Burnout and Work-Life Balance: A Longitudinal Study Into the Transition From Medical School to Postgraduate Training

Much discussion currently surrounds the intense occupational stress of the practical year (the final year of medical school in Germany) and the early years of postgraduate medical training, yet the extent of subjectively experienced stress during the transition from medical school to postgraduate training has not been measured to date.

We conducted a longitudinal survey of medical students in their 9th and 10th semesters and in their practical year, with a 2-year follow-up. Data were acquired with the Maslach Burnout Inventory (MBI), the Trier Abbreviated Scale on Work-Life Balance, and questions about patient care. Trends were analyzed with linear mixed models.

321 students participated; 216 (67.3%) were female. The mean values for exhaustion and depersonalization/loss of empathy rose over time, while personal performance remained steadily low. Classification in categories revealed a high level of emotional exhaustion in 10.3% of subjects, rising to 47.4% in the first year of postgraduate training. It also revealed that 43.6% of subjects exhibited a very high level of depersonalization/loss of empathy as early as the 9^th semester of medical school, with a further rise at later times. Personal accomplishment was very low at the beginning in 48.7% of subjects, and then dropped even lower. Work-life balance declined from medical school to the practical year and continued to decline from the practical year to postgraduate training.

The MBI scale scores were unfavorable at the outset and worsened over time, indicating high stress throughout. There is an urgent need to improve the structural framework of undergraduate and postgraduate medical education.