title: Factors associated with resilience to and recovery from burnout: a prospective, multi-institutional study of US medical students.
abstract: BACKGROUND
  Burnout is prevalent among medical students and is a predictor of subsequent serious consideration of dropping out of medical school and suicide ideation. Understanding of the factors that protect against burnout is needed to guide student wellness programmes.
  
  
  METHODS
  A total of 1321 medical students attending five institutions were studied longitudinally (2006-2007). The surveys included standardised instruments to evaluate burnout, quality of life, fatigue and stress. Additional items explored social support, learning climate, life events, employment status and demographics. Students who did not have burnout at either time-point (resilient students) were compared with those who indicated burnout at one or both time-points (vulnerable students) using a Wilcoxon-Mann-Whitney test or Fisher's exact test. Similarly, the differences between those who recovered and those who were chronically burned out were also compared in students with burnout at the first time-point. Logistic regression modelling was employed to evaluate associations between the independent variables and resiliency to and recovery from burnout.
  
  
  RESULTS
  Overall, 792 (60.0%) students completed the burnout inventory at both time-points. No differences in demographic characteristics were observed between resilient (290/792 [36.6%]) and vulnerable (502/792 [63.4%]) students. Resilient students were less likely to experience depression, had a higher quality of life, were less likely to be employed, had experienced fewer stressful life events, reported higher levels of social support, perceived their learning climate more positively and experienced less stress and fatigue (all p < 0.05) than vulnerable students. On multivariable analysis, perceiving student education as a priority for faculty staff, experiencing less stress, not being employed and being a minority were factors independently associated with recovery from burnout.
  
  
  CONCLUSIONS
  Modifiable individual factors and learning climate characteristics including employment status, stress level and perceptions of the prioritising of student education by faculty members relate to medical students' vulnerability to burnout.
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, Minnesota 55906, USA. dyrbye.liselotte@mayo.edu
authors.forename: Liselotte N
authors.initials: LN
authors.lastname: Dyrbye
authors.forename: David V
authors.initials: DV
authors.lastname: Power
authors.forename: F Stanford
authors.initials: FS
authors.lastname: Massie
authors.forename: Anne
authors.initials: A
authors.lastname: Eacker
authors.forename: William
authors.initials: W
authors.lastname: Harper
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Thomas
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Szydlo
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000523:psychology*; D005221:Fatigue / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D055500:Resilience, Psychological; D012944:Social Support; D013337:Students, Medical / Q000523:psychology*; D014481:United States; D055815:Young Adult