 items), depersonalization (D) (5 items) and Personal accomplishment (PA) (8 items).The participants recorded their responses by choosing only one statement from the six options which reveal how often they encountered what is described in the item. Each one of the options had been given a specific score (0: Never; 1: A few times a year; 2: Monthly; 3: A few times a month; 4: Every week; 5: A few times a week and 6: Everyday).
The ranges for subscales according to the MBI-key score were as follows: EE: (high => 27, moderate = 17-26 and low = 0-16), D: (high => 14, moderate = 9-13 and low = 0-8) and PA: (high = < 30, moderate = 36-31 and low = 48-37).
The subscales (EE, D, and PA) had to be kept separate and the scores on each subscale were classified according to percentile of each scale.
A high risk of burnout was considered present, when the respondent scored high in both (EE) and (D) and low in (PA).
The English and Arabic versions of the inventory were used since English and Arabic are the teaching languages in the Sudan dental schools.
The total scores for each of the three subscales were calculated for each student by calculating the sum of responses to the items in the subscale. Mean values were calculated for each students group separately and the results of the entire students groups were compared using the t-test and Mann-Whitney tests with the level of significance set at P value <0.05.
| Results|| |
A total of 259 students completed the questionnaire, providing a response rate of 94.18%. The students were predominantly females: 196 (75.7%) versus 63 (24.3%) males. 50.7% of the students were from public universities and 49.03% from private. Fourth year students comprised 54.44% while fifth year were 45.55%. Students who chose dentistry as first line of study were 51%. According to the known ranges of the three subscales of burnout, students were grouped into high, moderate and low levels, as shown in [Figure 1], [Figure 2], [Figure 3]. The sum of responses of the students, regarding each of the subscales, were described in terms of mean and standard deviation, and then compared: There was no significant difference in the level of the subscales of the Burnout syndrome between males and females [Table 1], fourth and fifth year [Table 2] and those who selected dentistry as first line career and those who did not [Table 3], but There is statistical significant difference between students from private and those from public universities, regarding personal accomplishment P = 0.003 [Table 4].
|Table 1: Mean scores of burnout components among clinical dental students according to their gender (n = 259)|
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|Table 2: Means scores of burnout syndrome components among clinical dental students according to the year of study (n = 259)|
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|Table 3: Mean scores of burnout syndrome components among clinical dental students according to their choice of dentistry as a first line career (n = 259)|
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|Table 4: Means scores of burnout syndrome components among clinical dental students according to public and private universities (n = 259)|
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|Figure 1: Distribution of dental students according to the emotional exhaustion scores (EE) (n=259)|
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|Figure 2: Distribution of the dental students according to personal accomplishment scores (n=259)|
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|Figure 3: Distribution of the dental students according to Depersonalization scores n=259|
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| Discussion|| |
Burnout is a real problem facing people working in direct contact with the community. Students response to the study was high (94.18%), the topic was interesting as mentioned by many, and the questionnaires were hand delivered by the researcher and gathered immediately after they completed.
More than half of the students suffered a high level of emotional exhaustion interestingly similar to the results from our region,  but contradicted those from Europe. , This high emotional exhaustion score was probably related to the pressure of studying, and to the fact that some of Sudanese dental students, came from abroad mainly from gulf region, Europe and north America for studying dentistry and lived alone without their families. Also examinations, competition and the fulfillment of the minimal clinical requirements with shortness of patients, in addition to limitation of the leisure time and social activities, affected the results.
A high level of personal accomplishment was seen in most of the students, which meant more involvement with the patients, more satisfaction with the profession and consequently a lower degree of burnout. It was also similar to the previous regional study,  but dissimilar to the European one.  Socialization of life in Middle East region prevent high level of depersonalization as in ours and in the Jordanian one,  but it disagrees with the European one which concluded that the main cause of depersonalization was the lack of social integration.  Depersonalization is the most critical aspect of burnout, perceiving the patient as an impersonal object rather than a human being might result in detrimental negligence in treatment procedures and disregard of the psychological aspect of treating the patients.
Regarding gender, there was no significant difference in the three aspects of the burnout syndrome, but females had slightly higher emotional exhaustion than males. The insignificant difference could be attributed to the fact that there was no barrier or separation between both genders, in addition to that they were living and working in the same environment and facing the same sources and amount of stressors.
Surprisingly, almost half of the students did not choose dentistry as a first line career. This high percentage could be attributed to not scoring enough marks to join the medical school, indifference regarding the whole medical field, parental pressure, and to the good financial reward of dentists even if no post-graduate studies are made and peer effect. There was insignificant difference between those who chose dentistry as a first line career and those who did not. A feature that contradicted other like that done among Nigerian students,  this could be explained by the possibility that both groups were stressed; those who selected dentistry stress themselves to perfection, while the other group was stressed because they were obligated to fulfill the requirements, another explanation is that the first pre-clinical years of studying dentistry do not really convey the true concept about dental practice.
Regarding the three aspects of burnout; fifth year students had higher mean scores than fourth year students, but were not statistically significant. This result is similar to,  but contradicted,  which revealed that fourth year students were suffering a significantly higher level of burnout. The almost similarity in the level of burnout among fourth and fifth year dental students could be attributed to the fact that fourth year students were stressed out because of the new clinical environment (as usually most of the Sudanese dental schools started clinical work during fourth year) and had to deal with patients for the first time, in addition to the fear of committing clinical mistakes, both of which were stressful at the beginning. On the other hand, fifth year students were familiar with the clinical work, so that they became more confident and could deal more effectively with the patients, but concomitantly there is increase in the work load to fulfill the clinical requirements to be able to graduate.
Dental students of the private universities showed significantly higher level of personal accomplishment than those of the public universities. This could be justified by the fewer number of students in private universities, in addition to the availability of more facilities, and the ability of the students to pay for the commitments. Therefore they have less stress in obtaining the required number of patients, materials and equipments in addition to better supervision, thus confidence and self esteem increase.
| Conclusion|| |
There was no burnout-gender predilection, as well as minor differences between fourth and fifth year students, and between those who chose dentistry as a first career and those who did not (P > 0.05).
Private universities students revealed significantly higher level of personal accomplishment than those studying in public universities (P = 0.003), but there was no significant difference in emotional exhaustion (P = 0.474) and depersonalization (P = 0.969).
Burnout syndrome affecting undergraduate dental students could have an adverse effect in their future career. Specialized committee or body should be founded in each Dental school to prevent and treat burnout syndrome. Student or a group of students showing any signs or symptoms of burnout should be counsel and the reason or reasons behind that should be treated early.
| Acknowledgment|| |
Specially appreciate the valuable contributions of the University of Medical Sciences and Technology for supporting this study.
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Alhadi Mohieldin Awooda
Conservative Dentistry Department, Faculty of Dentistry, University of Medical Science and Technology
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]