Date of Award

January 2019

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

John Encandela


Studies have shown that health professional students are at high risk for burnout compared to the general population. The authors predicted that some students may experience burnout during the first year of health professional education—some even when they first matriculate. The aim of the study was to use mixed methods to identify the prevalence of and factors associated with burnout in first-year students. First-year medical (MD), physician assistant (PA), and advance practice registered nurse (APRN) students at Yale University completed surveys including validated measures of empathy and burnout in October 2017 (a pre-test) and in April 2018 (a post-test). Unadjusted differences in pre-test burnout and its sub-components--exhaustion and disengagement--were calculated by demographic variables: gender, training program, empathy, and direct entry from undergraduate study. Multivariable linear regression was used to examine adjusted associations of burnout with the same variables. Paired t-tests were used to assess the change in burnout from the pre- to post-test. Linear regression with ANCOVA, adjusted for baseline burnout and demographic variables, was used to examine associations with a change in total burnout and each sub-component (i.e., subscale). To contextualize the survey, in-person interviews with first year students were conducted. The average APRN burnout (p<0.0001) and exhaustion (p<0.0001) scores were higher than the average MD scores in the pre-test, but they decreased over the year and were actually lower than MD scores by the end. High empathy scores (p<0.05) and direct entry from undergraduate study (p<0.05) were associated with higher burnout at the end of the year but not at the beginning. Student interviewees suggested that work overload, grades, and lack of social support contributed to first year burnout, whereas meaningful patient encounters, pass/fail grading systems, and community building were protective against burnout. Overall, some students had high total burnout and emotional exhaustion scores at the beginning of their health professional training, which may imply that health professional faculty and administrators might begin addressing burnout and minimizing it early in the first year of training.


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