An anonymous online self-administered survey for medical students participating in the Hungarian-language programs of Hungarian medical schools was sent out two times in a message through the student information systems in cooperation with the administration offices. 530 students filled out our questionnaire sent out by the administration offices. The response-rate was 8,86%.
The questionnaire contained questions regarding general demographic data (gender, sexual orientation, region and type of permanent residence) and studies (university, grade), as well as a standardized, Hungarian-language versions of the following psychometric scales: questionnaire about physical symptoms related to psychosomatic stress (PHQ-15), Connor-Davidson resilience scale questionnaire (CD-RISC), WHO Well-being Questionnaire (WB5), Perceived Stress Scale (PSS), survey for Zimet’s multidimensional scale of perceived social support (MSPSS), Maslach Burnout Inventory-Student Survey (MBI-SS), Spielberger’s State-Trait Anxiety Inventory.
Moreover, our questionnaire contained the following two questions related to minority status and experienced discrimination to be found in the Eurobarometer:
“In the past 12 months have you personally felt discriminated against or harassed on one or more of the following grounds?” (Ethnic origin, Gender (male/female), Sexual orientation (gay, lesbian or bisexual), Being under 30 years old, Religion or belief, disability, Gender identity (transgender or transsexual), For other reasons, I don’t know, I did not experience discrimination).
“Where you live, do you consider yourself to be part of any of the following? Please indicate all that apply.” (An ethnic minority, A religious minority, a national minority, A sexual minority (for example, gay, lesbian, bisexual or queer), A gender minority (transgender, transsexual), A minority in terms of disability, Any other minority group (for example people suffering from obesity, longstanding health conditions or mental illness), None.)
During the data assessment procedure, students who indicated that they think they belong to any of the listed minority groups were treated as minority students, and a dichotomous variable was created for indicating experienced discrimination (“yes, experienced” - “no, not experienced”).
In the literature, minority communities are studied in general separately: alongside the protected identity-building features, researchers indicate for example ethnic minorities, sexual and gender minorities, disabled people, etc.. In the course of studying the data used in international literature, we experienced that medical students and doctors belonging to different minority communities exposed to very similar challenges - overt or disguised discrimination, glass ceiling, glass wall -, thus, during the present research, we treated those people who identified themselves as persons belonging to racial or ethnic minorities, migrants or LGBTQ people as „minority”.
Features of Psychometric Scales
MBI-SS was used for measuring student burnout. The questionnaire is a 7-point Likert scale with 15 items (0-6), whose three subscales can be grouped separately (emotional exhaustion; depersonalization; personal accomplishment). Based on the current literature three categories were formed during data procession for the level of burn out: low, moderate and high (74). Thus the cut-off points were 7-14 points for moderate Emotional Exhaustion, 5-10 points for moderate Depersonalization and 1-17 points for moderate Personal Accomplishment (74). The confidence interval of the entire MBI-SS scale (Cronbach-alpha) was 0.89 in our study, and the various subscales were characterized by the following values: emotional exhaustion: 0.84; depersonalization: 0.86; personal accomplishment: 0.83.
For measuring the level of experienced stress, the Perceived Stress Scale – PSS questionnaire was used (75, 76). The questionnaire consists of 10 items, and a 5-point Likert scale (0-4) is available for the respondent to assess how frequently a given thought or feeling was characteristic in the past month. Based on the answers - after decoding the items to be reversed -, and after calculating the total score, the amount of general stress experienced in the last period by the respondent could be deduced. During the present assessment, the value of the PSS-10 Cronbach-alpha was 0.88. During processing the results of the examination, a dichotomous variable was created based on the total scores: “below average” and “above average”.
Zimet ’s Multidimensional Scale of Perceived Social Support served as an instument for assessing the level of social support. The 7-point Likert scale of 12 items (1- Very Strongly Disagree, 7- Very Strongly Agree) could be divided into 3 subscales: Significant Other, Family and Friends. The total score is calculated through dividing the total sum of the items by 12, while the score of each subscale is also determined by adding up the scores of the given questions and then dividing the sum by 4. The value of the Cronbach-alpha of the scale is the following: for Friends: 0.94; for Family: 0.90, for Other: 0.95; the total scale is characterized by a confidence interval of 0.90. During data processing, a dichotomous variable was created based on the results of the scale: “below mean” and “above mean”.
For measuring resilience, the Connor-Davidson Resilience questionnaire was used, which consists of 10 items, and respondents choose from a 5-point Likert scale (0 - rarely; 4 - true nearly all of the time) how characteristic is the given statement for them (77). The value of the Cronbach-alpha of the questionnaire is 0.83. The scores available in the questionnaire range from 0 to 40, and higher scores mean higher resilience.
The Hungarian version of the State-Trait Inventory was applied for measuring anxiety. The part of the questionnaire measuring current anxiety contains 20 questions, and when completing them, the respondent has to answer how “they are feeling at the moment” (78). The second part of the questionnaire measures the trait anxiety level, meaning the assessment to what extent the respondent is susceptible to anxiety. This part also consists of 20 items, and the respondent answers the question “how they feel in general”. In both cases, respondents have to determine on a 4-point scale how fitting a given statement is (1 – Almost Never, 4 – Almost Always). The total score of both subscales range from 20 to 80 points. Higher scores mean a higher level of anxiety on both subscales. The confidence interval was 0.95 in case of the state anxiety scale, while 0.92 in case of the trait anxiety scale.
Data were weighted by three factors (gender, medical school, and grade) before the evaluation process. SPSS 22.0 software was used for the data processing.
The present study examines which factors may influence burnout among medical students. At first, univariate analysis was made by using Chi-squared test for categorical variables and linear regression for continuous variables, then the variables of significance levels of p ≤ 0.01 of the univariate analysis were included in a multivariate binary logistic regression model. During the statistical analysis, demographic data were used as categorical variables, while burnout, experienced stress and social support as a dichotomous variable, and the scores of the state and trait anxiety questionnaire as well as the total sum of resilience as continuous variables.