burnout among clinical dental students at jordanian universities

7/29/2019 Burnout among clinical dental students at Jordanian universities

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EMHJ Vol. 16 No. 4 2010 Eastern Mediterranean Health JournalLa Revue de Sant de la Mditerrane orientale

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Burnout among clinical dental students at JordanianuniversitiesD.H. Badran,1M.H. Al-Ali,2 R.B. Duaibis2 and W.M. Amin2

ABSTRACT Dentistry is a proession demanding physical and mental eorts as well as people contact, whichcan result in burnout. The level o burnout among 307 clinical dental students in 2 Jordanian universities wasevaluated using the Maslach Burnout Inventory survey. Scores or the inventorys 3 subscales were calculatedand the mean values or the students groups were computed separately. Dental students in both universitiessuered high levels o emotional exhaustion and depersonalization. The dental students at the University o

Jordan demonstrated a signifcantly higher level o emotional exhaustion than their counterparts at the JordanUniversity o Science and Technology.

1Centre for Educational Development; 2Department of Prosthetic Dent istry, Faculty of Dentistry, University of Jordan, Amman, Jordan(Correspondence to W.M. Amin: [email protected]).

Received: 02/12/07; accepted: 13/02/08

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Lpuisement proessionnel chez les tudiants en dentisterie des universits jordaniennes

RSUM La dentisterie est une proession qui demande des eorts physiques et mentaux et un contact avecle public qui peuvent conduire lpuisement proessionnel. Le niveau dpuisement de 307 tudiants endentisterie de deux universits jordaniennes a t valu laide de linventaire dpuisement proessionnel deMaslach. Les scores obtenus pour les trois sous-chelles de linventaire ont t calculs et les valeurs moyennespour les groupes dtudiants ont t dtermines sparment. Les tudiants en dentisterie des deux universitsprsentaient des niveaux levs dpuisement motionnel et de dpersonnalisation. Les tudiants de luniversitde Jordanie ont montr un niveau dpuisement motionnel nettement suprieur celui de des tudiants deluniversit jordanienne des sciences et de la technologie.


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Introduction

Dentistry is a profession demandingphysical and mental eort as well aspersonal contact, which can result in a

condition known as burnout. Burnoutis dened as a syndrome of emotionalexhaustion and cynicism that occursfrequently among individuals who dopeople-work of some kind [1]. It ischaracterized by 3 key aspects: emo-tional exhaustion (mental fatigue),depersonalization (psychologicaldistancing from others) and reducedpersonal accomplishment [2,3].

e rate of burnout among den-

tists and its eect on their lives havebeen previously investigated by manyresearchers [412]. Burnout can leadto early retirement and indierenceto treatment outcomes and patientsconditions or needs [4]. e aecteddentist also tends to avoid contact withpeople, including colleagues, patients,friends or even family. Burnout there-fore obviously has serious detrimentaleects on the profession as well as on

society [3,6].Many researchers have studied the

existence of stress among dental stu-dents [2,712] and a few have studiedthe prevalence of burnout [2,79,12].In a study aimed at testing the rate ofburnout among German dental stu -dents at 3 universities [3], there werehigh scores for burnout regardless ofthe education system used. In a separate

study, emotional exhaustion amongdental students at 7 European schoolswas signicantly higher than amongmedical students [2]. e perceivedstress among dental students had beenaributed to factors such as fear offailure [7], the load of academic andclinical work [8,11], nonavailability insome colleges of materials for studyand clinical training [10] and perform-ance pressure and self-ecacy beliefs

[12]. It has been reported that studentswho demonstrated high levels of stresstended to show lower grades in clinical

competency and contextual under-standing [9].

e aim of this study was to deter-mine the presence and level of burnoutamong clinical dental students at the 2

dentals schools in Jordan.

Methods

In Jordan, there are only 2 dentalschools, the University of Jordan (UJ)and at the Jordan University of Scienceand Technology (JUST), both oeringa bachelor degree programme.

e extent of burnout in 307 clinical

dental students was assessed using theMaslach Burnout InventoryHumanServices Survey (MBI-HSS) [1]. einventory comprises 22 items (phrases)measuring 3 subscales of burnout:emotional exhaustion (9 items), de-personalization (5 items) and personalaccomplishment (8 items). Respond-ents score items on a scale from 1 to 4indicating how oen they encounterthe item: 1 (never, rarely or a few times a

year); 2 (once or a few times a month);3 (once or a few times a week); 4 (daily).A high degree of burnout is reectedby high scores on the emotional anddepersonalization subscales and lowscores on the personal accomplishmentsubscale and vice versa. e 3 subscales,though related, are independent andtherefore the degree of burnout is ex-pressed by the scores of its 3 subscalesrather than by a total score.

e MBI-HSS is an eective toolof proven reliability and validity in de-tecting the presence and assessing thedegree of burnout in human servicesworkers. e English version of the in-ventory was used since English is theteaching language in both the Jordaniandental schools.

e clinical students (4th and 5thyear) of the dental schools at UJ (n

= 83 and n = 93 respectively) and JUST(n = 64 and n = 67 respectively) wereasked to complete the inventory during

a lecture at each of the universities dur-ing the 2nd semester aer the midtermexaminations. e instructions wereexplained thoroughly to the studentsby the researchers. e responses were

totally anonymous to ensure con-dentiality. Prior to the survey, studentswere briefed on the objectives of thesurvey and the impact it would haveon planning their study curriculum;the response rate was 100%. Studentswere also asked to double-check theiranswers to ensure complete responses.

e score for each of the 3 subscaleswas calculated for each student fromthe sum of responses to the items in

the subscale. Mean values were thencalculated for each student group sepa-rately. ShapiroWilk test of normalityindicated that the data were not nor-mally distributed in many instances;consequently, nonparametric statisticaltests were used to compare the resultsof the 4 student groups. KruskalWallis1-way analysis of variance (ANOVA)based on ranks was used in determin-ing whether any signicant dierencesexisted among the groups. Multiplecomparisons among the groups wereperformed using the MannWhitneyrank sum test. Statistical analysis wascarried out usingSPSS, version 14.0,with the level of signicance set at P< 0.05.

Results

e responses for the 4th and 5th yearstudents of each university were de-scribed in terms of mean and standarddeviation (SD). Cut-o values abovewhich a subsca le score was deemedhigh were obtained by correcting thevalues indicated in the MBI-HSS scor-ing key to compensate for the dierencein scoring scale.

Female students at UJ had signi-

cantly higher mean scores on emotionalexhaustion (P< 0.05) than their malecounterparts in both the 4th year [mean


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EMHJ Vol. 16 No. 4 2010 Eastern Mediterranean Health JournalLa Revue de Sant de la Mditerrane orientale

436

score 27.3 (SD 5.2) versus 23.2 (SD4.6)] and 5th year [29.9 (SD 4.8) versus26.7 (SD 5.5)]. No signicant dier-ences were found between males andfemales of either university in deper-

sonalization or in personal achievementscores (Table 1).

Pairwise comparisons showed thatthe 4th year UJ students exhibited sig-nicantly higher degrees of burnout inall 3 subscales than their 5th year coun-terparts (P< 0.05). On the other hand,no signicant dierences were foundbetween 4th and 5th year students atJUST. Comparisons between the uni-versities showed that UJ students had

signicantly higher degrees of emotion-al exhaustion than their counterparts atJUST (P< 0.05) (Table 2).

Discussion

Almost all of the students in the 4thand 5th years in the 2 dental schoolsin the 2 Jordanian universities suered

high degrees of emotional exhaustion.In a previous study it was reported thatonly 22% of the surveyed students from7 European dental schools had highdegrees of emotional exhaustion [2].

e scores of emotional exhaustiondetermined in this study were extremelyhigh, especially those of the UJ students.Even the relatively lower scores aainedby the JUST students were still higherthan those reported by the Europeanstudy [2]. e cause of the high levels ofemotional exhaustion shown by the Jor-danian dental students may be related tothe pressures of studying, examinations,competition and fullment of the mini-

mum clinical requirements in additionto the primary cause of direct contactwith patients. Further investigations todetermine the possible factors related tothis problem and its possible causes arenecessary and of signicant importance.

Comparisons between the 2 den-tal faculties showed that UJ studentshad signicantly higher scores of emo-tional exhaustion than JUST students.

Although the clinical training schemeis similar in both universities, there aresome dierences which may be favour-able to JUST students. e dental facul-ties of both universities have a clinical

training system which obliges a studentto successfully complete a minimumamount of clinical requirements in orderto pass any clinical course. Nevertheless,the minimum clinical requirements ofUJ dental faculty are greater in terms ofquantity and variety of clinical tasks thanthose of JUST for 4th or 5th year stu-dents (data not presented). is couldrequire more physical and mental eortby the UJ students compared with their

counterparts at JUST. In addition, UJstudents have to nd their own patientsdue to the absence of a patient recordsling system. e dental faculty of JUST,on the other hand, organizes the studentspatient records and distributes themaccording to the students needs. isincreased the number of patients the UJstudents had to interact with (data notpresented), which consequently mayhave increased the emotional exhaus-

tion level in those students.Clinical sessions were longer and less

frequent in JUST dental faculty (datanot presented). us, UJ students mayhave been more stressed trying to nishtheir procedures in time. Furthermore,having more clinical sessions per weekmeans a higher level of patient contacts,which in turn is likely to increase thelevel of emotional exhaustion.

e availability of the sta duringthe clinical sessions might also haveplayed a role. In JUST, the sta-to-student ratio was very favourable forboth the learning experience and thestudents mental health. As each clinicalinstructor handles fewer students, thestudent receives a longer time and bet-ter aention from the sta. Moreover,JUST provides an allied dental sciencesprogramme whose students assist the

clinical dental students during their ses-sions, puing 4-handed dentistry intopractice. e Faculty of Dentistry at UJ

Table 1 Scores on the 3 subscales o the Maslach Burnout InventoryHumanServices Survey or 4 student groups

Student group/sex Emot ionalexhaustion

(max. score 36)

Depersonalization(max. score 20)

Personalachievement

(max. score 32)

Mean (SD) Mean (SD) Mean (SD)

4th year UJ

Male 23.2* (4.6) 7.0 (2.3) 26.7 (2.9)

Female 27.3* (5.2) 7.0 (2.6) 25.2 (4.6)

All 26.1 (5.4) 7.0 (2.5) 25.6 (4.1)

5th year UJ

Male 26.7* (5.5) 8.1 (2.9) 23.6 (4.6)

Female 29.9* (4.8) 8.2 (2.6) 22.6 (4.0)

All 29.0 (5.2) 8.1 (2.7) 22.9 (4.2)

4th year JUST

Male 20.8 (5.4) 6.4 (2.2) 26.1 (4.2)

Female 22.7 (5.2) 7.2 (2.3) 26.5 (4.0)

All 21.8 (5.4) 6.9 (2.3) 26.0 (4.6)

5th year JUST

Male 20.8 (4.8) 7.5 (2.3) 24.9 (4.6)

Female 22.7 (4.9) 7.3 (2.3) 26.3 (4.0)

All 21.0 (4.9) 7.6 (2.1) 24.9 (5.0)*P < 0.05 between males and females of the same student group.

SD = standard deviation; UJ = University of Jordan; JUST = Jordan University of Science and Technology.


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does not oer such programmes; thishas obliged the students of the UJ tond their own patients and to handlethem entirely by themselves

Depersonalization may be the mostcritical aspect of burnout in a health careprofession such as dentistry. Perceiv-ing the patient as an impersonal objectrather than a human being might resultin detrimental negligence in treatmentprocedures and disregard of the psy-chological aspects of treating patients.In both dental schools 5th year studentshad signicantly higher scores of de-personalization than 4th year students.

No signicant dierences were foundbetween students of the 2 schools inthe same academic level. ese ndingsmight suggest that depersonalization in-creases with increased patient contact.Longitudinal studies are necessary toconrm this suggestion, but increasingthe students as well as the instructors

Conclusions andrecommendations

e ndings of this study indicated thatdental students at Jordanian universi-

ties suered considerable degrees ofburnout. Dental students as wel l asinstructors should be informed aboutburnout and its elements to increasetheir awareness of the problem. Ana-lytical studies targeting students healthand psychology should be carried outregularly to determine the causes andfactors related to the high degree ofburnout among dental students.

Acknowledgements

e authors express their sinceregratitude to the dental students of theuniversities who participated in thissurvey and to the deans of the 2 facul-ties for their interest in the study andfor providing access to lectures. Specialthanks go to Ms Ikram Tamimi of theCentre for Educational Development

for her invaluable assistance in tabulat-ing the data and organizing the results.e authors would also like to expresstheir thanks to Dr Hanan Jafar of theFaculty of Medicine and Dr AmmarKassab, intern and research fellow at theFaculty of Dentistry for their eorts andassistance in conducting the survey.

awareness of such a problem is impera-tive to avoid further development of theproblem in the future clinical career ofthe students.

High scores of personal achieve-ment mean more involvement with thepatients and more satisfaction with theprofession and consequently, lower de-grees of burnout. e lower mean scoresof personal achievement in 5th yearstudents at UJ compared with 4th yearstudents should be viewed as anothersign of increasing burnout which wasrelated to increased patient contact in

terms of frequency and duration (datanot presented). is scale of burnoutis extremely important and should beclosely monitored during the clinicaltraining period of dental students andeven aer their graduation to ensurethat feelings of lack of personal achieve-ment have diminished.

Table 2 Signifcance o dierences (MannWhitney rank sum test) among studentsor the 3 subscales o t he Maslach Burnout InventoryHuman Services Survey

Compared groups,year and university

P-value

Emotionalexhaustion

Depersonalization Personalachievement

4th UJ versus 5th UJ < 0.001 0.005 < 0.001

4th JUST versus 5th JUST 0.466 0.105 0.305

4th UJ versus 4th JUST < 0.001 0.914 0.422

5th UJ versus 5th JUST < 0.001 0.270 0.014

UJ = University of Jordan; JUST = Jordan University of Science and Technology.

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burnout among clinical dental students at jordanian universities

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