Physician Burnout and Fulfilment in Sierra Leone Ii: an Online Cross-Sectional Study

Physician Burnout and Fulfilment in Sierra Leone Ii: an Online Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Physician Burnout and Fulfilment in Sierra Leone Ii: an Online Cross-Sectional Study Kehinde Sunday Oluwadiya, Mohamed Bawoh, Nellie Bell, Adetunji Oladeni Adeniji, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8544221/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Physician burnout is a significant occupational hazard, with a high prevalence in low- and middle-income countries. The burnout rate among clinicians in Sierra Leone, however, is unknown. This study aimed to determine the prevalence and predictors of burnout among Sierra Leonean physicians. Methods A cross-sectional, online-based study was conducted among 153 physicians across Sierra Leone. Using the Stanford Professional Fulfillment Index (PFI), the study assessed burnout as well as sociodemographic and workplace characteristics. Results The overall rates of burnout and professional fulfillment were 58.8 percent and 26.8 percent, respectively. Six variables, professional status, nationality, salary sufficiency, age of youngest and oldest children, and years in practice, were significantly associated with both burnout and professional fulfillment. Three factors (marital status, subspecialty, and supplementary income) were independently associated only with burnout, while four others (type of employer, practice location, hazardous drinking, and commuting distance to work) were associated only with professional fulfillment. Conclusion The burnout rate is high, while the professional fulfillment rate is low, among physicians practicing in Sierra Leone. Strategies designed to mitigate burnout while promoting professional fulfilment are needed among physicians in Sierra Leone. Sierra Leone Burnout Physicians Professional Fulfilment Moral Injury Workplace Stress Introduction Burnout, a syndrome resulting from chronic workplace stress that is not effectively managed, is a growing global health concern. Its prevalence varies widely across occupations, geographic regions, and cultural settings, and is influenced by workplace support structures. Although, the global prevalence rates varies widely depending on the criteria and the methodology, the incidence of burnout is disproportionately higher in Low and Middle-Income Countries (LMICs) compared to High-Income Countries (HICs), and more prevalent in Africa than other continents. (1–3) This disparity is often attributed to inadequate resources and lack of support structures in LMICs. (4–6) A global systematic review by Rotenstein et al. highlights a stark contrast in burnout rates, with figures in Africa and Asia compared to Europe and North America, and a wide variance within African countries themselves. (2) Particularly vulnerable to burnout is the medical profession, where factors such as high workload, patient load, and the emotional impact of patient outcomes contribute to elevated burnout rates among physicians.(2,7,8) This is evidenced by higher prevalence rates among physicians compared to other professionals or the general population. (9,10). Despite the global prevalence of burnout syndrome among medical professionals, particularly in Low and Middle-Income Countries (LMICs) like Africa, there is a notable lack of comprehensive studies in certain countries, such as Sierra Leone, leaving a critical gap in understanding the extent, patterns, and underlying factors of burnout among medical doctors in these countries. Rotenstein et al. in their systematic review of 45 studies revealed that a mere 24.4% of burnout studies I their review originate from LMIC, with none coming from Africa. Another systematic review of burnout among healthcare workers in sub-Saharan Africa did not include any study from Sierra Leone.(4) If little has been reported on burnout in Africa, even less has been reported on professional fulfilment and the interaction between the two from the continent. To our knowledge, only one study from South Africa has dealt with both phenomena from Africa. (11) This gap in research is concerning, given the high prevalence and impact of burnout on healthcare professionals. Therefore, this research proposal aims to investigate the prevalence, patterns, and determinants of burnout among medical doctors in Sierra Leone, a topic which has not been adequately studied, to better understand the unique challenges faced by physicians in this region and inform strategies for effective management and support. The findings of this study are important for several reasons. First, they help address a significant research gap. Given the limited data on physician burnout in Sierra Leone and across much of Africa, the study contributes valuable insights to the global understanding of burnout in diverse socioeconomic and cultural contexts. Second, by identifying the prevalence and determinants of burnout among medical doctors in Sierra Leone, the study offers evidence that can inform strategies to mitigate burnout, thereby potentially improving healthcare delivery and patient outcomes in a region already burdened by limited medical resources. Third, the study provides a foundation for policy formulation and implementation. Its outcomes can assist policymakers and healthcare administrators in Sierra Leone and similar settings in developing and executing programs that support the mental health and well-being of medical professionals. Furthermore, by illuminating the impact of burnout on physicians, the study highlights the need for targeted interventions aimed at improving job satisfaction, professional efficacy, and overall quality of life for healthcare workers. Finally, the findings have global relevance. Burnout is a widespread concern in the medical profession, and insights from this study can contribute to the broader international discourse on effective strategies for supporting healthcare providers, particularly in resource-constrained environments. In essence, this study stands to offer valuable contributions to the understanding of burnout in an under-researched region, with implications for improving healthcare outcomes both locally and globally. The following research questions will be addressed by the study: What is the prevalence of burnout and professional fulfilment among medical doctors in Sierra Leone and how does this vary across different groups as defined by such as status, specialization and type of employment? What is the association between burnout/professional fulfilment and social and workplace factors such as gender, age, workload, professional status etc? Methodology Study Setting This study was conducted in Sierra Leone, a West African country with an estimated population of 7.8 million. The country has fewer than 1,000 practicing physicians, resulting in a doctor-to-population ratio (2.4/100,000) that falls significantly below the World Health Organization (WHO) recommendation.(12) Sierra Leone operates a three-tiered healthcare delivery system: 1. Tertiary care is provided by six units within the national teaching hospital complex. 2. Secondary care is delivered through government hospitals in each of the country’s sixteen districts. 3. Primary care is available via district health units. Additionally, private hospitals deliver both secondary and tertiary care services. Physicians in the public sector are employed by the Ministry of Health and receive salaries under the national civil service scheme. Cadres include interns, medical officers, resident doctors (postgraduate trainees), specialists (residents who have passed the Part I examination of the postgraduate medical college), and consultants. The Study Instrument: Data were collected using a structured, self-administered questionnaire composed of the following sections: • Socio-demographic characteristics : Age, gender, religion, income, family structure, and level of religiosity. • Workplace-related variables : professional status, years of experience, specialization, workload, and alcohol use. The Professional Fulfillment Index (PFI) This is a 16-item instrument scored on a Likert scale. (11,13) Ten items (four on work exhaustion and six on interpersonal disengagement) assess burnout, with a mean score ≥ 1.33 indicating burnout. The remaining six items evaluate professional fulfillment; a mean score ≥ 3.0 on these items indicates a fulfilled professional state Five indicators of workplace stress, derived from validated questionnaires, were incorporated into the survey instrument.(14–19) Four of the five indicators were assessed using two items each; moral injury was assessed with one item. • Moral Injury: This refers to situations in which a physician has the competence to provide care but is prevented from doing so due to constraints beyond their control. (14) It was assessed with the item: “Have you found yourself in a position where you felt patient care was compromised due to failure of the healthcare system?” Responses were captured using a six-point Likert scale: strongly agree, mildly agree, neutral, mildly disagree, strongly disagree, and not applicable. For analysis, responses were recoded into three categories: Yes (combining strongly agree and mildly agree), No (combining strongly disagree and mildly disagree), and Maybe (neutral). Responses marked not applicable were excluded. • Compassion Fatigue: Defined as a decline in a physician’s ability to feel empathy due to the prolonged stress of caregiving.(19,20) It was assessed using two items: “Do you think you have ever felt fatigued by dealing with a patient who has experienced trauma?” (focused on fatigue), and “Do you get satisfaction from being able to help patients?” (focused on satisfaction). Responses were recoded as follows: At times, Often, and Very Often were grouped as Yes; Rarely/never as No; and Not sure as Maybe. Responses marked not applicable were excluded. • Approval Addiction: Refers to when a physician’s self-worth is closely tied to how others perceive them.(16) It was assessed with two dichotomous items: “Is your happiness dependent on what others think of you?” and “Do you struggle to say ‘no’?” • Imposter Phenomenon: Describes physicians who feel like frauds despite objective evidence of their competence.(17) It was assessed using two items: “Have you ever been surprised by your successful completion of a task or received promotion and felt it was most likely a consequence of luck or ‘being in the right place at the right time’?” and “Do you find it hard to accept compliments or praise due to fear you will be ‘found out’ as a fraud or not as intelligent as others perceive you to be?” Responses were recoded as follows: Always, Often, and Sometimes as Yes; Never as No; and Rarely as Maybe. Missing responses were excluded. • Second Victim Syndrome: Refers to the emotional distress physicians may experience following a perceived error or adverse patient outcome.(18) It was assessed with two items: “Have you felt physically or psychologically distressed by a negative patient outcome for which you felt responsible?” and “Has the experience from the previous question negatively affected your desire to work, attend work, or changed your perception of your abilities?” Sample size determination : Data collection procedure This was an online cross-sectional questionnaire-based survey that was hosted on Google Forms. The study population was doctors who were currently working in Sierra Leone for at least six months, and all of them were eligible except for those on treatment for any psychiatric illness. Sampling Given that the respondents were spread across Sierra Leone and belong to many groups, sampling was by purposive and snowballing methods. The link to the survey website was distributed through social media groups like SLMA, hospital groups, NGO groups, and other categories. Influential peers such as group executives and hospital associations were encouraged to spread the info. Using snowballing methods, small groups were targeted so that they would be equally represented. Ethical Issues Ethical approval was obtained from the Ethics and Scientific Review Committee of the University of Sierra Leone Teaching Hospitals Complex. The study was conducted in accordance with the Declaration of Helsinki (2013 revision). Informed consent was obtained from all participants. The online survey form contained an introductory section providing information about the study’s purpose, potential risks and benefits, confidentiality, and the participants’ right to withdraw from the study at any time. All study participants gave informed consent and voluntarily agreed to participate in the research. To ensure data security, secure passwords protect all questionnaires and collected data. Data Analysis Plan The data collection process involved transferring responses from Google Forms to Google Sheets and subsequently to Microsoft Excel for initial data cleaning and preparation. Chi-square, t-test and Mann-Whitney-U statistics was used to explore the association between PFI domains and socio-demographic and professional variables. The data analysis was conducted using SPSS version 26. Results One hundred and sixty-five responses were received in Google Form. Twenty-three (13.9%) cases had missing data. Twelve of the cases whose PFI could not be calculated because of excessive missing data were excluded from data analysis, leaving a total of 153 cases for the final analysis. The mean age of the study participants was 36.9 (9.5 SD) years, ranging was 25-77years. Sixty-eight percent (104 of 153) were males, and 32% were females (49 of 153). Majority of physicians are married (90, 58.8%,) or single (55, 35.9%) and are working in hospitals in Freetown. Most of the study participants worked within the public sector, and the median work experience was 6 (IQR 1–9) years. Excluding calls, the median weekly working hours was 48 hours (IQR 40–49) and each took two median weekend calls per month. Approximately 92% of the physicians reported their salaries as insufficient. Table 1 summarizes the socio-demographics and work details of the respondents. Table 1 Descriptive statistics of socio-demographics and workplace characteristics Count Percentage Median IQR Age 35yrs 30.5–40.0 Sex Male 104 68.0 Female 49 32.0 Religious Christian 88 58.3 Muslim 58 38.4 Others 5 3.3 Place Practicing Freetown 113 81.3 Other Places 26 18.7 Employer Government 139 90.8 NGO 8 5.2 Private 6 4.0 Status House job 44 28.9 Registrar 42 27.7 Specialist 20 13.2 MO 25 16.4 Consultant 21 13.2 Years in Practice 5 1–9 House-Hospital Distance (Km) 11 5–23 Median salary 9600 8200–12000 Salary Sufficiency Sufficient 11 7.3 Not Sufficient 139 92.7 Weekly Working Hour (minus calls) 48 40–49 Median number of weekend call/week 2 1–3 Alcohol Drinks alcohol 40 73.3 Does not drink alcohol 110 26.7 CAGE Alcohol Screening (n = 77) Low likelihood of problematic drinking 69 89.6 Possible alcohol use disorder (hazardous/harmful use) 8 10.4 Burnout and Professional Fulfillment Status Of the 153 respondents in the study, 90(58.8%) were categorized with burnout and 63 (41.2% did not have burnout. Similarly, only 41(26.8%) were categorized as professionally fulfilled while the remaining 112 (72.3%) were not professionally fulfilled. Among physicians who reported burnout, 90.0% were classified as not professionally fulfilled, while only 10.0% were fulfilled. In contrast, among those without burnout, 50.8% reported being professionally fulfilled and 49.2% were not. (Table 2 ). These findings indicate that lower professional fulfilment is strongly associated with increased risk of burnout, and this was statistically significant (P < 0.001). Table 2 Crosstabulation of burnout vs professional fulfilment Burnout Status PFI: Fulfilled PFI: Not Fulfilled Total p-Value Burnout 9 (10.0%) 81 (90.0%) 90 (100%) < 0.001 Not Burnout 32 (50.8%) 31 (49.2%) 63 (100%) Total 41 (26.8%) 112 (72.3%) 153 (100%) Workplace Distress Indicators Table 3 summarizes responses to selected indicators of workplace stress. A large majority of participants (87.2%) reported experiencing moral injury, affirming that they had found themselves unable to deliver optimal care due to systemic healthcare failures. Regarding approval addiction, 4.6% admitted that their happiness depended on others’ opinions, while 23.7% reported struggling to say “no.” In terms of compassion fatigue, 67.3% reported having felt fatigued by exposure to patients who had experienced trauma, while all respondents (100%) reported deriving satisfaction from helping patients. Two indicators assessed the imposter phenomenon. About 63.2% had felt surprised by their own success or recognition, attributing it to luck or circumstance, and 30.3% reported discomfort with praise due to fears of being exposed as less competent. With respect to second victim syndrome, 74.2% acknowledged psychological or physical distress following adverse patient outcomes for which they felt responsible, and 35.1% indicated that these experiences had negatively impacted their motivation, attendance, or self-perception at work. Table 3 Frequency Table of Workplace Distress Indicators Item Yes No Maybe Moral Injury Have you found yourself in a position where you felt patient care was compromised due to failure of the healthcare system ? 129 (87.2%) 14 (9.5%) 5 (3.4%) Approval Addiction Is your happiness dependent on what others think of you? 7 (4.6%) 108 (70.6%) 38 (24.8%) Do you struggle to say “NO”? 36 (23.7%) 72 (47.4%) 44 (28.9%) Compassion Fatigue Do you think you have ever felt fatigued by dealing with a patient who has experienced trauma? 103 (67.3%) 20 (13.1%) 28 (18.3%) Do you get satisfaction from being able to help patients? 153 (100.0%) 0 (0.0%) 0 (0.0%) Imposter Phenomenon Have you ever been surprised by your successful completion of a task or received promotion and felt it was most likely as a consequence of luck or ‘being in the right place at the right time’? 96 (63.2%) 20 (13.2%) 36 (23.7%) Do you find it hard to accept compliments or praise due to fear you will be ‘found out’ as a fraud or not as intelligent as you perceive people think you are? 46 (30.3%) 59 (38.8%) 47 (30.9%) Second Victim Syndrome Have you felt physically or psychologically distressed by a negative patient outcome for which you felt responsible? 112 (74.2%) 39 (25.8%) 0 (0.0%) Has the experience from the previous question negatively affected your desire to work, attend work, or changed your perception of your abilities? 52 (35.1%) 96 (64.9%) 0 (0.0%) Association Between Burnout/ PFI and Workplace Distress Table 4 shows the association between workplace stressor indicators and burnout status. Do you think you have ever felt fatigued by dealing with a patient who has experienced trauma? (Compassion Fatigue 1) was significantly associated with burnout ( p = .001), as was “Have you ever been surprised by your successful completion of a task or received promotion and felt it was most likely as a consequence of luck or ‘being in the right place at the right time’? (Imposter Phenomenon 1) ( p = .044) and “Has the experience from the previous question negatively affected your desire to work, attend work, or changed your perception of your abilities?” (Second Victim Syndrome 2) ( p = .003). These results suggest that experiences of emotional fatigue, self-doubt, and perceived harm from adverse events are more common among physicians classified as burned out. Other indicators did not achieve significant associations with burnout status. Regarding the association between workplace stressor indicators and Professional Fulfillment Index (PFI), two of the stressors, Compassion Fatigue 1 ( p = .003) and Imposter Phenomenon 1 ( p = .011) that were significantly associated with burnout were also significantly associated with PFI. The remaining indicators were not statistical significance. Table 4 Association between Burnout/PROFESSIONAL FULFILMENT and workplace stress indicators Variable & Category Burnout Professional Fulfilment Burnout n (%) No Burnout n (%) Total n (%) p-value Fulfilled n (%) Not Fulfilled n (%) Total n (%) p-value Moral Injury 0.366 0.270 Yes 9 (75.0%) 3 (25.0%) 12 (100%) 6 (21.4%) 22 (78.6%) 28 (100%) No 77 (58.8%) 24 (41.2%) 101 (100%) 44 (33.8%) 86 (66.2%) 130 (100%) Maybe 2 (40.0%) 3 (60.0%) 5 (100%) 1 (20.0%) 4 (80.0%) 5 (100%) Approval Addiction 1 0.084 0.321 Yes 6 (85.7%) 1 (14.3%) 7 (100%) 1 (14.3%) 6 (85.7%) 7 (100%) No 47 (65.3%) 25 (34.7%) 72 (100%) 32 (29.4%) 77 (70.6%) 109 (100%) Maybe 40 (90.9%) 4 (9.1%) 44 (100%) 13 (34.2%) 25 (65.8%) 38 (100%) Approval Addiction 2 0.172 0.123 Yes 24 (66.7%) 12 (33.3%) 36 (100%) 6 (16.7%) 30 (83.3%) 36 (100%) No 52 (72.2%) 20 (27.8%) 72 (100%) 26 (29.9%) 61 (70.1%) 87 (100%) Maybe 28 (63.6%) 16 (36.4%) 44 (100%) 23 (52.3%) 21 (47.7%) 44 (100%) Compassion Fatigue 1 0.001 0.003 Yes 57 (55.3%) 46 (44.7%) 103 (100%) 41 (39.8%) 62 (60.2%) 103 (100%) No 9 (45.0%) 11 (55.0%) 20 (100%) 3 (15.0%) 17 (85.0%) 20 (100%) Maybe 22 (78.6%) 6 (21.4%) 28 (100%) 9 (21.4%) 33 (78.6%) 42 (100%) Imposter Phenomenon 1 0.044 0.011 Yes 53 (55.2%) 43 (44.8%) 96 (100%) 36 (37.5%) 60 (62.5%) 96 (100%) No 9 (45.0%) 11 (55.0%) 20 (100%) 5 (25.0%) 15 (75.0%) 20 (100%) Maybe 27 (75.0%) 9 (25.0%) 36 (100%) 0 (0.0%) 37 (100.0%) 37 (100%) Imposter Phenomenon 2 0.801 0.099 Yes 29 (63.0%) 17 (37.0%) 46 (100%) 10 (21.7%) 36 (78.3%) 46 (100%) No 37 (62.7%) 22 (37.3%) 59 (100%) 16 (28.1%) 41 (71.9%) 57 (100%) Maybe 23 (48.9%) 24 (51.1%) 47 (100%) 12 (25.5%) 35 (74.5%) 47 (100%) Second Victim Syndrome 1 0.246 0.191 Yes 68 (60.7%) 44 (39.3%) 112 (100%) 25 (22.3%) 87 (77.7%) 112 (100%) No 20 (51.3%) 19 (48.7%) 39 (100%) 13 (34.2%) 25 (65.8%) 38 (100%) Second Victim Syndrome 2 0.003 0.063 Yes 32 (61.5%) 20 (38.5%) 52 (100%) 8 (15.7%) 43 (84.3%) 51 (100%) No 53 (55.2%) 43 (44.8%) 96 (100%) 28 (28.9%) 69 (71.1%) 97 (100%) Association between Burnout and Sociodemographic and work Variables Tables 5 and 6 highlights the result of crosstabulations of burnout and professional fulfilment categories with sociodemographic and professional characteristics of the physicians in the study. Factors associated with both burnout and professional fulfilment Six variables exhibited simultaneous associations with both outcomes. These include professional status with burnout being most prevalent among house officers (77.3%), medical officers (72.0%) and registrars (51.2%) compared to consultants and senior registrars/specialists who had the lowest burnout rates of 33.3% and 47.6%, respectively. Professional fulfilment showed the inverse pattern: consultants and specialists were the only groups in which more than half of respondents felt fulfilled (57.1% and 47.6%, respectively), whereas fulfilment was uncommon among house officers (18.2%) and medical officers (8.0%) ( p = 0.003 for burnout; p < 0.001 for fulfilment). In the same vein, physicians from Sierra Leone had markedly higher burnout (63.6%) and lower fulfilment (19.7%) than doctors from other African countries (25.0% burnout, 75.0% fulfilment) or the rest of the world (40.0% burnout, 80.0% fulfilment). This variable remained significant for both outcomes (p = 0.022 for burnout; p < 0.001 for professional fulfilment). Among physicians who said their salary was insufficient, 63.3% were burned out and only 21.6% felt professionally fulfilled; by contrast, those who viewed their salary as sufficient had far lower burnout (18.2%) and much higher fulfilment (72.7%) (p = 0.003 and p < 0.001, respectively). Mann-U analyses showed that non‑burned‑out and fulfilled doctors tend to have older youngest and oldest children (Table 6 ). For instance, the mean rank for the age of the youngest child was 55.47 in the no‑burnout group versus 43.63 in the burnout group (p = 0.038), and 65.35 in the fulfilled group versus 43.01 in the not‑fulfilled group (p = 0.001). Longer years of professional practice was significantly associated with lower burnout (p = 0.003) and higher fulfilment (p = 0.016). The mean rank for years practising was 85.42 in the no‑burnout group versus 64.72 in the burnout group and 86.97 in the fulfilled group versus 68.04 in the not‑fulfilled group. Physicians who slept more while on call were both less burned out (p = 0.005) and more fulfilled (p = 0.021). Factors unique to burnout Three factors were significant only for burnout. Marital status showed that 76.4% of single physicians were burned out compared with 51.1% of married physicians and 33.3% of those in other marital arrangements (p = 0.004), whereas marital status had no significant association with fulfilment (p = 0.14). Subspecialty also influenced burnout (p = 0.008), as burnout was highest among interns (77.3%) and paediatricians (63.6%) and lowest among family‑medicine practitioners (16.7%) and psychiatrists (25.0%). These differences were not mirrored in the fulfilment analysis (p = 0.11), where fulfilment remained low across most specialties. Doctors with higher supplementary income had lower burnout (mean rank 33.34 vs. 24.60; p = 0.045), yet supplementary income did not differ by fulfilment status (p = 0.227). Factors unique to professional fulfilment Conversely, four variables were uniquely significant for professional fulfilment. Primary employer status showed that public sector doctors were seldom fulfilled (22.9%), whereas fulfilment was common among those working in NGOs (75.0%) or private practice (60.0%). Burnout did not differ significantly by this factor (p = 0.167). Also, physicians based in districts reported higher professional fulfilment than those in Freetown (42.3% vs. 21.2%, p = 0.026), whereas burnout rates were virtually identical in both locations (≈ 61%). Hazardous drinkers were uniformly unfulfilled (0% fulfilled vs. 100% not fulfilled, p = 0.044), though their burnout prevalence (75.0%) was not significantly higher than that of low‑risk drinkers (53.6%, p = 0.249). Finally, fulfilled physicians had longer commuting distances (mean rank 68.62 vs. 48.54; p = 0.005), whereas burnout was unrelated to distance (p = 0.097). Table 5 Association between Burnout/Professional Fulfilment and Categorical Physicians Characteristics Burnout Professional Fulfilment Variable & Category Burnout n (%) No Burnout n (%) Total n (%) p-value Fulfilled n (%) Not Fulfilled n (%) Total p-value Sex 0.772 0.26 Female 28 (57.1%) 21 (42.9%) 49 (100%) 16 (32.7%) 33 (67.3%) 49 Male 62 (59.6%) 42 (40.4%) 104 (100%) 25 (24.0%) 79 (76.0%) 104 Religion 0.173 0.15 Christian 47 (53.4%) 41 (46.6%) 88 (100%) 27 (30.7%) 61 (69.3%) 88 Islam 40 (69.0%) 18 (31.0%) 58 (100%) 10 (17.2%) 48 (82.8%) 58 Other 3 (60.0%) 2 (40.0%) 5 (100%) 2 (40.0%) 3 (60.0%) 5 Professional status 0.003 < 0.001 Consultant 7 (33.3%) 14 (66.7%) 21 (100%) 12 (57.1%) 9 (42.9%) 21 House officer 34 (77.3%) 10 (22.7%) 44 (100%) 8 (18.2%) 36 (81.8%) 44 Medical officer 18 (72.0%) 7 (28.0%) 25 (100%) 2 (8.0%) 23 (92.0%) 25 Registrar 21 (51.2%) 20 (48.8%) 41 (100%) 8 (19.5%) 33 (80.5%) 41 Senior registrar/specialist 10 (47.6%) 11 (52.4%) 21 (100%) 10 (47.6%) 11 (52.4%) 21 Religiosity 0.630 0.77 Very religious 34 (59.6%) 23 (40.4%) 57 (100%) 15 (26.3%) 42 (73.7%) 57 Moderately religious 43 (55.8%) 34 (44.2%) 77 (100%) 20 (26.0%) 57 (74.0%) 77 Areligious 11 (73.3%) 4 (26.7%) 15 (100%) 4 (26.7%) 11 (73.3%) 15 Missing 2 (50.0%) 2 (50.0%) 4 (100%) 2 (50.0%) 2 (50.0%) 4 Nationality 0.022 < 0.001 Other African countries 3 (25.0%) 9 (75.0%) 12 (100%) 9 (75.0%) 3 (25.0%) 12 Rest of the world 2 (40.0%) 3 (60.0%) 5 (100%) 4 (80.0%) 1 (20.0%) 5 Sierra Leone 84 (63.6%) 48 (36.4%) 132 (100%) 26 (19.7%) 106 (80.3%) 132 Academic appointment 0.321 0.47 No 70 (60.9%) 45 (39.1%) 115 (100%) 29 (25.2%) 86 (74.8%) 115 Yes 18 (51.4%) 17 (48.6%) 35 (100%) 11 (31.4%) 24 (68.6%) 35 Primary employment sector 0.167 0.001 Government 85 (60.7%) 55 (39.3%) 140 (100%) 32 (22.9%) 108 (77.1%) 140 NGO 4 (50.0%) 4 (50.0%) 8 (100%) 6 (75.0%) 2 (25.0%) 8 Private 1 (20.0%) 4 (80.0%) 5 (100%) 3 (60.0%) 2 (40.0%) 5 Town 0.969 0.026 Freetown 70 (61.9%) 43 (38.1%) 113 (100%) 24 (21.2%) 89 (78.8%) 113 Districts 16 (61.5%) 10 (38.5%) 26 (100%) 11 (42.3%) 15 (57.7%) 26 Marital status 0.004 0.14 Married 46 (51.1%) 44 (48.9%) 90 (100%) 26 (28.9%) 64 (71.1%) 90 Single 42 (76.4%) 13 (23.6%) 55 (100%) 10 (18.2%) 45 (81.8%) 55 Other 2 (33.3%) 4 (66.7%) 6 (100%) 3 (50.0%) 3 (50.0%) 6 Subspecialty 0.008 0.11 Intern 34 (77.3%) 10 (22.7%) 44 (100%) 8 (18.2%) 36 (81.8%) 44 Medicine 6 (46.2%) 7 (53.8%) 13 (100%) 4 (30.8%) 9 (69.2%) 13 Surgery 13 (59.1%) 9 (40.9%) 22 (100%) 8 (36.4%) 14 (63.6%) 22 Obstetrics & Gynaecology 11 (55.0%) 9 (45.0%) 20 (100%) 5 (25.0%) 15 (75.0%) 20 Paediatrics 7 (63.6%) 4 (36.4%) 11 (100%) 2 (18.2%) 9 (81.8%) 11 Psychiatry 2 (25.0%) 6 (75.0%) 8 (100%) 3 (37.5%) 5 (62.5%) 8 Public health 2 (28.6%) 5 (71.4%) 7 (100%) 2 (28.6%) 5 (71.4%) 7 Family medicine 1 (16.7%) 5 (83.3%) 6 (100%) 5 (83.3%) 1 (16.7%) 6 Other 2 (22.2%) 7 (77.8%) 9 (100%) 2 (22.2%) 7 (77.8%) 9 Spouse/partner support 0.415 0.78 Not supportive 7 (70.0%) 3 (30.0%) 10 (100%) 3 (30.0%) 7 (70.0%) 10 Somewhat supportive 9 (45.0%) 11 (55.0%) 20 (100%) 4 (20.0%) 16 (80.0%) 20 Supportive 50 (56.2%) 39 (43.8%) 89 (100%) 24 (27.0%) 65 (73.0%) 89 Salary sufficiency 0.003 < 0.001 Not sufficient 88 (63.3%) 51 (36.7%) 139 (100%) 30 (21.6%) 109 (78.4%) 139 Sufficient 2 (18.2%) 9 (81.8%) 11 (100%) 8 (72.7%) 3 (27.3%) 11 Alcohol misuse (CAGE) 0.249 0.044 Low likelihood 37 (53.6%) 32 (46.4%) 69 (100%) 24 (34.8%) 45 (65.2%) 69 Hazardous use 6 (75.0%) 2 (25.0%) 8 (100%) 0 (0.0%) 8 (100.0%) 8 Table 6 Association between Burnout/Professional Fulfilment and Continuous Physicians Characteristics Variable Burnout Mean Rank No Burnout Mean Rank p-value Fulfilled Mean Rank Not Fulfilled Mean Rank p-value How old is youngest child 43.63 55.47 0.038 65.35 43.01 0.001 How old is oldest child 37.26 50.59 0.014 54.27 39.62 0.013 Years practising in Sierra Leone 64.72 85.42 0.003 86.97 68.04 0.016 Hours worked per week (excluding calls) 73.84 72.99 0.905 76.46 72.50 0.620 Calls per week (excluding weekends) 67.30 69.08 0.782 70.50 67.16 0.642 Weekend calls per month 75.48 63.57 0.083 68.46 71.81 0.666 Hours per week of sports 69.03 77.65 0.192 80.03 69.90 0.172 Hours per week of hobbies 69.29 80.83 0.102 80.72 71.49 0.236 Average hours of sleep per day when on call 63.51 82.72 0.005 84.51 66.54 0.021 Average hours of sleep per day when not on call 72.61 79.72 0.309 82.36 73.00 0.229 Distance to work (km) 67.53 56.63 0.097 48.54 68.62 0.005 Monthly salary (local currency) 59.97 68.20 0.217 72.26 60.69 0.150 Supplementary income per month 24.60 33.34 0.045 32.83 26.91 0.227 Years since graduation 66.72 89.70 0.001 96.67 68.80 0.001 Discussion We found a prevalence rate of 58.8% in our study which is higher than the 23.6–51.7% reported from a systemic review of burnout among doctors in Nigeria(21) but falls on the high end range of the 0-80.5% global prevalence among physicians from report of systemic reviews worldwide.(2) We also found a professional fulfilment Rate of 26.8%, which is within the range reported from both HIC and LHIC countries.(11) Thus, the burnout rate in our study is 2,19 times professional fulfilment rate. This reflects the relationship between burnout and professional fulfilment observed in LHICs; however, the ratios reported here are higher than those typically seen in HICs. The ratio reported from Turkey was 1:8.2 and 1.1 in South Africa and Rwanda,(11,22,23) while those from the USA ranged from 1:1.8 to 1:0.45.(24,25). One reason for this may be that hospitals in HIC provide a more supportive environment, more adequate resources, workloads that are more manageable and greater opportunities for growth than their LMIC counterparts; conditions that have been found to foster professional fulfilment and protect against burnout.(26) Is professional fulfilment then a driver of burnout and vice versal? While our study revealed that lower professional fulfilment is strongly associated with an increased risk of burnout, it does not imply that an absence of burnout does not automatically ensure professional fulfilment, nor does the presence of professional fulfilment imply a lack of burnout (Lu et al).(24,27) This is because a small group of physicians (20.26%) in the study were neither burned out nor professionally fulfilled and a smaller percentage (5.8%) are both burned out and fulfilled. The fact that several factors are associated with either burnout or professional fulfilment alone (and not the two together) seems to support this view. For example, doctors who are fulfilled significantly drove longer distance to work than those who were not fulfilled, and the distance traveled was not significantly associated with burnout. This counterintuitive finding may be explained by the fact that socioeconomic factors, for example, choosing to live in more desirable areas, make them fulfilled. Another example is that a physician might be emotionally exhausted due to heavy workload (a component of burnout) but still find deep meaning in patient care (a component of fulfilment).Most likely the relationship between professional fulfilment and burnout is a continuum and the interaction is dynamic.(27) As shown in our study, there may be an overlap of factors that impact both together, but the degree to which each factor was associated with professional fulfilment and burnout differs substantially. However, our study also shows that there are several factors that affect each entity in isolation. Thus, efforts to mitigate burnout or promote professional fulfilment among physicians have the largest impact on each of the entities. Physicians in this study faced a high prevalence of workplace distress, as demonstrated by very high rates of moral injury, second-victim syndrome (“Have you felt physically or psychologically distressed by a negative patient outcome for which you felt responsible?”), impostor phenomenon (“Have you ever been surprised by your successful completion of a task or receipt of a promotion and felt it was most likely due to luck or ‘being in the right place at the right time’?”), and compassion fatigue (“Do you think you have ever felt fatigued by dealing with a patient who has experienced trauma?”). Yet, they also exhibited resilience, as evidenced by simultaneously high prevalence of attitudes that might help them cope with workplace stresses. All 153 physicians reported gaining “satisfaction from being able to help patients.” While 74.2 percent reported feeling psychologically distressed by a negative patient outcome for which they felt responsible, only 35.1 percent allowed the experience to negatively affect their desire to work or alter their perception of their abilities. This resiliency may be due to the traditional African way of seeing each other in a group as family and reaching out to help each other. For example, Jallo et al., in a qualitative study of Sierra Leonean physicians working in the district, highlighted coping mechanisms including peer-to-peer support and formal and informal mentorship as key coping mechanism for burnout.(28) Lo et al., also emphasized the fact that even though Burnout originated as a western concept, understanding and coping with it has to be from the sociocultural perspectives of the community. (29) That is why our finding that moral injury was not significantly associated with burnout or professional fulfilment in our study may not be as counterintuitive as it initially appears when considered more closely. Many studies have found moral injury to be a predisposing factor to burnout (30) and some authors have gone as far as equating moral injury as burnout by another name.(14) In places with chronic shortage of medical resources like insufficient medication, equipment or personnel, moral injury might become so common health workers develop emotional callouses, so that they no longer consciously perceive or emotionally respond to those situations. This can occur through the processes of desensitization, when chronic repeated exposure to stressful or morally distressing situations can reduce emotional responsiveness;(31) and habituation, which is the reduced psychological and emotional reaction to repeated exposure to the same stressful stimulus (31–33) whereby a doctor experiencing persistent moral distress may gradually perceive these events as part of a typical workday, thus lessening the emotional impact. Several studies have identified various causal factors of burnout. These factors can be broadly classified into work, personal, and organizational factors.(34) Work factors include excessive workloads, long working hours, specialty choice, frequent call duties, professional status and seniority, and comprehensive documentation in electronic medical records.(11,29,34) Personal characteristics associated with burnout include sleep deprivation, inadequate support system outside work (e.g. having no spouse and children), age, sex, the presence of dependents, and the inability to balance work and family responsibilities. (11,27,29,30,34) Organizational-level factors include high workload, insufficient salary and rewards, inadequate facilities, bureaucratic tasks, social support for physicians, and administrative responsibilities. (11,24,27,34) With regard to work-related factors, some factors were found to be associated with both burnout and professional fulfilment. Young doctors, especially house officers, had higher rates of burnout and lower levels of professional fulfilment compared to consultants and specialists. This finding is consistent with several prior studies and is concerning, as burnout has been linked to poor performance in examinations.(4,6,11,21,27,28,35) This is particularly worrisome in the context of Sierra Leone, where efforts are ongoing to rebuild the specialist and consultant workforce. Two other work-related factors that were associated with both professional fulfilment and burnout were years since graduation and average hours of sleep per day when on call. Both are widely supported in the literature.(34) Older doctors tend to be less burned out and more fulfilled than their younger counterparts. Conversely, sleep deprivation, especially during on-call periods; is associated with higher burnout and reduced professional fulfilment, consistent with numerous previous reports in the literature.(11,29,34) This finding is particularly disconcerting in resource-poor settings such as Sierra Leone, where procedures like surgery and high-cost investigations are often delayed due to patients’ inability to pay, as most payments are made out of pocket. Other causes of such delays include power outages, unavailability of essential anaesthetic drugs, and pending laboratory investigation results (our paper on delays).(36) It is one thing to be deprived of sleep while engaged in meaningful, progressive work; it is quite another to lose sleep while wasting time waiting for a procedure to be initiated; uncertain of when, or even whether, it will ever begin.(28,36,37) The doctor’s subspecialty was another work-related factor that was significantly associated with burnout, but not with professional fulfilment. Paediatrics, followed by surgery and then O&G, had the highest rates of burnout, while family medicine, psychiatry, and public health had the lowest. This disparity may be related to both workload and the previously mentioned issue of time-wasting delays. Both surgery and O&G are surgical subspecialties, and in resource-poor settings, avoidable delays are a major source of frustration and fatigue. Pediatrics, on the other hand, may be associated with the emotional toll of caring for suffering children, as well as the cumulative burden of time-consuming routine procedures, such as venous cannulation, which can be particularly lengthy when performed by interns or junior residents. On the other hand, doctors who choose surgical subspecialties, and especially paediatrics, often do so out of a deeply ingrained sense of calling and purpose. This core mission can be powerful and enduring. In these subspecialties, a successful operation or the delivery of a healthy baby has an immediate and visible impact. These “wins,” however hard-won, provide a profound sense of accomplishment and reinforce the physician’s sense of purpose. In paediatrics, even small improvements in a child’s health can be especially rewarding, as the vulnerability of the patients often deepens the physician’s sense of responsibility. Thus, while powerful conditions leading to exhaustion and cynicism (burnout) exists in these subspecialties, they are counterbalanced by their deeply ingrained motivation, and the intermittent, powerful positive outcomes which keep their core professional fulfilment intact.(38) They are "burned out" by the struggle, but not necessarily "burned out" from their deeply held professional identity and mission. Personal factors that have been found to be significantly associated with burnout among doctors has to do with children. Doctors with older children were also less likely to report burnout and more likely to report fulfilment than those with younger children. On the other hand, the actual number of children has no bearing on either burnout or professional burnout. These findings aligns with the results of O’Connor et al. among South African orthopaedic surgeons and residents.(11) However, in contrast to some previously reported studies, we found no association between gender and burnout.(11) Curiously, self-reported alcohol use was not associated with either burnout or professional fulfilment. However, physicians who screened positive for hazardous drinking on the CAGE questionnaire did not differ in burnout scores but showed significantly lower levels of professional fulfilment. These findings are consistent with reports in the literature indicating that burnout and hazardous alcohol use are not always strongly correlated. A mixed-methods systematic review concluded that associations between burnout and substance misuse, which includes alcohol abuse, are inconsistent and often modest in magnitude.(39) Similarly, in a large cohort of U.S. surgeons, alcohol abuse was associated with lower career satisfaction; an indirect indicator of diminished professional fulfilment.(40) Our study also highlighted the limitations of simple yes/no self-report measures of alcohol use, which often fail to detect problematic consumption. In contrast, validated tools such as the CAGE or AUDIT questionnaires are more effective in capturing clinically relevant patterns that may affect professional well-being. Organization factors that are significantly associated with burnout and professional fulfilment include salary sufficiency. Less than one in ten doctors felt that their salaries were sufficient, and more than 50 percent reported having to work extra time to supplement their income. Organizational factors that are uniquely associated with professional fulfilment include employment status: doctors working in the public sector were less likely to be fulfilled than those working with NGOs or in the private sector. Additionally, physicians based in the districts reported higher fulfilment than those based in Freetown. Limitation Apart from the inherent limitation of being a cross-sectional study, which restricts causal inference, the other major weakness lies in the sample size. Although adequate for simple bivariate analyses, the sample is insufficient for more complex interclass analyses and logistic regression. However, given the total number of physicians in the country and the broad geographic distribution of respondents across most of Sierra Leone, the sample size is reasonably large for generalization. A major strength of the study is that it represents the first reported investigation of burnout and professional fulfillment among physicians in Sierra Leone, and indeed in the West African subregion Recommendation: This study identified several factors that must be addressed to mitigate burnout and promote professional fulfillment among physicians working in Sierra Leone. Some of these factors are systemic and require action at both organizational and governmental levels. Key issues include salary sufficiency and workload; both of which have been consistently shown in prior studies to be fundamental in reducing burnout and enhancing professional fulfillment. House officers and junior residents were found to be particularly vulnerable and should receive targeted interventions. Providing accommodation within hospital premises for house officers, for instance, would reduce the exhausting commute during odd hours often required by their duties. Additionally, departments with high patient volumes and inadequate physician staffing, such as pediatrics, should receive increased personnel support. Meals should also be provided for physicians on emergency duty. Given the heightened vulnerability of healthcare workers to burnout, institutional support systems, which have been shown to reduce burnout, should be put in place. Regular, structured assessments of burnout should be conducted. Furthermore, our findings indicate that self-administered drinking questionnaires were less sensitive than standardized tools such as the CAGE instrument for detecting alcohol-related problems. Therefore, validated screening tools must be included in burnout assessments to effectively identify alcohol misuse. Abbreviations High-Income Countries ( HICS ), Low- And Middle-Income Countries ( LMICS ), Professional Fulfilment ( PF ), Professional Fulfillment Index ( PFI ), Interquartile Range ( IQR ) Declarations Ethical approval and consent to participate: Ethical approval was obtained from the Ethics and Scientific Review Committee of the University of Sierra Leone Teaching Hospitals Complex. The study was conducted in accordance with the Declaration of Helsinki (2013 revision). Informed consent was obtained from all participants. The online survey form contained an introductory section providing information about the study’s purpose, potential risks and benefits, confidentiality, and the participants’ right to withdraw from the study at any time. All study participants gave informed consent and voluntarily agreed to participate in the research (There was a statement to the effect that continuing with the study was consent to participate). To ensure data security, secure passwords protect all questionnaires and collected data. Funding: The authors declared that no grants were involved in supporting this work. Clinical trial registration: Not applicable. Conflict of interest: The authors declare no conflict of interest Consent for publication: Not applicable Authors’ contributions: K. S. O-Conceptualized the study, drafted the manuscript and performed statistical analysis, M. B – Manuscript draft, N. B- data collection and manuscript draft, A. O. A- Data collection, manuscript draft, S. S: data collection and manuscript draft I. O. O: Data analysis and C. O reviewed the manuscript. All authors read and approved the final draft. Acknowledgements The authors wish to express their sincere gratitude to all individuals and institutions who contributed to the successful completion of this study. We are particularly grateful to the management and staff of the University of Sierra Teaching Hospitals Complex (USLTHC), College of Medicine and Allied Health Sciences-University of Sierra Leone (COMAHS-USL) and the Ola During Children’s Hospital for their invaluable support and collaboration. Our appreciation also goes to the study participants and their families for their time and cooperation. Finally, we thank all colleagues, and technical staff whose efforts made this work possible. Data Availability The datasets generated for the study are available in the Open Science Framework (OSF) website at https://osf.io/5w2jn/?view_only=8d31f42190944013b0547a9ded69770c References Alahmari MA, Al Moaleem MM, Hamdi BA, Hamzi MA, Aljadaani AT, Khormi FA, et al. Prevalence of Burnout in Healthcare Specialties: A Systematic Review Using Copenhagen and Maslach Burnout Inventories. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2022;28:e938798-1. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8544221","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587131543,"identity":"bb503fa6-b464-401d-b751-b6a5cb19ee78","order_by":0,"name":"Kehinde Sunday Oluwadiya","email":"","orcid":"","institution":"University of Sierra Leone Teaching Hospitals Complex","correspondingAuthor":false,"prefix":"","firstName":"Kehinde","middleName":"Sunday","lastName":"Oluwadiya","suffix":""},{"id":587131544,"identity":"cb135299-244c-4132-9b5e-f0cbec9f26e1","order_by":1,"name":"Mohamed Bawoh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYFACHhDBzGAAJisYGPiADAkgliFSyxkGBjaoFh7itDC2EaFFt7334KcbFdYM5uxnDB8Xzjtsz8bAfPA2D0MdTi1mZ84lS+ecSWew7MkxNp657XBiGwNbsjUPw2HcWm7kGEjnth1mMDiQu02ad9vhBDYGHjNpHoYD+LQY/879B9Ry/i1QyxyQw/i/SeN12I0cM+ncBqCWGyBbGg4DQ4CHDaiFGY9fzphZ5xxL57Gc8f6zMc+x9MQ2ZjZjyzkGePxyvMf4dk6NtZw5f1riY54aa3t+9uaHN95U1Mnh0gIDSGYygwgDQhpGwSgYBaNgFOADAP4SSgbpITC8AAAAAElFTkSuQmCC","orcid":"","institution":"University of Sierra Leone","correspondingAuthor":true,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"Bawoh","suffix":""},{"id":587131545,"identity":"f94dd41b-6b01-4095-9a45-7ba3da6b14cd","order_by":2,"name":"Nellie Bell","email":"","orcid":"","institution":"University of Sierra Leone Teaching Hospitals Complex","correspondingAuthor":false,"prefix":"","firstName":"Nellie","middleName":"","lastName":"Bell","suffix":""},{"id":587131546,"identity":"adf510bd-28b3-487c-8bdd-a998fca2a4f8","order_by":3,"name":"Adetunji Oladeni Adeniji","email":"","orcid":"","institution":"Ladoke Akintola University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Adetunji","middleName":"Oladeni","lastName":"Adeniji","suffix":""},{"id":587131547,"identity":"294ed637-b0b6-403b-b358-3d3337664a79","order_by":4,"name":"Sonia Spencer","email":"","orcid":"","institution":"University of Sierra Leone Teaching Hospitals Complex","correspondingAuthor":false,"prefix":"","firstName":"Sonia","middleName":"","lastName":"Spencer","suffix":""},{"id":587131548,"identity":"f2ed8d51-33ea-4048-8cd7-c4592822cd3b","order_by":5,"name":"Ibironke Omowunmi Oluwadiya","email":"","orcid":"","institution":"Obafemi Awolowo University","correspondingAuthor":false,"prefix":"","firstName":"Ibironke","middleName":"Omowunmi","lastName":"Oluwadiya","suffix":""},{"id":587131549,"identity":"5693da80-ccb4-4149-a91c-35004971e0a3","order_by":6,"name":"Caroline Ofovwe","email":"","orcid":"","institution":"University of Sierra Leone Teaching Hospitals Complex","correspondingAuthor":false,"prefix":"","firstName":"Caroline","middleName":"","lastName":"Ofovwe","suffix":""}],"badges":[],"createdAt":"2026-01-07 17:38:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8544221/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8544221/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102404203,"identity":"aeea0815-4005-47fb-ab19-8a88c8ecbad0","added_by":"auto","created_at":"2026-02-11 11:03:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1733296,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8544221/v1/2a5d5378-5af5-4313-8cc4-a9f20bb0e5fd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePhysician Burnout and Fulfilment in Sierra Leone Ii: an Online Cross-Sectional Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBurnout, a syndrome resulting from chronic workplace stress that is not effectively managed, is a growing global health concern. Its prevalence varies widely across occupations, geographic regions, and cultural settings, and is influenced by workplace support structures. Although, the global prevalence rates varies widely depending on the criteria and the methodology, the incidence of burnout is disproportionately higher in Low and Middle-Income Countries (LMICs) compared to High-Income Countries (HICs), and more prevalent in Africa than other continents. (1\u0026ndash;3) This disparity is often attributed to inadequate resources and lack of support structures in LMICs. (4\u0026ndash;6) A global systematic review by Rotenstein et al. highlights a stark contrast in burnout rates, with figures in Africa and Asia compared to Europe and North America, and a wide variance within African countries themselves. (2)\u003c/p\u003e \u003cp\u003eParticularly vulnerable to burnout is the medical profession, where factors such as high workload, patient load, and the emotional impact of patient outcomes contribute to elevated burnout rates among physicians.(2,7,8) This is evidenced by higher prevalence rates among physicians compared to other professionals or the general population. (9,10).\u003c/p\u003e \u003cp\u003eDespite the global prevalence of burnout syndrome among medical professionals, particularly in Low and Middle-Income Countries (LMICs) like Africa, there is a notable lack of comprehensive studies in certain countries, such as Sierra Leone, leaving a critical gap in understanding the extent, patterns, and underlying factors of burnout among medical doctors in these countries. Rotenstein et al. in their systematic review of 45 studies revealed that a mere 24.4% of burnout studies I their review originate from LMIC, with none coming from Africa. Another systematic review of burnout among healthcare workers in sub-Saharan Africa did not include any study from Sierra Leone.(4)\u003c/p\u003e \u003cp\u003eIf little has been reported on burnout in Africa, even less has been reported on professional fulfilment and the interaction between the two from the continent. To our knowledge, only one study from South Africa has dealt with both phenomena from Africa. (11) This gap in research is concerning, given the high prevalence and impact of burnout on healthcare professionals. Therefore, this research proposal aims to investigate the prevalence, patterns, and determinants of burnout among medical doctors in Sierra Leone, a topic which has not been adequately studied, to better understand the unique challenges faced by physicians in this region and inform strategies for effective management and support.\u003c/p\u003e \u003cp\u003eThe findings of this study are important for several reasons. First, they help address a significant research gap. Given the limited data on physician burnout in Sierra Leone and across much of Africa, the study contributes valuable insights to the global understanding of burnout in diverse socioeconomic and cultural contexts. Second, by identifying the prevalence and determinants of burnout among medical doctors in Sierra Leone, the study offers evidence that can inform strategies to mitigate burnout, thereby potentially improving healthcare delivery and patient outcomes in a region already burdened by limited medical resources.\u003c/p\u003e \u003cp\u003eThird, the study provides a foundation for policy formulation and implementation. Its outcomes can assist policymakers and healthcare administrators in Sierra Leone and similar settings in developing and executing programs that support the mental health and well-being of medical professionals. Furthermore, by illuminating the impact of burnout on physicians, the study highlights the need for targeted interventions aimed at improving job satisfaction, professional efficacy, and overall quality of life for healthcare workers.\u003c/p\u003e \u003cp\u003eFinally, the findings have global relevance. Burnout is a widespread concern in the medical profession, and insights from this study can contribute to the broader international discourse on effective strategies for supporting healthcare providers, particularly in resource-constrained environments.\u003c/p\u003e \u003cp\u003e In essence, this study stands to offer valuable contributions to the understanding of burnout in an under-researched region, with implications for improving healthcare outcomes both locally and globally. The following research questions will be addressed by the study:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat is the prevalence of burnout and professional fulfilment among medical doctors in Sierra Leone and how does this vary across different groups as defined by such as status, specialization and type of employment?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat is the association between burnout/professional fulfilment and social and workplace factors such as gender, age, workload, professional status etc?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting\u003c/h2\u003e \u003cp\u003eThis study was conducted in Sierra Leone, a West African country with an estimated population of 7.8\u0026nbsp;million. The country has fewer than 1,000 practicing physicians, resulting in a doctor-to-population ratio (2.4/100,000) that falls significantly below the World Health Organization (WHO) recommendation.(12) Sierra Leone operates a three-tiered healthcare delivery system:\u003c/p\u003e \u003cp\u003e1. \u003cb\u003eTertiary care\u003c/b\u003e is provided by six units within the national teaching hospital complex.\u003c/p\u003e \u003cp\u003e2. \u003cb\u003eSecondary care\u003c/b\u003e is delivered through government hospitals in each of the country\u0026rsquo;s sixteen districts.\u003c/p\u003e \u003cp\u003e3. \u003cb\u003ePrimary care\u003c/b\u003e is available via district health units.\u003c/p\u003e \u003cp\u003eAdditionally, private hospitals deliver both secondary and tertiary care services. Physicians in the public sector are employed by the Ministry of Health and receive salaries under the national civil service scheme. Cadres include interns, medical officers, resident doctors (postgraduate trainees), specialists (residents who have passed the Part I examination of the postgraduate medical college), and consultants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe Study Instrument:\u003c/h3\u003e\n\u003cp\u003eData were collected using a structured, self-administered questionnaire composed of the following sections:\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cb\u003eSocio-demographic characteristics\u003c/b\u003e: Age, gender, religion, income, family structure, and level of religiosity.\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cb\u003eWorkplace-related variables\u003c/b\u003e: professional status, years of experience, specialization, workload, and alcohol use.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eThe Professional Fulfillment Index (PFI)\u003c/strong\u003e \u003cp\u003eThis is a 16-item instrument scored on a Likert scale. (11,13) Ten items (four on work exhaustion and six on interpersonal disengagement) assess burnout, with a mean score\u0026thinsp;\u0026ge;\u0026thinsp;1.33 indicating burnout. The remaining six items evaluate professional fulfillment; a mean score\u0026thinsp;\u0026ge;\u0026thinsp;3.0 on these items indicates a fulfilled professional state\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFive indicators of workplace stress, derived from validated questionnaires, were incorporated into the survey instrument.(14\u0026ndash;19) Four of the five indicators were assessed using two items each; moral injury was assessed with one item.\u003c/p\u003e \u003cp\u003e\u0026bull; Moral Injury: This refers to situations in which a physician has the competence to provide care but is prevented from doing so due to constraints beyond their control. (14) It was assessed with the item: \u0026ldquo;Have you found yourself in a position where you felt patient care was compromised due to failure of the healthcare system?\u0026rdquo; Responses were captured using a six-point Likert scale: strongly agree, mildly agree, neutral, mildly disagree, strongly disagree, and not applicable. For analysis, responses were recoded into three categories: Yes (combining strongly agree and mildly agree), No (combining strongly disagree and mildly disagree), and Maybe (neutral). Responses marked not applicable were excluded.\u003c/p\u003e \u003cp\u003e\u0026bull; Compassion Fatigue: Defined as a decline in a physician\u0026rsquo;s ability to feel empathy due to the prolonged stress of caregiving.(19,20) It was assessed using two items: \u0026ldquo;Do you think you have ever felt fatigued by dealing with a patient who has experienced trauma?\u0026rdquo; (focused on fatigue), and \u0026ldquo;Do you get satisfaction from being able to help patients?\u0026rdquo; (focused on satisfaction). Responses were recoded as follows: At times, Often, and Very Often were grouped as Yes; Rarely/never as No; and Not sure as Maybe. Responses marked not applicable were excluded.\u003c/p\u003e \u003cp\u003e\u0026bull; Approval Addiction: Refers to when a physician\u0026rsquo;s self-worth is closely tied to how others perceive them.(16) It was assessed with two dichotomous items: \u0026ldquo;Is your happiness dependent on what others think of you?\u0026rdquo; and \u0026ldquo;Do you struggle to say \u0026lsquo;no\u0026rsquo;?\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026bull; Imposter Phenomenon: Describes physicians who feel like frauds despite objective evidence of their competence.(17) It was assessed using two items: \u0026ldquo;Have you ever been surprised by your successful completion of a task or received promotion and felt it was most likely a consequence of luck or \u0026lsquo;being in the right place at the right time\u0026rsquo;?\u0026rdquo; and \u0026ldquo;Do you find it hard to accept compliments or praise due to fear you will be \u0026lsquo;found out\u0026rsquo; as a fraud or not as intelligent as others perceive you to be?\u0026rdquo; Responses were recoded as follows: Always, Often, and Sometimes as Yes; Never as No; and Rarely as Maybe. Missing responses were excluded.\u003c/p\u003e \u003cp\u003e\u0026bull; Second Victim Syndrome: Refers to the emotional distress physicians may experience following a perceived error or adverse patient outcome.(18) It was assessed with two items: \u0026ldquo;Have you felt physically or psychologically distressed by a negative patient outcome for which you felt responsible?\u0026rdquo; and \u0026ldquo;Has the experience from the previous question negatively affected your desire to work, attend work, or changed your perception of your abilities?\u0026rdquo;\u003c/p\u003e\u003cdiv class=\"Heading\"\u003e\u003cb\u003eSample size determination\u003c/b\u003e:\u003c/div\u003e \u003cp\u003e \u003cstrong\u003eData collection procedure\u003c/strong\u003e \u003cp\u003eThis was an online cross-sectional questionnaire-based survey that was hosted on Google Forms. The study population was doctors who were currently working in Sierra Leone for at least six months, and all of them were eligible except for those on treatment for any psychiatric illness.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSampling\u003c/strong\u003e \u003cp\u003eGiven that the respondents were spread across Sierra Leone and belong to many groups, sampling was by purposive and snowballing methods. The link to the survey website was distributed through social media groups like SLMA, hospital groups, NGO groups, and other categories. Influential peers such as group executives and hospital associations were encouraged to spread the info. Using snowballing methods, small groups were targeted so that they would be equally represented.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Issues\u003c/strong\u003e \u003cp\u003e Ethical approval was obtained from the Ethics and Scientific Review Committee of the University of Sierra Leone Teaching Hospitals Complex. The study was conducted in accordance with the Declaration of Helsinki (2013 revision). Informed consent was obtained from all participants. The online survey form contained an introductory section providing information about the study\u0026rsquo;s purpose, potential risks and benefits, confidentiality, and the participants\u0026rsquo; right to withdraw from the study at any time. All study participants gave informed consent and voluntarily agreed to participate in the research. To ensure data security, secure passwords protect all questionnaires and collected data.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Analysis Plan\u003c/strong\u003e \u003cp\u003eThe data collection process involved transferring responses from Google Forms to Google Sheets and subsequently to Microsoft Excel for initial data cleaning and preparation. Chi-square, t-test and Mann-Whitney-U statistics was used to explore the association between PFI domains and socio-demographic and professional variables. The data analysis was conducted using SPSS version 26.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOne hundred and sixty-five responses were received in Google Form. Twenty-three (13.9%) cases had missing data. Twelve of the cases whose PFI could not be calculated because of excessive missing data were excluded from data analysis, leaving a total of 153 cases for the final analysis.\u003c/p\u003e \u003cp\u003eThe mean age of the study participants was 36.9 (9.5 SD) years, ranging was 25-77years. Sixty-eight percent (104 of 153) were males, and 32% were females (49 of 153). Majority of physicians are married (90, 58.8%,) or single (55, 35.9%) and are working in hospitals in Freetown. Most of the study participants worked within the public sector, and the median work experience was 6 (IQR 1\u0026ndash;9) years. Excluding calls, the median weekly working hours was 48 hours (IQR 40\u0026ndash;49) and each took two median weekend calls per month. Approximately 92% of the physicians reported their salaries as insufficient. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the socio-demographics and work details of the respondents.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of socio-demographics and workplace characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIQR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.5\u0026ndash;40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace Practicing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFreetown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Places\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNGO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHouse job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegistrar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsultant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears in Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHouse-Hospital Distance (Km)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian salary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8200\u0026ndash;12000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSalary Sufficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Sufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly Working Hour (minus calls)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian number of weekend call/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinks alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoes not drink alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAGE Alcohol Screening (n\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow likelihood of problematic drinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePossible alcohol use disorder (hazardous/harmful use)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eBurnout and Professional Fulfillment Status\u003c/h3\u003e\n\u003cp\u003eOf the 153 respondents in the study, 90(58.8%) were categorized with burnout and 63 (41.2% did not have burnout. Similarly, only 41(26.8%) were categorized as professionally fulfilled while the remaining 112 (72.3%) were not professionally fulfilled. Among physicians who reported burnout, 90.0% were classified as not professionally fulfilled, while only 10.0% were fulfilled. In contrast, among those without burnout, 50.8% reported being professionally fulfilled and 49.2% were not. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These findings indicate that lower professional fulfilment is strongly associated with increased risk of burnout, and this was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCrosstabulation of burnout vs professional fulfilment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurnout Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePFI: Fulfilled\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePFI: Not Fulfilled\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBurnout\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81 (90.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNot Burnout\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (50.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (49.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112 (72.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eWorkplace Distress Indicators\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes responses to selected indicators of workplace stress. A large majority of participants (87.2%) reported experiencing moral injury, affirming that they had found themselves unable to deliver optimal care due to systemic healthcare failures. Regarding approval addiction, 4.6% admitted that their happiness depended on others\u0026rsquo; opinions, while 23.7% reported struggling to say \u0026ldquo;no.\u0026rdquo;\u003c/p\u003e \u003cp\u003eIn terms of compassion fatigue, 67.3% reported having felt fatigued by exposure to patients who had experienced trauma, while all respondents (100%) reported deriving satisfaction from helping patients.\u003c/p\u003e \u003cp\u003eTwo indicators assessed the imposter phenomenon. About 63.2% had felt surprised by their own success or recognition, attributing it to luck or circumstance, and 30.3% reported discomfort with praise due to fears of being exposed as less competent.\u003c/p\u003e \u003cp\u003eWith respect to second victim syndrome, 74.2% acknowledged psychological or physical distress following adverse patient outcomes for which they felt responsible, and 35.1% indicated that these experiences had negatively impacted their motivation, attendance, or self-perception at work.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency Table of Workplace Distress Indicators\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaybe\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoral Injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you found yourself in a position where you felt patient care was compromised due to failure of the healthcare system ?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e129 (87.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApproval Addiction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs your happiness dependent on what others think of you?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (70.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38 (24.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you struggle to say \u0026ldquo;NO\u0026rdquo;?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44 (28.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompassion Fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you think you have ever felt fatigued by dealing with a patient who has experienced trauma?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103 (67.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you get satisfaction from being able to help patients?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImposter Phenomenon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you ever been surprised by your successful completion of a task or received promotion and felt it was most likely as a consequence of luck or \u0026lsquo;being in the right place at the right time\u0026rsquo;?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96 (63.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you find it hard to accept compliments or praise due to fear you will be \u0026lsquo;found out\u0026rsquo; as a fraud or not as intelligent as you perceive people think you are?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (30.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond Victim Syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you felt physically or psychologically distressed by a negative patient outcome for which you felt responsible?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (74.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the experience from the previous question negatively affected your desire to work, attend work, or changed your perception of your abilities?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (35.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96 (64.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssociation Between Burnout/ PFI and Workplace Distress\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the association between workplace stressor indicators and burnout status. Do you think you have ever felt fatigued by dealing with a patient who has experienced trauma? (Compassion Fatigue 1) was significantly associated with burnout (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.001), as was \u0026ldquo;Have you ever been surprised by your successful completion of a task or received promotion and felt it was most likely as a consequence of luck or \u0026lsquo;being in the right place at the right time\u0026rsquo;? (Imposter Phenomenon 1) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.044) and \u0026ldquo;Has the experience from the previous question negatively affected your desire to work, attend work, or changed your perception of your abilities?\u0026rdquo; (Second Victim Syndrome 2) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003). These results suggest that experiences of emotional fatigue, self-doubt, and perceived harm from adverse events are more common among physicians classified as burned out. Other indicators did not achieve significant associations with burnout status.\u003c/p\u003e \u003cp\u003eRegarding the association between workplace stressor indicators and Professional Fulfillment Index (PFI), two of the stressors, Compassion Fatigue 1 ( \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003) and Imposter Phenomenon 1 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.011) that were significantly associated with burnout were also significantly associated with PFI. The remaining indicators were not statistical significance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between Burnout/PROFESSIONAL FULFILMENT and workplace stress indicators\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable \u0026amp; Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eBurnout\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eProfessional Fulfilment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurnout n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Burnout n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFulfilled n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNot Fulfilled n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoral Injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e22 (78.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77 (58.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44 (33.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e86 (66.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e130 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaybe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApproval Addiction 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e32 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e77 (70.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e109 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaybe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (90.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13 (34.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25 (65.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApproval Addiction 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (72.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (27.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e61 (70.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e87 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaybe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23 (52.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e21 (47.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompassion Fatigue 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57 (55.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e41 (39.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e62 (60.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e103 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e17 (85.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaybe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (78.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e33 (78.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImposter Phenomenon 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (44.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e60 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e96 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaybe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e37 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImposter Phenomenon 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (63.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e36 (78.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e46 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (62.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (37.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16 (28.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e41 (71.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaybe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (48.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (51.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12 (25.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e35 (74.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond Victim Syndrome 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68 (60.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25 (22.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e87 (77.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e112 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (48.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13 (34.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25 (65.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond Victim Syndrome 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e43 (84.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e51 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (44.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28 (28.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e69 (71.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e97 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eAssociation between Burnout and Sociodemographic and work Variables\u003c/h3\u003e\n\u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e highlights the result of crosstabulations of burnout and professional fulfilment categories with sociodemographic and professional characteristics of the physicians in the study.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with both burnout and professional fulfilment\u003c/h2\u003e \u003cp\u003eSix variables exhibited simultaneous associations with both outcomes. These include professional status with burnout being most prevalent among house officers (77.3%), medical officers (72.0%) and registrars (51.2%) compared to consultants and senior registrars/specialists who had the lowest burnout rates of 33.3% and 47.6%, respectively. Professional fulfilment showed the inverse pattern: consultants and specialists were the only groups in which more than half of respondents felt fulfilled (57.1% and 47.6%, respectively), whereas fulfilment was uncommon among house officers (18.2%) and medical officers (8.0%) ( p\u0026thinsp;=\u0026thinsp;0.003 for burnout; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for fulfilment). In the same vein, physicians from Sierra Leone had markedly higher burnout (63.6%) and lower fulfilment (19.7%) than doctors from other African countries (25.0% burnout, 75.0% fulfilment) or the rest of the world (40.0% burnout, 80.0% fulfilment). This variable remained significant for both outcomes (p\u0026thinsp;=\u0026thinsp;0.022 for burnout; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for professional fulfilment). Among physicians who said their salary was insufficient, 63.3% were burned out and only 21.6% felt professionally fulfilled; by contrast, those who viewed their salary as sufficient had far lower burnout (18.2%) and much higher fulfilment (72.7%) (p\u0026thinsp;=\u0026thinsp;0.003 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively).\u003c/p\u003e \u003cp\u003eMann-U analyses showed that non‑burned‑out and fulfilled doctors tend to have older youngest and oldest children (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). For instance, the mean rank for the age of the youngest child was 55.47 in the no‑burnout group versus 43.63 in the burnout group (p\u0026thinsp;=\u0026thinsp;0.038), and 65.35 in the fulfilled group versus 43.01 in the not‑fulfilled group (p\u0026thinsp;=\u0026thinsp;0.001). Longer years of professional practice was significantly associated with lower burnout (p\u0026thinsp;=\u0026thinsp;0.003) and higher fulfilment (p\u0026thinsp;=\u0026thinsp;0.016). The mean rank for years practising was 85.42 in the no‑burnout group versus 64.72 in the burnout group and 86.97 in the fulfilled group versus 68.04 in the not‑fulfilled group. Physicians who slept more while on call were both less burned out (p\u0026thinsp;=\u0026thinsp;0.005) and more fulfilled (p\u0026thinsp;=\u0026thinsp;0.021).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFactors unique to burnout\u003c/h2\u003e \u003cp\u003eThree factors were significant only for burnout. Marital status showed that 76.4% of single physicians were burned out compared with 51.1% of married physicians and 33.3% of those in other marital arrangements (p\u0026thinsp;=\u0026thinsp;0.004), whereas marital status had no significant association with fulfilment (p\u0026thinsp;=\u0026thinsp;0.14). Subspecialty also influenced burnout (p\u0026thinsp;=\u0026thinsp;0.008), as burnout was highest among interns (77.3%) and paediatricians (63.6%) and lowest among family‑medicine practitioners (16.7%) and psychiatrists (25.0%). These differences were not mirrored in the fulfilment analysis (p\u0026thinsp;=\u0026thinsp;0.11), where fulfilment remained low across most specialties. Doctors with higher supplementary income had lower burnout (mean rank 33.34 vs. 24.60; p\u0026thinsp;=\u0026thinsp;0.045), yet supplementary income did not differ by fulfilment status (p\u0026thinsp;=\u0026thinsp;0.227).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFactors unique to professional fulfilment\u003c/h2\u003e \u003cp\u003eConversely, four variables were uniquely significant for professional fulfilment. Primary employer status showed that public sector doctors were seldom fulfilled (22.9%), whereas fulfilment was common among those working in NGOs (75.0%) or private practice (60.0%). Burnout did not differ significantly by this factor (p\u0026thinsp;=\u0026thinsp;0.167). Also, physicians based in districts reported higher professional fulfilment than those in Freetown (42.3% vs. 21.2%, p\u0026thinsp;=\u0026thinsp;0.026), whereas burnout rates were virtually identical in both locations (\u0026asymp;\u0026thinsp;61%). Hazardous drinkers were uniformly unfulfilled (0% fulfilled vs. 100% not fulfilled, p\u0026thinsp;=\u0026thinsp;0.044), though their burnout prevalence (75.0%) was not significantly higher than that of low‑risk drinkers (53.6%, p\u0026thinsp;=\u0026thinsp;0.249). Finally, fulfilled physicians had longer commuting distances (mean rank 68.62 vs. 48.54; p\u0026thinsp;=\u0026thinsp;0.005), whereas burnout was unrelated to distance (p\u0026thinsp;=\u0026thinsp;0.097).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between Burnout/Professional Fulfilment and Categorical Physicians Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eBurnout\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eProfessional Fulfilment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable \u0026amp; Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurnout n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Burnout n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFulfilled n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNot Fulfilled n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33 (67.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (59.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (40.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e79 (76.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (53.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (46.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (30.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e61 (69.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (69.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48 (82.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsultant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHouse officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (77.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (72.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23 (92.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegistrar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (19.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33 (80.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior registrar/specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (52.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (52.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligiosity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery religious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (59.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (40.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42 (73.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerately religious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (55.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (44.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e57 (74.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAreligious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther African countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRest of the world\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSierra Leone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e132 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e106 (80.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic appointment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (60.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (25.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e86 (74.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24 (68.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary employment sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (60.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e108 (77.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNGO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFreetown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e89 (78.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistricts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (42.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15 (57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (51.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (48.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (28.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e64 (71.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (76.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (23.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubspecialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (77.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (53.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (59.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (40.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetrics \u0026amp; Gynaecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaediatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychiatry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpouse/partner support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot supportive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomewhat supportive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupportive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (56.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (27.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65 (73.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSalary sufficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot sufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (63.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e139 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e109 (78.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol misuse (CAGE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow likelihood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (53.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (46.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45 (65.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHazardous use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between Burnout/Professional Fulfilment and Continuous Physicians Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurnout Mean Rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Burnout Mean Rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFulfilled Mean Rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot Fulfilled Mean Rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow old is youngest child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e65.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow old is oldest child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears practising in Sierra Leone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e86.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e68.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHours worked per week (excluding calls)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e72.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalls per week (excluding weekends)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e67.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekend calls per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e71.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHours per week of sports\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e69.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHours per week of hobbies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e71.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage hours of sleep per day when on call\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e66.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage hours of sleep per day when not on call\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e82.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e73.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to work (km)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e68.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly salary (local currency)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupplementary income per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears since graduation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e96.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e68.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e We found a prevalence rate of 58.8% in our study which is higher than the 23.6\u0026ndash;51.7% reported from a systemic review of burnout among doctors in Nigeria(21) but falls on the high end range of the 0-80.5% global prevalence among physicians from report of systemic reviews worldwide.(2) We also found a professional fulfilment Rate of 26.8%, which is within the range reported from both HIC and LHIC countries.(11) Thus, the burnout rate in our study is 2,19 times professional fulfilment rate. This reflects the relationship between burnout and professional fulfilment observed in LHICs; however, the ratios reported here are higher than those typically seen in HICs. The ratio reported from Turkey was 1:8.2 and 1.1 in South Africa and Rwanda,(11,22,23) while those from the USA ranged from 1:1.8 to 1:0.45.(24,25). One reason for this may be that hospitals in HIC provide a more supportive environment, more adequate resources, workloads that are more manageable and greater opportunities for growth than their LMIC counterparts; conditions that have been found to foster professional fulfilment and protect against burnout.(26)\u003c/p\u003e \u003cp\u003eIs professional fulfilment then a driver of burnout and vice versal? While our study revealed that lower professional fulfilment is strongly associated with an increased risk of burnout, it does not imply that an absence of burnout does not automatically ensure professional fulfilment, nor does the presence of professional fulfilment imply a lack of burnout (Lu et al).(24,27) This is because a small group of physicians (20.26%) in the study were neither burned out nor professionally fulfilled and a smaller percentage (5.8%) are both burned out and fulfilled. The fact that several factors are associated with either burnout or professional fulfilment alone (and not the two together) seems to support this view. For example, doctors who are fulfilled significantly drove longer distance to work than those who were not fulfilled, and the distance traveled was not significantly associated with burnout. This counterintuitive finding may be explained by the fact that socioeconomic factors, for example, choosing to live in more desirable areas, make them fulfilled. Another example is that a physician might be emotionally exhausted due to heavy workload (a component of burnout) but still find deep meaning in patient care (a component of fulfilment).Most likely the relationship between professional fulfilment and burnout is a continuum and the interaction is dynamic.(27) As shown in our study, there may be an overlap of factors that impact both together, but the degree to which each factor was associated with professional fulfilment and burnout differs substantially. However, our study also shows that there are several factors that affect each entity in isolation. Thus, efforts to mitigate burnout or promote professional fulfilment among physicians have the largest impact on each of the entities.\u003c/p\u003e \u003cp\u003ePhysicians in this study faced a high prevalence of workplace distress, as demonstrated by very high rates of moral injury, second-victim syndrome (\u0026ldquo;Have you felt physically or psychologically distressed by a negative patient outcome for which you felt responsible?\u0026rdquo;), impostor phenomenon (\u0026ldquo;Have you ever been surprised by your successful completion of a task or receipt of a promotion and felt it was most likely due to luck or \u0026lsquo;being in the right place at the right time\u0026rsquo;?\u0026rdquo;), and compassion fatigue (\u0026ldquo;Do you think you have ever felt fatigued by dealing with a patient who has experienced trauma?\u0026rdquo;). Yet, they also exhibited resilience, as evidenced by simultaneously high prevalence of attitudes that might help them cope with workplace stresses. All 153 physicians reported gaining \u0026ldquo;satisfaction from being able to help patients.\u0026rdquo; While 74.2 percent reported feeling psychologically distressed by a negative patient outcome for which they felt responsible, only 35.1 percent allowed the experience to negatively affect their desire to work or alter their perception of their abilities. This resiliency may be due to the traditional African way of seeing each other in a group as family and reaching out to help each other. For example, Jallo et al., in a qualitative study of Sierra Leonean physicians working in the district, highlighted coping mechanisms including peer-to-peer support and formal and informal mentorship as key coping mechanism for burnout.(28) Lo et al., also emphasized the fact that even though Burnout originated as a western concept, understanding and coping with it has to be from the sociocultural perspectives of the community. (29)\u003c/p\u003e \u003cp\u003eThat is why our finding that moral injury was not significantly associated with burnout or professional fulfilment in our study may not be as counterintuitive as it initially appears when considered more closely. Many studies have found moral injury to be a predisposing factor to burnout (30) and some authors have gone as far as equating moral injury as burnout by another name.(14) In places with chronic shortage of medical resources like insufficient medication, equipment or personnel, moral injury might become so common health workers develop emotional callouses, so that they no longer consciously perceive or emotionally respond to those situations. This can occur through the processes of desensitization, when chronic repeated exposure to stressful or morally distressing situations can reduce emotional responsiveness;(31) and habituation, which is the reduced psychological and emotional reaction to repeated exposure to the same stressful stimulus (31\u0026ndash;33) whereby a doctor experiencing persistent moral distress may gradually perceive these events as part of a typical workday, thus lessening the emotional impact.\u003c/p\u003e \u003cp\u003eSeveral studies have identified various causal factors of burnout. These factors can be broadly classified into work, personal, and organizational factors.(34) Work factors include excessive workloads, long working hours, specialty choice, frequent call duties, professional status and seniority, and comprehensive documentation in electronic medical records.(11,29,34) Personal characteristics associated with burnout include sleep deprivation, inadequate support system outside work (e.g. having no spouse and children), age, sex, the presence of dependents, and the inability to balance work and family responsibilities. (11,27,29,30,34) Organizational-level factors include high workload, insufficient salary and rewards, inadequate facilities, bureaucratic tasks, social support for physicians, and administrative responsibilities. (11,24,27,34)\u003c/p\u003e \u003cp\u003eWith regard to work-related factors, some factors were found to be associated with both burnout and professional fulfilment. Young doctors, especially house officers, had higher rates of burnout and lower levels of professional fulfilment compared to consultants and specialists. This finding is consistent with several prior studies and is concerning, as burnout has been linked to poor performance in examinations.(4,6,11,21,27,28,35) This is particularly worrisome in the context of Sierra Leone, where efforts are ongoing to rebuild the specialist and consultant workforce.\u003c/p\u003e \u003cp\u003eTwo other work-related factors that were associated with both professional fulfilment and burnout were years since graduation and average hours of sleep per day when on call. Both are widely supported in the literature.(34) Older doctors tend to be less burned out and more fulfilled than their younger counterparts. Conversely, sleep deprivation, especially during on-call periods; is associated with higher burnout and reduced professional fulfilment, consistent with numerous previous reports in the literature.(11,29,34)\u003c/p\u003e \u003cp\u003eThis finding is particularly disconcerting in resource-poor settings such as Sierra Leone, where procedures like surgery and high-cost investigations are often delayed due to patients\u0026rsquo; inability to pay, as most payments are made out of pocket. Other causes of such delays include power outages, unavailability of essential anaesthetic drugs, and pending laboratory investigation results (our paper on delays).(36) It is one thing to be deprived of sleep while engaged in meaningful, progressive work; it is quite another to lose sleep while wasting time waiting for a procedure to be initiated; uncertain of when, or even whether, it will ever begin.(28,36,37)\u003c/p\u003e \u003cp\u003eThe doctor\u0026rsquo;s subspecialty was another work-related factor that was significantly associated with burnout, but not with professional fulfilment. Paediatrics, followed by surgery and then O\u0026amp;G, had the highest rates of burnout, while family medicine, psychiatry, and public health had the lowest. This disparity may be related to both workload and the previously mentioned issue of time-wasting delays. Both surgery and O\u0026amp;G are surgical subspecialties, and in resource-poor settings, avoidable delays are a major source of frustration and fatigue. Pediatrics, on the other hand, may be associated with the emotional toll of caring for suffering children, as well as the cumulative burden of time-consuming routine procedures, such as venous cannulation, which can be particularly lengthy when performed by interns or junior residents. On the other hand, doctors who choose surgical subspecialties, and especially paediatrics, often do so out of a deeply ingrained sense of calling and purpose. This core mission can be powerful and enduring. In these subspecialties, a successful operation or the delivery of a healthy baby has an immediate and visible impact. These \u0026ldquo;wins,\u0026rdquo; however hard-won, provide a profound sense of accomplishment and reinforce the physician\u0026rsquo;s sense of purpose. In paediatrics, even small improvements in a child\u0026rsquo;s health can be especially rewarding, as the vulnerability of the patients often deepens the physician\u0026rsquo;s sense of responsibility. Thus, while powerful conditions leading to exhaustion and cynicism (burnout) exists in these subspecialties, they are counterbalanced by their deeply ingrained motivation, and the intermittent, powerful positive outcomes which keep their core professional fulfilment intact.(38) They are \"burned out\" by the struggle, but not necessarily \"burned out\" from their deeply held professional identity and mission.\u003c/p\u003e \u003cp\u003ePersonal factors that have been found to be significantly associated with burnout among doctors has to do with children. Doctors with older children were also less likely to report burnout and more likely to report fulfilment than those with younger children. On the other hand, the actual number of children has no bearing on either burnout or professional burnout. These findings aligns with the results of O\u0026rsquo;Connor et al. among South African orthopaedic surgeons and residents.(11) However, in contrast to some previously reported studies, we found no association between gender and burnout.(11)\u003c/p\u003e \u003cp\u003eCuriously, self-reported alcohol use was not associated with either burnout or professional fulfilment. However, physicians who screened positive for hazardous drinking on the CAGE questionnaire did not differ in burnout scores but showed significantly lower levels of professional fulfilment. These findings are consistent with reports in the literature indicating that burnout and hazardous alcohol use are not always strongly correlated. A mixed-methods systematic review concluded that associations between burnout and substance misuse, which includes alcohol abuse, are inconsistent and often modest in magnitude.(39) Similarly, in a large cohort of U.S. surgeons, alcohol abuse was associated with lower career satisfaction; an indirect indicator of diminished professional fulfilment.(40) Our study also highlighted the limitations of simple yes/no self-report measures of alcohol use, which often fail to detect problematic consumption. In contrast, validated tools such as the CAGE or AUDIT questionnaires are more effective in capturing clinically relevant patterns that may affect professional well-being.\u003c/p\u003e \u003cp\u003eOrganization factors that are significantly associated with burnout and professional fulfilment include salary sufficiency. Less than one in ten doctors felt that their salaries were sufficient, and more than 50 percent reported having to work extra time to supplement their income. Organizational factors that are uniquely associated with professional fulfilment include employment status: doctors working in the public sector were less likely to be fulfilled than those working with NGOs or in the private sector. Additionally, physicians based in the districts reported higher fulfilment than those based in Freetown.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eApart from the inherent limitation of being a cross-sectional study, which restricts causal inference, the other major weakness lies in the sample size. Although adequate for simple bivariate analyses, the sample is insufficient for more complex interclass analyses and logistic regression. However, given the total number of physicians in the country and the broad geographic distribution of respondents across most of Sierra Leone, the sample size is reasonably large for generalization. A major strength of the study is that it represents the first reported investigation of burnout and professional fulfillment among physicians in Sierra Leone, and indeed in the West African subregion\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eRecommendation:\u003c/h2\u003e \u003cp\u003eThis study identified several factors that must be addressed to mitigate burnout and promote professional fulfillment among physicians working in Sierra Leone. Some of these factors are systemic and require action at both organizational and governmental levels. Key issues include salary sufficiency and workload; both of which have been consistently shown in prior studies to be fundamental in reducing burnout and enhancing professional fulfillment.\u003c/p\u003e \u003cp\u003eHouse officers and junior residents were found to be particularly vulnerable and should receive targeted interventions. Providing accommodation within hospital premises for house officers, for instance, would reduce the exhausting commute during odd hours often required by their duties. Additionally, departments with high patient volumes and inadequate physician staffing, such as pediatrics, should receive increased personnel support. Meals should also be provided for physicians on emergency duty.\u003c/p\u003e \u003cp\u003eGiven the heightened vulnerability of healthcare workers to burnout, institutional support systems, which have been shown to reduce burnout, should be put in place. Regular, structured assessments of burnout should be conducted. Furthermore, our findings indicate that self-administered drinking questionnaires were less sensitive than standardized tools such as the CAGE instrument for detecting alcohol-related problems. Therefore, validated screening tools must be included in burnout assessments to effectively identify alcohol misuse.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHigh-Income Countries (\u003cstrong\u003eHICS\u003c/strong\u003e), Low- And Middle-Income Countries (\u003cstrong\u003eLMICS\u003c/strong\u003e), Professional Fulfilment (\u003cstrong\u003ePF\u003c/strong\u003e), Professional Fulfillment Index (\u003cstrong\u003ePFI\u003c/strong\u003e),\u0026nbsp;Interquartile Range (\u003cstrong\u003eIQR\u003c/strong\u003e)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical approval was obtained from the Ethics and Scientific Review Committee of the University of Sierra Leone Teaching Hospitals Complex. The study was conducted in accordance with the Declaration of Helsinki (2013 revision). Informed consent was obtained from all participants. The online survey form contained an introductory section providing information about the study’s purpose, potential risks and benefits, confidentiality, and the participants’ right to withdraw from the study at any time. All study participants gave informed consent and voluntarily agreed to participate in the research (There was a statement to the effect that continuing with the study was consent to participate). To ensure data security, secure passwords protect all questionnaires and collected data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors declared that no grants were involved in supporting this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u0026nbsp;\u003c/strong\u003eK. S. O-Conceptualized the study, drafted the manuscript and performed statistical analysis, M. B – Manuscript draft, N. B- data collection and manuscript draft, A. O. A- Data collection, manuscript draft, S. S: data collection and manuscript draft I. O. O: Data analysis and C. O reviewed the manuscript. All authors read and approved the final draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to express their sincere gratitude to all individuals and institutions who contributed to the successful completion of this study. We are particularly grateful to the management and staff of the University of Sierra Teaching Hospitals Complex (USLTHC), College of Medicine and Allied Health Sciences-University of Sierra Leone (COMAHS-USL) and the Ola During Children’s Hospital for their invaluable support and collaboration. Our appreciation also goes to the study participants and their families for their time and cooperation. Finally, we thank all colleagues, and technical staff whose efforts made this work possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated for the study are available in the Open Science Framework (OSF) website at https://osf.io/5w2jn/?view_only=8d31f42190944013b0547a9ded69770c\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlahmari MA, Al Moaleem MM, Hamdi BA, Hamzi MA, Aljadaani AT, Khormi FA, et al. Prevalence of Burnout in Healthcare Specialties: A Systematic Review Using Copenhagen and Maslach Burnout Inventories. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2022;28:e938798-1. \u003c/li\u003e\n\u003cli\u003eRotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, et al. Prevalence of Burnout Among Physicians: A Systematic Review. 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Acad Psychiatry. 2018 Feb;42(1):11\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eDean W, Talbot S, Dean A. Reframing clinician distress: moral injury not burnout. Federal Practitioner. 2019;36(9):400. \u003c/li\u003e\n\u003cli\u003eBride BE, Radey M, Figley CR. Measuring Compassion Fatigue. Clin Soc Work J. 2007 Sept 1;35(3):155\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eKelly JDI. Your Best Life: Overcoming Approval Addiction. Clinical Orthopaedics and Related Research\u0026reg;. 2020 Aug;478(8):1733. \u003c/li\u003e\n\u003cli\u003eSakulku J, Alexander J. The Impostor Phenomenon. 2025 May 4 [cited 2025 May 4]; Available from: https://thementalhealthtoolbox.com/wp-content/uploads/2022/03/Sakulku.2011.The-impostor-phenomenon.pdf\u003c/li\u003e\n\u003cli\u003eOzeke O, Ozeke ,Vildan, Coskun ,Ozlem, and Budakoglu II. Second victims in health care: current perspectives. Advances in Medical Education and Practice. 2019 Aug 12;10:593\u0026ndash;603. \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Connor M, Ferreira N, Smith M, Webster P, Venter G, Marais L. High burnout among the South African orthopaedic community: a cross-sectional study. SA orthop j. 2022;61(3):132\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eBride BE, Radey M, Figley CR. Measuring Compassion Fatigue. Clin Soc Work J. 2007 Sept 1;35(3):155\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eOgunsuji OO, Adebayo O, Olaopa O, Efuntoye O, Agbogidi JM, Kanmodi K, et al. Burnout among Nigerian Doctors: A Systematic Review. Nigerian Medical Practitioner. 2019 Oct 17;76(1\u0026ndash;3):24\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eEksioglu M, Koca A, Azapoglu Kaymak B, Cimilli Ozturk T, Halil Elhan A. Validation of the Turkish Version of the Professional Fulfillment Index. West J Emerg Med. 2024 Nov 1;25(6):958\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eNyirigira G, Bailey J, Felix R, Neil K, Bould M, Kwizera R, et al. Staff burnout and its risk factors at King Faisal Hospital Rwanda: a cross-sectional survey. BMC Health Services Research. 2025 Apr 7;25. \u003c/li\u003e\n\u003cli\u003eSakamoto JT, Lee J, Lu DW, Sundaram V, Bird SB, Blomkalns AL, et al. Factors driving burnout and professional fulfillment among emergency medicine residents: A national wellness survey by the Society for Academic Emergency Medicine. AEM Educ Train. 2022 June 23;6(Suppl 1):S5\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003ePreiksaitis C, Wright KN, Alvarez A, Chan TM, Gottlieb M, Little AG, et al. Measuring burnout and professional fulfillment among emergency medicine residency program leaders in the United States: a cross-sectional survey study. Clin Exp Emerg Med. 2024 Sept 6;12(1):76\u0026ndash;85. \u003c/li\u003e\n\u003cli\u003eRazai MS, Kooner P, Majeed A. Strategies and Interventions to Improve Healthcare Professionals\u0026rsquo; Well-Being and Reduce Burnout. J Prim Care Community Health. 2023 May 29;14:21501319231178641. \u003c/li\u003e\n\u003cli\u003eLu DW, Lee J, Alvarez A, Sakamoto JT, Bird SB, Sundaram V, et al. Drivers of professional fulfillment and burnout among emergency medicine faculty: A national wellness survey by the Society for Academic Emergency Medicine. Academic Emergency Medicine. 2022;29(8):987\u0026ndash;98. \u003c/li\u003e\n\u003cli\u003eJalloh MB, Naveed A, Johnson SAA, Bah AK, Jegede AG, Barrie FB, et al. Perceptions of burnout among public sector physicians in Sierra Leone: A qualitative study. PLOS Glob Public Health. 2024 Sept 16;4(9):e0003739. \u003c/li\u003e\n\u003cli\u003eLo D, Wu F, Chan M, Chu R, Li D. A systematic review of burnout among doctors in China: a cultural perspective. Asia Pac Fam Med. 2018 Feb 8;17(1):3. \u003c/li\u003e\n\u003cli\u003eCousino MK, Bogle C, Lim HM, McCormick AD, Sturza J, Fredericks EM, et al. Burnout, professional fulfillment, and post-traumatic stress among pediatric solid organ transplant teams. Pediatr Transplant. 2021 June;25(4):e14020. \u003c/li\u003e\n\u003cli\u003eHabituation and sensitization | EBSCO Research Starters [Internet]. [cited 2025 July 30]. Available from: https://www.ebsco.com/research-starters/anatomy-and-physiology/habituation-and-sensitization\u003c/li\u003e\n\u003cli\u003eGrissom N, Bhatnagar S. Habituation to repeated stress: get used to it. Neurobiol Learn Mem. 2009 Sept;92(2):215\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eWhat is Habituation, and How Does it Work? - iMotions [Internet]. 2024 [cited 2025 July 30]. Available from: https://imotions.com/blog/insights/research-insights/what-is-habituation-and-how-does-it-work/\u003c/li\u003e\n\u003cli\u003ePatel RS, Bachu R, Adikey A, Malik M, Shah M. Factors Related to Physician Burnout and Its Consequences: A Review. Behav Sci (Basel). 2018 Oct 25;8(11):98. \u003c/li\u003e\n\u003cli\u003eOluwadiya KS, Owoeye OK, Adeoti AO. Evaluating the factor structure, reliability and validity of the Copenhagen Burnout Inventory-Student Survey (CBI-SS) among faculty of arts students of Ekiti State University, Ado-Ekiti, Nigeria. Sci Rep. 2024 May 7;14(1):10476. \u003c/li\u003e\n\u003cli\u003eOluwadiya KS, Olasinde AA, Olakulehin A, Olatoke SA, Oginni LM, Ako F. The Causes and Outcomes of Cancellation of Orthopaedic Surgeries at the Obafemi Awolowo University Teaching Hospital Complex lle-lfe, Nigeria. \u003c/li\u003e\n\u003cli\u003eS. Oluwadiya K. A Theatre Time Utilization Survey in a University Teaching Hospital from a Developing Country. J Anesthe Clinic Res [Internet]. 2012 [cited 2025 July 30];03(05). Available from: https://www.omicsonline.org/a-theatre-time-utilization-survey-in-a-university-teaching-hospital-from-a-developing-country-2155-6148.1000210.php?aid=6616\u003c/li\u003e\n\u003cli\u003eShanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings. 2017 Jan 1;92(1):129\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eRyan E, Hore K, Power J, Jackson T. The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: A mixed methods systematic review. Front Public Health [Internet]. 2023 Mar 30 [cited 2025 July 30];11. Available from: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1133484/full\u003c/li\u003e\n\u003cli\u003eOreskovich M, Shanafelt T, Dyrbye L, Tan LJ, Sotile W, Satele D, et al. The prevalence of substance use disorders in American physicians. The American Journal on Addictions. 2014 Nov 1;24. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sierra Leone, Burnout, Physicians Professional Fulfilment, Moral Injury, Workplace Stress","lastPublishedDoi":"10.21203/rs.3.rs-8544221/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8544221/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePhysician burnout is a significant occupational hazard, with a high prevalence in low- and middle-income countries. The burnout rate among clinicians in Sierra Leone, however, is unknown. This study aimed to determine the prevalence and predictors of burnout among Sierra Leonean physicians.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional, online-based study was conducted among 153 physicians across Sierra Leone. Using the Stanford Professional Fulfillment Index (PFI), the study assessed burnout as well as sociodemographic and workplace characteristics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall rates of burnout and professional fulfillment were 58.8 percent and 26.8 percent, respectively. Six variables, professional status, nationality, salary sufficiency, age of youngest and oldest children, and years in practice, were significantly associated with both burnout and professional fulfillment. Three factors (marital status, subspecialty, and supplementary income) were independently associated only with burnout, while four others (type of employer, practice location, hazardous drinking, and commuting distance to work) were associated only with professional fulfillment.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe burnout rate is high, while the professional fulfillment rate is low, among physicians practicing in Sierra Leone. Strategies designed to mitigate burnout while promoting professional fulfilment are needed among physicians in Sierra Leone.\u003c/p\u003e","manuscriptTitle":"Physician Burnout and Fulfilment in Sierra Leone Ii: an Online Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-10 16:47:50","doi":"10.21203/rs.3.rs-8544221/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-17T20:00:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106984566812577713955653298920928562610","date":"2026-02-17T10:39:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286271142968867098334672098972641289254","date":"2026-02-15T04:34:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"189863467529189961965153770759416880182","date":"2026-02-10T10:41:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92581355361540951246975248782441675455","date":"2026-02-06T16:59:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260195034577602499189162942975470779231","date":"2026-02-05T08:45:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-05T07:37:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-03T06:35:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-09T16:31:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-09T16:15:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-01-09T16:09:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"89d292b7-e987-4c66-85da-8e73271da15a","owner":[],"postedDate":"February 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-10T16:47:52+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-10 16:47:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8544221","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8544221","identity":"rs-8544221","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}