Prevalence of Burnout among Dental Students during COVID-19 Lockdown in UAE

DISCUSSION

In the past few years, the interest in the occurrence and prevalence of educational burnout among dental students has been increasing, with several studies conducted to bring light to the matter. A study carried out in 2011 by Montero-Marin et al. in Spain has adapted a short version of the “burnout clinical subtype questionnaire” to be applied to students in the dental field through the “burnout clinical subtype questionnaire-12-SS” or “BCSQ-12-SS”, with results favoring its usage.² Another study was conducted in Iran by Mohebbi et al. to evaluate the psychometric characteristics of the bridged adaptation and has concluded that the survey has construct as well as convergent and divergent.¹¹

In the present study, the age of dental students had no significant effect on educational burnout. The fact that students who participated in our study from both universities were all in a close age range might be the reason behind this. The entire study populations were undergraduate students and interns, who are generally young. Similar results were conducted in many studies. In terms of COVID-19 lockdown situations, Hull et al. reported that age has no quarantine-related negative psychological outcomes.¹² Whereas, Taylor et al. reported that individuals who are younger (14–24-year-old) are more prone to negative psychological effects during quarantine, thus more subject to educational burnout.¹³

Since lockdown was imposed due to COVID-19, online education was taking place in both participating universities at the time of questionnaire distribution. Volchok’s study showed that online classes, in comparison to face-to-face classes, had no effect on male students’ performance and they had the same chance of getting a passing grade. Whereas, females had a significantly higher possibility of earning a passing grade.¹⁴ On the other hand, Cava et al. and Brooks et al. reported that females are more prone to negative psychological outcomes during quarantine,^15,16 resulting in higher chances of educational burnout, even though females exhibited higher academic performance than males in general.¹⁴ Montero-Marin et al. found no significant difference in educational burnout of female and male dental students.² Their finding was in line with our findings, which indicated that females and males have equal performance in fields in which males used to be dominant. The stresses of girls competing with boys no longer exist.¹⁷

In the present study, educational burnout of students was not significantly correlated to the relationship status. Mohebbi et al. reported the same results.¹¹ However, due to family support provided to married students in UAE, students seem to have fewer financial difficulties than single students. Contrarily, married students might have higher responsibilities, interfering with their educational progress. Mafla et al. reported that older students, married students, and students in higher semesters had higher levels of educational burnout among Colombian dental students.¹⁸ Cava et al. suggested that demographic factors including the marital status have no association with quarantine-related negative psychological impacts but having one child as opposed to no children may be correlated.^15,17

Higher levels of educational burnout were reported to be in correlation with living independently and away from parents since students who live alone are no longer supported by their families. This makes them exposed to educational burnout. Also, people who live alone can find the experience of being quarantined away from their families is challenging.¹⁹ However, in our study, the students’ residential status and distance from the family had no significant effect on the educational score of the questionnaire. This might be due to the fact that students who live away from their parents were actually with their families at the time of questionnaire distribution, since quarantine regulations including dormitories closure were announced in early March 2020.

According to the results of our research, family support significantly affected the risk of developing burnout (p = 0.016). Levens et al. concluded in their study that the impact of family emotional support on reducing burnout symptoms depended on the level of stress reactivity. In other words, a higher family emotional support would be more effective only if the stress reactivity was low. Otherwise, the effect of higher family emotional support would not be significant.²⁰ This could explain why the majority of the respondents in our study who had good family support showed signs of burnout and were at risk.

According to the results of the present study, there seemed to be a significant correlation between the acquirement of a scholarship and the risk of burnout (p = 0.019). Most of the participants were not granted scholarships and showed high scores for burnout. This could be related to the failure to understand certain learning techniques or disinterest in learning.²¹ It could also be due to the financial toll of their education, as it can create concerns for those who have limited financial support, especially during the lockdown period, when thinking about their ability to finish their education, had they not obtained a scholarship. This was supported by Brooks et al., in which they reported that negative stressors of quarantine included financial loss.¹⁶ Whereas, adequate financial support can significantly prevent burnout. In contrast, Montero-Marin et al. concluded in their study that students who did obtain a scholarship achieved higher burnout scores. The reason was that students with scholarships can become neglectful given that their academic performance would grant them a scholarship the following year, therefore, they would not need to justify their current scholarship.²

As for the weekly hours spent on studying, they did not seem to be associated with the burnout risk in our study. However, the majority of respondents who invested less than 30 hours revealed high scores. It has been proposed that such results may be justified by lack of enthusiasm and loss of interest in studying or feeling stressed and unable to focus on studies, especially if experienced frequently. The fact that the respondents completed the questionnaire during a pandemic-induced lockdown could be a contributing factor. It has been proposed that insistence of social distancing shone a light on online distance learning, which allowed students room to procrastinate, due to the greater flexibility and lack of self-discipline and motivation. Consequently, less than satisfactory grades and grade point average (GPAs) can be the product, which yields directly to high burnout risks. On the other hand, Montero-Marin et al. in their study found that students who spent more hours studying experienced greater levels of exhaustion. Hence, they were more likely to score high and become at burnout risk.²

The variable “failed subjects” in our study did not seem to be in association with being at risk of burnout. It is worth mentioning that majority of our samples who did not fail any subject showcased high scores when responding to the questions of the BCSQ-12-SS. In terms of quarantine, a lot of the respondents’ lives were disrupted, therefore, stressing about maintaining grades amidst a period of unrest could have taken its toll on them. Also, those who passed all subjects may be high achievers who overload themselves to pursue success on the account of their health; thus, they would experience greater levels of exhaustion. On the contrary, several studies reported that failing courses and having low GPA scores were consistent with higher burnout levels. For example, Shadid et al. reflected that failing subjects in college acts as an additional source of stress since students would need to work harder and pass the course for them to pass the year.²² Regarding the academic year of study, the results of our study indicated that the year of study did not significantly impact the risk of having burnout. The greater majority of the respondents from all years showed at least a few signs of burnout. This is in contrast to other studies that demonstrated different responses, with students from second to fourth year being at a greater risk.

For instance, Shadid et al. showed results of higher stress and burnout rates among first- and fourth-year students, with first-year undergraduates experiencing additional stress brought by adapting to a new and competitive environment, learning new subjects, as well as perceived lack of time.²² Montero-Marin et al. reported that fifth-year seniors were less likely to be overloaded and experience burnout compared to younger years. They reasoned that since they have come this far in their academic careers, they would have already adapted to the stresses and learned to better manage them.² Contrarily, Dyrbye et al. mentioned how seniors, who were close to graduating, expressed growing concerns in regards to having deficient skills and not being able to meet their parent’s high expectations, which yielded to higher stress and exhaustion levels as compared to the younger juniors.²³ The cancellation of graduation as a result of social distancing restrictions could have also played a role, as reported.

This study presented some shortcomings. Regardless of the total number of participants from both universities that provided a sufficient response rate, the generalization of all dental students in the country cannot be made. Another drawback is having a cross-sectional design. A longitudinal design would be more preferable for further confirmation of the correlations. Furthermore, our data were obtained from dental students during lockdown situations that might have affected the scores. No previous reports from the same two universities regarding educational burnout were made during regular studying situations. This prevented any comparisons to be made. Thus, the actual effect of quarantine, whether it was positively or negatively affecting the burnout risks of students, will need to be further investigated.