Factors Associated With Burnout and Stress in Trainee Physicians: A Systematic Review and Meta-analysis

Year Published:


Question: What factors are associated with burnout/stress in trainee physicians?

Findings: This systematic review and meta-analysis of 48 studies included 36 266 trainee physicians. The odds ratios for the associations between workplace factors and burnout/stress were found to be higher compared with nonmodifiable and non-work-related factors such as age and grade.

Meaning: The findings of this study highlight the importance of improving training and work environments to possibly prevent burnout among trainee physicians and suggest that implementing multicomponent interventions to target major stressors uncovered in this study could be promising.

Importance: Evidence suggests that physicians experience high levels of burnout and stress and that trainee physicians are a particularly high-risk group. Multiple workplace- and non-workplace-related factors have been identified in trainee physicians, but it is unclear which factors are most important in association with burnout and stress. Better understanding of the most critical factors could help inform the development of targeted interventions to reduce burnout and stress.

Objective: To estimate the association between different stressors and burnout/stress among physicians engaged in standard postgraduate training (ie, trainee physicians). Data Sources: Medline, Embase, PsycINFO, and Cochrane Database of Systematic reviews from inception until April 30, 2019. Search terms included trainee, foundation year, registrar, resident, and intern. Study Selection: Studies that reported associations between stressors and burnout/stress in trainee physicians.

Data Extraction and Synthesis: Two independent reviewers extracted the data and assessed the quality of the evidence. The main meta-analysis was followed by sensitivity analyses. All analyses were performed using random-effects models, and heterogeneity was quantified using the I2 statistic.

Main Outcome and Measures: The main outcome was the association between burnout/stress and workplace- or non-workplace-related factors reported as odds ratios (ORs) and their 95% CIs. Results: Forty-eight studies were included in the meta-analysis (n = 36 266, median age, 29 years [range, 24.6-35.7 years]). One study did not specify participants’ sex; of the total population, 18 781 participants (52%) were men. In particular, work demands of a trainee physician were associated with a nearly 3-fold increased odds for burnout/stress (OR, 2.84; 95% CI, 2.26-3.59), followed by concerns about patient care (OR, 2.35; 95% CI, 1.58-3.50), poor work environment (OR, 2.06; 95% CI, 1.57-2.70), and poor work-life balance (OR, 1.93; 95% CI, 1.53-2.44). Perceived/reported poor mental or physical health (OR, 2.41; 95% CI, 1.76-3.31), female sex (OR, 1.34; 95% CI, 1.20-1.50), financial worries (OR, 1.35; 95% CI, 1.07-1.72), and low self-efficacy (OR, 2.13; 95% CI, 1.31-3.46) were associated with increased odds for burnout/stress, whereas younger age and a more junior grade were not significantly associated. Conclusions and Relevance: The findings of this study suggest that the odds ratios for burnout and stress in trainee physicians are higher than those for work-related factors compared with nonmodifiable and non-work-related factors, such as age and grade. These findings support the need for organizational interventions to mitigate burnout in trainee physicians. This systematic review and meta-analysis examines the factors associated with burnout and stress among physicians receiving standard postgraduate training.


Relevant Evidence Summaries

The evidence was reviewed and included in the following summaries: 

What works to reduce burnout and vicarious trauma among refugee service providers?

There is strong evidence for a variety of strategies to reduce vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout among helping professionals. A strong body of evidence has developed in the past twenty years on reducing stress reactions among a variety of professional helpers in a wide range of settings and professions. Strategies to […]

About this study

AGE: Adults




HOST COUNTRY: Multiple countries



INTERVENTION: Organizational strategies

OUTCOME AREA: Reduction of compassion fatigue, burnout, and secondary trauma


TYPE OF STUDY: Meta-analysis