In this study, we examined the association between social support and learning burnout. We found that even after adjusting for the grade and residence, there was a significant and relevant association between the social support and learning burnout in our sample of Tongji medical college.
Learning burnout prevalence
In our study, we found that an average of 45.9% students had symptoms suggestive of learning burnout. The result was much higher than the rates of 21.76% and 36.46% of Chinese medical students, that were described by Tang et  and Yang , who used the same instrument and criteria. Students in Kingdom of Saudi Arabia had a moderate to high level of stress at the start of the COVID-19 outbreak . Our students mainly came from Hubei province, which was the earliest and the worst area affected by COVID-19 in China. Therefore, they may have more physical and psychological stress, which was related to high burnout scores, during this period of home isolation.
Environmental factors associated with learning burnout
In this study, we found that the prevalence of learning burnout was higher for students in more advanced years. The result was in line with previous research . This may be due to the pressure of senior students facing employment or internships [26-28]. Besides, we calculated that the burnout rate of graduation students (63.6%) was much higher than that of non-graduation students (45.2%). Studies indicated that medical graduates faced more pressure, which involved in high burnout, than non-graduates [29, 30]. The possible reason could be that the uncertainty about the pandemic effect may have increased their worry about graduating, finding a job or enrolling in further study .
We found that environmental factors, especially those related to the economy, were closely related to learning burnout. Besides, whilst there was no significant difference in burnout rates of medical students from different residences, medical students from rural areas had a significantly higher rate than those from cities in improper behavior or reduced personal accomplishment dimension. The economic pressure may be considered to facilitate the development of burnout [32, 33]. Students with family difficulties or in rural areas had to face extra pressure of the economy from their families. This situation may give rise to more learning burnout. Besides, our results showed that the higher the learning time and frequency of communication, the lower the learning burnout. This phenomenon suggested that communicating with teachers or students may reduce students' learning burnout and increase the learning time. The two factors were all closely related to social support, especially the subjective support and utilization of support.
The protective effect of social support on learning burnout
Social support have a protective effect for burnout symptom in medical students . We found a similar effect of social support on learning burnout, but the subjective support and utilization of support have a greater impact on learning burnout. A meta‐analysis also reported that seeking social support from friends or family members was already found to be correlated with burnout in a work setting . Lazarus’s stress and coping theory holds that active communication was an effective way to relieve stress. Our results also demonstrated that subjective support and utilization of support could reduce learning burnout by communicating with relatives or friends. Social support provides a buffering effect against stress in that an individual who has more social support is also more resilient to stress . Besides, Thoits argued that social support served to regulate the stress itself and also provided a coping context, which could help the individual cope with stress or buffer the person against the demands . This prompted us to further explore what social support environment and other mechanisms of social support to alleviate learning burnout.
The current study also has some limitations. First, although the response rate of 30.9% was relatively low, we collected 684 samples that exceed those of studies with higher response rates. Second, we measured students’ burnout with LBS instead of MBI, Considering the differences in culture context, this may set obstacles comparing with peers over the world. However, this scale had been widely used in China. Moreover, our sample was drawn from a single school, and we should acknowledge that our results may be less generalizable to other schools and countries.