📄 medicine

Prevalence and Coping Strategies of Burnout among MBBS Students at a Medical College in Pokhara, Nepal: A Cross-Sectional Study Using the Maslach Burnout Inventory – Student Survey

This cross-sectional study of MBBS students in Pokhara, Nepal, reveals that while strict burnout affects 12.1% of students, nearly 90% exhibit at least one burnout dimension, with the highest prevalence occurring in pre-clinical years and a strong association found between maladaptive coping strategies and burnout symptoms.

Original authors: Pranisha Dotel, Bipin Bajgain, Yam Bahadur Roka, Ghanshyam Yadav, Hemanta Tiwari, Aryan Kumar Yadav

Published 2026-07-07

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Pranisha Dotel, Bipin Bajgain, Yam Bahadur Roka, Ghanshyam Yadav, Hemanta Tiwari, Aryan Kumar Yadav

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine medical school as a grueling, multi-year marathon. Most people assume the runners get most tired near the finish line, when the terrain gets rough and the pressure to perform is highest. But a new study from a medical college in Pokhara, Nepal, found something surprising: the runners are actually most exhausted right at the starting line.

Here is the story of that study, broken down into simple terms.

The Race and the Runners

The researchers looked at 199 medical students (MBBS students) at Gandaki Medical College. They wanted to know how many were "burned out." Think of burnout not just as being tired, but as a three-part storm hitting a student's mind:

Emotional Exhaustion: Feeling like your emotional battery is completely drained.
Cynicism: Feeling detached, like you're just going through the motions or rolling your eyes at everything.
Low Academic Efficacy: Feeling like you aren't good enough or that your hard work doesn't matter.

To be considered "fully burned out," a student had to be suffering from all three storms at once.

The Big Surprise: The Early Years are the Hardest

The researchers expected that students in their later years (the "clinical" years where they treat real patients) would be the most burned out. They thought the stress of hospitals and sick people would be the breaking point.

They were wrong.

The study found that the students in their first and second years (the "pre-clinical" years where they mostly study books and labs) were actually the most exhausted and cynical.

The Analogy: Imagine a video game. The researchers expected the final boss battle to be the hardest. Instead, they found that the tutorial level (Year 1) was so overwhelming with new rules, huge amounts of information, and living away from home for the first time, that it drained the players' energy faster than the later levels.
The Numbers: About 12% of the students were fully burned out (suffering from all three storms). However, a massive 89% of students were showing at least one sign of burnout. It's like saying only 1 in 8 cars have a blown engine, but 9 in 10 cars have at least one flat tire or a warning light on.

The Coping Toolkit

The study also looked at how students tried to handle the stress. They carried two types of "mental backpacks":

Adaptive Backpacks (Good Tools): These include things like planning ahead, asking for help, or finding a way to laugh at the situation.
Maladaptive Backpacks (Bad Tools): These include venting anger, giving up, or trying to escape by sleeping too much or using substances.

The Findings:

Students who used the "Bad Tools" (like venting or giving up) were much more likely to feel exhausted and cynical.
Students who used the "Good Tools" felt more confident in their ability to succeed.
Interestingly, the most popular tools students used were actually the good ones (like acceptance and planning), but more than half of the students still relied on the bad tools more than the good ones.

What Didn't Matter

Gender: The study found that being male or female didn't significantly change the burnout levels. Both groups felt the stress similarly.
Grades: Students who did better on exams generally felt more confident in their abilities, but the link between grades and total burnout wasn't a simple straight line.

The Takeaway

The study concludes that the "danger zone" for medical students isn't when they are treating patients in the hospital; it's when they first walk through the door of medical school.

The authors suggest that if a school wants to help its students, it shouldn't wait until the students are seniors to offer support. Instead, they should introduce stress-management and coping skills on day one, right when the students are most vulnerable to the shock of the new environment.

In short: The marathon is tough from the very first step, not just the last. To keep the runners going, you need to give them water and rest at the start, not just at the finish.

Technical Summary: Prevalence and Coping Strategies of Burnout among MBBS Students at a Medical College in Pokhara, Nepal

Problem Statement
Student burnout is a critical issue in global medical education, characterized by emotional exhaustion, cynicism, and diminished academic efficacy. While medical training in Nepal has expanded rapidly, particularly in the Pokhara region, empirical data on burnout prevalence in this specific setting remains scarce. Existing literature from Nepal is limited to studies conducted in Kathmandu using different measurement tools (Copenhagen and Oldenburg inventories), which reported high prevalence rates (48.8% and 65.9%). No prior study had utilized the Maslach Burnout Inventory – Student Survey (MBI-SS) in Pokhara or Gandaki Province, leaving a gap in evidence-based institutional responses to student distress.

Methodology
This cross-sectional analytical study was conducted in May 2026 at Gandaki Medical College and Teaching Hospital (GMCTH), Pokhara.

Participants: The study included undergraduate MBBS students from Year 1 through Internship. From 200 online responses, 199 were eligible for analysis after excluding one incomplete response. The mean age was 21.7 ± 2.1 years, with 54.3% female participants.
Instruments: Data were collected via a structured questionnaire comprising:
1. Sociodemographic and lifestyle items.
2. The 16-item MBI-SS, measuring three subscales: Emotional Exhaustion (EE), Cynicism (CY), and Academic Efficacy (AE). Internal consistency was excellent for EE ( $\alpha$ = 0.893) and AE ( $\alpha$ = 0.888), and good for CY ( $\alpha$ = 0.760).
3. A 16-item adapted Brief COPE inventory, categorizing strategies into adaptive (e.g., active coping, planning) and maladaptive (e.g., venting, substance use).
4. Academic experience items.
Operational Definitions: Burnout was strictly defined as the simultaneous co-occurrence of high EE (mean $\ge$ 3.50), high CY (mean $\ge$ 2.00), and low AE (mean $\le$ 3.17). An "at-risk" classification was applied to students meeting at least one criterion.
Statistical Analysis: Analyses were performed using Python (pandas, scipy, statsmodels). Given non-normal distributions of MBI-SS subscales, both parametric (t-test, ANOVA) and non-parametric (Mann-Whitney U, Kruskal-Wallis) tests were utilized. Correlations were assessed via Pearson and Spearman coefficients. A backward-elimination binary logistic regression was conducted to identify independent predictors.

Key Results

Prevalence: Strict tripartite burnout was identified in 24 students (12.1%; 95% CI 8.2–17.3%). This was significantly lower than the study's a priori hypothesis of $\ge$ 40% and lower than previous Nepali studies. However, 88.9% of students met at least one burnout criterion, indicating widespread subclinical symptomatology.
Dimensional Breakdown: High Cynicism was the most prevalent dimension (59.3%), followed by low Academic Efficacy (50.3%) and high Emotional Exhaustion (34.7%).
Academic Year Gradient: Contrary to the hypothesis that clinical years would carry the highest burden, pre-clinical students (Years 1–2) exhibited significantly higher EE (3.44 vs. 2.50, $p < 0.001$ ) and CY (2.72 vs. 2.18, $p = 0.010$ ) than their clinical counterparts. Year 1 students specifically showed the highest scores.
Demographics: Sex did not significantly influence any burnout dimension, though female students showed a non-significant trend toward higher prevalence (14.8% vs. 8.8%).
Coping Strategies: Maladaptive coping was positively correlated with EE ( $r = 0.27, p < 0.001$ ) and CY ( $r = 0.30, p < 0.001$ ). Adaptive coping was positively correlated with AE ( $r = 0.28, p < 0.001$ ). In multivariable logistic regression, no predictor reached statistical significance after backward elimination, though maladaptive coping retained the strongest association (adjusted OR 1.95, $p = 0.076$ ). The authors note the analysis was likely underpowered due to the small number of strict burnout cases ( $n=24$ ).

Significance and Claims
The study claims to be the first to document burnout among MBBS students in Pokhara using the MBI-SS. Its primary significance lies in challenging the assumption that burnout peaks during clinical training; instead, it identifies the transition into medical school (pre-clinical years) as the period of highest risk.

The authors argue that the discrepancy between their strict prevalence rate (12.1%) and higher rates in previous Nepali studies is likely methodological, stemming from the use of single-dimension criteria in earlier work versus the strict co-occurrence definition used here. They posit that while strict burnout is less common than hypothesized, the high prevalence of at least one elevated dimension (88.9%) suggests a broad need for preventive intervention.

The paper concludes that institutional wellbeing programs should not be reactive or limited to senior clinical years. Instead, it advocates for proactive coping-skills training, peer mentorship, and counseling access starting from the induction phase (Year 1) to address the acute stressors of the initial transition into medical education. The authors call for multi-institutional, longitudinal studies to confirm these patterns and evaluate the efficacy of early interventions.