A cross-sectional study on physician burnout in Sudan: The role of workplace violence

A cross-sectional study on physician burnout in Sudan: The role of workplace violence | 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 A cross-sectional study on physician burnout in Sudan: The role of workplace violence Hassan Sarsour, Yasir Ahmed Mohammed Elhadi, Esra Abdallah Abdalwahed Mahgoub, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7456917/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Burnout is a widespread occupational hazard among physicians and can lead to negative effects on both physicians and patients. Sudanese physicians work in a fragile health system, and under very challenging conditions. However, a few studies have explored burnout drivers among them. This study aimed to measure burnout prevalence, determine its associated factors, and compare its levels among physicians in a major federal hospital in Sudan. Methods A cross-sectional study was conducted among physicians working at Ibrahim Malik teaching hospital in Khartoum, Sudan. An online questionnaire containing the Maslach Burnout Inventory-Human Services Survey for Medical Personnel was used to collect data from house officers, medical officers, and registrars. Burnout was defined as either i. high emotional exhaustion and high depersonalization, or ii. High emotional exhaustion and low personal accomplishment. Results Of the 245 physicians who participated in the study, 44 (18%) had burnout; 63 (25.7%) had high emotional exhaustion, 60 (24.5%) had high depersonalization, and 193 (78.8%) had low personal accomplishment. More than half (56.7%) had experienced workplace violence in the last year, which was associated with burnout (P = 0.024). The logistic regression found that female physicians had higher odds of burnout ( OR = 2.07, 95% CI: 1.00–4.28, P = 0.049). Also, physicians who experienced workplace violence had increased burnout odds ( OR = 2.53, 95% CI: 1.07–5.96) for one incident , and ( OR = 7.04, 95% CI: 1.65–30.08) for three or more incidents. Furthermore, high emotional exhaustion was associated with job title, while high depersonalization was associated with job title and experience. Conclusion High burnout prevalence was noticed among Sudanese physicians, which was linked to workplace violence. Policy makers should employ strict legislation to protect physicians at their workplace. Also, interventions such as expanding the hospital or hiring additional staff could be considered to reduce burnout. Burnout Physicians Maslach Burnout Inventory Workplace violence Sudan Introduction Burnout is a common occupational problem in people-centered professions, like healthcare, education, and human services. These occupations tend to have long working hours, intense personal engagement, and high stress levels, especially in low-resources settings [ 1 ]. Herbert Freudenberger, an American phycologist, used the term burnout in the seventies. He described the outcomes of severe stress among helping professions such as doctors and nurses who sacrifice their own well-being for their patients [ 2 ]. Burnout is not a medical condition [ 3 , 4 ]. Some researchers, including Schonfeld et al [ 5 ], argued that burnout is a form of depression [ 6 ]. But in depression the symptoms are generalized across the life aspects rather than only work-related in burnout [ 2 , 5 , 7 ]. No agreement was reached on one definition of burnout. However, building on the early work by Maslach et al [ 8 , 9 ], there is a consensus on the three main elements of the burnout experience: Emotional Exhaustion (EE), Depersonalization (DP), and reduced Personal Accomplishment (PA). Burnout was classified in the International Classification of Diseases-10 (ICD-10) under “problems related to life-management difficulty” [ 10 ]. The ICD-11 defines Burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and a sense of ineffectiveness and lack of accomplishment” [ 4 ]. Several tools have been developed to measure burnout; they differ in the number of dimensions that they assess; and the most used one is Maslach Burnout Inventory™ (MBI). The MBI assesses three scales of EE, DP, and PA [ 11 ]. Other tools, such as the Bergen Burnout Inventory [ 12 ], the Oldenburg Burnout Inventory [ 13 ], the Shirom-Melamed Burnout Measure [ 14 ], and the Copenhagen Burnout Inventory [ 15 ], differ in scope, but all of them measure the exhaustion component. Burnout is common among physicians; its prevalence can reach as high as 80.5% [ 6 ]. It can lead to decreased physician productivity, job dissatisfaction, absenteeism, increased turnover; substance use, depression and suicidal ideation, medical errors, and decreased patients’ satisfaction [ 16 ]. Physicians in Sudan face significant challenges that make them vulnerable to burnout, including difficult working conditions , low salaries, unpaid training, economic crisis and high inflation rate, and job insecurity. Also, Sudan has a physician density of only 2.5 per 10,000 population, which is below the regional and global rates (11.6 and 17.2 per 10,000 population respectively) [ 17 , 18 ]. Although some studies were conducted about physician burnout in Sudan, understanding its drivers is limited. This study aimed to assess the prevalence of burnout, identify its associated factors, and compare its levels among Sudanese physicians working at a major federal hospital to inform policies and workforce strategies. Methods Study design and setting A descriptive cross-sectional study was conducted at Ibrahim Malik teaching hospital, a major federal referral hospital in Khartoum, Sudan. The hospital was established in 1977 as a district hospital of the “Arkaweet” neighborhood. In 2016, it became a federal hospital without any infrastructure development. Consequently, its bed capacity was increased from 264 to 412. The study population was 629 physicians working at the hospital at the study time. They were distributed by job title as follows: 144 registrars, 216 house officers, and 269 medical officers. Data collection Data were collected between October 1 and October 31, 2022, using a standardized self-administered questionnaire distributed via Google forms. The questionnaire had two sections. Section one included informed consent and the study variables. Section two contained the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) tool [ 19 , 20 ], used under “license to administer” the MBI-HSS for Medical Personnel from Mind Garden platform [ 21 ]. The tool consists of 22 items, measured on a 7-point Likert scale ranging from (0 = never) to (6 = daily). It assesses the three dimensions of burnout; EE (nine items), DP (five items), and PA (eight items). Each scale is divided into low, moderate, or high with reference to pre-defined cut-off points. For EE: low (0–16), moderate (17–26), and high (≥ 27); for DP: low (0–6), moderate (7–12), and high (≥ 13); and for PA: low (≤ 31), moderate (32–38), and high (≥ 39) [ 20 ]. The criteria of either (high EE and high DP) or (high EE and low PA) was used to define burnout [ 22 ]. Data analysis Data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 25. Descriptive statistics focused on drawing percentages and proportions. Pearson’s Chi-square test was used to examine the associations between burnout and categorical variables. Binary logistic regression analysis was performed to identify independent predictors of burnout, and results were reported as odds ratios (OR) with 95% confidence intervals (CI). A P value < 0.05 was considered statistically significant. Ethical Considerations This study was carried out following the Helsinki Declaration principles. Ethical approval was granted by the Research Technical Committee , Al-Neelain University. Participation was voluntary. All participants provided written informed consent electronically. The consent was embedded at the beginning of the online questionnaire, and submission of the form was conditional on agreeing to participate. No personal identifiable information was collected, and the data confidentiality was maintained. Results Sociodemographic and work-related characteristics of participants The Sociodemographic and work-related characteristics of participants are presented in Table 1 . A total of 245 physicians participated in the study. Among these, 127 (51.8%) were males, and 118 (48.2%) were females. Almost half (n = 122, 49.8%) were less than 30 years old and more than half (n = 143,58.4%) were single. In terms of job title, 105 (42.9%) were medical officers, 84 (34.3%) were house officers, and 56 (22.9%) were registrars. The majority (n = 109, 44.5%) were practicing medicine for more than 2 years, and reported working between 25 to 48 hours (n = 104, 42.4%). About a quarter (n = 61, 24.9%) reported that they pursued a career in medicine to help people and alleviate suffering. More than half of participants (n = 139, 56.7%) have experienced violence at least once in the last year. Table 1 Sociodemographic and work-related characteristics of participants (n = 245). Characteristic N (%) Age (years) 35 45 (18.4) Gender Male 127 (51.8) Female 118 (48.2) Marital status Single 143 (58.4) Married 61 (24.9) Divorced 29 (11.8) Widowed 12 (4.9) Living situation With family 94 (38.4) Alone 54 (22) In a shared household 53 (21.6) With friends 44 (18) Reason for pursuing a career in medicine To help people/Alleviate pain and suffering 61 (24.9) Family Pressure 52 (21.2) Peer Pressure 51 (20.8) For Social prestige 47 (19.2) For Money 34 (13.9) Job Title House officer 84 (34.3) Medical officer 105 (42.9) Registrar 56 (22.9) Duration of practicing medicine (years) 2 109 (44.5) Working hours per week 8 to 24 67 (27.4) 25 to 48 104 (42.4) > 48 74 (30.2) Exposure to workplace violence (in the last year) Never 106 (43.3) once 83 (33.9) 2–3 times 43 (17.5) > 3 times 13 (5.3) Burnout among physicians Burnout levels across the three scales and the overall burnout are presented in Table 2 . Almost 4 of every 5 physicians (78.8%) had low personal accomplishment. About a quarter of physicians had high emotional exhaustion and high depersonalization (25.7%, and 24.5% respectively). The prevalence of overall burnout was 18%. Table 2 Burnout levels across the three scales and the overall burnout among physicians. Burnout Scales Low Moderate High Emotional Exhaustion (EE) a 136 (55.5%) 46 (18.8%) 63 (25.7%) Depersonalization (DP) b 87 (35.5%) 98 (40%) 60 (24.5%) Personal accomplishment (PA) c 193 (78.8%) 52 (10.2%) 27 (11%) Overall burnout d 44 (18%) a low (0–16), moderate (17–26), and high (≥ 27). b low (0–6), moderate (7–12), and high (≥ 13). c low (≤ 31), moderate (32–38), and high (≥ 39). d (high EE and high DP) or (high EE and low PA). Factors associated with burnout and its scales among physicians Table 3 shows the association between burnout and the sociodemographic and work-related characteristics. Burnout was significantly associated with exposure to violence in the last year (P = 0.024). No other significant associations were found between burnout and the other study variables. Table 3 Association between burnout and physicians’ sociodemographic and work-related characteristics. Characteristic Burnout (n = 44) No Burnout (n = 201) P-value a Age (years) 0.936 35 8 (17.8%) 37 (82.2%) Gender 0.109 Male 18 (14.2%) 109 (85.8%) Female 26 (22%) 92 (78%) Marital status 0.937 Single 24 (16.8%) 119 (83.2%) Married 12 (19.7%) 49 (80.3%) Divorced 6 (20.7%) 23 (79.3%) Widowed 2 (16.7%) 10 (83.3%) Living situation 0.650 With family 18 (19.1%) 76 (80.9%) Alone 9 (16.7%) 45 (83.3%) In a shared household 7 (13.2%) 46 (86.8%) With friends 10 (22.7%) 34 (77.3%) Reason for pursuing a career in medicine 0.251 To help people/Alleviate pain and suffering 10 (16.4%) 51 (83.6%) Family Pressure 11 (21.2%) 41 (78.8%) Peer Pressure 8 (15.7%) 43 (84.3%) For Social prestige 5 (10.6%) 42 (89.4%) For Money 10 (29.4%) 24 (70.6%) Job title 0.238 House officer 17 (20.2%) 67 (79.8%) Medical officer 14 (13.3%) 91 (86.7%) Registrar 13 (23.2%) 43 (76.8%) Duration of practicing medicine (years) 0.740 > 1 14 (20.9%) 53 (79.1%) 1 to 2 11 (15.9%) 58 (84.1%) > 2 19 (17.4%) 90 (82.6%) Working hours per week 0.708 8 to 24 13 (19.4%) 54 (80.6%) 25 to 48 20 (19.2%) 84 (80.8%) > 48 11 (14.9%) 63 (85.1%) Exposure to workplace violence (in the last year) 0.024* Never 11 (10.4%) 95 (89.6%) once 18 (21.7%) 65 (78.3%) 2–3 times 10 (23.3%) 33 (76.7%) > 3 times 5 (38.5%) 8 (61.5%) a Pearson Chi-Square test * Statistically significant at P-value < 0.05 Table 4 shows the association between burnout scales and some physicians’ characteristics. High emotional exhaustion was significantly associated with the job title (P = 0.001); it was highest among house officers. High depersonalization was significantly associated with the job title and experience (P values were 0.005 and 0.011, respectively). It was highest among the registers and those who had more than 2 years of experience. None of the variables studied were significantly associated with the level of personal accomplishment. Table 4 Association between burnout scales and some physicians’ characteristics. Burnout Scale Characteristic Category Low Moderate High P-value a Emotional Exhaustion Job title House officer 46 (54.8%) 11 (13.1%) 27 (32.1%) 0.001* Medical officer 70 (66.7%) 16 (15.2%) 19 (18.1%) Registrar 20 (35.7%) 19 (33.9%) 17 (30.4%) Experience 2 Years 63 (57.8%) 23 (21.1%) 23 (21.1%) Depersonalization Job title House officer 25 (29.8%) 36 (42.8%) 23 (27.4%) 0.005* Medical officer 47 (44.8%) 43 (40.9%) 15 (14.3%) Registrar 15 (26.8%) 19 (33.9%) 22 (39.3%) Experience 2 Years 27 (24.8%) 53 (48.6%) 29 (26.6%) Personal Accomplishment Job title House officer 68 (81.0%) 7 (8.3%) 9 (10.7%) 0.740 Medical officer 80 (76.2%) 11 (10.5%) 14 (13.3%) Registrar 45 (80.4%) 7 (12.5%) 4 (7.1%) Experience 2 Years 93 (85.3%) 8 (7.3%) 8 (7.3%) a Pearson Chi-Square test * Statistically significant at P-value < 0.05 Predictors of burnout Table 5 shows the results of the binary logistic regression that identify the predictors of burnout. The model demonstrated statistical significance (χ² (12) = 23.503, P = 0.024) accounting for 15% of the variance in burnout (Nagelkerke R²), and achieving an overall classification accuracy of 83.3%. The independent variables included in the model were gender, marital status, job title, working hours, and frequency of workplace violence. Two predictors were significant: gender and workplace violence. Female physicians had 2.1 the odds of burnout compared to their male counterparts (P = 0.049). Physicians who experienced workplace violence showed a significantly increased risk of burnout. The odds were 2.5 and 7 in those who had one incident of workplace violence, and three or more incidents, respectively, compared to those with no reported incidents. Table 5 Binary logistic regression predicting burnout among physicians. Predictor variable Category p-value Adjusted Odds Ratio (OR) 95% Confidence interval for OR Gender Male — Reference — Female 0.049 * 2.072 1.003–4.281 Job title Registrar — Reference — House officer 0.710 0.837 0.327–2.139 Medical officer 0.097 0.444 0.170–1.157 Working hours per week 8–24 hours — Reference — 25–48 hours 0.635 0.816 0.352–1.889 > 48 hours 0.097 0.416 0.148–1.171 Workplace violence during last year Never — Reference — > 3 time 0.008 * 7.047 1.650- 30.086 2–3 times 0.051 2.699 0.996–7.316 Once 0.034 * 2.533 1.073–5.976 Marital status Married — Reference — Not married 0.289 0.622 0.259–1.495 * Statistically significant at P-value < 0.05 Discussion This study aimed to assess the burnout prevalence, identify its associated factors, and compare its levels among physicians working at a major federal hospital in Sudan. We found that 18% of physicians had burnout; with 25.7% had high EE, 24.5% had high DP, and 78.8% had low PA. Burnout was associated with exposure to workplace violence, but no differences were found in relation to other study variables, including the job title. Gender (female) and exposure to workplace violence were found to be predictors of burnout. The findings suggest substantial stress among these physicians. The stress is further amplified by the high workload, as the hospital covers a large catchment area and receives a lot of patients. Our results are within global and regional ranges reported in two systematic reviews. Worldwide, Rotenstein et al reported a range of burnout prevalence (0%-80.5%); and high EE, high DP, and low PA prevalence ranges: (0%-86.2%), (0–89.9%), and (0%-87.1%), respectively [ 6 ]. In the Arab countries, Elbarazi et al reported these ranges for the three burnout scales: High EE (20–81.0%), high DP (9.2–80%), and low PA (13.3–85.8%) [ 23 ]. When comparing our results to previous studies, the physicians’ burnout prevalences vary. Our reported prevalence (18.0%) is consistent with two studies from Tunisia (17.4%) and Syria (19.3%) [ 24 , 25 ]. It is higher than a study from Yemen (11.7%) [ 26 ], and one from Sudan (13.9%) [ 27 ]. It is lower than a study in Egypt (22.6%) [ 28 ], and a study from Sudan (45.3%) [ 29 ]. It is far lower than two studies from UAE and KSA that reported prevalences of 70% and 80.7%, respectively [ 30 , 31 ]. These disparities can be explained using different definitions and tools to measure burnout prevalence; and different cut-off points of burnout three scales. We used two scales to define burnout; either i. high EE and high DP or ii. high EE and low PA [ 22 ]; Abdulrahman et al [ 30 ], and Hameed et al [ 31 ] used only one scale (either high EE or high DP); and most other studies used the three scales together (high EE and high DP and low PA). Like our study, Al-Dubai et al [ 26 ] and Elhadi et al [ 27 ] used cut-off points of ≥ 27, ≥13, and ≤ 31; while Alhaffar et al [ 24 ] used points of > 27, >9, < 33 for EE, DP, and PA, respectively. Abdulrahman et al [ 30 ], and Hameed et al [ 31 ] used cuff-off points of ≥ 27 for the EE, and ≥ 10 for the DP. In contrast to most studies, Ahmed et al. [ 29 ] used an abbreviated version of MBI (with 10 questions and 3-point scale instead of 22 questions and 6-point scale), which explains the high prevalence reported (45.3%). This is similar to a study that overestimated the prevalence by almost 40% when using the abbreviated version [ 32 ]. Our study found that 25.7% of participants had high EE. A similar finding was reported among neurologists in Saudi Arabia, where 23.5% of residents and 37.1% of consultants had high EE [ 33 ]. A higher percentage was reported in a study from Sudan that showed 44.4% of physicians and nurses had high EE [ 34 ]. Also, in a study from Egypt that found the overall high EE to be 46.9%, segregated as 39.7% of physicians and 52.8% of nurses [ 28 ]. The higher prevalence of EE among nurses might be due to higher workload when compared to physicians. High DP was found in 24.5% of participants in this study. Close results were reported from Egypt (22.6%) and Yemen (19.4%) [ 26 , 28 ]. Far higher results were reported among residents in KSA (70.6%) and UAE (84%) [ 30 , 31 ]. The reason behind these discrepancies might be because both studies from KSA and UAE sampled only residents, while our study and that from Yemen the sample included other physicians as well. This might indicate a higher stress in the residency programs. Our study found that 78.8% of participants had a high level of low PA. This finding was prominent across studies from Sudan, UAE, and Egypt. In these studies, the high levels of low PA among physicians were 73.1%, 74%, and 99.2%, respectively [ 27 , 28 , 30 ]. However, lower rates were seen in studies from Syria, Palestine, and Yemen. These Studies reported that the rates of high levels of low PA among physicians were 13.7%, 32.1 %, and 33, respectively [[ 24 , 26 , 35 ]. These variances might indicate different levels of social and/or financial rewards across health systems. In analysis of all the factors linked to burnout, only a significant association was found with exposure to workplace violence, either verbal or physical, in the last year. The logistic regression model showed that the odds of developing burnout are 2.5 in physicians who had one incident of workplace violence, and 7 in those who had three or more incidents. Similar findings were reported in studies from Palestine and Turkey [ 35 , 36 ]. Hamdan et al studied burnout among emergency departments workers in Palestine. They found a 2 times risk to develop a high level of burnout in those who experienced physical violence, but not verbal violence, in the last year [[ 35 ]. Hacer et al found that high EE and high DP were associated with physicians’ exposure to verbal and physical violence, while high EE, high DP, and low PA were associated with exposure to psychological violence [ 36 ]. Although gender showed no association with burnout in bivariate analysis, the logistic regression analysis revealed that female physicians had twice the odds to develop burnout compared to their male counterparts. This might indicate that gender effect becomes apparent after adjusting for other factors. Our finding corresponds to evidence from a systematic review that concluded that female physicians are more likely to experience burnout compared to male physicians , especially on the emotional exhaustion element [ 37 ]. When analyzing the parameters linked to the scales of burnout, we found that high EE was associated with the job title; high DP was associated with the job title and experience; and low PA had no associations. The frequency of high EE was the highest among the house officers. This might be explained by the fact that house officers are fresh graduates who joined medical practice recently, work with minimum supervision, and make decisions with outcomes on patients; also, the idea of being responsible for patients’ lives is overwhelming, so they end up exhausted emotionally. This association corresponds with the model that suggests a sequential progression of burnout; with EE being the first dimension to occur, followed by cynicism (DP), and lastly inefficiency (reduced PA) [ 7 ]. The frequency of high DP was the highest among registrars, and in those who had more than 2 years of experience (i.e. all registers but not all medical officers). This could be because with longer practice, some doctors prefer to keep distance and not be emotionally involved with their patients. This association agrees with the theory that burnout arises later in career, instead of earlier, as it is an outcome of long exposure to stressors [ 7 ]. Strengths and limitations Our study has several limitations. It employed a cross-sectional design, so it is not possible to establish a causal relationship. Furthermore, it included only one federal hospital due to resource constraints, hence its results cannot be generalized to the whole healthcare system in Sudan. However, it has notable strengths. Our study took place in one of the largest federal hospitals in Khartoum, the capital of Sudan. Unlike previous studies in Sudan, the study examined a comprehensive array of predictors of burnout, including workplace violence. Also, our study had a relatively large sample size compared to previous studies in Sudan. Conclusion This study found a high prevalence of burnout among physicians working at Ibrahim Malik teaching hospital. Exposure to workplace violence was found to be a significant predictor of burnout, with female physicians having a higher risk of burnout. The findings indicate high levels of stress among physicians, who work in an already fragile health system, augmented by high workload. The reported overall burnout, and its three dimensions are within global and regional ranges. Some variations were due to different methodologies and healthcare systems. Burnout dimensions varied with career level. The new physicians (house officers) reported higher EE levels, while more experienced physicians (such as registrars) reported higher DP levels. Our results highlight the need for a safer work environment. Policy makers should prioritize the development and implementation of strict legislation to address workplace violence. Also, efforts to expand the hospital, or hiring more staff could help reduce burnout. Declarations Ethics approval and consent to participate This study was carried out following the Helsinki Declaration principles. Ethical approval was granted by the Research Technical Committee, Al-Neelain University. Participation was voluntary. All participants provided written informed consent electronically. The consent was embedded at the beginning of the online questionnaire, and submission of the form was conditional on agreeing to participate. No personal identifiable information was collected, and the data confidentiality was maintained. Clinical trial registration Not applicable Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare that no competing interests exist Funding The authors received no specific funding for this work Authors contributions Conceptualization: HS; Methodology: HS, YAME; Investigation: HS, EAAM, YAME; Data curation: EAAM, YAME; Formal analysis: EAAM, YAME; Supervision: ASO; Writing – original draft: HS, YAME; Writing – review and editing: DAE, AM, ASO. All authors read and approved the final manuscript. Acknowledgements Not applicable References Maslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry. 2016;15: 103–111. doi:10.1002/wps.20311 Depression: Learn More – What is burnout? - InformedHealth.org - NCBI Bookshelf. [cited 4 June 2025]. 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Academic Journal of Research and Scientific Publishing |. 2020;3: 5–6. Available: www.ajrsp.comwww.ajrsp.com Abdulrahman M, Farooq M, Al Kharmiri A, Al Marzooqi F, Carrick F. Burnout and depression among medical residents in the United Arab Emirates: A Multicenter study. J Family Med Prim Care. 2018;7: 435. doi:10.4103/jfmpc.jfmpc_199_17 Hameed TK, Masuadi E, Al Asmary NA, Al-Anzi FG, Al Dubayee MS. A study of resident duty hours and burnout in a sample of Saudi residents. BMC Med Educ. 2018;18. doi:10.1186/s12909-018-1300-5 Lim WY, Ong J, Ong S, Hao Y, Abdullah HR, Koh DLK, et al. The abbreviated maslach burnout inventory can overestimate burnout: A study of anesthesiology residents. J Clin Med. 2020;9: 1–14. doi:10.3390/jcm9010061 Al-Qahtani ZA, Alhazzani A. Prevalence of burnout among neurologists in Saudi Arabia. Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021;57. doi:10.1186/s41983-021-00309-0 Hamid AAM, Abdullah AS. Job distress and burnout among Tanzanian and Sudanese health professionals: a comparative study. South African Journal of Psychology. 2020;50: 411–424. doi:10.1177/0081246319898054 Hamdan M, Hamra AA. Burnout among workers in emergency Departments in Palestinian hospitals: Prevalence and associated factors. BMC Health Serv Res. 2017;17. doi:10.1186/s12913-017-2356-3 Hacer TY, Ali A. Burnout in physicians who are exposed to workplace violence. J Forensic Leg Med. 2020;69. doi:10.1016/j.jflm.2019.101874 Hoff T, Lee DR. Burnout and Physician Gender: What Do We Know? Med Care. 2021 Aug 1;59(8):711-720. doi: 10.1097/MLR.0000000000001584 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-7456917","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":507797393,"identity":"67171641-abb6-4849-8a94-8cf92aa4de35","order_by":0,"name":"Hassan Sarsour","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYBACAwglkcAmwXwAxJAhVotNAr8EWwJICw+xWtISJGfwgNmEtZizH3/84eeOw3kGt3s+v7pRY8HDwH746AZ8Wix7cswke88cLja4c3abdc4xoMN40tJu4HXYgRw2Bt62w4kbbuRuM85hA2qR4DHDr+X888cf/4K15DwzzvlHjJYbCQbSvG1piTNn5DA/zm0jSssbM2nZNpvEfok0M+bcPgkeNoJ+OZ/++OPbNonENonkx59zvtXJ8bMfPoZXCzJgkwCTxCoHAeYPpKgeBaNgFIyCkQMAMuxM/WVxgtkAAAAASUVORK5CYII=","orcid":"","institution":"Sudan Medical Specialization Board","correspondingAuthor":true,"prefix":"","firstName":"Hassan","middleName":"","lastName":"Sarsour","suffix":""},{"id":507797394,"identity":"f747c987-64f6-4315-b4aa-580d25bb6e3c","order_by":1,"name":"Yasir Ahmed Mohammed Elhadi","email":"","orcid":"","institution":"United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Yasir","middleName":"Ahmed Mohammed","lastName":"Elhadi","suffix":""},{"id":507797395,"identity":"46e93a3a-0a09-481f-8ff7-b2f8864ca17e","order_by":2,"name":"Esra Abdallah Abdalwahed Mahgoub","email":"","orcid":"","institution":"Federal Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Esra","middleName":"Abdallah Abdalwahed","lastName":"Mahgoub","suffix":""},{"id":507797396,"identity":"a99760db-ebaa-4989-8552-3716068d79ac","order_by":3,"name":"Abdelmageed Musa","email":"","orcid":"","institution":"International University of Africa","correspondingAuthor":false,"prefix":"","firstName":"Abdelmageed","middleName":"","lastName":"Musa","suffix":""},{"id":507797397,"identity":"c5ff1b49-5a9b-4cc5-b2ba-0f8e9aedd01c","order_by":4,"name":"Daffalla Alam Elhuda","email":"","orcid":"","institution":"Federal Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Daffalla","middleName":"Alam","lastName":"Elhuda","suffix":""},{"id":507797398,"identity":"a79ec44b-4e4a-4495-aa4c-33c5a8765191","order_by":5,"name":"Amira Siddig Omer","email":"","orcid":"","institution":"Al-Neelain University","correspondingAuthor":false,"prefix":"","firstName":"Amira","middleName":"Siddig","lastName":"Omer","suffix":""}],"badges":[],"createdAt":"2025-08-25 20:53:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7456917/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7456917/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90464419,"identity":"69596050-8bbe-4eed-badf-1323228f7b98","added_by":"auto","created_at":"2025-09-03 05:09:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1284754,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7456917/v1/0e58f487-d2ac-445c-859e-e06ec85f1bd0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A cross-sectional study on physician burnout in Sudan: The role of workplace violence","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBurnout is a common occupational problem in people-centered professions, like healthcare, education, and human services. These occupations tend to have long working hours, intense personal engagement, and high stress levels, especially in low-resources settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Herbert Freudenberger, an American phycologist, used the term burnout in the seventies. He described the outcomes of severe stress among helping professions such as doctors and nurses who sacrifice their own well-being for their patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBurnout is not a medical condition [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Some researchers, including Schonfeld et al [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], argued that burnout is a form of depression [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. But in depression the symptoms are generalized across the life aspects rather than only work-related in burnout [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. No agreement was reached on one definition of burnout. However, building on the early work by Maslach et al [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], there is a consensus on the three main elements of the burnout experience: Emotional Exhaustion (EE), Depersonalization (DP), and reduced Personal Accomplishment (PA).\u003c/p\u003e\u003cp\u003eBurnout was classified in the International Classification of Diseases-10 (ICD-10) under \u0026ldquo;problems related to life-management difficulty\u0026rdquo; [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The ICD-11 defines Burnout as \u0026ldquo;a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one\u0026rsquo;s job, or feelings of negativism or cynicism related to one's job; and a sense of ineffectiveness and lack of accomplishment\u0026rdquo; [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral tools have been developed to measure burnout; they differ in the number of dimensions that they assess; and the most used one is Maslach Burnout Inventory\u0026trade; (MBI). The MBI assesses three scales of EE, DP, and PA [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Other tools, such as the Bergen Burnout Inventory [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], the Oldenburg Burnout Inventory [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], the Shirom-Melamed Burnout Measure [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and the Copenhagen Burnout Inventory [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], differ in scope, but all of them measure the exhaustion component.\u003c/p\u003e\u003cp\u003eBurnout is common among physicians; its prevalence can reach as high as 80.5% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It can lead to decreased physician productivity, job dissatisfaction, absenteeism, increased turnover; substance use, depression and suicidal ideation, medical errors, and decreased patients\u0026rsquo; satisfaction [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePhysicians in Sudan face significant challenges that make them vulnerable to burnout, including \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003edifficult working conditions\u003c/span\u003e, low salaries, unpaid training, economic crisis and high inflation rate, and job insecurity. Also, Sudan has a physician density of only 2.5 per 10,000 population, which is below the regional and global rates (11.6 and 17.2 per 10,000 population respectively) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough some studies were conducted about physician burnout in Sudan, understanding its drivers is limited. This study aimed to assess the prevalence of burnout, identify its associated factors, and \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ecompare its levels\u003c/span\u003e among Sudanese physicians working at a major federal hospital to inform policies and workforce strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eA descriptive cross-sectional study was conducted at Ibrahim Malik teaching hospital, a major federal referral hospital in Khartoum, Sudan. The hospital was established in 1977 as a district hospital of the \u0026ldquo;Arkaweet\u0026rdquo; neighborhood. In 2016, it became a federal hospital without any infrastructure development. Consequently, its bed capacity was increased from 264 to 412. The study population was 629 physicians working at the hospital at the study time. They were distributed by job title as follows: 144 registrars, 216 house officers, and 269 medical officers.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected between October 1 and October 31, 2022, using a standardized self-administered questionnaire distributed via Google forms. The questionnaire had two sections. Section one included informed consent and the study variables. Section two contained the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) tool [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], used under \u0026ldquo;license to administer\u0026rdquo; the MBI-HSS for Medical Personnel from Mind Garden platform [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The tool consists of 22 items, measured on a 7-point Likert scale ranging from (0\u0026thinsp;=\u0026thinsp;never) to (6\u0026thinsp;=\u0026thinsp;daily). It assesses the three dimensions of burnout; EE (nine items), DP (five items), and PA (eight items). Each scale is divided into low, moderate, or high with reference to pre-defined cut-off points. For EE: low (0\u0026ndash;16), moderate (17\u0026ndash;26), and high (\u0026ge;\u0026thinsp;27); for DP: low (0\u0026ndash;6), moderate (7\u0026ndash;12), and high (\u0026ge;\u0026thinsp;13); and for PA: low (\u0026le;\u0026thinsp;31), moderate (32\u0026ndash;38), and high (\u0026ge;\u0026thinsp;39) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The criteria of either (high EE and high DP) or (high EE and low PA) was used to define burnout [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using Statistical Package for the Social Sciences (SPSS) Version 25. Descriptive statistics focused on drawing percentages and proportions. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePearson\u0026rsquo;s Chi-square test was used to examine the associations between burnout and categorical variables. Binary logistic regression analysis was performed to identify independent predictors of burnout, and results were reported as odds ratios (OR) with 95% confidence intervals (CI).\u003c/span\u003e A P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e This study was carried out following the Helsinki Declaration principles.\u003c/span\u003e Ethical approval was granted by the \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eResearch Technical Committee\u003c/span\u003e, Al-Neelain University. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eParticipation was voluntary. All\u003c/span\u003e participants provided written informed consent electronically. The consent was embedded at the beginning of the online questionnaire, and submission of the form was conditional on agreeing to participate. No personal identifiable information was collected, and the data confidentiality was maintained.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSociodemographic and work-related characteristics of participants\u003c/h2\u003e\u003cp\u003eThe Sociodemographic and work-related characteristics of participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 245 physicians participated in the study. Among these, 127 (51.8%) were males, and 118 (48.2%) were females. Almost half (n\u0026thinsp;=\u0026thinsp;122, 49.8%) were less than 30 years old and more than half (n\u0026thinsp;=\u0026thinsp;143,58.4%) were single. In terms of job title, 105 (42.9%) were medical officers, 84 (34.3%) were house officers, and 56 (22.9%) were registrars. The majority (n\u0026thinsp;=\u0026thinsp;109, 44.5%) were practicing medicine for more than 2 years, and reported working between 25 to 48 hours (n\u0026thinsp;=\u0026thinsp;104, 42.4%). About a quarter (n\u0026thinsp;=\u0026thinsp;61, 24.9%) reported that they pursued a career in medicine to help people and alleviate suffering. More than half of participants (n\u0026thinsp;=\u0026thinsp;139, 56.7%) have experienced violence at least once in the last year.\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\u003eSociodemographic and work-related characteristics of participants (n\u0026thinsp;=\u0026thinsp;245).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e122 (49.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78 (31.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45 (18.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\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\u003e127 (51.8)\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\u003e118 (48.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\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\u003e143 (58.4)\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\u003e61 (24.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (11.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (4.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving situation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94 (38.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn a shared household\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53 (21.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReason for pursuing a career in medicine\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo help people/Alleviate pain and suffering\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (24.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily Pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (21.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeer Pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (20.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFor Social prestige\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47 (19.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFor Money\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (13.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eJob Title\u003c/b\u003e\u003c/p\u003e\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\u003e84 (34.3)\u003c/p\u003e\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\u003e105 (42.9)\u003c/p\u003e\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\u003e56 (22.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of practicing medicine (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (27.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 to 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (28.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e109 (44.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorking hours per week\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8 to 24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (27.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25 to 48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e104 (42.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74 (30.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExposure to workplace violence (in the last year)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106 (43.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eonce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (33.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;3 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (17.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (5.3)\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\u003eBurnout among physicians\u003c/h3\u003e\n\u003cp\u003eBurnout levels across the three scales and the overall burnout are presented in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Almost 4 of every 5 physicians (78.8%) had low personal accomplishment. About a quarter of physicians had high emotional exhaustion and high depersonalization (25.7%, and 24.5% respectively). \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe prevalence of overall burnout was 18%.\u003c/span\u003e\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\u003eBurnout levels across the three scales and the overall burnout among physicians.\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=\"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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBurnout Scales\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh\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\u003eEmotional Exhaustion (EE)\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e136 (55.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDepersonalization (DP)\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (35.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98 (40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60 (24.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePersonal accomplishment (PA)\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e193 (78.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOverall burnout\u003c/b\u003e \u003csup\u003e\u003cb\u003ed\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e44 (18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ea low (0\u0026ndash;16), moderate (17\u0026ndash;26), and high (\u0026ge;\u0026thinsp;27).\u003c/p\u003e\u003cp\u003eb low (0\u0026ndash;6), moderate (7\u0026ndash;12), and high (\u0026ge;\u0026thinsp;13).\u003c/p\u003e\u003cp\u003ec low (\u0026le;\u0026thinsp;31), moderate (32\u0026ndash;38), and high (\u0026ge;\u0026thinsp;39).\u003c/p\u003e\u003cp\u003ed (high EE and high DP) or (high EE and low PA).\u003c/p\u003e\n\u003ch3\u003eFactors associated with burnout and its scales among physicians\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the association between burnout and the sociodemographic and work-related characteristics. Burnout was significantly associated with exposure to violence in the last year (P\u0026thinsp;=\u0026thinsp;0.024). No other significant associations were found between burnout and the other study variables.\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\u003eAssociation between burnout and physicians\u0026rsquo; sociodemographic and work-related characteristics.\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=\"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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBurnout (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo Burnout (n\u0026thinsp;=\u0026thinsp;201)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value a\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e0.936\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (17.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101 (82.8%)\u003c/p\u003e\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\u003e30\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (19.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63 (80.8%)\u003c/p\u003e\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\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (17.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (82.2%)\u003c/p\u003e\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\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.109\u003c/b\u003e\u003c/p\u003e\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\u003e18 (14.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e109 (85.8%)\u003c/p\u003e\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\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92 (78%)\u003c/p\u003e\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\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.937\u003c/b\u003e\u003c/p\u003e\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\u003e24 (16.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119 (83.2%)\u003c/p\u003e\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\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49 (80.3%)\u003c/p\u003e\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\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (20.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (79.3%)\u003c/p\u003e\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\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (83.3%)\u003c/p\u003e\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\u003e\u003cb\u003eLiving situation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.650\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (19.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (80.9%)\u003c/p\u003e\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\u003eAlone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45 (83.3%)\u003c/p\u003e\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\u003eIn a shared household\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (13.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (86.8%)\u003c/p\u003e\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\u003eWith friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (77.3%)\u003c/p\u003e\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\u003e\u003cb\u003eReason for pursuing a career in medicine\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.251\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo help people/Alleviate pain and suffering\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (83.6%)\u003c/p\u003e\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\u003eFamily Pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (21.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (78.8%)\u003c/p\u003e\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\u003ePeer Pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (15.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (84.3%)\u003c/p\u003e\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\u003eFor Social prestige\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (10.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (89.4%)\u003c/p\u003e\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\u003eFor Money\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (29.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (70.6%)\u003c/p\u003e\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\u003e\u003cb\u003eJob title\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.238\u003c/b\u003e\u003c/p\u003e\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\u003e17 (20.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (79.8%)\u003c/p\u003e\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\u003eMedical officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (13.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91 (86.7%)\u003c/p\u003e\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\u003eRegistrar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (23.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (76.8%)\u003c/p\u003e\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\u003e\u003cb\u003eDuration of practicing medicine (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.740\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (20.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (79.1%)\u003c/p\u003e\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\u003e1 to 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (84.1%)\u003c/p\u003e\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\u003e\u0026gt;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (17.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90 (82.6%)\u003c/p\u003e\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\u003e\u003cb\u003eWorking hours per week\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.708\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8 to 24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54 (80.6%)\u003c/p\u003e\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\u003e25 to 48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (19.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 (80.8%)\u003c/p\u003e\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\u003e\u0026gt;\u0026thinsp;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (14.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63 (85.1%)\u003c/p\u003e\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\u003e\u003cb\u003eExposure to workplace violence (in the last year)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.024*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (10.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95 (89.6%)\u003c/p\u003e\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\u003eonce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (21.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (78.3%)\u003c/p\u003e\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\u003e2\u0026ndash;3 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (76.7%)\u003c/p\u003e\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\u003e\u0026gt;\u0026thinsp;3 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (38.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (61.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ea Pearson Chi-Square test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Statistically significant at P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the association between burnout scales and some physicians\u0026rsquo; characteristics. High emotional exhaustion was significantly associated with the job title (P\u0026thinsp;=\u0026thinsp;0.001); it was highest among house officers. High depersonalization was significantly associated with the job title and experience (P values were 0.005 and 0.011, respectively). It was highest among the registers and those who had more than 2 years of experience. None of the variables studied were significantly associated with the level of personal accomplishment.\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 scales and some physicians\u0026rsquo; 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=\"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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBurnout Scale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003eEmotional Exhaustion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eJob title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHouse officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46 (54.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (13.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27 (32.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedical officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (66.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19 (18.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRegistrar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (35.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (33.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17 (30.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eExperience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (47.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24 (35.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.257\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;2 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (59.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (17.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16 (23.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;2 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63 (57.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (21.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23 (21.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003eDepersonalization\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eJob title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHouse officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (29.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36 (42.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23 (27.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.005*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedical officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47 (44.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43 (40.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRegistrar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (26.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (33.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22 (39.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eExperience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (50.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (28.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14 (20.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.011*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;2 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26 (37.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (37.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17 (24.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;2 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (24.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53 (48.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29 (26.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003ePersonal\u003c/b\u003e \u003c/p\u003e\u003cp\u003e\u003cb\u003eAccomplishment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eJob title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHouse officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68 (81.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9 (10.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.740\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedical officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80 (76.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14 (13.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRegistrar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45 (80.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eExperience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47 (70.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (13.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.194\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;2 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53 (76.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (11.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8 (11.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;2 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93 (85.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (7.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8 (7.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003ea Pearson Chi-Square test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e* Statistically significant at P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePredictors of burnout\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the results of the binary logistic regression that identify the predictors of burnout. The model demonstrated statistical significance (χ\u0026sup2; (12)\u0026thinsp;=\u0026thinsp;23.503, P\u0026thinsp;=\u0026thinsp;0.024) accounting for 15% of the variance in burnout (Nagelkerke R\u0026sup2;), and achieving an overall classification accuracy of 83.3%. The independent variables included in the model were gender, marital status, job title, working hours, and frequency of workplace violence. Two predictors were significant: gender and workplace violence. Female physicians had 2.1 the odds of burnout compared to their male counterparts (P\u0026thinsp;=\u0026thinsp;0.049). Physicians who experienced workplace violence showed a significantly increased risk of burnout. The odds were 2.5 and 7 in those who had one incident of workplace violence, and three or more incidents, respectively, compared to those with no reported incidents.\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\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBinary logistic regression predicting burnout among physicians.\u003c/span\u003e\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=\"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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePredictor variable\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCategory\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ep-value\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAdjusted Odds Ratio (OR)\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e95% Confidence interval for OR\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eGender\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMale\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eReference\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFemale\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.049\u003c/span\u003e\u003csup\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.072\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1.003\u0026ndash;4.281\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eJob title\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eRegistrar\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eReference\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eHouse officer\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.710\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.837\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.327\u0026ndash;2.139\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMedical officer\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.097\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.444\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.170\u0026ndash;1.157\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eWorking hours per week\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e8\u0026ndash;24 hours\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eReference\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e25\u0026ndash;48 hours\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.635\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.816\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.352\u0026ndash;1.889\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026gt;\u0026thinsp;48 hours\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.097\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.416\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.148\u0026ndash;1.171\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eWorkplace violence during last year\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNever\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eReference\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026gt;\u0026thinsp;3 time\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.008\u003c/span\u003e\u003csup\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e7.047\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1.650- 30.086\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2\u0026ndash;3 times\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.051\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.699\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.996\u0026ndash;7.316\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOnce\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.034\u003c/span\u003e\u003csup\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.533\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1.073\u0026ndash;5.976\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eMarital status\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMarried\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eReference\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026mdash;\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNot married\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.289\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.622\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.259\u0026ndash;1.495\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Statistically significant at P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to assess the burnout prevalence, identify its associated factors, and compare its levels among physicians working at \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea major federal hospital in Sudan. We\u003c/span\u003e found that 18% of physicians had burnout; with 25.7% had high EE, 24.5% had high DP, and 78.8% had low PA. Burnout was associated with exposure to workplace violence, but no differences were found in relation to other study variables, including the job title. Gender (female) and exposure to workplace violence \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewere found to be predictors of burnout.\u003c/span\u003e The findings suggest substantial stress among these physicians. The stress is further amplified by the high workload, as the hospital covers a large catchment area and receives a lot of patients.\u003c/p\u003e\u003cp\u003e Our results are within global and regional ranges reported in two systematic reviews. Worldwide, Rotenstein et al reported a range of burnout prevalence (0%-80.5%); and high EE, high DP, and low PA prevalence ranges: (0%-86.2%), (0\u0026ndash;89.9%), and (0%-87.1%), respectively [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In the Arab countries, Elbarazi et al reported these ranges for the three burnout scales: High EE (20\u0026ndash;81.0%), high DP (9.2\u0026ndash;80%), and low PA (13.3\u0026ndash;85.8%) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhen comparing our results to previous studies, the physicians\u0026rsquo; burnout prevalences vary. Our reported prevalence (18.0%) is consistent with two studies from Tunisia (17.4%) and Syria (19.3%) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It is higher than a study from Yemen (11.7%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and one from Sudan (13.9%) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It is lower than a study in Egypt (22.6%) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and a study from Sudan (45.3%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. It is far lower than two studies from UAE and KSA that reported prevalences of 70% and 80.7%, respectively [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese disparities can be explained using different definitions and tools to measure burnout prevalence; and different cut-off points of burnout three scales. We used two scales to define burnout; either i. high EE and high DP or ii. high EE and low PA [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]; Abdulrahman et al [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and Hameed et al [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] used only one scale (either high EE or high DP); and most other studies used the three scales together (high EE and high DP and low PA). Like our study, Al-Dubai et al [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and Elhadi et al [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] used cut-off points of \u0026ge;\u0026thinsp;27, \u0026ge;13, and \u0026le;\u0026thinsp;31; while Alhaffar et al [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] used points of \u0026gt;\u0026thinsp;27, \u0026gt;9, \u0026lt; 33 for EE, DP, and PA, respectively. Abdulrahman et al [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and Hameed et al [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] used cuff-off points of \u0026ge;\u0026thinsp;27 for the EE, and \u0026ge;\u0026thinsp;10 for the DP. In contrast to most studies, Ahmed et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] used an abbreviated version of MBI (with 10 questions and 3-point scale instead of 22 questions and 6-point scale), which explains the high prevalence reported (45.3%). This is similar to a study that overestimated the prevalence by almost 40% when using the abbreviated version [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study found that 25.7% of participants had high EE. A similar finding was reported among neurologists in Saudi Arabia, where 23.5% of residents and 37.1% of consultants had high EE [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. A higher percentage was reported in a study from Sudan that showed 44.4% of physicians and nurses had high EE [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Also, in a study from Egypt that found the overall high EE to be 46.9%, segregated as 39.7% of physicians and 52.8% of nurses [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The higher prevalence of EE among nurses might be due to higher workload when compared to physicians.\u003c/p\u003e\u003cp\u003eHigh DP was found in 24.5% of participants in this study. Close results were reported from Egypt (22.6%) and Yemen (19.4%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Far higher results were reported among residents in KSA (70.6%) and UAE (84%) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The reason behind these discrepancies might be because both studies from KSA and UAE sampled only residents, while our study and that from Yemen the sample included other physicians as well. This might indicate a higher stress in the residency programs.\u003c/p\u003e\u003cp\u003eOur study found that 78.8% of participants had a high level of low PA. This finding was prominent across studies from Sudan, UAE, and Egypt. In these studies, the high levels of low PA among physicians were 73.1%, 74%, and 99.2%, respectively [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, lower rates were seen in studies from Syria, Palestine, and Yemen. These Studies reported that the rates of high levels of low PA among physicians were 13.7%, 32.1 %, and 33, respectively [[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These variances might indicate different levels of social and/or financial rewards across health systems.\u003c/p\u003e\u003cp\u003eIn analysis of all the factors linked to burnout, only a significant association was found with exposure to workplace violence, either verbal or physical, in the last year. The logistic regression model showed that the odds of developing burnout are 2.5 in physicians who had one incident of workplace violence, and 7 in those who had three or more incidents. Similar findings were reported in studies from Palestine and Turkey [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Hamdan et al studied burnout among emergency departments workers in Palestine. They found a 2 times risk to develop a high level of burnout in those who experienced physical violence, but not verbal violence, in the last year [[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Hacer et al found that high EE and high DP were associated with physicians\u0026rsquo; exposure to verbal and physical violence, while high EE, high DP, and low PA were associated with exposure to psychological violence [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough gender showed no association with burnout in bivariate analysis, the logistic regression analysis revealed that female physicians had twice the odds to develop burnout compared to their male counterparts. This might indicate that gender effect becomes apparent after adjusting for other factors. Our finding corresponds to evidence from a systematic review that concluded that female physicians are more likely to experience burnout \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ecompared to male physicians\u003c/span\u003e, especially on the emotional exhaustion element [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhen analyzing the parameters linked to the scales of burnout, we found that high EE was associated with the job title; high DP was associated with the job title and experience; and low PA had no associations. The frequency of high EE was the highest among the house officers. This might be explained by the fact that house officers are fresh graduates who joined medical practice recently, work with minimum supervision, and make decisions with outcomes on patients; also, the idea of being responsible for patients\u0026rsquo; lives is overwhelming, so they end up exhausted emotionally. This association corresponds with the model that suggests a sequential progression of burnout; with EE being the first dimension to occur, followed by cynicism (DP), and lastly inefficiency (reduced PA) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The frequency of high DP was the highest among registrars, and in those who had more than 2 years of experience (i.e. all registers but not all medical officers). This could be because with longer practice, some doctors prefer to keep distance and not be emotionally involved with their patients. This association agrees with the theory that burnout arises later in career, instead of earlier, as it is an outcome of long exposure to stressors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eOur study has several limitations. It employed a cross-sectional design, so it is not possible to establish a causal relationship. Furthermore, it included only one federal hospital due to resource constraints, hence its results cannot be generalized to the whole healthcare system in Sudan. However, it has notable strengths. Our study took place in one of the largest federal hospitals in Khartoum, the capital of Sudan. Unlike previous studies in Sudan, the study examined a comprehensive array of predictors of burnout, including workplace violence. Also, our study had a relatively large sample size compared to previous studies in Sudan.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis study found a high prevalence of burnout among physicians working at Ibrahim Malik teaching hospital. Exposure to workplace violence was found to be a significant predictor of burnout, with female physicians having a higher risk of burnout. The findings indicate high levels of stress among physicians, who work in an already fragile health system, augmented by high workload. The reported overall burnout, and its three dimensions are within global and regional ranges.\u003c/span\u003e Some variations were due to different methodologies and healthcare systems. Burnout dimensions varied with career level. The new physicians (house officers) reported higher EE levels, while more experienced physicians (such as registrars) reported higher DP levels. Our results highlight the need for a safer work environment. Policy makers should prioritize the development and implementation of strict legislation to address workplace violence. Also, efforts to \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eexpand the hospital, or hiring more staff could help reduce burnout.\u003c/span\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cbr\u003eThis study was carried out following the Helsinki Declaration principles. Ethical approval was granted\u0026nbsp;by the Research Technical Committee, Al-Neelain University. Participation was voluntary. All participants provided written informed consent electronically. The consent was embedded at the beginning of the online questionnaire, and submission of the form was conditional on agreeing to participate. No personal identifiable information was collected, and the data confidentiality was maintained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003cbr\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cbr\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no competing interests exist\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003eThe authors received no specific funding for this work \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003cbr\u003eConceptualization: HS; Methodology: HS, YAME; Investigation: HS, EAAM, YAME; Data curation: EAAM, YAME; Formal analysis: EAAM, YAME; Supervision: ASO; Writing \u0026ndash; original draft: HS, YAME; Writing \u0026ndash; review and editing: DAE, AM, ASO. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cbr\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMaslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry. 2016;15: 103\u0026ndash;111. doi:10.1002/wps.20311\u003c/li\u003e\n \u003cli\u003eDepression: Learn More \u0026ndash; What is burnout? - InformedHealth.org - NCBI Bookshelf. [cited 4 June 2025]. Available: https://www.ncbi.nlm.nih.gov/books/NBK279286/\u003c/li\u003e\n \u003cli\u003eBurn-out an \u0026ldquo;occupational phenomenon\u0026rdquo;: International Classification of Diseases. [cited 4 June 2025]. Available: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. 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Prevalence of and factors associated with burnout among health care professionals in Arab countries : a systematic review. 2017; 1\u0026ndash;10. doi:10.1186/s12913-017-2319-8\u003c/li\u003e\n \u003cli\u003eAlhaffar BA, Abbas G, Alhaffar AA. The prevalence of burnout syndrome among resident physicians in Syria. Journal of Occupational Medicine and Toxicology. 2019;14. doi:10.1186/s12995-019-0250-0\u003c/li\u003e\n \u003cli\u003eBen Zid A, Homri W, Ben Romdhane I, Bram N, Labbane R. Burnout in Tunisian medical residents: About 149 cases. Encephale. 2018;44: 337\u0026ndash;342. doi:10.1016/j.encep.2017.06.006\u003c/li\u003e\n \u003cli\u003eAl-Dubai S, Abdo Radman AL-DUBAI S, Gopal RAMPAL K. Prevalence and Associated Factors of Burnout among Doctors in Yemen. J Occup Health. 2010.\u003c/li\u003e\n \u003cli\u003eElhadi YAM, Ahmed A, Salih EB, Abdelhamed OS, Ahmed MHH, Dabbah NA El. A cross-sectional survey of burnout in a sample of resident physicians in Sudan. PLoS One. 2022;17. doi:10.1371/journal.pone.0265098\u003c/li\u003e\n \u003cli\u003eAbdo SA, El-Sallamy RM, El-Sherbiny AA, Kabbash IA. Burnout among physicians and nursing staff working in the emergency hospital of Tanta University, Egypt. East Mediterr Health J. 2016 Mar 15;21(12):906-15. doi: 10.26719/2015.21.12.906\u003c/li\u003e\n \u003cli\u003eHamid Abdulhamid O, Eldin Eljack Suleiman I. The Prevalence and Factors associated with Burnout among Sudanese Health Care Professionals at Primary Health Care Centers in Wad Madani Al-Kubra (Sudan), and Sharjah (UAE), 20 October \u0026ndash; 20 November 2020. Academic Journal of Research and Scientific Publishing |. 2020;3: 5\u0026ndash;6. Available: www.ajrsp.comwww.ajrsp.com\u003c/li\u003e\n \u003cli\u003eAbdulrahman M, Farooq M, Al Kharmiri A, Al Marzooqi F, Carrick F. Burnout and depression among medical residents in the United Arab Emirates: A Multicenter study. J Family Med Prim Care. 2018;7: 435. doi:10.4103/jfmpc.jfmpc_199_17\u003c/li\u003e\n \u003cli\u003eHameed TK, Masuadi E, Al Asmary NA, Al-Anzi FG, Al Dubayee MS. A study of resident duty hours and burnout in a sample of Saudi residents. BMC Med Educ. 2018;18. doi:10.1186/s12909-018-1300-5\u003c/li\u003e\n \u003cli\u003eLim WY, Ong J, Ong S, Hao Y, Abdullah HR, Koh DLK, et al. The abbreviated maslach burnout inventory can overestimate burnout: A study of anesthesiology residents. J Clin Med. 2020;9: 1\u0026ndash;14. doi:10.3390/jcm9010061\u003c/li\u003e\n \u003cli\u003eAl-Qahtani ZA, Alhazzani A. Prevalence of burnout among neurologists in Saudi Arabia. Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021;57. doi:10.1186/s41983-021-00309-0\u003c/li\u003e\n \u003cli\u003eHamid AAM, Abdullah AS. Job distress and burnout among Tanzanian and Sudanese health professionals: a comparative study. South African Journal of Psychology. 2020;50: 411\u0026ndash;424. doi:10.1177/0081246319898054\u003c/li\u003e\n \u003cli\u003eHamdan M, Hamra AA. Burnout among workers in emergency Departments in Palestinian hospitals: Prevalence and associated factors. BMC Health Serv Res. 2017;17. doi:10.1186/s12913-017-2356-3\u003c/li\u003e\n \u003cli\u003eHacer TY, Ali A. Burnout in physicians who are exposed to workplace violence. J Forensic Leg Med. 2020;69. doi:10.1016/j.jflm.2019.101874\u003c/li\u003e\n \u003cli\u003eHoff T, Lee DR. Burnout and Physician Gender: What Do We Know? Med Care. 2021 Aug 1;59(8):711-720. doi: 10.1097/MLR.0000000000001584\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Burnout, Physicians, Maslach Burnout Inventory, Workplace violence, Sudan","lastPublishedDoi":"10.21203/rs.3.rs-7456917/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7456917/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBurnout is a widespread occupational hazard among physicians and can lead to negative effects on both physicians and patients. Sudanese physicians work in a fragile health system, and under very challenging conditions. However, a few studies have explored burnout drivers among them. This study aimed to measure burnout prevalence, determine its associated factors, and compare its levels among physicians in a major federal hospital in Sudan.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-sectional study was conducted among physicians working at Ibrahim Malik teaching hospital in Khartoum, Sudan. An online questionnaire containing the Maslach Burnout Inventory-Human Services Survey for Medical Personnel was used to collect data from house officers, medical officers, and registrars. Burnout was defined as either i. high emotional exhaustion and high depersonalization, or ii. High emotional exhaustion and low personal accomplishment.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the 245 physicians who participated in the study, 44 (18%) had burnout; 63 (25.7%) had high emotional exhaustion, 60 (24.5%) had high depersonalization, and 193 (78.8%) had low personal accomplishment. More than half (56.7%) had experienced workplace violence in the last year, which was associated with burnout (P\u0026thinsp;=\u0026thinsp;0.024). The logistic regression found that female physicians had higher odds of burnout (\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOR\u0026thinsp;=\u0026thinsp;2.07, 95% CI: 1.00\u0026ndash;4.28, P\u0026thinsp;=\u0026thinsp;0.049).\u003c/span\u003e Also, physicians who experienced workplace violence had increased burnout odds (\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOR\u0026thinsp;=\u0026thinsp;2.53, 95% CI: 1.07\u0026ndash;5.96) for one incident\u003c/span\u003e, and (\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOR\u0026thinsp;=\u0026thinsp;7.04, 95% CI: 1.65\u0026ndash;30.08) for\u003c/span\u003e three or more incidents. Furthermore, high emotional exhaustion was associated with job title, while high depersonalization was associated with job title and experience.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eHigh burnout prevalence was noticed among Sudanese physicians, which was linked to workplace violence. Policy makers should employ strict legislation to protect physicians at their workplace. Also, interventions such as expanding the hospital or hiring additional staff could be considered to reduce burnout.\u003c/p\u003e","manuscriptTitle":"A cross-sectional study on physician burnout in Sudan: The role of workplace violence","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 05:09:03","doi":"10.21203/rs.3.rs-7456917/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4c79218d-6384-41d3-946a-0f4dd82ca161","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-03T05:09:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 05:09:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7456917","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7456917","identity":"rs-7456917","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}