Study Design and Participants
An online questionnaire-based survey of academic physicians was carried out among academic physicians in Nigeria between December 2022 and January 2023 using Google Form as the tool and WhatsApp as the distribution platform. For the purposes of this study, an academic physician is a consultant doctor who is a fellow of either or both postgraduate medical colleges in Nigeria or their equivalent and whose main job is to teach at a medical school while also working as a consultant in a teaching hospital. Frequently, the individual will also be responsible for teaching resident doctors. Therefore, an academic physician combines clinical and academic responsibilities.
Ethical Approval and Consent to Participate.
Ethical approval for this study was obtained from the Ekiti State University Teaching Hospital Institutional Review Board (EKSUTH/A67/2022/10/011). All methods were carried out in accordance with relevant guidelines and regulations. The written informed consent was contained in the online survey form’s introduction, which describes the study's purpose, procedures, potential risks and benefits, confidentiality, and the participants' right to withdraw from the study at any time. The section concluded with the following statement “By completing this survey, you are consenting to participate in this study.”
Survey Administration
We created a Google form and distributed its link to academic physicians via the WhatsApp's broadcast feature. Using the WhatsApp broadcast feature, we sent the Google form to 256 recipients. This method was chosen because it permitted us to calculate the response rate. In addition, the method guaranteed anonymity and permitted us to provide study participants with feedback. Confidentiality was maintained by not including any identifying information in the questionnaires. Participation in the study was completely voluntary. The protocol and survey instrument were reviewed and approved by the Ekiti State University Teaching Hospital Institutional Review Board.
Survey Instrument
For this study, we modified the Maslach questionnaire, used to study burnout among university educators in Canada,[3] which has been validated in Nigeria.[12, 13] It consisted of 46 questions divided into two main sections as follows:
Section One: Professional and socio-demographic information. Five questions were asked to collect basic demographic information, including age, sex, marital status, religion, and geopolitical zone. Four additional questions collected information on professional practice, including the year of graduation, the year the individual began academic teaching, their medical school, and whether the individual is employed by a private or government institution. Five questions addressed potential stressors, including income, research output, side jobs, other administrative duties, and academic load, which was measured by asking respondents how many hours per week they spent instructing medical students. Finally, their attitude toward academics was evaluated by asking them three questions: "Would you consider yourself a person who enjoys teaching? ," "Would you consider yourself a person who enjoys writing academic papers?" and "Would you consider yourself indifferent to clinical teaching/lecturing?"
Section Two: Maslach Burnout Inventory (MBI). This questionnaire contains 22 questions that address the three components of burnout: nine questions on emotional exhaustion (EE), five questions on depersonalization (DP), and eight questions on personal accomplishment (PA). Respondents were then asked to rate the frequency of encountering these situations on a 7-point Likert scale ranging from "never" (0) to "every day (7)." To determine a patient's overall score for each subscale, we added the values of each item in the subscale that he or she ticked. For each subscale, the respondent is categorized into Low, Moderate, or High Burnout, as shown in Table 1. To obtain a high total score on burnout, you had to obtain high scores on emotional exhaustion (≥27) and depersonalization (≥10) as well as a low score on personal accomplishment (≤33). At the end of this section, there was a place for general comments.
Table 1: Categorization of burnout subscales
|
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Mental Exhaustion
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Depersonalization
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Personal Accomplishment
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Low
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≤18
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≤5
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≤33
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|
Moderate
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19-26
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6-12
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34-39
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|
High
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≥27
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≥13
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≥40
|
Statistical Analysis
We performed a statistical analysis on data collected through a Google form. The data were downloaded in Microsoft Excel format and imported into IBM-SPSS Version 25. Discrete variables were compared using chi-square tests, while continuous variables were compared using t-tests.
A binary logistic regression was conducted to investigate the effect of 13 predictors on emotional exhaustion, depersonalization, and personal accomplishment. The predictors were age, teaching experience, geopolitical zone of practice, university ownership (private, federal government-owned, state government-owned), number of published peer-review articles, sex, annual student contact in weeks, teaching hours/week, enjoyment of academic writing, apathy toward teaching, religion, monthly salary, and monthly supplementary income. These variables were selected based on findings from a literature review and significant associations with the burnout dimensions in univariate analysis. The model selection was performed through a backward conditional method, and model checking was conducted. The models for depersonalization and personal accomplishment were rejected due to poor fit, as indicated by the Hosmer-Lemeshow Goodness of Fit test (P<0.05). Only emotional exhaustion was further analyzed, as the Hosmer-Lemeshow test indicated that all eight models had a good fit (p>0.05). Model 1 was selected as the best fit because it had the highest Cox and Snell R-square (0.374) and Nagelkerke R-square (0.571) values and it explained 82.1% of the variance in the model, which was one of the highest.
Dataset
This is reposited on the Open Science Framework (OSF) Website.[14]