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American Journal of  Medical 
Science and Innovation (AJMSI) 

Attributes Associated with Burnout among Pediatric Residents in Training Hospitals of  
Central Visayas

Ellaine Shiela Marie Corpuz1*, Michelene E. Escobar-Buot1, Mary Ann A. Wagas1

Volume 3 Issue 2, Year 2024
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v3i2.3078
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: June 12, 2024
Accepted: July 14, 2024
Published: July 17, 2024

This study focused on burnout among pediatric resident physicians in Central Visayas, 
exploring its association with various factors and coping strategies. The research objectives 
aimed to describe the socio-demographic profiles of  respondents, assess burnout levels, 
analyze psychological distress, examine associations between socio-demographic factors 
and burnout/psychological distress, and identify burnout factors and coping strategies. The 
study utilized a cross-sectional design involving 80 pediatric residents, using the Maslach 
Burnout Inventory, Patient Health Questionnaire, and self-assessment questions. The 
analysis included mean, standard deviation, chi-square, and Fisher’s exact tests to explore 
associations and predictors of  burnout. The findings revealed no incidence of  burnout 
but indicated moderate emotional exhaustion, high depersonalization, and high personal 
accomplishment. The majority had experienced burnout in previous residency years. The 
top burnout factors were co-residents, conflicts, and consultants, while coping strategies 
included stress eating, exercise, and vacation leave. Psychological distress ranged from 
mild to severe, with anxiety and depression prevalent among certain groups. The study 
suggests the need for work-life balance training to address burnout incidents, particularly in 
developing economies like the Philippines. This recommendation aims to support the well-
being of  pediatric residents and improve their work-life balance.

Keywords
Burnout, Psychological Distress, 
Pediatric Resident Physicians, 
Central Visayas

1 Visayasmed Hospital, Philippines
* Corresponding author’s e-mail: Esm.Cpz@Gmail.Com

INTRODUCTION
Physician burnout is a growing problem worldwide 
causing mental fatigue, depersonalization, and diminished 
self-value. It is noted as more prevalent in an environment 
that is potentially intense and physically demanding or 
requires higher levels of  commitment and resiliency, such 
as the pediatric residency program. According to the 
American Academy of  Pediatrics (2022), the prevalence 
of  burnout for all pediatric disciplines increased by 10% 
within a 3 - year period (2011 to 2014).
Pediatric resident burnout is multifactorial and recent 
evidence has shown that burnout may begin as early 
during medical school and into residency period. 
Among the demographics, it was reported that there 
was a higher prevalence of  20% to 60% burnout rate in 
women physicians than male counterparts (AAP 2022). 
Meanwhile, a significant association between burnout 
and anxiety was concluded (Koutsimani, et al. 2019), and 
among the significant sources of  anxiety are changes in 
workflow, and competing demands between service and 
training (Franco, et al 2022). These factors may contribute 
to burnout, which affects the resident’s mental health, 
performance, and the quality of  their training and has 
adverse consequences on patient care.
Burnout may be challenging to recognize, and many 
questionnaires have been developed to measure it. 
The most extensively used and considered standard is 
the Maslach Burnout Inventory which includes three 
domains: emotional exhaustion, depersonalization, and 
personal accomplishment. This study investigated the 

incidence and attributes of  burnout among pediatric 
residents in hospital-accredited training hospitals by the 
Philippine Pediatric Society in Central Visayas.

LITERATURE REVIEW
Respondents’ Profile and Burnout
The incidence of  burnout among physicians has certain 
demographic attributes and personal experiences linked 
with physician burnout. In general, females prefer a career 
in pediatrics compared to males and this may explain a 
higher work satisfaction and therefore less burnout risk. 
One study in Jordan revealed that male residents were 
found to have significantly higher burnout and levels 
were significantly different among residency years (Nimer 
et al, 2021).
In some cases, burnout was associated with younger age 
groups as seen in those younger than 30 years old (Ji et al 
2020). Unmarried residents were also seen to have higher 
burnout rates as married residents have the social support 
of  their spouse which acts as a buffer for the period of  
the residency program and protects against the proneness 
of  burnout (Sreelatha et al., 2018). This contrasts with 
one study where a statistically significant relationship 
was noted between burnout and relationship status, 
where married residents suffered from higher emotional 
exhaustion and depersonalization (Jamjoom & Park, 
2018). Studies also show that as the years of  residency 
increased, the burnout in all three dimensions also 
increased with the 3rd year residents having the highest 
burnout rates in all three dimensions. Moreover, burnout 



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was prevalent and remained stable over at least 12 months 
among pediatric residents (Kemper et al., 2019).
Nevertheless, burnout may not necessarily imply a strong 
association with profiles. Some studies also showed that 
demographic variables like gender, ethnicity, marital 
status, and residential status did not reveal any significant 
association with the level of  burnout (Kemper et al., 2019; 
Bari et al., 2019).

Incidence and Factors of  Burnout
The role of  physicians has unique job factors and 
responsibilities that may predispose to significant 
burnout. Studies have shown using the Maslach Burnout 
Inventory that residents had high levels of  burnout on at 
least one subscale in two components and or alarmingly 
high levels on all three subscales. It is multifactorial and 
some attribute it to working ≥40 hours per week (Nimer 
et al 2021), sleep deprivation (Kemper et al, 2019, Ji et al., 
2020), relationship with workers, feelings of  isolation, 
dealing with patients’ psychosocial problems, disturbance 
of  home/family life by work (Nimer et al 2021, Kemper 
et al, 2019), overloaded workloads, lack of  autonomy 
(Rotenstein et al, 2018), and recent medical errors (Kemper 
et al, 2019). These factors can contribute to residents’ 
emotional exhaustion that can make the practitioner feel 
perpetually exhausted and annoyed, unaccomplished, and 
unappreciated.
Despite this, not all studies revealed the presence of  
burnout in all residents.  One study in Thailand showed 
none of  their forty-one pediatric residents had high levels 
of  burnout in all three domains of  the Maslach Burnout 
Inventory questionnaire, with a positive relation between 
educational climate (perceptions of  role autonomy, 
perceptions of  teaching, perceptions of  social support) 
and work-related quality of  life (Kemper et al, 2019). 
Predictive factors of  decreased burnout also include 
resilience and mindfulness of  stress (Reed et al., 2018). 
Other factors identified to reduce the risk of  burnout 
include minimizing unnecessary or duplicated workload, 
scheduling time arrangements to avoid extension of  
regular duty hours, and clearly defining role expectations 
(Puranitee et al. 2019).

Psychological Distress and Burnout
Research on burnout among physicians has increased 
awareness of  physician mental health and well-being as 
an important issue. Psychologic distress and burnout 
share risk factors, manifestations, and complications. 
Some notable consequences of  burnout include 
psychological alterations, a syndrome on concentration 
and memory problems, difficulty in decision-making, low 
coping capacity, anxiety, depression, dissatisfaction with 
life, insomnia, irritability, and increased consumption 
of  alcohol and tobacco (Laguia et al., 2022, Brunsberg 
et al., 2019); health consequences manifested as physical 
health problems including musculoskeletal pain, stomach 
pains, cardiovascular disorders, headache, increased 
susceptibility to infections, insomnia and chronic fatigue 

and even a health risk for type 2 diabetes (Laguia et al., 
2022, Roberts et al., 2021).
High psychological distress has been associated with 
higher sickness rates, absenteeism, and diminished work 
performance that progresses to physical health issues 
(Roberts et al., 2021). Furthermore, for various reasons, 
those who suffer from depression or burnout can be slow 
to seek assistance leading to a two-fold increased risk of  
suicidal thoughts (Brunsberg et al. 2019).
Work problems that cause distress were frequently 
adversely affected by episodes of  psychological distress. 
Screening positive for depression was associated with 
a 3.0-fold higher rate of  harmful errors (Brunsberg 
et al., 2019; Okoro et al. (2024). Hence, identifying any 
psychological distress among physicians may contribute 
to less frequency of  burnout, or vice-versa, and is crucial 
in influencing the long-term mental health of  physicians. 
In contrast to psychological stress, mindfulness, resilience, 
and self-compassion were longitudinally associated 
with lower stress and greater confidence in providing 
compassionate care and may be key areas for improved 
wellness (Reed et al., 2018, Kemper et al., 2020, Brunsberg 
et al., 2019). Attributes that are associated with burnout 
and compassion fatigue include the type of  institution 
(government), sleeping hours (average of  fewer than 4 
hours per day), and interrupted leaves, while differences 
observed in compassion satisfaction and burnout 
were age, marital status (married), child dependents, 
higher level of  training (Ang et. al, 2021, Kemper et 
al., 2020), location and type of  institution (Ang et. al, 
2021). However, there also had been studies showing 
no association of  demographic data between a positive 
screen for depression or burnout and age, gender, or year 
of  residency (Brunsberg et al., 2019).

Coping Mechanism of  Burnout
Coping mechanisms are necessary to help overcome these 
stressors in the workplace. Organizational ergonomic 
issues, including work stress and burnout of  healthcare 
professionals, can negatively impact patient care and 
safety. Burned-out physicians reported sub-optimal 
patient care practices that, in turn, are negatively associated 
with patient satisfaction. Balancing activities addressed 
to individual stressors can contribute to improving the 
resident’s well-being thereby making the environment less 
stressful. Mindfulness-based stress reduction for two and 
half  hours a week for two months showed substantial 
improvements in burnout scores and mental well-being. 
Taking vacations, exercising, and personal hobbies can 
contribute to reducing the level of  burnout (Alotaibi et 
al., 2019). 
Quiet quitting, then, is often used to cope with burnout. 
It has been defined in a couple of  different ways — some 
describe it as not actively going above and beyond at 
work, while others see it as doing only the bare minimum 
to remain employed. Some defend quiet quitting as “just 
doing your job,” whereas others see it as passive resistance 
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and personal lives (Quiet Quitting, 2023). While burnout 
is not classified as a medical condition, it is important 
to note that it is an occupational phenomenon that can 
severely affect employees’ mental and physical health. 
This is different from having a bad week or a stressful 
project. Burnout is a consistent and prolonged state 
of  being in a non-productive state due to physical and 
psychological emotions often related to issues and factors 
in the workplace or living environment.
Burned-out workers are more likely to take a sick day, 
actively look for a different job, become less confident 
in their performance, and are more likely to visit the 
emergency room. When unaddressed, the costs of  
burnout are too big to ignore. The financial burden of  
work-related stress and burnout in the U.S. amounts to 
approximately $190 billion a year in additional healthcare 
expenses, and when absenteeism is added to the cost, 
turnover diminished productivity, and legal and insurance 
costs, it totals about $300 billion (Rokka & Khanal, 
2023). Burnout may be common in the workplace, but 
the physical symptoms and the broader consequences 
vary by person, role, and industry. In addition to creating 
and encouraging an empathetic culture, employers need 
to adopt a proactive approach to managing the unique 
needs of  each employee. Some employees benefit from 
feeling more involved at work, whereas others might need 
space to step away and decompress. Managers cannot 
adopt a “one size fits all” approach to mitigating burnout. 
Thus, this study is deemed important in addressing all the 
consequences mentioned earlier when pediatric residents 
suffer from burnout.

Statement of  the Problem
This study determined the incidence and factors of  
burnout among Pediatric Resident Physicians in Central 
Visayas. Specifically, it aimed to:

1. Describe the respondent’s profile in terms of  age, 
sex, civil status, year graduated from the College of  
Medicine, year level in residency training, and type of  
training institution.

2. Determine the level of  burnout incidence among 
respondents manifested in the following dimensions 
on emotional exhaustion, depersonalization, sense of  
personal accomplishment.

3. Determine the level of  psychological distress among 
respondents.

4. Determine if  there is an association between 
respondent’s profile and level of  psychological distress 
among respondents.

5. Determine if  there is an association between 
respondent’s profile and level of  burnout.

6. Determine the factors and coping strategies of  
burnout among pediatric residents.

Theoretical Framework 
This study was anchored on Demand-Resources Theory 
and Structural Theory.
Demands–Resources Theory postulates that burnout 

happens when there is an imbalance between demands 
and resources at the workplace. Work-related demands 
are those factors that require sustained physical or mental 
effort and are associated with certain physiological costs 
resulting from activation of  the hypothalamic-pituitary-
adrenal axis and psychological costs like subjective 
fatigue, the low focus of  attention, and redefinition of  
work requirements. Common work-related demands may 
include work overload, emotional labor, time pressure, or 
interpersonal conflicts. When recovery in the face of  such 
demands is insufficient, physical, and mental exhaustion 
can be triggered (Laguia et. al, 2022). On the other hand, 
work resources include the physical, psychological, and 
social aspects of  work that can reduce the demands of  
work. The moment demands exceed resources, fatigue 
happens; if  this imbalance is maintained over a period, 
fatigue may become chronic then burnout appears as 
emotional exhaustion, while the existence of  work 
resources may inversely influence depersonalization by 
reducing its use as a coping strategy.
Structural Theory postulates that burnout is a response to 
chronic work-related stress that occurs when the coping 
strategies employed by the practitioners in managing work 
stressors fail. At first, work stress will elicit a series of  
coping strategies. However, when prior coping strategies 
employed are not successful, it leads to professional 
failure hence a feeling of  low personal fulfillment at work 
and emotional exhaustion will be developed. Having 
these feelings, the practitioner develops depersonalization 
attitudes as a new form of  coping mechanism (Laguia et. 
al, 2022). 

Scope and Limitations
This study was limited in determining the incidence 
and attributes associated with and coping mechanism 
of  burnout. Variables under study were respondent’s 
profile such as sex, age, civil status, residency year level, 
year graduated from the college of  medicine, and type 
of  training institution. Other variables include the level 
of  psychological distress and the three dimensions of  
burnout: emotional exhaustion, depersonalization, and a 
sense of  personal accomplishment. It was conducted in 
2024 and involved only the pediatric resident physicians 
from the twelve (12) accredited pediatric residency 
training hospitals by the Philippine Pediatric Society in 
Central Visayas. Respondents were only those with at least 
six months into the training program and who consented 
to participate in the study. The data was gathered using 
the Patient Health Questionnaire for Depression and 
Anxiety (PHQ-4) to measure psychological distress and 
the Maslach Burnout Inventory (MBI) for the incidence 
of  burnout. 

METHODOLOGY
Research Design
This study employed a descriptive cross-sectional 
design utilizing a survey questionnaire. This design is 
considered advantageous as it determined the incidence 



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and attributes associated with burnout and psychological 
distress among pediatric residents. Literature pointed out 
that a cross sectional study is most suitable for estimating 
the incidence of  a behavior in a population at a certain 
moment in time.

Study Setting
This study was conducted in twelve (12) hospital-
accredited pediatric residency training hospitals by the 
Philippine Pediatric Society in Central Visayas, namely: 
Cebu City Medical Center (N. Bacalso Ave., Cebu City), 
Cebu Doctors University Hospital (Osmeña Blvd., Cebu 
City), Cebu Velez General Hospital (F. Ramos St., Cebu 
City), Chong Hua Hospital (Fuente Osmeña, Cebu City), 
Chong Hua Hospital- Mandaue (Mandaue City, Cebu), 
Gov. Celestino Gallares Hospital (Tagbilaran City, Bohol), 
Perpetual Succour Hospital (Gorordo Ave., Cebu City), 
Silliman University Medical Center (Dumaguete City), 
Southwestern University Medical Center (Urgello St., 
Cebu City), University of  Cebu Medical Center (Mandaue 
City, Cebu), Vicente Sotto Memorial Medical Center 
(B. Rodriguez St., Cebu City) and VisayasMed Hospital 
(Osmeña Blvd., Cebu City).

Study Population and Sampling Technique
This study included 80 residents from 100 Pediatric 
Resident Physicians in 12 accredited Pediatric Residency 
Training Hospitals by the Philippine Pediatric Society in 
Central Visayas, who had at least 6 months of  residency 

training. The sample size is computed using a web 
calculator based on a 95% CI, 5% error, proportion of  
50%, and population base of  100.

Research Instruments
The instrument used in this survey was a self-
administered online questionnaire in Google form 
and is a modified adaptation of  the Maslach Burnout 
Inventory and Patient Health Questionnaire-4 for 
Depression and Anxiety consisting of  three parts. The 
first part comprised the general information on the 
sociodemographic characteristics of  the respondents 
such as age, sex, civil status, year graduated from the 
College of  Medicine, residency year level, and type of  
training institution (government or private hospital). The 
second part comprised the 22-item Maslach Burnout 
Inventory questionnaire which comprises three (3) 
domains: emotional exhaustion, depersonalization, 
and sense of  personal accomplishment, a validated 
questionnaire to assess burnout and the four-item Patient 
Health Questionnaire for Depression and Anxiety (PHQ-
4), to measure psychological distress, a validated brief  
screening tool for both anxiety and depression. The third 
part comprised the self-assessment questionnaire for 
burnout factors and the participant’s coping mechanism. 
No dialect translation will be done since all respondents 
are post-graduate level and can understand English.

Scoring Procedure 

Table 1: Level of  Burnout (22-item Maslach Burnout Inventory)
Dimension Score (Sum across domain-specific items) Interpretation
Emotional Exhaustion 17 and below Low-level

18 to 29 Moderate
30 and above High-level

Depersonalization Five and below Low-level
6 to 11 Moderate
12 and above High-level

Sense of  personal accomplishment
(Consequence of  the first two)

33 and below High Level
34 to 39 Moderate
Greater than 40 Low level

Burnout: High Emotional Exhaustion, High Depersonalization, but Low sense of  Personal Accomplishment

Table 2: Psychological Distress: Anxiety and Depression 
(Patient Health Questionnaire-4)
Score (Sum of  each of  
the four items)

Interpretation

0-2 Normal
3-5 Mild Distress
6-8 Moderate Distress
9-12 Severe Distress

Statistical Treatment of  Data
Data were statistically described in terms of  mean ± SD, 
or frequencies when appropriate. Comparison was done 
using Student t, or Chi-square (χ2) tests. Fisher’s Exact 
test was used instead when the expected frequency was 
<5, or when the assumptions of  Chi-square were violated. 
All tests were two-tailed, and the level of  significance was 
set at p-value <0.05.

Ethical Consideration
The study complied with the ethical principles outlined 
in the Declaration of  Helsinki and the National Ethical 

A total score ≥3 for the first two questions suggests anxiety. A 
total score ≥3 for the last two questions suggests depression.



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Guideline for Health and Health-related Research (2017). 
Before the study initiation, the protocol was reviewed 
and approved by the Institutional Review Board (IRB) of  
VisayasMed Hospital.
The researcher ensured that all records from the 
respondents were treated with strict confidentiality. Their 
names were not reflected in the file for data analysis. 
Instead, only the numbers corresponding to their names 
in the source code can be seen.
The source code is in the possession of  the researcher 
only. Only the researcher and the biostatistician have sole 
access to collected data. Excel sheets for data processing 
did not contain any information that would give away the 

identity of  Pediatric Resident Physicians.  Also, this paper 
is self-funded because it is intended for the compliance 
of  residency training of  the hospital and the Philippine 
Pediatric Society, Inc. Thus, it is not funded by any 
organization or pharmaceutical companies that might 
benefit from the study results.

RESULTS AND DISCUSSIONS
Results
Profile of  Residents in Terms of  Age, Sex, Civil 
Status, Year Graduated from the College of  
Medicine, Year Level in Residency Training, and 
Type of  Training Institution.

Table 3: Sociodemographic profile of  the respondents
Profile All Respondents Government Private p-value

N=80 n=17 n=63
Age, years,  (%)
20 – 29 30 (37.5) 3 (17.6) 27 (42.9) .100
30 – 39 48 (60.0) 14 (82.4) 34 (54.0)
Older than 40 2 (2.5) - 2 (3.1)
Sex
Male 15 (18.8) 6 (35.3) 9 (14.3) .049
Female 65 (81.2) 11 (64.7) 54 (85.7)
Civil status
Unmarried 67 (83.8) 15 (88.2) 52 (82.5) .572
Married 13 (16.2) 2 (11.8) 11 (17.5)
Year graduated from the College of  Medicine
Before 2020 44 (55.0) 11 (64.7) 33 (52.4) .538
2020 13 (16.3) 3 (17.6) 10 (15.9)
2021 20 (25.0) 2 (11.8) 18 (28.6)
2022 3 (3.7) 1 (5.9) 2 (3.1)
Residency year level
Y1 34 (42.5) 9 (52.9) 25 (39.7) .142
Y2 12 (15.0) - 12 (19.0)
Y3 34 (42.5) 8 (47.1) 26 (41.3)

Table 3 presents the distribution of  the respondents 
according to the socio-demographic profiles. There were 
80 respondents to this survey, who were mostly from 
private training hospitals (78.75%). The difference in the 
proportion of  respondents from private and government 
institutions is statistically significant (p<.0001). Most of  
the pediatric residents were 30 years and older (62.5%), 
but those from the government institution were mostly 
30 – 39 years old (82.4%). Further, most of  them were 
females (81.2%), from private (85.7%) and government 

hospitals (64.7%). They are mostly unmarried (83.8%) 
and are in their first year (42.5%) and third year (42.5%) 
of  their residency training. There were no second-year 
respondents from the government institution.  With this 
number of  participants, this limits the findings since it 
resulted in a skewed result.

Level of  Burnout Incidence among Respondents as 
Manifested in Emotional Exhaustion,  Depersonalization, 
and Sense of  Personal Accomplishment

Table 4: Distribution of  Respondents’ Level of  Burnout based on Dimension (EE, DP, PA) and Type Training Hospitals
Dimension All Respondents Government Private p-value
Emotional Exhaustion 13.1 ± 4.4 13.9 ± 4.6 12.9 ± 4.3 .375
Low 66 (82.5) 13 (76.5) 53 (84.1) .461
Moderate 14 (17.5) 4 (23.5) 10 (15.9)



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Table 4 shows the distribution of  respondents on the 

level of  burnout from different training hospitals under 
the subscales of  emotional exhaustion, depersonalization, 
and sense of  personal accomplishment. Overall, the 
findings revealed that most of  the respondents had low 
emotional exhaustion (82.5%) but moderate to high levels 
of  depersonalization (76.2%). Remarkably, respondents 
from both sectors displayed a high sense of  personal 
accomplishment, demonstrating identical mean scores.

Legend:
Normative scores to calculate the level of  burnout with the 
Maslach Burnout Inventory Emotional Exhaustion (Sum of  
Scores) Low: <17; Moderate: 18-29; High: >30
Depersonalization score (Sum of  Scores) Low: <5, Moderate: 
6-11; High: >12;
Sense of  personal accomplishment (Sum of  Scores) Low: >40; 
Moderate: 34-39; High: <33

Depersonalization 8.2 ± 4.0 8.65 ± 4.3 8.13 ± 4.9 .636
Low 19 (23.8) 4 (23.5) 15 (23.8) .985
Moderate 41 (51.2) 9 (52.9) 32 (50.8)
High 20 (25.0) 4 (23.5) 16 (25.4)
Sense of  personal accomplishment 20.0 ± 4.1 20.0 ± 3.9 20.0 ± 4.2 .989
High 80 (100.) 17 (100.0) 63 (100.0) -

Table 5: Respondent’s Responses to the Burnout Survey Questionnaire
Questions No. of  Respondents Percentage
1. In your current residency year, have you ever felt burned out during your previous years in residency?
No 6 7.5 
Yes 74 92.5 
2.  If  this is not your first time/exposure in pediatric residency training, can you recall if  you have felt burnout?
No 73 91.3
Yes 7 8.7
3.  What was your year level when you experienced burnout in your previous years in residency?
None 29 36.3 
y1 31 38.8 
y2 6 7.5 
y3 3 3.8 
y1 & y2 5 6.3 
y1, y2, y3 5 6.3 

Results from a survey questionnaire on burnout confirmed 
previous experience of  burnout as shown in table 5 The 
respondents, when asked if  they ever felt burned out during 
their previous years of  residency, answered “YES” (92.5%). 
However, they could not recall (91.3%) when the first time 
they felt the feeling of  burnout. However, some said it was in 
their first year of  residency in training (38.8%). 

Residents’ Level of  Psychological Distress and 
Incidence of  Anxiety and Depression
Table 6 shows the respondent’s level of  psychological 
distress and incidence of  depression and anxiety. 
Generally, mild (5.7 ± 3.5) psychological distress can 
be noted among respondents, where the majority 
(52.9%) were from government training hospitals. It is 

Table 6: Respondents Level of  psychological distress and Incidence of  Anxiety and Depression
Dimension All Respondents Government Private p-value

N= 80 n=17 n=63
Psychological distress 5.7 ± 3.5 5.5 ± 2.9 5.7 ± 3.7 .801
Normal 16 (20.0) 2 (11.8) 14 (22.2) .564
Mild 31 (38.8) 9 (52.9) 22 (34.9)
Moderate 22 (27.5) 4 (23.5) 18 (28.6)
Severe 11 (13.8) 2 (11.8) 9 (14.3)
Presence of  Anxiety 39 (48.8) 7 (41.2) 32 (50.8) .481
Presence of  Depression 30 (37.5) 6 (35.3) 24 (38.1) .832



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noteworthy that almost half  of  the respondents had the 
presence of  anxiety (48.8%), and depression (37.5%). 
And their emotional state did not significantly differ 
whether they were from the government or private 
training hospitals.

Association between Residents’ Profile and Level of  
Burnout on Emotional Exhaustion
It can be gleaned from Table 7 that there was no 
significant association between emotional exhaustion 
and each of  the respondent’s sociodemographic profiles 
as indicated in p-values exceeding the 0.05 level of  
significance. However, it can be noted that there are 
pediatric physicians with moderate levels of  emotional 
exhaustion including those 30 years and older (64.3%), 

Psychological Distress: Normal 0-2; Mild distress 3-5; Moderate 
6-8; Severe 9-12
Presence of  anxiety: ≥3 for the first two questions (PHQ4)
Presence of  Depression: ≥3 for the last two questions (PHQ4)

Table 7: Sociodemographic profile of  the respondents and emotional exhaustion
Profile All Respondents Low Moderate p-value

N= 80 n=66 n=14
Age, years,  
20 – 29 30 (37.5) 25 (37.9) 5 (35.7) .782
30 – 39 48 (60.0) 39 (59.1) 9 (64.3)
Older than 40 2 (2.5) 2 (3.0) -
Sex
Male 15 (18.8) 12 (18.2) 3 (21.4) .777*
Female 65 (81.2) 54 (81.8) 65 (81.6)
Civil status
Unmarried 67 (83.8) 57 (86.4) 10 (71.4) .169
Married 13 (16.2) 9 (13.6) 4 (28.6)
Residency year level
Y1 34 (42.5) 28 (42.4) 25 (39.7) .142
Y2 12 (15.0) 11 (16.7) 12 (19.0)
Y3 34 (42.5) 27 (40.9) 26 (41.3)
Type of  training institution
Government 17 (21.3) 13 (19.7) 4 (26.6) .461
Private 63 (78.7) 53 (80.3) 10 (71.4)

Legend: Significant at p<0.05 alpha level; S *Significant; NS-Not Significant

females (81.6%), unmarried (71.4%), 3rd-year residents 
(41.3%), and those from private institutions (71.4%).

Association between Profile and Level of  Burnout 
on Depersonalization
Table 8 describes the association between the 
sociodemographic profile of  the respondents and 
the level of  depersonalization. Data revealed that 
there is no significant association between the level of  

depersonalization and their socio-demographic profile, 
except for age, with a p-value of  0.45 which is lower than 
the significant value of  0.05. Moreover, there are pediatric 
physicians with high levels of  depersonalization with an 
age range of  30 to 39 years old (50.0%), females (75.0%), 
unmarried (95.0%), in their third year of  residency 
training (55.0%) and mostly from private training 
hospitals (80.0%).

Table 8: Profile of  the respondents and level of  depersonalization
Profile All Respondents Low Moderate High p-value

N= 80 n=19 n=41 n=20
Age, years,  (%)
20 – 29 30 (37.5) 8 (42.1) 12 (29.3) 10 (50.0) .045
30 – 39 48 (60.0) 9 (47.4) 29 (70.7) 10 (50.0)
Older than 40 2 (2.5) 2 (10.5) - -
Sex
Male 15 (18.8) - 10 (24.4) 5 (25.0) .056



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Female 65 (81.2) 19 (100.0) 31 (75.6) 15 (75.0)
Civil status
Unmarried 67 (83.8) 15 (78.9) 33 (80.5) 19 (95.0) .286
Married 13 (16.2) 4 (21.1) 8 (19.5) 1 (5.0)
Residency year level
Y1 34 (42.5) 12 (63.2) 16 (39.0) 6 (30.0) .215
Y2 12 (15.0) 1 (5.3) 8 (19.5) 3 (15.0)
Y3 34 (42.5) 6 (31.5) 17 (41.5) 11 (55.0)
Type of  training institution
Government 17 (21.3) 4 (21.1) 9 (22.0) 4 (20.0) .985
Private 63 (78.7) 15 (78.9) 32 (78.0) 16 (80.0)

Legend: Significant at p<0.05 alpha level; S *Significant; NS-Not Significant

Residents’ Profile and Level of  Psychological 
Distress
Table 9 shows the association between the respondent’s 
sociodemographic profile and their level of  emotional 
distress. The analysis of  respondents across various levels 
of  psychological distress reveals diverse trends. Firstly, 
respondents predominantly fall into the normal and 
mild distress categories, with smaller proportions in the 
moderate and severe categories. Despite this, individuals 
in the 30-39 age group exhibit higher representation 
across all distress levels, although there is no significant 
difference in age distribution among the distress levels. 
Females constitute the majority across all distress levels, 
with variations in the distribution of  males and females, 
yet not statistically significant.

Additionally, unmarried individuals dominate all distress 
levels, with a higher percentage in the severe distress 
category, though the difference in civil status distribution 
among distress levels is not statistically significant. 
Moreover, the distribution of  residents across different 
year levels remains relatively balanced across distress 
levels, with no significant difference observed. Similarly, 
respondents from private training institutions form the 
majority across all distress levels, with no significant 
disparity in distribution between government and private 
training institutions among distress levels. Overall, while 
certain demographic groups exhibit higher representation 
across distress levels, there are no significant associations in 
age, gender, civil status, residency year level, or institutional 
affiliation distribution among the distress levels. 

Table 9: Profile of  the respondents and level of  emotional distress
Profile All Respondents Normal Mild Moderate Severe p-value

N= 80 n=16 n=31 n=22 n=11
Age, years, n (%)
20 – 29 30 (37.5) 4 (25.0) 12 (38.7) 10 (45.5) 4 (36.4) .783
30 – 39 48 (60.0) 11 (68.8) 18 (58.1) 12 (54.5) 7 (63.6)
Older than 40 2 (2.5) 1 (6.2) 1 (3.2) - -
Sex
Male 15 (18.8) 3 (18.8) 4 (12.9) 7 (31.8) 1 (9.1) .280
Female 65 (81.2) 13 (81.2) 27 (87.1) 15 (68.2) 10 (90.9)
Civil status
Unmarried 67 (83.8) 13 (81.3) 24 (77.4) 20 (90.9) 10 (90.9) .526
Married 13 (16.2) 3 (18.7) 7 (22.6) 2 (9.1) 1 (9.1)
Residency year level
Y1 34 (42.5) 7 (43.8) 14 (45.2) 8 (36.4) 5 (45.5) .987
Y2 12 (15.0) 2 (12.5) 5 (16.1) 3 (13.6) 2 (18.2)
Y3 34 (42.5) 7 (43.8) 12 (38.7) 11 (50.0) 4 (36.3)
Type of  training institution
Government 17 (21.3) 2 (12.5) 9 (29.0) 4 (18.2) 2 (18.2) .564
Private 63 (78.7) 14 (87.5) 22 (71.0) 9 (81.8) 9 (81.8)



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Association of  Profile and Anxiety and Depression
Table 10 explains the sociodemographic profile of  
the respondents and the incidence of  anxiety and 
depression. It can be gleaned that there was no significant 
association between each of  the socio-demographic 
profiles of  the respondents and the prevalence of  anxiety 
and depression. However, data shows that anxiety is 
prevalent among older pediatric resident physicians. 
Its distribution level across different age groups shows 
a higher percentage (53.8%) of  residents between 30 

to 39 years old compared to those aged 20-29 (43.6%). 
Most individuals experiencing anxiety and depression 
are females (A=79.5%, D= 73.3%), and unmarried 
(A=89.7%, D=90%). The distribution of  anxiety and 
depression levels across residency year levels varied 
where the incidence of  anxiety was more seen among 
1st-year residents while the incidence of  depression was 
more seen among those in their 3rd year of  residency, and 
most were from private training hospitals.

Table 10: Profile of  the respondents and the presence of  anxiety and depression
Profile Anxiety p-value Depression p-value

n= 39 n=30
Age, years,  (%)
20 – 29 18 (46.2) .142 12 (40.0) .527
30 – 39 21 (53.8) 18 (60.0)
Older than 40 - -
Sex
Male 8 (20.5) .694 8 (26.7) .160
Female 31 (79.5) 22 (73.3)
Civil status
Unmarried 35 (89.7) .156 27 (90.0) .240
Married 4 (10.3) 3 (10.0)
Residency year level
Y1 17 (43.6) .686 12 (40.0) .837
Y2 7 (17.9) 4 (13.3)
Y3 15 (38.5) 14 (46.7)
Type of  training institution
Government 7 (17.9) .481 6 (20.0) .832
Private 32 (82.1) 24 (80.0)

Distribution of  the Attributes of  Burnout
Table 11 illustrates the factors of  burnout.  The top three 
factors of  burnout are caused by co-residents (42.5%), 
misunderstanding and interpersonal conflicts (40.0%), 
and consultants (37.5%). All three are about human 
factors and their interaction in the workplace. Meanwhile, 
most pediatric resident physicians were least bothered 

about work schedules, the other people in the hospitals, 
and bullying as it ranks the lowest three among the 
identified factors (8%,9%, and 11% respectively).  
Meanwhile, there was no in-depth interview conducted 
to support how these top three (3) identified factors 
specifically attributed to the respondent’s burnout which 
limits the findings of  the study.

Table 11: Attributes of  burnout
Attributes No. of  Respondents Percentage
Co-residents 34 42.5
Misunderstanding, interpersonal conflicts 32 40.0
Consultants 30 37.5
Workload 23 28.7
Living alone 18 22.5
Loneliness 18 22.5
Overload, unfair workload 16 20.0
Bullying 9 11.3
Other people in the hospital 7 8.8
Work schedule 6 7.5



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Coping Mechanisms on Factors of  Burnout
Table 12 shows the respondents’ coping mechanisms. 
The most common coping mechanism reported by 
respondents is indulging in food trips, with 72.5% of  
individuals using this method. Some went to wellness and 
self-care activities such as yoga, massage, spa, and exercise 

(43.8%), while some went on vacation leave (41.3%). 
Although there were a few who opted to quit (2.5%) and 
did online shopping (1.3%), diving or shooting (1.3%) 
which is somewhat scary, and one has opted to seek 
professional help (1.3%). The burnout for this resident is 
deep because they opted to seek professional help.

Table 12: Coping Mechanisms
Coping No. of  Respondents Percentage
Food trip 58 72.5
Exercise, yoga, spa, massage 35 43.8
Vacation leave 33 41.3
Drinking 11 13.8
Sleeping 7 8.8
Binge-watching, video games 5 6.3
Quitting 2 2.5
Online shopping 1 1.3
Sought professional help 1 1.3
Diving, shooting 1 1.3

Table 13: Training plan on work-life balance for pediatric physicians
Area of  Concern Specific Objectives Strategies/ 

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CONCLUSIONS
Pediatric resident physicians in Central Visayas had 
no burnout incidence with subscales showing only 
moderate emotional exhaustion, high depersonalization, 
and high personal accomplishment. Most of  them had 
an age range of  30-39 years old, female, unmarried, and 
graduated before 2020. The residents’ profiles except for 
age, are not significantly associated with burnout outcome 
domains. Further, residents have psychological distress 
ranging from mild to severe. Anxiety and depression 
were prevalent among older residents, female, unmarried, 
and in the first year of  residency and those from private 
training hospitals.
Majority of  the respondents (92.5%) had experienced 
burnout during their previous residency years. The 
top three attributes to burnout are co-residents, 
misunderstanding and interpersonal conflicts, and 
consultants. The top 3 coping mechanisms are wellness 
and self-care activities such as food trips, going to yoga, 
massage, spa and exercise, and vacationing.

RECOMMENDATIONS
Pediatric resident burnout is multifactorial and based on 
the findings of  the study, the researcher recommends a 
proposed comprehensive training plan that is developed 
and tailored specifically for pediatric resident physicians 
in Central Visayas, Philippines. Meanwhile, pediatric 
resident physicians must be more aware of  their self-care 
practices in coping with psychological distress and the 
attributes of  burnout in the exercise of  self-preventive 
measures for a worthwhile life as practitioners.
The hospital institutions and training providers could 
help strengthen its support facilities by giving priority 
to crafting annual training plans for work-life balance. 
Also, a call for more support is needed from the pediatric 
department in reinforcing the AAP 2022 aim in Physician 
Health and Wellness, shifting the focus from burnout 
treatment to preventive physician health and wellness 
including targeted interventions developed by, and for 
physicians. This includes the promotion of  a balanced 

lifestyle that includes passive program strategies like 
joining lectures or website resources on topics like stress 
management, emotional wellness, and professionalism 
and active program strategies with out-of-hospital 
components like social outings, retreats, or team-building 
activities.

REFERENCES
Al-Dubai, S. A., & Rampal, K. G. (2010). Prevalence 

and Associated Factors of  Burnout among doctors 
in Yemen. Journal of  Occupational Health, 52(1), 58–65. 
https://doi.org/10.1539/joh.o8030

Alotaibi, A. K., Alsalim, A., Alruwaili, F., Almubarak, A., 
Alhamzah, A., Albahlal, A., & Alrobaian, M. (2019). 
Burnout during Ophthalmology Residency Training: 
A national survey in Saudi Arabia. Saudi journal of  
ophthalmology: official Journal of  the Saudi Ophthalmological 
Society, 33(2), 130–134. https://doi.org/10.1016/j.
sjopt.2019.01.007

Ang, A., & Estrella, A. (2021). Burnout, compassion 
fatigue, and compassion satisfaction among obstetrics 
and gynecology resident physicians in the Philippines: 
A cross-sectional study. Philippine Journal of  Obstetrics 
& Gynecology, 45(1), 1-10. https://www.pogsjournal.
org/article.asp?issn=0116-6069;year=2021;volume=
45;issue=1;spage=1;epage=10;aulast=Ang;aid=Phili
ppJObstetGynecol_2021_45_1_1_321182

Bari, A., Kamran, R., Haroon, F., & Bano, I. (2019). 
Burnout among pediatric residents and junior 
consultants working at a tertiary care hospital. Pakistan 
journal of  medical sciences, 35(1), 45–49. https://doi.
org/10.12669/pjms.35.1.43

Becker’s Hospital Review. (2023, April 23). 29 physician 
specialties ranked by 2022 burnout rates. Becker’s 
Hospital Review. https://www.beckershospitalreview.
com/hospital-physician-relationships/29-physician-
specialties-ranked-by-2022-burnout-rates.html

Brunsberg, K. A., Landrigan, C. P., Garcia, B. M., Petty, C. 
R., Sectish, T. C., Simpkin, A. L., Spector, N. D., Starmer, 
A. J., West, D. C., & Calaman, S. (2019). Association 



Pa
ge

 
42

https://journals.e-palli.com/home/index.php/ajmsi

Am. J. Med. Sci. Innov. 3(2) 31-43, 2024

of  Pediatric Resident Physician Depression and 
Burnout with Harmful Medical Errors on Inpatient 
Services. Academic medicine: journal of  the Association of  
American Medical Colleges, 94(8), 1150–1156. https://
doi.org/10.1097/ACM.0000000000002778

Carayon, P. (Ed.). (2011). Handbook of  human factors 
and ergonomics in healthcare and patient safety (2nd 
ed.). CRC Press. https://books.google.com.ph/
books?id=7IJMP6UlHUIC

Dimitriu, M. C. T., Pantea-Stoian, A., Smaranda, A. C., 
Nica, A. A., Carap, A. C., Constantin, V. D., Davitoiu, 
A. M., Cirstoveanu, C., Bacalbasa, N., Bratu, O. G., 
Jacota-Alexe, F., Badiu, C. D., Smarandache, C. G., 
& Socea, B. (2020). Burnout syndrome in Romanian 
medical residents in time of  the COVID-19 
pandemic. Medical hypotheses, 144, 109972. https://doi.
org/10.1016/j.mehy.2020.109972

Edú-Valsania, S., Laguía, A., & Moriano, J. A. (2022). 
Burnout: A Review of  Theory and Measurement. 
International journal of  environmental research and 
public health, 19(3), 1780. https://doi.org/10.3390/
ijerph19031780

Gleason, F., Malone, E., Wood, L., Baker, S. J., Hollis, R. 
H., Richman, J. S., Chu, D. I., & Lindeman, B. (2020). 
The Job Demands-Resources Model as a Framework 
to Identify Factors Associated with Burnout in 
Surgical Residents. Journal of  Surgical Research, 247, 
https://doi.org/10.1016/j.jss.2019.10.034

Gray, P., Senabe, S., Naicker, N., Kgalamono, S., Yassi, A., 
& Spiegel, J. (2019). Workplace-Based Organizational 
Interventions Promoting Mental Health and 
Happiness among Healthcare Workers: A Realist 
Review. International Journal of  Environmental Research 
and Public Health (Online), 16(22), 4396. https://doi.
org/10.3390/ijerph16224396

Jamjoom, R. S., & Park, Y. S. (2018). Assessment of  
pediatric residents’ burnout in a tertiary academic 
center. Saudi Medical Journal, 39(3), 296–300. https://
doi.org/10.15537/smj.2018.3.22328

Ji, L., Xiaowei, Z., Ling, K., Yao, F., Qingkun, S., & 
Jun, Z. (2020). Burnout level and job satisfaction 
in Chinese pediatrics residents: A web-based cross-
sectional study. Medicine, 99(8), e19249. https://doi.
org/10.1097/MD.0000000000019249

Kelly, F., Uys, M., Bezuidenhout, D., Mullane, S. L., & 
Bristol, C. (2021). Improving healthcare worker 
resilience and well-being during COVID-19 using a self-
directed e-learning intervention. Frontiers in Psychology, 
12. https://doi.org/10.3389/fpsyg.2021.748133

Kemper, K. J., McClafferty, H., Wilson, P. M., Serwint, J. 
R., Batra, M., Mahan, J. D., Schubert, C. J., Staples, B. 
B., & Schwartz, A. (2019). Pediatric Resident Burnout-
Resilience Study Consortium. Do Mindfulness 
and Self-Compassion Predict Burnout in Pediatric 
Residents? Academic medicine: journal of  the Association 
of  American Medical Colleges, 94(6), 876–884. https://
doi.org/10.1097/ACM.0000000000002546

Kemper, K. J., Schwartz, A., Wilson, P. M., Mahan, J. 

D., Schubert, C. J., Staples, B. B., McClafferty, H., 
Serwint, J. R., & Batra, M. (2020). Pediatric Resident 
Burnout-Resilience study Consortium.  Burnout in 
Pediatric Residents: Three Years of  National Survey 
Data. Pediatrics, 145(1), e20191030. https://doi.
org/10.1542/peds.2019-1030

Kim, J., & Kim, H. (2017). Demographic and 
Environmental Factors Associated with Mental 
Health: A Cross-Sectional Study. International Journal 
of  Environmental Research and Public Health, 14(4), 431. 
https://doi.org/10.3390/ijerph14040431

Koinis, A., Giannou, V., Drantaki, V., Angelaina, S., 
Stratou, E., & Saridi, M. (2015). The impact of  
healthcare workers’ job environment on their mental-
emotional health. Coping strategies: The case of  a 
local general hospital. Health Psychology Research, 3(1), 
1984. https://doi.org/10.4081/hpr.2015.1984

Lebert-Charron, A., Dorard, G., Boujut, E., & Wendland, 
J. (2018). Maternal burnout syndrome: Contextual 
and psychological associated factors. Frontiers in 
Psychology, 9, Article 885. https://doi.org/10.3389/
fpsyg.2018.00885

Maslach, C., & Leiter, M. P. (2016). Understanding 
the burnout experience: Recent research and its 
implications for psychiatry. World Psychiatry, 15(2), 
103-111. https://doi.org/10.1002/wps.20311

McClafferty, H. H., Hubbard, D. K., Foradori, D., Brown, 
M. L., Profit, J., & Tawfik, D. S. (2022). Section 
on Integrative Medicine; Physician Health and 
Wellness. Pediatrics, 150(5), e2022059665. https://doi.
org/10.1542/peds.2022-059665

Nimer, A., Naser, S., Sultan, N., Alasad, R. S., Rabadi, 
A., Abu-Jubba, M., Al-Sabbagh, M. Q., Jaradat, K. 
M., AlKayed, Z., Aborajooh, E., Daradkeh, S., & 
Abufaraj, M. (2021). Burnout Syndrome during 
Residency Training in Jordan: Prevalence, Risk 
Factors, and Implications. International journal of  
environmental research and public health, 18(4), 1557. 
https://doi.org/10.3390/ijerph18041557

Patel, R. S., Bachu, R., Adikey, A., Malik, M., & Shah, 
M. (2018). Factors Related to Physician Burnout and 
Its Consequences: A Review. Behavioral sciences (Basel, 
Switzerland), 8(11), 98. https://doi.org/10.3390/
bs8110098

Physician burnout? (2023). from https://www.ama-assn.
org/practice-management/physician-health/what-
physician-burnout

Prins, J. T., Hoekstra-Weebers, J. E. H. M., Gazendam-
Donofrio, S. M., Dillingh, G. S., Bakker, A. B., 
Huisman, M., Jacobs, B., & Van Der Heijden, F. M. M. 
A. (2010). Burnout and engagement among resident 
doctors in the Netherlands: A national study. Medical 
Education, 44(3), 236-247. https://doi.org/10.1111/
j.1365-2923.2009.03590.x 

Puranitee, P., Stevens, F. F. C. J., Pakakasama, S., 
Plitponkarnpim, A., Vallibhakara, S. A., Busari, J. 
O., Heeneman, S., & van Mook, W. N. K. A. (2019). 
Exploring burnout and the association with the 



Pa
ge

 
43

https://journals.e-palli.com/home/index.php/ajmsi

Am. J. Med. Sci. Innov. 3(2) 31-43, 2024

educational climate in pediatric residents in Thailand. 
BMC Medical Education, 19(1), 245. https://doi.
org/10.1186/s12909-019-1687-7

Ratnakaran, B., Prabhakaran, A., & Karunakaran, V. 
(2016). Prevalence of  burnout and its correlates 
among residents in a tertiary medical center in 
Kerala, India: A cross-sectional study. Journal of  
Postgraduate Medicine, 62(3), 157-161. https://doi.
org/10.4103/0022-3859.184274

Reed, S., Kemper, K. J., Schwartz, A., Batra, M., Staples, 
B. B., Serwint, J. R., McClafferty, H., Schubert, C. J., 
Wilson, P. M., Rakowsky, A., Chase, M., & Mahan, J. 
D. (2018). Variability of  Burnout and Stress Measures 
in Pediatric Residents: An Exploratory Single-Center 
Study from the Pediatric Resident Burnout-Resilience 
Study Consortium. Journal of  evidence-based integrative 
medicine, 23, 2515690X18804779. https://doi.
org/10.1177/2515690X18804779

Navinés, R., Olivé, V., & Rocío Martín-Santos, F. F. 
(2021). Work stress, and resident burnout, before and 
during the COVID-19 pandemia: An update. Medicina 
Clínica (English Edition), 157(3), 130-140. https://doi.
org/10.1016/j.medcle.2021.04.005

Okoro, L. C., Odukoya, O., Ikwuka, A. O., & Udeh, F. 
C. (2024). Prevalence, Patterns and Peculiarities of  
Depression among Tuberculosis Patients Attending 
Directly Observed Treatment Short-course (DOTS) 
Centers in Lagos State Nigeria. American Journal of  
Medical Science and Innovation, 3(1), 62–72. https://doi.
org/10.54536/ajmsi.v3i1.2653

Roberts, T., Daniels, J., Hulme, W., Research and Audit 
Federation of  Trainees (RAFT), Irish Trainee 
Emergency Research Network (ITERN), Trainee 
Research in Intensive Care (TRIC), et al. (2021). 
Psychological distress and trauma in doctors 
providing frontline care during the COVID-19 
pandemic in the United Kingdom and Ireland: A 
prospective longitudinal survey cohort study. BMJ 
Open, 11(2021), e049680. https://doi.org/10.1136/
bmjopen-2021-049680

Rokka, D., & Khanal, N. (2023). Job Satisfaction of  
Health Professionals Working in Governmental 
Tertiary Level Hospitals of  Nepal. American Journal of  
Medical Science and Innovation, 2(1), 39–46. https://doi.

org/10.54536/ajmsi.v2i1.1330
Rotenstein, L. S., Torre, M., & Ramos, M. A. (2018). 

Prevalence of  burnout among physicians: A 
systematic review. JAMA, 320(11), 1131–1150. 
https://doi.org/10.1001/jama.2018.12777

Sreelatha, P., Premlal, L., & Ryali, V. S. S. R. (2018). 
Burnout and coping strategies among residents of  
a private medical college in South India: A cross-
sectional study. Industrial Psychiatry Journal, 27(2), 213-
218. https://doi.org/10.4103/ipj.ipj_53_18

Stanford, F. C. (2020). The importance of  diversity and 
inclusion in the healthcare workforce. Journal of  
the National Medical Association, 112(3), 247–249. 
https://doi.org/10.1016/j.jnma.2020.03.014

Szabo, S., Nove, A., Matthews, Z., Bajracharya, A., 
Dhillon, I. S., Singh, D. R., Soares, A., & Campbell, J. 
(2020). Health workforce demography: a framework 
to improve understanding of  the health workforce 
and support achievement of  the Sustainable 
Development Goals. Human Resources for Health, 18(1). 
https://doi.org/10.1186/s12960-020-0445-6

Søvold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, 
S., Essa, M. M., Grobler, C., & Münter, L. (2021). 
Prioritizing the Mental Health and Well-Being of  
Healthcare Workers: An urgent global public health 
priority. Frontiers in Public Health, 9. https://doi.
org/10.3389/fpubh.2021.679397

The top 5 causes of  burnout and how they relate to “quiet 
quitting”. Retrieved (April 23, 2023). From https://
business.kaiserpermanente.org/insights/mental-
health-workplace/employee-burnout-quiet-quitting

World Health Organization. (2009). WHO patient 
safety curriculum guide for medical schools. World 
Health Organization. https://apps.who.int/iris/
handle/10665/44091

Uy, T. M. Z., & Alinea, M. C. D. (2022). Factors associated 
with attrition among residents in pediatrics: A mixed-
method study in a single center in the Philippines. Acta 
Medica Philippina, 56(9). https://actamedicaphilippina.
upm.edu.ph/index.php/acta/article/view/308

Zubairi, A. J., & Noordin, S. (2016). Factors associated 
with burnout among residents in a developing country. 
Annals of  Medicine and Surgery, 6, 60–63. https://doi.
org/10.1016/j.amsu.2016.01.090


