Self-Compassion Protects Against Burnout in Medical Students: A Mediation Analysis of Perceived Stress

Self-Compassion Protects Against Burnout in Medical Students: A Mediation Analysis of Perceived Stress | 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 Self-Compassion Protects Against Burnout in Medical Students: A Mediation Analysis of Perceived Stress Yusof Mohamed Omar, Mariam Wael Soliman, Lina Mohamed Omar, Nourhan Amr Elsaid, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7754481/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 Objectives This study aimed to examine whether perceived stress mediates the association between self-compassion and burnout in medical students. Methods A cross-sectional study was conducted using an online questionnaire. A total of 649 medical students from a public university in Egypt were recruited via convenience sampling. Participants completed the Self-Compassion Scale–Short Form (SCS-SF), the Perceived Stress Scale (PSS-10), and the Burnout Assessment Tool (BAT-23). Bivariate associations were tested with Pearson correlations; multivariable linear regression assessed predictors of burnout. Mediation analysis was performed with bias-corrected bootstrapped confidence intervals (10,000 samples) to estimate indirect effects. Results Sample means were 36.4 (SCS-SF), 22.2 (PSS-10), and 3.38 (BAT-23). Bivariate analyses revealed significant negative correlations between self-compassion and both perceived stress (r = -0.577) and burnout (r = -0.478), and a positive correlation between stress and burnout (r = 0.603; all p-values < .001). The regression model explained 39.9% of burnout variance (R² = .399); perceived stress was the strongest predictor (β = 0.488), while self-compassion remained a significant protective factor (β = -0.196). The mediation analysis confirmed a significant indirect effect of self-compassion on burnout via perceived stress (B = -0.026, 95% CI [-0.032, -0.021]). As the direct effect also remained significant (B = -0.018), a partial mediation model was supported, with the indirect pathway accounting for 59.2% of the total effect. Conclusions Higher self-compassion is associated with lower burnout largely through reduced perceived stress. Training self-compassion alongside stress-reduction strategies may help safeguard medical student well-being. Self-compassion Stress Burnout Medical students Egypt Figures Figure 1 Introduction Due to the rigorous and demanding nature of medical education, medical students often experience significant stress as they strive to develop the knowledge and skills required to provide patient care. This chronic stress is a contributes significantly to the development of burnout, a syndrome characterized by emotional and cognitive exhaustion, a cynical and detached attitude towards studies, and pervasive feelings of incompetence [ 1 ]. The prevalence of burnout among medical students is alarmingly high, with rates estimated at 37.2% globally [ 2 ] and as high as 88% in Egypt [ 3 ]. Burnout is considered one of the systemic problems in medicine given its associated severe long-term consequences, including poor academic performance, increased rates of anxiety and depression, and diminished empathy, all of which can compromise the quality of future patient care [ 4 ]. In response to the widespread prevalence and significant consequences of burnout, researchers have put significant effort into identifying psychological resources that can buffer against its impact. One such resource is self-compassion, which entails responding to personal struggles with kindness rather than self-criticism and maintaining a balanced, mindful perspective on distressing experiences [ 5 ]. Research links self-compassion to greater emotional resilience and more effective coping, enabling individuals to face challenges without excessive self-judgment or emotional distress [ 6 ]. Furthermore, a growing body of evidence suggests that higher levels of self-compassion are associated with greater psychological well-being, including lower rates of burnout, making it a vital resource for navigating the high-stress environment of medical school [ 7 ]. Nevertheless, while research has consistently reported a beneficial relationship between higher self-compassion and lower burnout [ 8 – 10 ], the exact underlying mechanism explaining this relationship remains poorly understood. One explanation is that self-compassion may buffer against burnout by shaping how students appraise and cope with stressors [ 11 ]. This notion aligns with Lazarus and Folkman’s transactional model of stress and coping, which entails that stress results from both external demands as well as an individual’s appraisal of those demands [ 12 ]. From this perspective, self-compassion may influence both how students interpret the challenges they face, and their capability of coping with them, thereby lowering perceived stress. By responding to academic and psychological challenges associated with studying medicine with self-kindness rather than self-criticism, students may reframe stressors as challenges rather than threats, reducing their likelihood of experiencing chronic stress and, consequently, burnout [ 13 ]. Despite this plausible pathway, few studies have empirically tested a mediational model linking self-compassion, perceived stress, and burnout in the high-stakes context of medical education [ 14 , 15 ]. With studies among medical students in Egypt consistently reporting high levels of stress [ 16 ], burnout [ 3 ], and significant hesitancy to seek mental health support [ 17 ], identifying accessible, internal resources for tackling the stress associated with medical education is therefore crucial. However, little research has examined how self-compassion exerts its protective effect against burnout in this population. This study aimed to determine whether perceived stress mediates the relationship between self-compassion and burnout among medical students. Methods Study Design and Setting This cross-sectional analytical study was conducted at the ***DE-IDENTIFIED***. Data were collected in May 2025. This period was selected as it represents a time in the second academic term when students are sufficiently engaged with the demands and stresses of medical education, yet not subjected to the heightened stress typically associated with final examinations (typically held in June and July). This study followed the strengthening the reporting of observational studies in epidemiology (STROBE) guidelines [ 18 ]. Participants and Procedure The study population comprised all undergraduate students from the first through fifth academic years at ***DE-IDENTIFIED***. Interns and postgraduate students were excluded from participation. Participants were recruited using a non-random convenience sampling method with proportional allocation across academic years to reflect the student distribution. Data were collected via an anonymous, self-administered online questionnaire created with Google Forms. The survey link was disseminated through official student Telegram channels for each academic year and by student collaborators among their peers. The introductory page of the survey provided a clear explanation of the study's aim and guaranteed participant anonymity. Participation was entirely voluntary, and completion of the questionnaire was considered implied informed consent. To encourage participation, respondents were offered the opportunity to view their individual scores for self-compassion, stress, and burnout upon survey completion. Sample Size An a-priori power analysis was conducted using the Monte Carlo Power Analysis for Indirect Effects web application [ 19 ]. This tool uses a simulation-based approach to estimate the power to detect a hypothesized indirect effect by generating confidence intervals using the Monte Carlo method [ 20 ]. For our analysis, we specified a target power of 0.80 at a 95% confidence level. The simulation was based on 1,000 replications and 20,000 Monte Carlo draws per replication. The model was populated with conservative correlation estimates from prior research in a medical student population: -0.21 between self-compassion and stress, 0.52 between stress and burnout, and − 0.40 between self-compassion and burnout [ 15 ]. The analysis indicated that a minimum sample size of 225 participants was required. To ensure the study was robustly powered to detect a more conservative effect size than suggested by prior research and to enhance the potential generalizability of the findings, we recruited a final sample of 646 participants. Measures We assessed perceived stress using the 10-item Perceived Stress Scale (PSS-10) [ 21 ], a widely used self-report measure of individuals’ perception of stress in their lives. Each item is rated on a 5-point Likert scale (0 = never to 4 = very often), yielding a total score ranging from 0 to 40, with higher scores indicating greater perceived stress. We selected the PSS-10 because it captures global stress appraisal, aligning with the Lazarus and Folkman transactional model that underpins our mediation hypothesis [ 12 ]. Although the scale can be analyzed using its two-factor structure (perceived helplessness and perceived self-efficacy) [ 21 ], we used the total score to reflect overall perceived stress, which was most relevant to our mediation model. The PSS-10 has been used in a previous study among medical students in Egypt [ 22 ], and has shown good reliability in a study in a similar population of university students in Saudi Arabia [ 23 ]. To measure the participants’ self-compassion, we used the 12-item Self-Compassion Scale – Short Form (SCS-SF) [ 24 ], a validated alternative to the original 26-item SCS that reliably measures the single higher-order factor of overall self-compassion. Each item is rated on a 5-point Likert scale (1 = Almost Never to 5 = Almost Always), with total scores ranging from 12 to 60; higher scores reflect greater self-compassion. Given the legnth of the survey and to minimize potential response fatigue, we used the SCS-SF as a unifactorial measure by calculating a total score. The construct validity of the original SCS has been supported in a study with Egyptian and Saudi university students, confirming the relevance of the self-compassion construct in this population [ 25 ]. Burnout was measured using the 23-item Burnout Assessment Tool – Student version (BAT-23), a recently validated instrument demonstrating strong convergent and discriminant validity with other burnout scales, including the Maslach and Oldenburg Burnout Inventories [ 1 , 26 ]. The BAT-23 is based on Schaufeli et al.’s four-dimensional model of burnout, encompassing exhaustion, mental distancing, cognitive impairment, and emotional impairment. Items are rated on a 5-point Likert scale (1 = never, 5 = always), with higher scores indicating greater burnout. The BAT-23 has demonstrated excellent reliability in a recent study among Egyptian medical students, which reported a Cronbach’s alpha of 0.92 consistent with the reliability reported in the original validation study [ 1 ]. Lastly, we collected non-identifying participant sociodemographic data, including age (in years), sex, nationality, residence, and academic year. Additionally, students were asked to self-report whether they’ve been previously diagnosed with a mental health disorder. Data Analysis All statistical analyses were performed using Jamovi (version 2.3.28). Continuous variables were summarized as means and standard deviations (SDs) and assessed for normality via visual inspection of Quantile-Quantile (Q-Q) plots, while categorical variables were reported as frequencies and percentages. Due to a data collection error, one item from the BAT-23 was inadvertently omitted from the online questionnaire, resulting in missing data for 224 participants. We addressed this using person-mean substitution; for any participant with a single missing item on a BAT subscale, the value was imputed with the mean of their responses to the other items within that subscale. This approach was chosen to preserve statistical power and was justified by a negligible impact on scale reliability (e.g., Cronbach’s α for total BAT score: 0.921 post-imputation vs. 0.919 pre-imputation). Group differences in mean scores were assessed using independent-samples t-tests for sociodemographics with two groups and one-way ANOVA for differences between academic years, followed by Tukey’s post hoc tests for pairwise comparisons when ANOVA results were significant. Pearson’s correlation was used to examine the relationships between self-compassion, stress, and burnout. Linear regression was conducted to identify predictors of burnout. To test our primary mediation hypothesis, we conducted a mediation analysis using the medmod module in Jamovi, with self-compassion as the independent variable, burnout as the dependent variable, and perceived stress as the mediator. The significance of the indirect effect was evaluated using bootstrapped 95% confidence intervals based on 10,000 samples. For all analyses, statistical significance was set at p < 0.05. Results Participant Characteristics and Bivariate Associations The study included 649 medical students with a mean age of 20.6 (SD = 1.87) years. The majority of participants were female (58.4%) and of Egyptian nationality (76.9%). The mean scores were 36.4 (SD = 6.75) for self-compassion, 22.2 (SD = 5.89) for perceived stress, and 3.38 (SD = 0.63) for burnout ( Table 1 ) . Table 1 Participant Characteristics and Comparison of Self-compassion, Stress, and Burnout Scores (N = 649) Characteristic n (%) Self-compassion 1,2 p Stress 1,3 p Burnout 1,4 p Overall 36.4 (6.75) 22.2 (5.89) 3.38 (0.63) Age, years 1 20.6 (1.87) Sex Female 395 (58.4%) 36.21 (7.05) 23.58 (5.75) 3.46 (0.63) Male 270 (41.6%) 36.76 (6.30) 0.309 20.15 (5.49) < .001 3.26 (0.61) < .001 Nationality Egyptian 499 (76.9%) 36.04 (6.72) 0.006 22.87 (5.73) < .001 3.42 (0.64) 0.002 Non Egyptian 150 (23.1%) 37.75 (6.72) 19.77 (5.78) 3.24 (0.57) Residence Rural 254 (39.1%) 36.50 (5.88) 0.837 22.01 (5.42) 0.612 3.41 (0.65) 0.318 Urban 395 (60.9%) 36.39 (7.27) 22.25 (6.18) 3.36 (0.62) Academic year 1st year 153 (23.6%) 36.99 (6.43) 0.137 20.87 (6.02) a,b < .001 3.23 (0.59) a,b 0.003 2nd year 148 (22.8%) 35.72 (7.18) 23.30 (6.29) 3.47 (0.66) 3rd year 111 (17.1%) 37.23 (6.94) 20.98 (6.12) a,b 3.31 (0.62) 4th year 134 (20.6%) 35.54 (6.79) 23.23 (5.15) 3.48 (0.63) 5th year 103 (15.9%) 36.96 (6.20) 22.28 (5.19) 3.40 (0.61) Mental health disorder No 518 (79.8%) 36.92 (6.65) < .001 21.84 (5.82) 0.006 3.35 (0.62) 0.002 Yes 131 (20.2%) 34.53 (6.85) 23.41 (6.01) 3.48 (0.67) 1 Mean (SD) 2 Self-Compassion Scale–Short Form (SCS-SF), possible range: 12–60. 3 Perceived Stress Scale (PSS-10), possible range: 0–40. 4 Burnout Assessment Tool–Student version (BAT-23), possible range: 23–115. a significantly less than 2nd years b significantly less than 4th years Female students reported higher stress (23.58 vs. 20.15; p < .001) and burnout (3.46 vs. 3.26; p < .001) compared to male students. A similar pattern was observed among Egyptian students and those with a self-reported mental health disorder, who consistently reported significantly higher stress and burnout, and lower self-compassion, compared to their counterparts ( p < .05). Significant differences were also found across academic years, with first-year students generally experiencing lower stress and burnout compared to those in their second and fourth years ( Table 1 ) . Consistent with these patterns, self-compassion correlated strongly and negatively with perceived stress (r = − 0.577, p < .001) and burnout (r = − 0.478, p < .001), while perceived stress correlated positively with burnout (r = 0.603, p < .001). In terms of burnout subscales, self-compassion was most negatively correlated with the affective and energetic dimensions of burnout, namely emotional impairment (r = − 0.484, p < .001) followed by exhaustion (r = − 0.375, p < .001) ( Table 2 ). Table 2 Pearson Correlation Matrix of Participants’ Self-Compassion, Perceived Stress, and Burnout ScoresTable Variable 1 2 3 4 5 6 7 1. Total Burnout — 2. Exhaustion 0.810*** — 3. Mental Distancing 0.748*** 0.501*** — 4. Cognitive Impairment 0.850*** 0.618*** 0.517*** — 5. Emotional Impairment 0.784*** 0.488*** 0.434*** 0.548*** — 6. Stress 0.603*** 0.542*** 0.467*** 0.577*** 0.484*** — 7. Self-Compassion -0.478*** -0.375*** -0.280*** -0.374*** -0.484*** -0.577*** — ***p < .001 Factors Associated with Burnout The overall regression model was statistically significant, explaining 39.9% of the variance in total burnout scores (R² = .399) ( Table 3 ). Perceived stress was the strongest positive predictor of burnout ( β = 0.49, p < .001), while self-compassion was a significant negative predictor ( β = -0., p < .001). Furthermore, compared to first-year students, being in the second, fourth, or fifth academic year was associated with higher burnout ( p < 0.05). Additionally, students from a rural residence reported significantly higher burnout than those from urban areas ( β = 0.128, p = .048). As detailed in Table 3 , after controlling for all other variables, perceived stress emerged as the strongest positive predictor of burnout (β = 0.49, p < .001). Self-compassion was a significant negative predictor, with higher levels associated with lower burnout scores (β = -0.20, p < .001). Furthermore, compared to first-year students, being in the second (B = 0.14, p = .034), fourth (B = 0.20, p = .020), or fifth academic year (B = 0.25, p = .017) was associated with higher burnout. Additionally, students from a rural residence reported significantly higher burnout than those from urban areas (B = 0.08, p = .048). Table 3 Multiple Linear Regression of Factors Associated with Burnout Among Medical Students Variables B [95% CI] β [95% CI] p Age (continuous) -0.03 [-0.06, 0.01] -0.09 [-0.19, 0.02] 0.11 Sex (Ref: Female) Male 0.02 [-0.07, 0.11] 0.03 [-0.12, 0.17] 0.693 Nationality (Ref: Egyptian) Non-Egyptian 0.05 [-0.05, 0.16] 0.08 [-0.08, 0.25] 0.319 Residence (Ref: Urban) Rural 0.08 [0.00, 0.16] 0.13 [0.00, 0.26] 0.048 Mental Health Disorder (Ref: No) Yes 0.02 [-0.08, 0.11] 0.03 [-0.13, 0.18] 0.719 Academic Year (Ref: 1st Year) 2nd Year 0.14 [0.01, 0.26] 0.22 [0.02, 0.42] 0.034 3rd Year 0.16 [-0.00, 0.32] 0.25 [-0.01, 0.50] 0.057 4th Year 0.20 [0.03, 0.37] 0.32 [0.05, 0.59] 0.02 5th Year 0.25 [0.04, 0.45] 0.39 [0.07, 0.71] 0.017 Perceived Stress 0.05 [0.04, 0.06] 0.49 [0.41, 0.57] < .001 Self-compassion -0.02 [-0.03, -0.01] -0.20 [-0.27, -0.12] < .001 B = unstandardized coefficient; β = standardized coefficient; CI = Confidence Interval. Mediating Role of Perceived Stress To test the primary hypothesis that perceived stress mediates the relationship between self-compassion and burnout, a mediation analysis was conducted. The results, detailed in Table 4 , supported a partial mediation model. Table 4 Mediation Analysis of the Indirect Effect of Self-Compassion on Burnout through Perceived Stress Pathway B SE 95% CI p Model Paths Self-compassion → Perceived Stress (Path a) -0.504 0.031 [-0.564, -0.442] < .001 Perceived Stress → Burnout (Path b) 0.052 0.004 [0.045, 0.060] < .001 Summary Effects Indirect Effect (a × b) -0.026 0.003 [-0.032, -0.021] < .001 Direct Effect (c') -0.018 0.003 [-0.025, -0.012] < .001 Total Effect (c' + ab) -0.045 0.003 [-0.050, -0.039] < .001 B = unstandardized regression coefficient; SE = standard error; CI = confidence interval Initially, the total effect of self-compassion on burnout was significant ( B = -0.045, p < .001). In the mediation model, higher self-compassion significantly predicted lower perceived stress (Path a : B = -0.504, p < .001), and higher perceived stress, in turn, predicted higher burnout (Path b : B = 0.052, p < .001). The analysis revealed a significant indirect effect of self-compassion on burnout through stress ( B = -0.026, 95% CI [-0.032, -0.021]). The direct effect of self-compassion also remained significant ( B = -0.018, p < .001). The indirect effect accounted for approximately 59.2% of the total effect, suggesting that a substantial portion of the protective relationship between self-compassion and burnout operates via reduced perceived stress (Fig. 1 ). Discussion In a culture where studies among medical students in Egypt consistently report high levels of stress [ 16 ], burnout [ 3 ], and significant hesitancy to seek mental health support [ 17 ], this study investigated the protective role of self-compassion against burnout. We found that self-compassion correlated strongly and negatively with both perceived stress and burnout. Further, mediation analysis confirmed that self-compassion’s protective effect on burnout was substantially explained, albeit not entirely (59.2%), by its role in reducing perceived stress. These findings position self-compassion as a potential target for both institutional and educational interventions aimed at mitigating burnout within this population. Our finding that perceived stress partially mediates the relationship between self-compassion and burnout aligns with several recent studies. For instance, Meng et al. similarily found that perceived stress partially mediated the relationship between self-compassion and anxiety/depression amongst medical workers [ 27 ]. Similarly, Zhao et al. also found that self‑compassion was both directly and indirectly associated with decreased depressive symptoms by increasing resilience and optimism and reducing perceived stress among Chinese medical and nursing students [ 14 ]. This pattern is reinforced by longitudinal data, where a cross-lagged panel study among students concluded that perceived stress mediated the link between self-compassion and well-being over time [ 28 ]. Our results are further in line with those of Dev et al., who also reported significant relationships between self-compassion, stress, and burnout in healthcare trainees [ 15 ]. However, unlike Dev et al., who conceptualized self-compassion as a moderator of the stress–burnout relationship and found no significant effect in medical students, we modeled self-compassion as an antecedent to stress and demonstrated a significant indirect effect on burnout. This suggests that self-compassion’s primary contribution may lie in reducing the experience of stress rather than buffering its impact on burnout. This interpretation is consistent with Lazarus and Folkman’s transactional model of stress and coping, which posits that stress arises from external demands and an individual’s appraisal of those demands [ 12 ]. From this perspective, self-compassion may shape how students view the challenges associated with medical education as well as their coping capacity, thereby reducing perceived stress. In line with this model, our findings showed a substantial indirect effect (≈ 59% of the total), highlighting stress reduction as a key mechanism. Nevertheless, the mediation was partial, as a significant direct effect remained, indicating that self-compassion also influences burnout through additional pathways. One possible mechanism is that self-compassion has been shown to increase resilience and engagement in self-care behaviors, which in turn reduce emotional exhaustion and enhance personal accomplishment [ 14 , 29 ]. This mechanism would be especially perneient to our sample, as studies among medical students in Egypt have repeatedly reported low resilience levels [ 16 , 30 ], and pessimistic attitude towards studying medicine [ 31 ]. Other studies highlight the role of psychological capital (hope, optimism, self-efficacy) and compassion satisfaction as mediators linking self-compassion to lower burnout and depression [ 14 , 32 ]. Self-compassion has also been associated with greater fulfillment of basic psychological needs for autonomy, competence, and relatedness, which are known protective factors against burnout [ 33 ]. Nevertheless, alternative causal sequences than the one reported in our study have also been described. For instance, Serrão et al. reported an alternative model among Portuguese university students in which stress predicted lower self-compassion, which in turn predicted higher depressive symptoms [ 34 ]. Adding further complexity, a 4-year longitudinal study by Park et al. found that an increase in stress actually predicted a subsequent increase in self-compassion, supporting a "stress inoculation" model [ 35 ]. Taken together, these findings suggest a reciprocal relationship where self-compassion mitigates the initial experience of stress, while the process of successfully navigating moderate stress may, in turn, build self-compassion over time. Future research should aim to disentangle these pathways through longitudinal and experimental designs that test whether interventions that cultivate self-compassion produce downstream reductions in burnout. Beyond the primary mediation model, our study identified several demographic factors associated with student distress. The finding that female students reported significantly higher stress and burnout is consistent with a large body of research, including both uni-center [ 30 ] and multi-center [ 16 ] studies among Egyptian medical students, both of which identified female gender as a significant risk factor for lower resilience. One potential explanation for this disparity may be related to barriers to mental health care. Studies on Egyptian students by have repeatedly reported a significant hesitancy to seek help due to factors like social stigma [ 36 ], wanting to solve their mental health problems on their own [ 17 ], and lack of trust in mental health services [ 37 ], barriers which may disproportionately affect female students. Our finding that burnout was significantly higher in later academic years differs from Serrão et al. who found that distress was highest among first-year university students in Portugal [ 34 ]. This discrepancy may reflect differences in curricular demands, with later years of Egyptian medical education being more academically and clinically intensive. Our findings have significant practical implications for medical education and student support services, as self-compassion is not a fixed trait but a skill that can be cultivated [ 38 ]. As an internal psychological resource, it represents an especially promising intervention target for Egyptian medical students, who consistently report significant barriers and reluctance to seeking formal mental health care. Our results highlight the value of prioritizing such interventions for vulnerable subgroups, particularly female students, those from rural areas, and those in the more demanding later years of training. Embedding evidence-based programs, such as Mindful Self-Compassion workshops which a recent meta-analysis found to be effective [ 39 ], within the curriculum may provide a proactive and scalable strategy to enhance coping, reduce stress, and ultimately prevent burnout among future physicians. Nevertheless, several limitations should be considered when interpreting the study’s findings. The cross-sectional design precludes causal inference; while our results support a mediational pathway, longitudinal research is needed to establish temporal relationships. The use of convenience sampling at a single institution may limit generalizability, highlighting the need for multi-center studies across diverse Egyptian medical schools to strengthen external validity. Reliance on self-report instruments introduces the possibility of response and recall bias, underscoring the value of incorporating objective or mixed-methods assessments in future work. Finally, although the missing BAT-23 item was imputed using a standard method with minimal impact on reliability, this may nonetheless have slightly affected the accuracy of the results. In conclusion, this study suggests that self-compassion is a vital psychological resource that protects against burnout among Egyptian medical students, operating largely by mitigating perceived stress. These results suggest that interventions aimed at cultivating self-compassion may be a practical strategy for medical educators and student wellness programs, especially in resource constrained settings such as Egypt. Fostering the ability of future physicians to respond to training challenges with self-kindness is a critical step in reducing burnout and building a sustainable, resilient healthcare workforce. Declarations Ethical Approval Ethical approval was obtained from the Institutional Research Board (IRB) of ***DE-IDENTIFIED*** (approval code: ***DE-IDENTIFIED***), and the study was conducted according to the principles of the Helsinki Declaration. All participants were invited to voluntarily and anonymously complete an online survey, provided electronic informed consent, and were free to respond at their convenience. Funding No funding or sponsorship was received from any companies, groups, individuals, organizations, or any other entities. Author Contribution The conception and design of the study were done by all authors. Acquisition of data was done by NAE-I, NAE-S, RI, and MSSA-Mansoura Team of Collaborators. Analysis and interpretation of data were done by YMO and AA. Drafting the manuscript was done by all authors except AE. Revising the manuscript critically for important intellectual content was done by YMO and AE. All authors read and approved the final manuscript. Acknowledgement MSSA-Mansoura Team of Collaborators: Renad Reda Elbeyaly, Sereen M. Al Tayara, Rofida Mokbel Ibrahim, Khaled Sameh Elbahnasi, Hassan M. Karrar, Ahmed A. Shousha, Fatma Abu Elsoud, Hassan Moustapha Sabbah, Rodina S. Elkhouly, Rady Turky Amhimd, Mariam M. Baz Data Availability The data of this study is available from the corresponding author upon reasonable request. References Schaufeli WB, Desart S, De Witte H. Burnout Assessment Tool (BAT)—Development, Validity, and Reliability. IJERPH. 2020;17:9495. https://doi.org/10.3390/ijerph17249495 . Almutairi H, Alsubaiei A, Abduljawad S, Alshatti A, Fekih-Romdhane F, Husni M, et al. Prevalence of burnout in medical students: A systematic review and meta-analysis. Int J Soc Psychiatry. 2022;68:1157–70. https://doi.org/10.1177/00207640221106691 . El-Gabry DA, Okasha T, Shaker N, Elserafy D, Yehia M, Aziz KA, et al. Mental health and wellbeing among Egyptian medical students: a cross-sectional study. 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Social Psychological and Personality Science. 2017;8:379–86. https://doi.org/10.1177/1948550617715068 . Cohen S. Perceived stress in a probability sample of the United States. In: The social psychology of health. Thousand Oaks, CA, US: Sage Publications, Inc; 1988. p. 31–67. Seedhom AE, Kamel EG, Mohammed ES, Raouf NR. Predictors of Perceived Stress among Medical and Nonmedical College Students, Minia, Egypt. International Journal of Preventive Medicine. 2019;10. https://doi.org/10.4103/ijpvm.IJPVM_6_18 . Anwer S, Manzar MD, Alghadir AH, Salahuddin M, Abdul Hameed U. Psychometric Analysis of the Perceived Stress Scale Among Healthy University Students. Neuropsychiatric Disease and Treatment. 2020;16:2389–96. https://doi.org/10.2147/NDT.S268582 . Raes F, Pommier E, Neff KD, Van Gucht D. Construction and factorial validation of a short form of the Self-Compassion Scale. Clin Psychology and Psychoth. 2011;18:250–5. https://doi.org/10.1002/cpp.702 . Alzamil WA, Ibrahem UM, Alabdulkareem R, Almusfir MF, ALqasem MA, Ahmed EM, et al. Factorial validity of the self-compassion scale among female University students: A comparative study between Saudi and Egyptian cultures. African Journal of Reproductive Health. 2023;27:88–100. Schaufeli W, De Witte H. Burnout Assessment Tool (BAT): A fresh look at burnout. In: Krägeloh CU, Alyami M, Medvedev ON, editors. International Handbook of Behavioral Health Assessment. Cham: Springer International Publishing; 2023. p. 1–24. https://doi.org/10.1007/978-3-030-89738-3_54-1 . Meng R, Luo X, Du S, Luo Y, Liu D, Chen J, et al. The Mediating Role of Perceived Stress in Associations Between Self-Compassion and Anxiety and Depression: Further Evidence from Chinese Medical Workers. Risk Manag Healthc Policy. 2020;13:2729–41. https://doi.org/10.2147/RMHP.S261489 . Ewert C, Buechner A, Schröder-Abé M. Stress Perception and Coping as Mediators of the Link Between Self-Compassion and Affective Well-being? Evidence From Two Longitudinal Studies. Mindfulness. 2024;15:372–88. https://doi.org/10.1007/s12671-023-02295-1 . Michael K, Schujovitzky D, Karnieli-Miller O. The associations between resilience, self-care, and burnout among medical students. PLOS ONE. 2024;19:e0309994. https://doi.org/10.1371/journal.pone.0309994 . Azzam H, Awad K, Ata AH, Elagouz M, Nabih MH, ElKaffas ME, et al. Resilience and its relation to Alexithymia and personality traits in Egyptian medical students: A Cross-Sectional Study. 2025. https://doi.org/10.21203/rs.3.rs-5510628/v1 . Kabbash I, El-Sallamy R, Zayed H, Alkhyate I, Omar A, Abdo S. The brain drain: why medical students and young physicians want to leave Egypt. Eastern Mediterranean Health Journal. 2021;27. Yıldırım N, Coşkun H, Polat Ş. The Relationship Between Psychological Capital and the Occupational Psychologic Risks of Nurses: The Mediation Role of Compassion Satisfaction. Journal of Nursing Scholarship. 2021;53:115–25. https://doi.org/10.1111/jnu.12607 . Gerber Z, Anaki D. The Role of Self-compassion, Concern for Others, and Basic Psychological Needs in the Reduction of Caregiving Burnout. Mindfulness (N Y). 2021;12:741–50. https://doi.org/10.1007/s12671-020-01540-1 . Serrão C, Valquaresma A, Rodrigues AR, Duarte I. Mediation of Self-Compassion on Pathways from Stress and Anxiety to Depression among Portuguese Higher Education Students. Healthcare. 2023;11:2494. https://doi.org/10.3390/healthcare11182494 . Park J, Bluth K, Lathren C, Leary M, Hoyle R. The synergy between stress and self-compassion in building resilience: A 4-year longitudinal study. Social and Personality Psychology Compass. 2024;18:e12978. https://doi.org/10.1111/spc3.12978 . El-Khawaga GO, Omar YM, Elsaadany M, Ghazy M, Abdelaal AK, Hekal M, et al. Healthcare-seeking behaviors and barriers among medical students in Egypt: a national cross-sectional study. BMC Public Health. 2025;25:743. https://doi.org/10.1186/s12889-025-21791-8 . Kamel MM, Westenberg JN, Suen J, Jang KL, Maragha T, Badawy A, et al. Mental health outcomes and help-seeking behaviours among Egyptian medical students: A cross-sectional study. Early Intervention in Psychiatry. 2022;16:1020–7. https://doi.org/10.1111/eip.13246 . Ferrari M, Hunt C, Harrysunker A, Abbott MJ, Beath AP, Einstein DA. Self-Compassion Interventions and Psychosocial Outcomes: a Meta-Analysis of RCTs. Mindfulness. 2019;10:1455–73. https://doi.org/10.1007/s12671-019-01134-6 . Póka T, Fodor LA, Barta A, Mérő L. A Systematic review and meta-analysis on the effectiveness of self-compassion interventions for changing university students’ positive and negative affect. Curr Psychol. 2024;43:6475–93. https://doi.org/10.1007/s12144-023-04834-4 . Additional Declarations No competing interests reported. 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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-7754481","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":529656016,"identity":"c1cc90e8-0822-4132-a1c8-2c1362ac8015","order_by":0,"name":"Yusof Mohamed Omar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABKUlEQVRIie2QMUvDQBTHnwRuCnYrCUfUj3BwcFYMfpaEwGVJdRBKxwMhm7qJLvoV4pI54YYu/QCFWxqE4uBQl5AhoEmtDnKDboL3g+MeD37833sABsNfZQoQ9L+zBtgR2+ZXoWW+VdxbIL9UsP0ThSzialkm/ungRpbKb1tPDOWqasD3ssKSz1oloaTM+bmjeHQ8TgkVmB9SGzjNCsRHegXh11yGQiUMjwUJBQ4YBpBhVtiM6AdbOWWnPKizGo/aXolrt4G3ThnUeiVgGyVTXRygXkmYY0PRp1hLjeLOXza7hI+K06PLlNIUJxNsk4jeScR0F9ud9RfL/fBeRdWiafe8axznbjM98a5mF09rjXJQfO+gj4G7ZwFyNMq+0GV/YulSDAaD4d/xDqv6cD0daSrBAAAAAElFTkSuQmCC","orcid":"","institution":"Mansoura University","correspondingAuthor":true,"prefix":"","firstName":"Yusof","middleName":"Mohamed","lastName":"Omar","suffix":""},{"id":529656017,"identity":"ec6c6c45-ff16-4837-a935-9943af8ded90","order_by":1,"name":"Mariam Wael Soliman","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Mariam","middleName":"Wael","lastName":"Soliman","suffix":""},{"id":529656018,"identity":"dc6e1ac5-e786-4d30-9e3c-74ad58fe27ce","order_by":2,"name":"Lina Mohamed Omar","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Lina","middleName":"Mohamed","lastName":"Omar","suffix":""},{"id":529656020,"identity":"2913e86a-fe0d-430d-b614-3daaa1ac3f0a","order_by":3,"name":"Nourhan Amr Elsaid","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Nourhan","middleName":"Amr","lastName":"Elsaid","suffix":""},{"id":529656022,"identity":"283903fa-19b5-48fd-bd02-99c0699939b3","order_by":4,"name":"Naglaa Ahmed El-Imam","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Naglaa","middleName":"Ahmed","lastName":"El-Imam","suffix":""},{"id":529656024,"identity":"3882c4c3-1b30-4ea0-81c8-f54642e9bfdb","order_by":5,"name":"Raghad Ismael","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Raghad","middleName":"","lastName":"Ismael","suffix":""},{"id":529656026,"identity":"0be0d5ec-f5fe-4233-8997-67162f0b28da","order_by":6,"name":"Ahmed Abdelmageed","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Abdelmageed","suffix":""},{"id":529656027,"identity":"46fe43f0-9cd0-4d06-817d-dbbcf0ceff86","order_by":7,"name":"MSSA-Mansoura Team of Collaborators","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"MSSA-Mansoura","middleName":"Team of","lastName":"Collaborators","suffix":""},{"id":529656028,"identity":"c6678b7f-d86d-4130-83a4-b87af15cc37c","order_by":8,"name":"Abdel-Hady El-Gilany","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Abdel-Hady","middleName":"","lastName":"El-Gilany","suffix":""}],"badges":[],"createdAt":"2025-09-30 19:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7754481/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7754481/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95118284,"identity":"1ab3de8d-9c67-4af3-b3d9-999310e9bf9f","added_by":"auto","created_at":"2025-11-04 13:36:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":89680,"visible":true,"origin":"","legend":"\u003cp\u003eUnstandardized regression coefficients (\u003cem\u003eB\u003c/em\u003e) and 95% confidence intervals for the relationship between self-compassion and burnout as mediated by perceived stress. Asterisk indicates significance level: *\u003cem\u003ep\u003c/em\u003e \u0026lt; .001.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7754481/v1/8b8a0cd2be484f2b48bb94f8.png"},{"id":100364682,"identity":"6a4f9010-8946-4db1-83a6-03e6258f9e3e","added_by":"auto","created_at":"2026-01-16 07:54:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1030008,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7754481/v1/3eb7a505-6fe5-4cc4-80e9-a6b6e9cfbbea.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Self-Compassion Protects Against Burnout in Medical Students: A Mediation Analysis of Perceived Stress","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDue to the rigorous and demanding nature of medical education, medical students often experience significant stress as they strive to develop the knowledge and skills required to provide patient care. This chronic stress is a contributes significantly to the development of burnout, a syndrome characterized by emotional and cognitive exhaustion, a cynical and detached attitude towards studies, and pervasive feelings of incompetence [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The prevalence of burnout among medical students is alarmingly high, with rates estimated at 37.2% globally [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and as high as 88% in Egypt [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Burnout is considered one of the systemic problems in medicine given its associated severe long-term consequences, including poor academic performance, increased rates of anxiety and depression, and diminished empathy, all of which can compromise the quality of future patient care [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn response to the widespread prevalence and significant consequences of burnout, researchers have put significant effort into identifying psychological resources that can buffer against its impact. One such resource is self-compassion, which entails responding to personal struggles with kindness rather than self-criticism and maintaining a balanced, mindful perspective on distressing experiences [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Research links self-compassion to greater emotional resilience and more effective coping, enabling individuals to face challenges without excessive self-judgment or emotional distress [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, a growing body of evidence suggests that higher levels of self-compassion are associated with greater psychological well-being, including lower rates of burnout, making it a vital resource for navigating the high-stress environment of medical school [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNevertheless, while research has consistently reported a beneficial relationship between higher self-compassion and lower burnout [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the exact underlying mechanism explaining this relationship remains poorly understood. One explanation is that self-compassion may buffer against burnout by shaping how students appraise and cope with stressors [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This notion aligns with Lazarus and Folkman\u0026rsquo;s transactional model of stress and coping, which entails that stress results from both external demands as well as an individual\u0026rsquo;s appraisal of those demands [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. From this perspective, self-compassion may influence both how students interpret the challenges they face, and their capability of coping with them, thereby lowering perceived stress. By responding to academic and psychological challenges associated with studying medicine with self-kindness rather than self-criticism, students may reframe stressors as challenges rather than threats, reducing their likelihood of experiencing chronic stress and, consequently, burnout [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Despite this plausible pathway, few studies have empirically tested a mediational model linking self-compassion, perceived stress, and burnout in the high-stakes context of medical education [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWith studies among medical students in Egypt consistently reporting high levels of stress [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], burnout [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and significant hesitancy to seek mental health support [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], identifying accessible, internal resources for tackling the stress associated with medical education is therefore crucial. However, little research has examined how self-compassion exerts its protective effect against burnout in this population. This study aimed to determine whether perceived stress mediates the relationship between self-compassion and burnout among medical students.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis cross-sectional analytical study was conducted at the ***DE-IDENTIFIED***. Data were collected in May 2025. This period was selected as it represents a time in the second academic term when students are sufficiently engaged with the demands and stresses of medical education, yet not subjected to the heightened stress typically associated with final examinations (typically held in June and July). This study followed the strengthening the reporting of observational studies in epidemiology (STROBE) guidelines [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants and Procedure\u003c/h3\u003e\n\u003cp\u003eThe study population comprised all undergraduate students from the first through fifth academic years at ***DE-IDENTIFIED***. Interns and postgraduate students were excluded from participation.\u003c/p\u003e\u003cp\u003e Participants were recruited using a non-random convenience sampling method with proportional allocation across academic years to reflect the student distribution. Data were collected via an anonymous, self-administered online questionnaire created with Google Forms. The survey link was disseminated through official student Telegram channels for each academic year and by student collaborators among their peers.\u003c/p\u003e\u003cp\u003eThe introductory page of the survey provided a clear explanation of the study's aim and guaranteed participant anonymity. Participation was entirely voluntary, and completion of the questionnaire was considered implied informed consent. To encourage participation, respondents were offered the opportunity to view their individual scores for self-compassion, stress, and burnout upon survey completion.\u003c/p\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eAn a-priori power analysis was conducted using the Monte Carlo Power Analysis for Indirect Effects web application [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This tool uses a simulation-based approach to estimate the power to detect a hypothesized indirect effect by generating confidence intervals using the Monte Carlo method [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For our analysis, we specified a target power of 0.80 at a 95% confidence level. The simulation was based on 1,000 replications and 20,000 Monte Carlo draws per replication. The model was populated with conservative correlation estimates from prior research in a medical student population: -0.21 between self-compassion and stress, 0.52 between stress and burnout, and \u0026minus;\u0026thinsp;0.40 between self-compassion and burnout [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The analysis indicated that a minimum sample size of 225 participants was required. To ensure the study was robustly powered to detect a more conservative effect size than suggested by prior research and to enhance the potential generalizability of the findings, we recruited a final sample of 646 participants.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eWe assessed perceived stress using the 10-item Perceived Stress Scale (PSS-10) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], a widely used self-report measure of individuals\u0026rsquo; perception of stress in their lives. Each item is rated on a 5-point Likert scale (0\u0026thinsp;=\u0026thinsp;never to 4\u0026thinsp;=\u0026thinsp;very often), yielding a total score ranging from 0 to 40, with higher scores indicating greater perceived stress. We selected the PSS-10 because it captures global stress appraisal, aligning with the Lazarus and Folkman transactional model that underpins our mediation hypothesis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Although the scale can be analyzed using its two-factor structure (perceived helplessness and perceived self-efficacy) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], we used the total score to reflect overall perceived stress, which was most relevant to our mediation model. The PSS-10 has been used in a previous study among medical students in Egypt [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and has shown good reliability in a study in a similar population of university students in Saudi Arabia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo measure the participants\u0026rsquo; self-compassion, we used the 12-item Self-Compassion Scale \u0026ndash; Short Form (SCS-SF) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], a validated alternative to the original 26-item SCS that reliably measures the single higher-order factor of overall self-compassion. Each item is rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;Almost Never to 5\u0026thinsp;=\u0026thinsp;Almost Always), with total scores ranging from 12 to 60; higher scores reflect greater self-compassion. Given the legnth of the survey and to minimize potential response fatigue, we used the SCS-SF as a unifactorial measure by calculating a total score. The construct validity of the original SCS has been supported in a study with Egyptian and Saudi university students, confirming the relevance of the self-compassion construct in this population [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBurnout was measured using the 23-item Burnout Assessment Tool \u0026ndash; Student version (BAT-23), a recently validated instrument demonstrating strong convergent and discriminant validity with other burnout scales, including the Maslach and Oldenburg Burnout Inventories [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The BAT-23 is based on Schaufeli et al.\u0026rsquo;s four-dimensional model of burnout, encompassing exhaustion, mental distancing, cognitive impairment, and emotional impairment. Items are rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;never, 5\u0026thinsp;=\u0026thinsp;always), with higher scores indicating greater burnout. The BAT-23 has demonstrated excellent reliability in a recent study among Egyptian medical students, which reported a Cronbach\u0026rsquo;s alpha of 0.92 consistent with the reliability reported in the original validation study [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLastly, we collected non-identifying participant sociodemographic data, including age (in years), sex, nationality, residence, and academic year. Additionally, students were asked to self-report whether they\u0026rsquo;ve been previously diagnosed with a mental health disorder.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed using Jamovi (version 2.3.28). Continuous variables were summarized as means and standard deviations (SDs) and assessed for normality via visual inspection of Quantile-Quantile (Q-Q) plots, while categorical variables were reported as frequencies and percentages.\u003c/p\u003e\u003cp\u003eDue to a data collection error, one item from the BAT-23 was inadvertently omitted from the online questionnaire, resulting in missing data for 224 participants. We addressed this using person-mean substitution; for any participant with a single missing item on a BAT subscale, the value was imputed with the mean of their responses to the other items within that subscale. This approach was chosen to preserve statistical power and was justified by a negligible impact on scale reliability (e.g., Cronbach\u0026rsquo;s α for total BAT score: 0.921 post-imputation vs. 0.919 pre-imputation).\u003c/p\u003e\u003cp\u003e Group differences in mean scores were assessed using independent-samples t-tests for sociodemographics with two groups and one-way ANOVA for differences between academic years, followed by Tukey\u0026rsquo;s post hoc tests for pairwise comparisons when ANOVA results were significant. Pearson\u0026rsquo;s correlation was used to examine the relationships between self-compassion, stress, and burnout. Linear regression was conducted to identify predictors of burnout.\u003c/p\u003e\u003cp\u003eTo test our primary mediation hypothesis, we conducted a mediation analysis using the medmod module in Jamovi, with self-compassion as the independent variable, burnout as the dependent variable, and perceived stress as the mediator. The significance of the indirect effect was evaluated using bootstrapped 95% confidence intervals based on 10,000 samples. For all analyses, statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eParticipant Characteristics and Bivariate Associations\u003c/h2\u003e\u003cp\u003eThe study included 649 medical students with a mean age of 20.6 (SD\u0026thinsp;=\u0026thinsp;1.87) years. The majority of participants were female (58.4%) and of Egyptian nationality (76.9%). The mean scores were 36.4 (SD\u0026thinsp;=\u0026thinsp;6.75) for self-compassion, 22.2 (SD\u0026thinsp;=\u0026thinsp;5.89) for perceived stress, and 3.38 (SD\u0026thinsp;=\u0026thinsp;0.63) for burnout \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\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\u003eParticipant Characteristics and Comparison of Self-compassion, Stress, and Burnout Scores (N\u0026thinsp;=\u0026thinsp;649)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSelf-compassion\u003csup\u003e1,2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStress\u003csup\u003e1,3\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eBurnout\u003csup\u003e1,4\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.4 (6.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.2 (5.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.38 (0.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge, years\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.6 (1.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e395 (58.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.21 (7.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23.58 (5.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.46 (0.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e270 (41.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.76 (6.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.15 (5.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.26 (0.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNationality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEgyptian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e499 (76.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.04 (6.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.87 (5.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.42 (0.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon Egyptian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150 (23.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.75 (6.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19.77 (5.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.24 (0.57)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eResidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e254 (39.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.50 (5.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.837\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.01 (5.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.41 (0.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.318\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e395 (60.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.39 (7.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.25 (6.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.36 (0.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eAcademic year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1st year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e153 (23.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.99 (6.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.87 (6.02)\u003csup\u003ea,b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.23 (0.59)\u003csup\u003ea,b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2nd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e148 (22.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.72 (7.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23.30 (6.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.47 (0.66)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3rd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111 (17.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.23 (6.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.98 (6.12)\u003csup\u003ea,b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.31 (0.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134 (20.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.54 (6.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23.23 (5.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.48 (0.63)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e103 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.96 (6.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.28 (5.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.40 (0.61)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMental health disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e518 (79.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.92 (6.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21.84 (5.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.35 (0.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131 (20.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.53 (6.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23.41 (6.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.48 (0.67)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Mean (SD)\u003c/p\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Self-Compassion Scale\u0026ndash;Short Form (SCS-SF), possible range: 12\u0026ndash;60.\u003c/p\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e Perceived Stress Scale (PSS-10), possible range: 0\u0026ndash;40.\u003c/p\u003e\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e Burnout Assessment Tool\u0026ndash;Student version (BAT-23), possible range: 23\u0026ndash;115.\u003c/p\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e significantly less than 2nd years\u003c/p\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e significantly less than 4th years\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\u003eFemale students reported higher stress (23.58 vs. 20.15; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and burnout (3.46 vs. 3.26; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) compared to male students. A similar pattern was observed among Egyptian students and those with a self-reported mental health disorder, who consistently reported significantly higher stress and burnout, and lower self-compassion, compared to their counterparts (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05). Significant differences were also found across academic years, with first-year students generally experiencing lower stress and burnout compared to those in their second and fourth years \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eConsistent with these patterns, self-compassion correlated strongly and negatively with perceived stress (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.577, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and burnout (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.478, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), while perceived stress correlated positively with burnout (r\u0026thinsp;=\u0026thinsp;0.603, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). In terms of burnout subscales, self-compassion was most negatively correlated with the affective and energetic dimensions of burnout, namely emotional impairment (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.484, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) followed by exhaustion (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.375, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\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\u003ePearson Correlation Matrix of Participants\u0026rsquo; Self-Compassion, Perceived Stress, and Burnout ScoresTable\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Total Burnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Exhaustion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.810***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Mental Distancing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.748***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.501***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Cognitive Impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.850***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.618***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.517***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Emotional Impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.784***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.488***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.434***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.548***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.603***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.542***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.467***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.577***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.484***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. Self-Compassion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.478***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.375***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.280***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.374***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.484***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.577***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e***p\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eFactors Associated with Burnout\u003c/h3\u003e\n\u003cp\u003eThe overall regression model was statistically significant, explaining 39.9% of the variance in total burnout scores (R\u0026sup2; = .399) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Perceived stress was the strongest positive predictor of burnout (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.49, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), while self-compassion was a significant negative predictor (\u003cem\u003eβ\u003c/em\u003e = -0., \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Furthermore, compared to first-year students, being in the second, fourth, or fifth academic year was associated with higher burnout (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, students from a rural residence reported significantly higher burnout than those from urban areas (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.128, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.048).\u003c/p\u003e\u003cp\u003eAs detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, after controlling for all other variables, perceived stress emerged as the strongest positive predictor of burnout (β\u0026thinsp;=\u0026thinsp;0.49, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Self-compassion was a significant negative predictor, with higher levels associated with lower burnout scores (β = -0.20, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Furthermore, compared to first-year students, being in the second (B\u0026thinsp;=\u0026thinsp;0.14, p\u0026thinsp;=\u0026thinsp;.034), fourth (B\u0026thinsp;=\u0026thinsp;0.20, p\u0026thinsp;=\u0026thinsp;.020), or fifth academic year (B\u0026thinsp;=\u0026thinsp;0.25, p\u0026thinsp;=\u0026thinsp;.017) was associated with higher burnout. Additionally, students from a rural residence reported significantly higher burnout than those from urban areas (B\u0026thinsp;=\u0026thinsp;0.08, p\u0026thinsp;=\u0026thinsp;.048).\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\u003e\u003cb\u003eMultiple Linear Regression of Factors Associated with Burnout Among Medical Students\u003c/b\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\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB [95% CI]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eβ [95% CI]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (continuous)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.03 [-0.06, 0.01]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.09 [-0.19, 0.02]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (Ref: Female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.02 [-0.07, 0.11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.03 [-0.12, 0.17]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.693\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNationality (Ref: Egyptian)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Egyptian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.05 [-0.05, 0.16]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.08 [-0.08, 0.25]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.319\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidence (Ref: Urban)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.08 [0.00, 0.16]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.13 [0.00, 0.26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.048\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health Disorder (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.02 [-0.08, 0.11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.03 [-0.13, 0.18]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.719\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Year (Ref: 1st Year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.14 [0.01, 0.26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.22 [0.02, 0.42]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.16 [-0.00, 0.32]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.25 [-0.01, 0.50]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.057\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4th Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.20 [0.03, 0.37]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.32 [0.05, 0.59]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5th Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.25 [0.04, 0.45]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.39 [0.07, 0.71]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.05 [0.04, 0.06]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.49 [0.41, 0.57]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-compassion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.02 [-0.03, -0.01]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.20 [-0.27, -0.12]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eB\u0026thinsp;=\u0026thinsp;unstandardized coefficient; β\u0026thinsp;=\u0026thinsp;standardized coefficient; CI\u0026thinsp;=\u0026thinsp;Confidence Interval.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eMediating Role of Perceived Stress\u003c/h2\u003e\u003cp\u003eTo test the primary hypothesis that perceived stress mediates the relationship between self-compassion and burnout, a mediation analysis was conducted. The results, detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, supported a partial mediation model.\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\u003eMediation Analysis of the Indirect Effect of Self-Compassion on Burnout through Perceived Stress\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\u003ePathway\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel Paths\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-compassion \u0026rarr; Perceived Stress (Path a)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.504\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[-0.564, -0.442]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived Stress \u0026rarr; Burnout (Path b)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[0.045, 0.060]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSummary Effects\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndirect Effect (a \u0026times; b)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[-0.032, -0.021]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect Effect (c')\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[-0.025, -0.012]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Effect (c' + ab)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[-0.050, -0.039]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eB\u0026thinsp;=\u0026thinsp;unstandardized regression coefficient; SE\u0026thinsp;=\u0026thinsp;standard error; CI\u0026thinsp;=\u0026thinsp;confidence interval\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\u003eInitially, the total effect of self-compassion on burnout was significant (\u003cem\u003eB\u003c/em\u003e = -0.045, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). In the mediation model, higher self-compassion significantly predicted lower perceived stress (Path \u003cem\u003ea\u003c/em\u003e: \u003cem\u003eB\u003c/em\u003e = -0.504, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and higher perceived stress, in turn, predicted higher burnout (Path \u003cem\u003eb\u003c/em\u003e: \u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.052, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\u003cp\u003eThe analysis revealed a significant indirect effect of self-compassion on burnout through stress (\u003cem\u003eB\u003c/em\u003e = -0.026, 95% CI [-0.032, -0.021]). The direct effect of self-compassion also remained significant (\u003cem\u003eB\u003c/em\u003e = -0.018, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). The indirect effect accounted for approximately 59.2% of the total effect, suggesting that a substantial portion of the protective relationship between self-compassion and burnout operates via reduced perceived stress (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn a culture where studies among medical students in Egypt consistently report high levels of stress [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], burnout [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and significant hesitancy to seek mental health support [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], this study investigated the protective role of self-compassion against burnout. We found that self-compassion correlated strongly and negatively with both perceived stress and burnout. Further, mediation analysis confirmed that self-compassion\u0026rsquo;s protective effect on burnout was substantially explained, albeit not entirely (59.2%), by its role in reducing perceived stress. These findings position self-compassion as a potential target for both institutional and educational interventions aimed at mitigating burnout within this population.\u003c/p\u003e\u003cp\u003eOur finding that perceived stress partially mediates the relationship between self-compassion and burnout aligns with several recent studies. For instance, Meng et al. similarily found that perceived stress partially mediated the relationship between self-compassion and anxiety/depression amongst medical workers [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Similarly, Zhao et al. also found that self‑compassion was both directly and indirectly associated with decreased depressive symptoms by increasing resilience and optimism and reducing perceived stress among Chinese medical and nursing students [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This pattern is reinforced by longitudinal data, where a cross-lagged panel study among students concluded that perceived stress mediated the link between self-compassion and well-being over time [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Our results are further in line with those of Dev et al., who also reported significant relationships between self-compassion, stress, and burnout in healthcare trainees [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, unlike Dev et al., who conceptualized self-compassion as a moderator of the stress\u0026ndash;burnout relationship and found no significant effect in medical students, we modeled self-compassion as an antecedent to stress and demonstrated a significant indirect effect on burnout. This suggests that self-compassion\u0026rsquo;s primary contribution may lie in reducing the experience of stress rather than buffering its impact on burnout.\u003c/p\u003e\u003cp\u003eThis interpretation is consistent with Lazarus and Folkman\u0026rsquo;s transactional model of stress and coping, which posits that stress arises from external demands and an individual\u0026rsquo;s appraisal of those demands [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. From this perspective, self-compassion may shape how students view the challenges associated with medical education as well as their coping capacity, thereby reducing perceived stress. In line with this model, our findings showed a substantial indirect effect (\u0026asymp;\u0026thinsp;59% of the total), highlighting stress reduction as a key mechanism. Nevertheless, the mediation was partial, as a significant direct effect remained, indicating that self-compassion also influences burnout through additional pathways.\u003c/p\u003e\u003cp\u003eOne possible mechanism is that self-compassion has been shown to increase resilience and engagement in self-care behaviors, which in turn reduce emotional exhaustion and enhance personal accomplishment [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This mechanism would be especially perneient to our sample, as studies among medical students in Egypt have repeatedly reported low resilience levels [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and pessimistic attitude towards studying medicine [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Other studies highlight the role of psychological capital (hope, optimism, self-efficacy) and compassion satisfaction as mediators linking self-compassion to lower burnout and depression [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Self-compassion has also been associated with greater fulfillment of basic psychological needs for autonomy, competence, and relatedness, which are known protective factors against burnout [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNevertheless, alternative causal sequences than the one reported in our study have also been described. For instance, Serr\u0026atilde;o et al. reported an alternative model among Portuguese university students in which stress predicted lower self-compassion, which in turn predicted higher depressive symptoms [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Adding further complexity, a 4-year longitudinal study by Park et al. found that an increase in stress actually predicted a subsequent increase in self-compassion, supporting a \"stress inoculation\" model [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Taken together, these findings suggest a reciprocal relationship where self-compassion mitigates the initial experience of stress, while the process of successfully navigating moderate stress may, in turn, build self-compassion over time. Future research should aim to disentangle these pathways through longitudinal and experimental designs that test whether interventions that cultivate self-compassion produce downstream reductions in burnout.\u003c/p\u003e\u003cp\u003eBeyond the primary mediation model, our study identified several demographic factors associated with student distress. The finding that female students reported significantly higher stress and burnout is consistent with a large body of research, including both uni-center [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and multi-center [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] studies among Egyptian medical students, both of which identified female gender as a significant risk factor for lower resilience. One potential explanation for this disparity may be related to barriers to mental health care. Studies on Egyptian students by have repeatedly reported a significant hesitancy to seek help due to factors like social stigma [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], wanting to solve their mental health problems on their own [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and lack of trust in mental health services [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], barriers which may disproportionately affect female students. Our finding that burnout was significantly higher in later academic years differs from Serr\u0026atilde;o et al. who found that distress was highest among first-year university students in Portugal [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This discrepancy may reflect differences in curricular demands, with later years of Egyptian medical education being more academically and clinically intensive.\u003c/p\u003e\u003cp\u003eOur findings have significant practical implications for medical education and student support services, as self-compassion is not a fixed trait but a skill that can be cultivated [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. As an internal psychological resource, it represents an especially promising intervention target for Egyptian medical students, who consistently report significant barriers and reluctance to seeking formal mental health care. Our results highlight the value of prioritizing such interventions for vulnerable subgroups, particularly female students, those from rural areas, and those in the more demanding later years of training. Embedding evidence-based programs, such as Mindful Self-Compassion workshops which a recent meta-analysis found to be effective [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], within the curriculum may provide a proactive and scalable strategy to enhance coping, reduce stress, and ultimately prevent burnout among future physicians.\u003c/p\u003e\u003cp\u003eNevertheless, several limitations should be considered when interpreting the study\u0026rsquo;s findings. The cross-sectional design precludes causal inference; while our results support a mediational pathway, longitudinal research is needed to establish temporal relationships. The use of convenience sampling at a single institution may limit generalizability, highlighting the need for multi-center studies across diverse Egyptian medical schools to strengthen external validity. Reliance on self-report instruments introduces the possibility of response and recall bias, underscoring the value of incorporating objective or mixed-methods assessments in future work. Finally, although the missing BAT-23 item was imputed using a standard method with minimal impact on reliability, this may nonetheless have slightly affected the accuracy of the results.\u003c/p\u003e\u003cp\u003eIn conclusion, this study suggests that self-compassion is a vital psychological resource that protects against burnout among Egyptian medical students, operating largely by mitigating perceived stress. These results suggest that interventions aimed at cultivating self-compassion may be a practical strategy for medical educators and student wellness programs, especially in resource constrained settings such as Egypt. Fostering the ability of future physicians to respond to training challenges with self-kindness is a critical step in reducing burnout and building a sustainable, resilient healthcare workforce.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthical Approval\u003c/h2\u003e\u003cp\u003e Ethical approval was obtained from the Institutional Research Board (IRB) of ***DE-IDENTIFIED*** (approval code: ***DE-IDENTIFIED***), and the study was conducted according to the principles of the Helsinki Declaration. All participants were invited to voluntarily and anonymously complete an online survey, provided electronic informed consent, and were free to respond at their convenience.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo funding or sponsorship was received from any companies, groups, individuals, organizations, or any other entities.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe conception and design of the study were done by all authors. Acquisition of data was done by NAE-I, NAE-S, RI, and MSSA-Mansoura Team of Collaborators. Analysis and interpretation of data were done by YMO and AA. Drafting the manuscript was done by all authors except AE. Revising the manuscript critically for important intellectual content was done by YMO and AE. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eMSSA-Mansoura Team of Collaborators: Renad Reda Elbeyaly, Sereen M. Al Tayara, Rofida Mokbel Ibrahim, Khaled Sameh Elbahnasi, Hassan M. Karrar, Ahmed A. Shousha, Fatma Abu Elsoud, Hassan Moustapha Sabbah, Rodina S. Elkhouly, Rady Turky Amhimd, Mariam M. Baz\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data of this study is available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSchaufeli WB, Desart S, De Witte H. Burnout Assessment Tool (BAT)\u0026mdash;Development, Validity, and Reliability. 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Curr Psychol. 2024;43:6475\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12144-023-04834-4\u003c/span\u003e\u003cspan address=\"10.1007/s12144-023-04834-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"Self-compassion, Stress, Burnout, Medical students, Egypt","lastPublishedDoi":"10.21203/rs.3.rs-7754481/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7754481/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eThis study aimed to examine whether perceived stress mediates the association between self-compassion and burnout in medical students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted using an online questionnaire. A total of 649 medical students from a public university in Egypt were recruited via convenience sampling. Participants completed the Self-Compassion Scale\u0026ndash;Short Form (SCS-SF), the Perceived Stress Scale (PSS-10), and the Burnout Assessment Tool (BAT-23). Bivariate associations were tested with Pearson correlations; multivariable linear regression assessed predictors of burnout. Mediation analysis was performed with bias-corrected bootstrapped confidence intervals (10,000 samples) to estimate indirect effects.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSample means were 36.4 (SCS-SF), 22.2 (PSS-10), and 3.38 (BAT-23). Bivariate analyses revealed significant negative correlations between self-compassion and both perceived stress (r = -0.577) and burnout (r = -0.478), and a positive correlation between stress and burnout (r\u0026thinsp;=\u0026thinsp;0.603; all p-values\u0026thinsp;\u0026lt;\u0026thinsp;.001). The regression model explained 39.9% of burnout variance (R\u0026sup2; = .399); perceived stress was the strongest predictor (β\u0026thinsp;=\u0026thinsp;0.488), while self-compassion remained a significant protective factor (β = -0.196). The mediation analysis confirmed a significant indirect effect of self-compassion on burnout via perceived stress (B = -0.026, 95% CI [-0.032, -0.021]). As the direct effect also remained significant (B = -0.018), a partial mediation model was supported, with the indirect pathway accounting for 59.2% of the total effect.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eHigher self-compassion is associated with lower burnout largely through reduced perceived stress. Training self-compassion alongside stress-reduction strategies may help safeguard medical student well-being.\u003c/p\u003e","manuscriptTitle":"Self-Compassion Protects Against Burnout in Medical Students: A Mediation Analysis of Perceived Stress","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-04 13:36:40","doi":"10.21203/rs.3.rs-7754481/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":"4be8e641-cb87-4904-b467-077b1fd13e84","owner":[],"postedDate":"November 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-25T13:38:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-04 13:36:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7754481","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7754481","identity":"rs-7754481","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}