Reduced burnout in medical and health science students during the pandemic COVID-19 – a follow-up study of a single institution in Hungary | BMC Medical Education
Student concerns about the pandemic, and the risk of viral infection, suggest that medical and health students may be exposed to mental stress as future members of the patient care team, even when not yet present in the clinical setting permanently. At the time of our study, there were widespread concerns about the potential shortage of healthcare workers. According to the new regulations in Hungary, students studying medicine and health sciences can be assigned indefinitely without their consent. This timing allowed us to capture a truly unique perspective among students in higher education in medical and health sciences to assess the impact of secondments on student burnout scores .
To the best of our knowledge, the Hungarian indefinite medical secondment without consent is unique compared to the surrounding countries. Consequently, in the international literature, volunteering among medical and health science students has been the main focus of research on the current epidemic. Factors supporting willingness to volunteer included: moral responsibility (social commitment, sense of duty and caring), potential learning opportunities, personal interest, provision of appropriate personal protective equipment, parental support, expertise, knowledge, and financial compensation [18, 19].
Lazarus et al. found that the most significant demographic factors influencing willingness to volunteer were male gender, residence in the central part of the country, education in a public school, and previous volunteer activity .
Students who negated volunteering cited fear of infection as the main reason for not volunteering and not wanting to infect older family members living in the same household, even by accident .
In the past, Ádám et al.  and Kovács et al.  drew attention to the burnout of medical students through cross-sectional examinations. In their surveys, 19.7–24.5%; 1.8–27.6%; and 4.7–55.8% of students were endangered by EX; CY, and PE dimensions, respectively. Our results showed that even the dramatic changes across the country and education did not increase the degree of burnout; it reduced them. (1. Table)
In our survey, the EX scores of female respondents were found to be higher than that of male respondents, which result agrees with the survey by Győrffy et al.,  where woman respondents were affected to a significantly greater extent in the EX dimension (32.1% vs. 41.8%, p = 0.012). During follow-up, there was a significant decrease in EX scores for both sexes. Male respondents were found to be more cynical in the first phase of the survey, in which value decreased significantly. Our results are consistent with those of Rusandi et al.  and Worly et al. , where EX and PE were higher in women and lower in CY than in men.
Zis et al.  investigated burnout among medical students before and during the COVID epidemic. Based on their results, the proportion of burned-out students did not change in the two measured periods (pre-COVID-19 18.1% vs. COVID-19 18.2%). In our study, we did not separately analyze the results of medical and health sciences students by year because the years of training and structure of the two faculties differ. Overall, our results show that the proportion of students belonging to the high burnout category decreased in the two sampling periods (19.67% vs. 14.75%).
In the sample examined by Zis et al. , EX decreased significantly among fourth-year students but increased significantly among sixth-year students. In contrast, the value of the CY dimension increased continuously during the training.
Studies in non-health-oriented universities have already reported the harmful effects of the coronavirus on student stress and anxiety [29, 30]. Medical students, in addition to increased mental health deterioration during the pandemic, expressed concern that the pandemic would disrupt their studies and not allow them to prepare for clinical practice  adequately. In Hungary, students studying medicine and health sciences were involved in medical secondments . When looking at the EX dimension, the values of students studying nursing, physiotherapy, laboratory analysis, radiography, and general medicine decreased significantly. Based on the results of Ruiz et al. , the proportion of medical students affected by the EX dimension increased from 5 to 14.4% during the COVID period. The PE scores of physiotherapy students showed a significant decrease. The CY scores of general medicine students also showed a significant decrease. The EX and CY of paramedic students increased non-significantly but not significantly. Interestingly, students studying to become laboratory analysts were the least affected by burnout.
69.4% (n = 127) of the student population we studied were on a medical secondment. Students who were on medical secondment had elevated mean scores for burnout. However, it should be noted that in all cases, the mean scores for these dimensions decreased significantly in this group of students. The students most affected by student burnout were those who only completed their medical secondment in a hospital setting. It is also worth noting for this group that students’ burnout indicators improved significantly after the second data collection. It may be due to the time spent away from the university environment and the practical assignments through which students could taste the values inherent in their chosen profession.
Several publications report [33, 34] higher rates of COVID-19 infection in students in clinical settings, which sometimes negatively affect students’ mental health. At the time of our survey, coronavirus infection affected 8.7% of students. Students who had a coronavirus infection were less affected by burnout. Students who were not under quarantine (74.5%) were more affected by burnout than their peers, but the rates experienced significantly improved at the second time point of the survey.
Students concerned about their health (69.4%) had elevated mean scores on the EX and CY dimensions. For students in this group, there was a significant decrease in EX, CY, and depression at the time of the second survey.
The improved results may be because more information on COVID-19 infection and precautions has become available over time. For the second data collection period, a quasi “more prepared” audience, the education and health care sector, was waiting for students than at the beginning. By this time, the scientific community had already begun to investigate the impact of COVID-19 on mental health among healthcare staff. The negative impact of COVID-19 on stress is unquestionable, but many reports indicate that front-line combat personnel was less affected in terms of mental health. It should be noted, however, that the international literature could be more consistent, as the severity and rapidity of infection waves varied between/across national borders.
Numerous publications substantiate [35,36,37] that resilience and hypermentalizing reduce the depression, anxiety, and stress levels of healthcare workers, thus resulting in lower burnout rates. Educational and training programs should consider these connections, especially during pandemic situations. Additionally, during COVID-19, depression, anxiety, and stress levels were significant in the population, mostly associated with factors such as smoking habits, fear of illness, religious beliefs, and socio-economic status. To protect the mental health of healthcare workers and mitigate the impact of the pandemic, it is necessary to monitor the effects and put in place coping techniques and emergency measures.
One of the limitations of our study was the low response rate, which was assumed to be due to the challenges faced by the students. Some students may have stopped reading the newsletter due to the workload. Another significant proportion of students presumably struggled with personal challenges related to the pandemic. It should also be noted that our survey focused only on students studying medicine and health sciences at the University of Pécs. We tried to increase the response rate by making our questionnaire available on social media platforms and involving representatives of the relevant specializations, including sending reminders for completion.