student burnout essay

MINI REVIEW article

Coping with students’ stress and burnout: learners’ ambiguity of tolerance.

• 1 School of Marxism, Dalian Maritime University, Dalian, China
• 2 School of Marxism, Dalian University of Technology, Dalian, China

In the learning milieu, academic stress is deemed as the most general mental condition that learners encounter throughout their educational process, and it has been viewed as one of the most central issues not only in general education but also specifically in language learning. Likewise, burnout has been the main point in this situation. The comprehensive sources of stress and the reasons for burnout are pinpointed in the literature so realizing their association with other aspects such as coping strategies, namely tolerance of uncertainty, are at the center of attention as it may help reduce burnout and decrease the level of stress. To this end, the goal of the present study is to prove the influence of the tolerance of ambiguity in explaining the role of stress and burnout. Briefly, some implications are set forth for the educational stakeholders.

Introduction

Taking into consideration today’s constantly altering cultural, social, economic, and political climate, it is expected that learners encounter high rates of stress and disclose feelings of being overwhelmed and fatigued ( Cheng et al., 2019 ). Even more important, scholastic stress is encountered because of substantial course work, hard and recurrent testing processes, high self-expectations, and the force to conduct and achieve ( Bedewy and Gabriel, 2015 ). Learners normally encounter difficulties that make the educational setting increasingly stressful when studying a new language, as numerous inquiries have shown, most learners encounter high degrees of academic stress ( Choi et al., 2019 ; Rajoo et al., 2019 ). In the educational cycle, learners with course stress, high course load, or other mental elements have low emotional exhaustion, and a low individual sense of success ( Yang, 2004 ).

In addition, dropout problems are primarily related to high scholastic stress, as they influence learners in several ways ( Kamtsios and Karagiannopoulou, 2015 ). The extent of stress that learners encounter in the foreign language educational cycle might have harmful influences on their scholastic achievement and success ( Iannello et al., 2017 ). Indeed, stress is a significant element that can influence learners’ education and success as learners studying English may encounter more language stress due to the number of mental, societal, and literary elements ( Khattak et al., 2011 ) and accordingly, burnout is also more popular among EFL learners than other learners that are the result of prolonged chronic stress that bring about issues like emotional fatigue, irritability, and physical symptoms like headaches, and intellectual impairment like memory and concentration issues ( Li, 2020 ), and this construct is associated with a variety of adverse consequences, including poor performance, mental distress, and even dropouts from school ( Bask and Salmela-Aro, 2013 ; Wang and Guan, 2020 ).

Although there is much literature on educators’ burnout in educational research, learners’ burnout has not been taken into consideration ( Robins et al., 2018 ) and it has become clear, nonetheless, that burnout is not limited to educators; rather, it can correspondingly happen to learners in foreign language settings ( Li, 2020 ). In fact, from a psychological point of view, like any other career, learners are emotionally and behaviorally involved in a variety of activities that may be considered as “work” that these activities are highly structured, mandatory (participating in class, doing homework, and taking examinations), and targeting success goals ( Schaufeli and Taris, 2005 ). Learners’ burnout is a significant element that has a profound effect on learners’ lives and education as it is a disorder that results from chronic distress or consecutive calamities of inefficacy in a particular profession or discipline ( Salanova and Llorens, 2008 ).

Moreover, a significant element in deciding scholastic achievement is the capability of dealing with life stress ( Kamtsios and Karagiannopoulou, 2015 ; Wang and Guan, 2020 ). To this end, various concepts have been associated with stress and burnout as the latest studies indicated that tolerance of ambiguity, as an emotional construct, may have a key role in adjusting and controlling stress ( Xu and Tracey, 2014 ). Tolerance of ambiguity is characterized as the propensity of a person to be unable to tolerate various responses caused by the discerned lack of prominent, important, or adequate knowledge and maintained by the associated discernment of ambiguity ( Carleton, 2016 ). A sense of ambiguity can be encountered at various phases and areas of life and language learners, for instance, may not be confident about their future objectives or career decisions. Ambiguity is overwhelming for people and can cause stress, and a deconstructive feeling, particularly for those who cannot tolerate it so those people who cannot tolerate ambiguity may regard the indispensability of life’s ambiguity as stressful ( Liao and Wei, 2011 ).

More specifically, people who do not tolerate ambiguity experience stress and anger and believe that it is deconstructive and must be prevented, and they have difficulties operating in unpredictable conditions. Unluckily, people who do not tolerate ambiguity are intolerant of numerous circumstances, as some ambiguities happen in their daily lives and the inclination to respond reconstructively to ambiguity can result in increased stress ( Buhr and Dugas, 2006 ). While individuals have the flexibility to respond to notions and convictions that differ from their own standpoints, others are more likely to decline notions that are inconsistent with their system and ambiguity of tolerance alludes to the way a person or group displays and handles information about an ambiguous circumstance when they experience a set of unknown, intricate, or inconsistent cues ( Nezhad et al., 2013 ). Even though great attention is drawn to these two concepts, stress, and burnout, based on the author’s knowledge, literature on the role of tolerance of ambiguity in the language learning domain is restricted so this study attempts to inspect the EFL learners’ tolerance of ambiguity as interpreters of stress and burnout.

A mounting response to a persistent stressor in the workplace is known as burnout that is characterized by the symptoms of emotional fatigue, depersonalization, and poor individual achievement and student burnout seem to have a grave impact on learners’ scholastic life ( Maslach and Leiter, 2016 ). A three-dimensional syndrome of emotional fatigue, cynicism, and expert efficacy is known as students’ burnout ( Schaufeli and Taris, 2005 ) as academic burnout alludes to learners’ fatigue due to high learning requirements (fatigue), distant and detached behavior toward school assignments, or educators (cynicism), and a sense of incompetence or a sense of absent success as a learner (inefficacy) that is also related to the self-assessment of unsuccessful learners in the academic context ( Zhang et al., 2007 ).

Academic Stress

Academic stress seems to be the most regular psychological condition encountered during their coaching period ( Ramli et al., 2018 ; Han, 2021 ). Stress is regularly utilized systematically to allude to a broad diversity of cycles, like life occurrences and circumstances, intellectual, emotional, and biological responses that such circumstances arouse ( Epel et al., 2018 ). Additionally, scholastic stress is a state created by the pressure of encountering scholastic difficult circumstances among learners ( Alvin, 2007 ). Moreover, it leads to the learners having an individual recognition of the inability to manage both environmental needs and learners’ actual assets. In fact, stress has a prolonged and uniform history as an element that adversely affects a learner’s scholastic background.

Tolerance of Ambiguity

In a language education setting, tolerance of ambiguity is the capability of coping with new ambiguities without feeling frustration or relying on knowledge sources; thus, learners who tolerate ambiguity are anticipated to comfortably learn a new language, despite encountering uncertainties and foreign phenomena in the structural and cultural dimensions ( Kamran, 2011 ). The absence of dependable or appropriate information is known as ambiguity that mirrors a trend of emotional responses to complexity, confounding, or unfamiliar information or occurrences ( Hillen et al., 2017 ). Poor tolerance of ambiguity can impede the creation of social connections, performance in ambiguous environments, the attainment of intricate notions and abilities, and those who are uncomfortable with an ambiguous situation may pull out of it or keep away from the same situation in the future ( Tynan, 2020 ). When learners face enormous amounts of new information or conflicts in their language classes, it can lead to strong negative emotional reactions such as stress. Ambiguity tolerance is generalized to various aspects of an individual’s emotional and cognitive functions and is characterized by cognitive style, belief, and viewpoint systems, associative and social functions, and problem-solving practices ( Furnham and Marks, 2013 ). Ambiguity of tolerance is characterized as an intellectual prejudice that influences how an individual discerns, interprets, and reacts to an ambiguous circumstance at the level of intellect, emotion, and behavior ( Dugas et al., 2004 ).

Implications and Future Directions

Learners’ stress can lead to a loss of excitement for taking part in the scholastic study. It can also jeopardize the learner’s scholastic future. Therefore, it is crucial to find ways and determine factors that assist learners to lessen their levels of stress and burnout and it is of utmost significance to enable learners to find tactics to use in the case of challenges and to cope with them in the scholastic context, which may decrease the risk of emotional stress. This minireview provides a number of implications for learners in language learning situations. Since a high degree of stress and burnout levels are both linked to diminished life fulfillment, and critical conceptions of dropping out, these regularly bring about low performance and decreased responsibility. Based on the expanding perception of Positive Psychology in language learning ( Wang et al., 2021 ), the concepts of stress and burnout may offer perceptions for educators in employing inhibition and involvement which are suited well into the learning situation focusing on tolerance of ambiguity as an effective way and strategies to counteract stress and burnout may be beneficial both for learners’ language progress, and their well-being. In this way, it can be argued that the intolerance of ambiguity is a person’s understanding of a circumstance centered on a person’s emotions ( Dugas et al., 2004 ). Tolerance of ambiguity has been accepted as a significant element in the remedy of stress and burnout so types of interventions could be premeditated and employed in an educational context to expand learners’ tolerance of ambiguity to eventually diminish the level of stress and burnout ( Shihata et al., 2016 ). Indeed, it is specifically critical to plan and employ approaches to lessen the occurrence of stress and burnout so tolerance of ambiguity, recognized as an emotional perception, can be considered as one way to deal with these problems because those learners who are exceedingly intolerant of ambiguity in case of an ambiguous incident understand the event as irritating and intolerable, while those learners who are tolerant of ambiguity consider the same phenomenon as less irritating. Learners who are more tolerant of ambiguity are more comfortable when faced with unknown cases or unpredictable in various educational circumstances. Students’ success can be affected by tolerance for ambiguity. Since everyday life is full of ambiguity, those who are intolerant of ambiguity can easily find many “reasons” to fret about ( Dugas et al., 2004 ) and learners with more tolerance of ambiguities are more likely to apply language policies to manage and regulate ambiguities ( Varasteh et al., 2016 ).

As a result of the negative impacts of stress and burnout on education, teaching staff representatives, counselors, and others who involve in learners could provide more control by inspiring learners to deal with the probable roots of their trauma, and by helping them find or design active and influential coping strategies to improve their intervention agendas. Furthermore, teachers are supposed to do a better job preparing and instructing their learners to contend with both their stress and consequently their burnout. In addition, more stress management training programs through workshops, seminars, and webinars should be held to assist students to be more relaxed and interested in the process of their education and arrange their future occupation policies and provide required support in their search of further instruction. As this study is a mini review and its purpose is not to implement intervention, ambiguity of tolerance could be regarded as a fundamental societal and emotive aptitude in further research that should be promoted in learners through some interventions with the purpose of addressing academic stress and burnout, so in this way, the results of such quantitative research can be added to the literature to confirm the consequences.

Author Contributions

Both authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

This review was supported by Liaoning social science planning fund “Research on the political construction of the Communist Party of China in the new era,” periodical achievement of (L20BDS016).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Alvin, N. O. (2007). Handling Study Stress: Panduan Agar Anda Bisa Belajar Bersama Anak-Anak Anda. Jakarta: Elex Media Komputindo.

Google Scholar

Bask, M., and Salmela-Aro, K. (2013). Burned out to drop out: exploring the relationship between school burnout and school dropout. Eur. J. Psychol. Educ. 28, 511–528. doi: 10.1007/s10212-012-0126-5

CrossRef Full Text | Google Scholar

Bedewy, D., and Gabriel, A. (2015). Examining perceptions of academic stress and its sources among university students: the perception of academic stress scale. Health Psychol. Open 2:2055102915596714. doi: 10.1177/2055102915596714

PubMed Abstract | CrossRef Full Text | Google Scholar

Buhr, K., and Dugas, M. J. (2006). Investigating the construct validity of intolerance of uncertainty and its unique relationship with worry. J. Anxiety Disord. 20, 222–236. doi: 10.1016/j.janxdis.2004.12.004

Carleton, R. N. (2016). Into the unknown: a review and synthesis of contemporary models involving uncertainty. J. Anxiety Disord. 39, 30–43. doi: 10.1016/j.janxdis.2016.02.007

Cheng, M., Singh, S., Chen, P., Chen, P. Y., Liu, S., and Hsieh, C. J. (2019). Sign-opt: a query-efficient hard-label adversarial attack. arXiv [Preprint] arXiv: 1909.10773,

Choi, C., Lee, J., Yoo, M. S., and Ko, E. (2019). South Korean children’s academic achievement and subjective well-being: the mediation of academic stress and the moderation of perceived fairness of parents and teachers. Child. Youth Serv. Rev. 100, 22–30.

Dugas, M. J., Buhr, K., and Ladouceur, R. (2004). “The role of intolerance of uncertainty in etiology and maintenance,” in Generalized Anxiety Disorder: Advances In Research And Practice , eds R. G. Heimberg, C. L. Turk, and D. S. Mennin (New York, NY: Guilford), 143–163.

Epel, E. S., Crosswell, A. D., Mayer, S. E., Prather, A. A., Slavich, G. M., Puterman, E., et al. (2018). More than a feeling: a unified view of stress measurement for population science. Front. Neuroendocrinol. 49:146–169. doi: 10.1016/j.yfrne.2018.03.001

Furnham, A., and Marks, J. (2013). Tolerance of ambiguity: a review of the recent literature. Psychology 4, 717–728. doi: 10.4236/psych.2013.49102

Han, K. (2021). Students’ well-being: the mediating roles of grit and school connectedness. Front. Psychol. 12:787861. doi: 10.3389/fpsyg.2021.787861

Hillen, M. A., Gutheil, C. M., Strout, T. D., Smets, E. M. A., and Han, P. K. J. (2017). Tolerance of uncertainty: conceptual analysis, integrative model, and implications for healthcare. Soc. Sci. Med. 180, 62–75. doi: 10.1016/j.socscimed.2017.03.024

Iannello, P., Mottini, A., Tirelli, S., Riva, S., and Antonietti, A. (2017). Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. Med. Educ. Online 22:1270009. doi: 10.1080/10872981.2016.1270009

Kamran, S. K. (2011). Effect of gender on ambiguity tolerance of Iranian English language learners. J. Educ. Pract. 2, 25–32.

Kamtsios, S., and Karagiannopoulou, E. (2015). Exploring relationships between academic hardiness, academic stressors and achievement in university undergraduates. J. Appl. Educ. Policy Res. 1, 53–73.

Khattak, Z. I., Jamshed, T., Ahmad, A., and Baig, M. N. (2011). An investigation into the causes of English language learning anxiety in students at AWKUM. Proc. Soc. Behav. Sci. 15, 1600–1604.

Li, C. (2020). Emotional intelligence and English achievement: the mediating effects of enjoyment, anxiety, and burnout. Foreign Lang. World 1, 69–78.

Liao, K. Y. H., and Wei, M. (2011). Intolerance of uncertainty, depression, and anxiety: the moderating and mediating roles of rumination. J. Clin. Psychol. 67, 1220–1239. doi: 10.1002/jclp.20846

Maslach, C., and Leiter, M. P. (2016). Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry 15, 103–111. doi: 10.1002/wps.20311

Nezhad, H. Y., Atarodi, I., and Khalili, M. (2013). Why on earth is learners’ patience wearing thin: the interplay between ambiguity tolerance and reading comprehension valence of Iranian intermediate level students. Theory Pract. Lang. Stud. 3, 1490–1495.

Rajoo, K. S., Karam, D. S., and Abdul Aziz, N. A. (2019). Developing an effective forest therapy program to manage academic stress in conservative societies: a multi-disciplinary approach. Urban For. Urban Green. 43, 126–353.

Ramli, N. H. H., Alavi, M., Mehrinezhad, S. A., and Ahmadi, A. (2018). Academic stress and self-regulation among university students in Malaysia: mediator role of mindfulness. Behav. Sci. 8, 12–20. doi: 10.3390/bs8010012

Robins, T. G., Roberts, R. M., and Sarris, A. (2018). The role of student burnout in predicting future burnout: exploring the transition from university to the workplace. Higher Educ. Res. Dev. 37, 115–130. doi: 10.1080/07294360.2017.1344827

Salanova, M., and Llorens, S. (2008). Current state of research on burnout and future challenges. Papeles Psicólogo 29, 59–67.

Schaufeli, W. B., and Taris, T. W. (2005). The conceptualization and measurement of burnout: common ground and worlds apart. Work Stress 19, 256–262. doi: 10.1080/02678370500385913

Shihata, S., McEvoy, P. M., Mullan, B. A., and Carleton, R. N. (2016). Intolerance of uncertainty in emotional disorders: what uncertainties remain? J. Anxiety Disord. 41, 115–124. doi: 10.1016/j.janxdis.2016.05.001

Tynan, M. C. (2020). Multidimensional Tolerance Of Ambiguity: Construct Validity, Academic Success, And Workplace Outcomes. Doctoral dissertation. Ames, IA: Iowa State University.

Varasteh, H., Ghanizadeh, A., and Akbari, O. (2016). The role of task value, effort-regulation, and ambiguity tolerance in predicting EFL learners’ test anxiety, learning strategies, and language achievement. Psychol. Stud. 61, 2–12. doi: 10.1007/s12646-015-0351-5

Wang, Y. L., and Guan, H. F. (2020). Exploring demotivation factors of Chinese learners of English as a foreign language based on positive psychology. Rev. Argent. Clin. Psicol. 29, 851–861. doi: 10.24205/03276716.2020.116

Wang, Y. L., Derakhshan, A., and Zhang, L. J. (2021). Researching and practicing positive psychology in second/foreign language learning and teaching: the past, current status and future directions. Front. Psychol. 12:731721. doi: 10.3389/fpsyg.2021.731721

Xu, H., and Tracey, T. J. G. (2014). The role of ambiguity tolerance in career decision making. J. Vocat. Behav. 85, 18–26.

Yang, H. (2004). Factors affecting student burnout and academic achievement in multiple enrolment programs in Taiwan’s technical-vocational colleges. Int. J. Educ. Dev. 24, 283–301. doi: 10.1016/j.ijedudev.2003.12.001

Zhang, Y., Gan, Y., and Cham, H. (2007). Perfectionism, academic burnout, and engagement among Chinese college students: a structural equation modeling analysis. Pers. Individ. Dif. 43, 1529–1540. doi: 10.1016/j.paid.2007.04.010

Keywords : learners’ academic stress, ambiguity of tolerance, burnout, positive psychology, emotional fatigue

Citation: Xu J and Ba Y (2022) Coping With Students’ Stress and Burnout: Learners’ Ambiguity of Tolerance. Front. Psychol. 13:842113. doi: 10.3389/fpsyg.2022.842113

Received: 23 December 2021; Accepted: 14 January 2022; Published: 17 February 2022.

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Copyright © 2022 Xu and Ba. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Jian Xu, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Interventions to reduce burnout in students: A systematic review and meta-analysis

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• Published: 03 August 2023

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• Daniel J. Madigan   ORCID: orcid.org/0000-0002-9937-1818 1 ,
• Lisa E. Kim 2 &
• Hanna L. Glandorf 1  

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Burnout is common among students and can negatively influence their motivation, performance, and wellbeing. However, there is currently little consensus regarding how to intervene effectively. Consequently, we provide the first systematic review and meta-analysis of studies examining the effectiveness of interventions aimed at reducing burnout in students. A systematic literature search returned 17 studies (10 randomized controlled trials and 7 quasi-experimental trials), which included 2,462 students from secondary and tertiary levels of education. These studies used a range of interventions (e.g., mindfulness, rational emotive behavior therapy, cognitive behavioral therapy). When the effects were aggregated across interventions, there was evidence for their effectiveness in reducing total burnout ( g + = 0.90, p  = .02, 95% CI: [0.04, 1.75], k  = 14). However, we also found evidence for moderation and nonsignificant effects when certain symptoms, designs, and intervention-types were examined. The strongest evidence for effectiveness was for randomized controlled trials, rational emotive behavior therapy, and mindfulness-based interventions. This review provides initial evidence for the efficacy of interventions in reducing burnout in students, but we note that a more systematic examination of particular intervention types, especially those designed to target the organisational-level, would be useful, and to have the most impact in informing policy, so too are studies examining the cost effectiveness of such interventions.

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Introduction

Student wellbeing is of growing concern to teachers, parents, and policymakers. This is because students appear to be increasingly susceptible to a range of mental and physical health problems, including depression, loneliness, and anxiety (e.g., Duffy et al., 2019 ; Twenge et al., 2018 ). One particular indication of poor mental wellbeing in a school context is burnout. Burnout not only negatively affects student mental health, but also has further negative consequences for achievement and motivation (e.g., Madigan & Curran, 2021 ; Ribeiro et al., 2018 ; Walburg, 2014 ). These effects may have only been exacerbated as a function of the COVID-19 pandemic (e.g., Salmela-Aro et al., 2022 ). As a consequence, in the present study, we provide the first systematic review and meta-analysis of studies examining interventions aimed at reducing burnout in students. We hope our findings will provide a basis from which to inform relevant policy and practice intending to safeguard student wellbeing.

The concept of burnout came to prominence in the mid-1970s. It was introduced to reflect observations of gradual exhaustion, cynicism, and loss of commitment in human services professionals (Maslach & Jackson, 1981 ). Theorized to arise as a result of chronic work stress, burnout was defined as a multidimensional syndrome comprising three symptoms. These symptoms are exhaustion (feelings of being emotionally overextended and exhausted by one's work), cynicism (a cynical and impersonal response toward recipients of one's care), and reduced efficacy (no longer feeling competent and successful at one’s work; Maslach et al., 1986 ). Much work has since explored complimentary theoretical approaches (e.g., Job Demands-Resources Theory; Bakker & de Vries, 2021 ) and clarified burnout’s distinctiveness from other wellbeing issues (e.g., depression; Meier & Kim, 2022 ). This work has also explored many negative outcomes associated with burnout, of which the most notable include interpersonal conflict, attrition, and reduced performance (Alarcon, 2011 ; Madigan & Kim, 2021a ; Taris, 2006 ). The latter has even been found to be a function of other peoples’ burnout (e.g., teacher burnout leading to worse student performance; Madigan & Kim, 2021b ).

Burnout affects individuals in a range of contexts but appears to be particularly common in education. In this regard, students themselves appear to be especially vulnerable to burnout. Although not formally considered work, the activities that students undertake for education share many similarities with those undertaken in work contexts (Schaufeli et al., 2002 ). For example, they attend classes and complete structured activities with specific goals in mind (e.g., gaining credits, passing a course, obtaining a degree). Accordingly, burnout can be contextualized to the academic domain for students. In this manner, student burnout represents a multidimensional syndrome of exhaustion from studying, cynicism directed towards one’s study, and reduced efficacy in relation to academic work (Salmela-Aro et al., 2009 ; Schaufeli et al., 2002 ).

Like in other work contexts, burnout in students has been linked to many outcomes. In this regard, it appears that burnout comes with several significant costs for students’ mental health. These costs include an increased likelihood of depression, more frequent suicidal ideation, and more intense feelings of anxiety (Walburg, 2014 ). Burnout will also negatively affect students’ motivation. This includes the thwarting of basic psychological needs and resulting shifts from autonomous to more controlled forms of motivation (Cazan, 2015 ; Rehman et al., 2020 ; Zhang et al., 2013 ). It is also possible that students’ self-worth and self-esteem will be negatively affected (Dyrbye et al., 2008 ; IsHak et al., 2013 ; Walburg, 2014 ). Finally, burnout will affect how students behave in the classroom. Such changes include increased apathy, more disruptive behaviours, and even absence from the classroom altogether (Schramer et al., 2019 ; Walburg, 2014 ). Combined, these changes can result in impaired student achievement (Madigan & Curran, 2021 ).

Interventions to reduce burnout

Given the many ways in which burnout can affect individuals across a variety of contexts, a growing body of work has sought to develop and test interventions aimed at reducing burnout symptoms. These interventions have been informed by various theoretical perspectives, including those originally proposed by Maslach and colleagues (e.g., Awa et al., 2010 ). Interventions have, therefore, been designed to target factors at the individual level (e.g., delivering stress management training) as well as at the organizational level (e.g., changing working hours; Maslach et al., 2012 ). In regards to specific examples of such interventions, in addition to traditional cognitive behavioral therapy techniques such as stress management and relaxation, developments from what is known as the third wave of cognitive behavioral therapy including mindfulness have been employed. The former techniques are based around changing underlying cognitive processes and patterns which in turn lead to more adaptive behaviours (e.g., Shafran et al., 2009 ), while the latter relates to the ability to stay attuned to the present in a non-judgmental manner, rather than ruminating about the past or worrying about the future (Kabat-Zinn, 2003 ).

There is evidence to suggest that interventions can indeed be effective in reducing burnout. For example, a review of interventions in physicians showed that they decreased burnout by approximately 10%, with both individual and organizational interventions being effective (West et al., 2016 ). The same is true for interventions with other medical professionals (e.g., nurses; Lee et al., 2016 ). Similarly, a review of the interventions for teacher burnout found small but significant reductions in total burnout, exhaustion, and reduced efficacy (Iancu et al., 2018 ). Finally, there is direct evidence for the effectiveness of burnout interventions in academic contexts. Specifically, a number of systematic reviews have shown that interventions can reduce burnout in medical residents (individuals practicing medicine under supervision; see e.g., Walsh et al., 2019 ), and that these are primarily based around duty hour restrictions (e.g., Williams et al., 2015 ).

What is currently unclear, however, is whether such interventions work for undergraduate and postgraduate students, and also for those in secondary education. This is particularly important because the conditions and experiences of students in these domains will likely differ substantially from those in medical contexts. For example, there will be differences in the hours worked, a different emphasis of training (theoretical vs. practical and field-based), and, especially for secondary students, differences in the type of tasks required of them (e.g., Honney et al., 2010 ). In addition, interventions (and how these are implemented) are likely to vary substantially too (e.g., duty hours do not apply; Busireddy et al., 2017 ). Yet, there is evidence that the performance, motivation, and wellbeing consequences for those engaged in undergraduate and postgraduate programs are just as severe (e.g., Madigan & Curran, 2021 ). There are also likely to be differences in working conditions and associated burnout interventions in comparison to occupations more broadly (see e.g., West et al., 2016 ). Collectively, these issues highlight the importance and necessity of effective student-focused burnout interventions.

The present study

Although intervention studies to reduce burnout in secondary, undergraduate, and postgraduate students have previously been conducted (e.g., Bresó et al., 2011 ), there has been no systematic summary of these studies. Moreover, we currently do not know what types of interventions have been employed, and perhaps more importantly, whether interventions are effective for these students. It is against this background that the present study aims to provide the first systematic review and meta-analysis of interventions aimed at reducing burnout in students. In doing so, given the strength of evidence they provide, we also focus on controlled trials. We first summarize the literature to identify what has been done so far and then conduct a meta-analysis to determine the interventions’ effectiveness. We then aim to discuss the implications for policy and practice.

Literature search

Following relevant recommendations (Page et al., 2021 ), we began with an extensive computerized literature search of the following psychology and education databases: PsychARTICLES, PsycINFO, MEDLINE, Education Abstracts, Educational Administration Abstracts, and ProQuest Dissertations. The following search terms were used: (burnout OR exhaustion OR depersonalization OR cynicism OR “reduced efficacy” OR “professional accomplishment”) AND (student) AND (intervention OR trial OR program OR treatment OR training OR workshop OR experiment OR RCT). The search was conducted in January 2023, and to be inclusive as possible we specified no explicit start date for the search. We included grey literature (theses, dissertations, conference presentations) in an attempt to reduce publication bias. As well as conducting this standardized search, we conducted an exploratory search on GoogleScholar and we also scanned the reference lists of relevant reviews, book chapters, and journal articles.

Inclusion criteria

We included studies in the present review if they: (a) included at least one treatment condition aimed at reducing burnout (either the primary or secondary outcome of the intervention); (b) included a control group; (c) measured burnout as an outcome; (d) examined students; (e) were published in English; (f) were a published journal article, thesis, dissertation, or conference presentation; (g) included a sample that was independent (not included in more than one study); and (h) included a sample of students outside the medical discipline.

Data extraction

We then reviewed studies in full and in order to summarize these studies, the following data were extracted: (a) publication information (authors/year), (b) n for experimental group, (c) n for control group, (d) instructional environment/level (secondary or tertiary), Footnote 1 (e) measure of burnout, (f) study design, (g) mode of delivery, (h) intervention duration, (i) intervention type, and (j) the main findings. Two authors then extracted the data. We calculated inter-rater reliability using Cohen’s Kappa (McHugh, 2012 ). Disagreements were resolved via a consensus among authors with reference to the original material.

Risk of bias

We then provided an assessment of the quality of studies. Here, we followed the assessment process outlined by Iancu et al. ( 2018 ) which was based on the Cochrane Collaboration tool (Higgins & Green, 2011 ). Studies were assessed against the six criteria proposed in this tool (i.e., sequence generation, allocation concealment, blinding of outcome assessor, incomplete outcome data, selective outcome reporting, and other potential threats to validity). For each of these criteria, studies were rated as having a low risk of bias, high risk of bias, or unclear risk of bias. Like Iancu et al., we computed three scores representing the total number of criteria on which each study was classified as having a low, high, or unclear risk of bias.

Meta-analytic procedures

In addition to summarizing the studies, we also assessed the effectiveness of burnout interventions for students by means of meta-analysis. In doing so, we examined posttest between group effect sizes (experimental vs. control group). Effect sizes were calculated for each study for each of the following outcome measures: (1) total burnout, (2) exhaustion, (3) cynicism, and (4) reduced efficacy. For those studies that did not report a total burnout score, the average of burnout effect sizes for a given study was used (see Dreison et al., 2018 ).

Following the recommendations of Lipsey and Wilson ( 2001 ), we used random-effects models to derive effect sizes and confidence intervals, as these models allow generalization beyond the present set of studies to future studies (Schmidt et al., 2009 ). An effect is significant ( p  < 0.05) if its 95% confidence interval does not include zero. In addition, to ensure statistical independence, each study contributed no more than one effect size per analysis (Lipsey & Wilson, 2001 ). We conducted the analyses using Meta-Essentials (Suurmond et al., 2017 ).

The analyses were based on Hedges’ g (Borenstein et al., 2009 ). Hedge’s g corrects for small samples and results in a less biased estimates compared to Cohen’s d (Borenstein et al., 2009 ). Moreover, it is also possible to interpret Hedge’s g in much the same way as Cohen’s d : with a g of 0.20 considered small, 0.50 considered medium, and 0.80 considered large (Cohen, 1992 ). We used means, standard deviations, and sample sizes to calculate g .

We report the total heterogeneity of the meta-analytic effect sizes ( Q T ), which provides an indication of whether the variance of the meta-analytic effect size is greater than that which would be expected from sampling error. The degree of inconsistency in the observed relationship across studies ( I 2 ) was also calculated. Values of 25%, 50%, and 75% are indicative of low, medium and high levels of heterogeneity (Higgins & Thompson, 2002 ).

Where substantial levels of heterogeneity were found, we conducted subgroup analyses. These analyses centered around the heterogeneity explained by any categorization in the data ( Q B ). When Q B is statistically significant there are differences between categories in terms of their effect sizes. Specific differences can be examined by comparing the overlap between 95% confidence intervals for effect sizes.

Finally, we assessed studies for publication bias. Tests of publication bias examine whether studies with statistically significant results are more likely to be published than non-statistically significant results (Rothstein et al., 2005 ). To do so, we first examined Rosenthal’s ( 1979 ) fail-safe number. This number should be greater than 5  k  + 10 (where k is the number of effect sizes; Rosenthal, 1979 ). Then, we calculated Egger’s regression intercept that regresses the effect size on the reciprocal of its standard error (Egger et al., 1997 ). If no publication bias is present, the 95% confidence interval of Egger’s regression coefficient includes zero.

We begin by providing the results of the search and selection process we then provide an overview of the characteristics of the included studies. This includes the design of the studies, the samples recruited, the measures of burnout that were used, and an evaluation of the quality of the studies. We then provide an overview of the interventions. Finally, we report the findings of the meta-analyses. Table 1 provides further details for each study.

Study selection

Our search returned 1,294 studies. Once duplicates were removed and abstracts were screened for relevance, 43 studies remained. These studies were then further assessed using the inclusion criteria. When we reviewed full texts, studies were excluded because they did not measure burnout ( n  = 14), did not include an intervention ( n  = 4), did not include a control group ( n  = 3), repeated data published elsewhere ( n  = 1), or included insufficient information ( n  = 4). These criteria therefore resulted in the final inclusion of 17 studies. We have provided an overview of this process in Fig.  1 . The extracted data can be found in Table 1 . The average value of Cohen’s Kappa across all coded data was 0.92 indicating an excellent level of inter-rater reliability.

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) diagram illustrating study selection process

Study designs

Ten of the studies adopted randomized controlled trials and seven studies adopted quasi-experimental trials. In addition, all studies were published journal articles.

Student samples

A total of 2,462 students were recruited across the present studies, of which 1,301 (range = 8–522, median = 30) were in the experimental groups, and 1,161 (range = 6–512, median = 32) in the control groups. In regard to which educational levels the students were recruited from, 15 of the studies were from tertiary settings (13 from undergraduate levels, and two from postgraduate levels) and two studies were from secondary settings.

Measures of burnout

In the 17 studies included in the present review, ten studies used the Maslach Burnout Inventory–Student Survey (Maslach et al., 1996 ). Three studies used the Student Burnout Inventory (Salmela-Aro et al., 2009 ). Three studies used the Oldenburg Burnout Inventory–Student Version (Reis et al., 2015 ) and one study used the original Maslach Burnout Inventory (Maslach et al., 1986 ). We have summarized this information in addition to including evidence for reliability of each measure (Cronbach’s alpha) in Table 2 . Overall, all measures had at least some evidence for their reliability in the student samples (alpha > 0.70; Nunnally, 1978 ), with only a couple of instances where alpha fell below this accepted threshold.

An overview of study quality ratings is presented in Table 1 . On the whole, based on meeting at least three of the criteria, there were five studies that appeared to be at a low risk and twelve studies that appeared to be at low-to-high risk.

Intervention outcomes

We now summarize specific intervention types. In doing so, we elaborate on what they were, how they were delivered, and their associated effectiveness (see also Table 1 for specific details for each study).

Mindfulness-Based Stress Reduction

Mindfulness relates to the ability to stay attuned to the present, rather than ruminating about the past or worrying about the future. A total of six interventions adopted this approach (two randomized controlled trials, four quasi-experimental studies; Clarkson et al., 2019 ; de Vibe et al., 2013 ; Lo et al. 2021 ; Modrego-Alarcon et al., 2021 ; O'Driscoll et al., 2019a ; O'Driscoll et al., 2019b ). The majority were delivered in person (5/6) and ranged from 4 to 8 weeks in length. 50% were effective in reducing at least one burnout symptom. Those that were effective were typically longer in duration (on average 1.5 h per week for 6 weeks) and adopted a range of delivery methods (in person, group, and online). Effect sizes were typically medium-sized ( g  = 0.30–0.70).

Rational Emotive Behavior Therapy

Rational emotive behavior therapy seeks to identify, challenge, and restructure irrational beliefs that are believed to underpin a negative pattern of behavior. Four studies followed this approach (all randomized controlled trials; Ezenwaji et al., 2019 ; Ezeudu et al., 2020 ; Igbokwe et al., 2019 ; Ogbuanya et al., 2019 ). All interventions were delivered in person and were either 10 or 12 weeks in duration (and approximately 20 sessions in total). All interventions were effective in reducing either total burnout or its symptoms with very large effect sizes ( g  > 2.00). We note here that all samples were recruited based on high initial burnout levels, which may help explain the very large effects in these studies.

Psychoeducation

Four studies adopted interventions that could be considered psychoeducational (systematic and structured knowledge transfer) (two randomized controlled trials and two quasi-experimental studies; Charbonnier et al., 2022 ; Fang et al., 2021 ; Noh et al., 2020 ; Vuori et al., 2008 ). They were all delivered in a range of formats (online, phone, in person) and ranged from 1 to 8 weeks in duration. Half the Interventions were effective. Total burnout was reduced compared to the control for an intervention designed to helps students approach important goals (that they had been avoiding; Fang et al., 2021 ) and for an intervention promoting skills for the transition from school, specifically in individuals with learning difficulties (Vuori et al., 2008 ). Effect sizes were medium-sized ( g  = 0.65).

Two studies utilized exercise as part of the intervention strategy (both randomized controlled trials; May et al., 2019 ; Rosales-Ricardo & Ferreira, 2022 ). May et al. ( 2019 ) compared 4-weeks high intensity interval training to biofeedback and control conditions. Biofeedback resulted in reduced burnout compared to the control with a large effect size ( g  > 1.0). Rosales-Ricardo and Ferreira ( 2022 ) compared aerobic exercise (low intensity) to strength training both for 16 weeks (3 times per week). Burnout symptoms reduced following the exercise intervention but not compared to the control group.

Cognitive Behavioral Therapy (CBT)

CBT refers to strategies based around changing underlying cognitive processes and patterns. One study adopted this approach adopting a quasi-experimental design (Bresó et al., 2011 ). The intervention specifically used CBT principles to enhance self-efficacy (one’s belief in one’s capacity). A total of 4 sessions over 4 months, delivered in person, resulted in reduced burnout symptoms compared to a healthy control group (but not a stressed control group) with small-to-medium effect sizes ( g  = 0.30).

Meta-analytic findings

Overall effect sizes.

Effects sizes for each study can be found in Table 3 . The findings of the meta-analysis can be found in Table 4 . Interventions appeared to be effective in reducing total burnout ( g +  = 0.90; p  = 0.02, 95% CI: [0.04, 1.75]; k  = 14; Q T  = 228.34; I 2  = 94.31%). There was however less evidence for their effectiveness in relation to exhaustion ( g +  = 0.47; p  = 0.06, 95% CI: [-0.03, 0.97]; k  = 9; Q T  = 33.10; I 2  = 75.83%), cynicism ( g +  = 0.51; p  = 0.33, 95% CI: [-0.69, 1.71]; k  = 9; Q T  = 80.54; I 2  = 90.07%), and reduced efficacy ( g +  = 0.37; p  = 0.28, 95% CI: [-0.59, 1.32]; k  = 5; Q T  = 20.53; I 2  = 80.51%).

Moderation Analysis

An examination of the total heterogeneity of the meta-analytic effects suggested that there was substantial moderation. We therefore conducted moderation analyses based on the study design (randomised controlled trial versus quasi-experimental trial) and the type of intervention. The results of these analyses are presented in Tables 5 and 6 . For total burnout, studies adopting a randomised controlled design showed larger effects ( g +  = 1.60; p  = 0.03, 95% CI: [0.16, 3.03]) than studies adopting a quasi-experimental design ( g +  = 0.23; p  = 0.001, 95% CI: [0.09, 0.37]). The only other significant effect was for quasi-experimental designs for exhaustion ( g +  = 0.26; p  < 0.001, 95% CI: [0.15, 0.37]). For total burnout, studies employing REBT showed larger effects ( g +  = 4.42; p  < 0.001, 95% CI: [3.20, 5.64]) than mindfulness ( g +  = 0.27; p  < 0.001, 95% CI: [0.19, 0.35]), psychoeducation ( g +  = 0.22; p  = 0.37, 95% CI: [-0.27, 0.71]), and exercise ( g +  = 0.79; p  = 0.06, 95% CI: [-0.03, 1.62]). The only other significant effect was for mindfulness for exhaustion ( g +  = 0.32; p  < 0.001, 95% CI: [0.22, 0.43]).

Publication Bias

Results of publication bias analyses can be found in Table 4 . For the majority of effects there was little evidence for publication bias (e.g., Egger’s intercept was nonsignificant). There was some evidence specifically for reduced efficacy where both Rosenthal’s fail-safe number and Egger’s intercept were indicative of publication bias. The findings for reduced efficacy should therefore be interpreted with caution.

The aim of the present study was to provide the first systematic review and meta-analysis of interventions aimed at reducing burnout in students. We found 17 studies adopting a broad range of intervention strategies, and which focused on secondary and tertiary levels of education. Overall, when considered individually and, when effects were aggregated, for total burnout, we found support for the efficacy of interventions in reducing student burnout. However, we also found evidence for moderation and nonsignificant effects when certain symptoms, designs, and intervention-types were examined. We now discuss the key findings of the review and then make recommendations for future research and provide implications for practice.

Key findings

Although numerous reviews exist examining the effects of interventions on students’ mental health (e.g., Regehr et al., 2013 ), until now, no such review existed for interventions targeting burnout. Its absence was surprising given the serious implications that burnout has for students’ performance, motivation, and mental health (e.g., Walburg, 2014 ). In line with reviews of burnout interventions in other contexts, including teachers (e.g., Iancu et al., 2018 ), we found evidence that researchers have begun to test many different types of interventions to reduce student burnout. This includes interventions based around stress reduction (e.g., mindfulness), challenging irrational beliefs (e.g., rational emotive behavior therapy), as well as more classical approaches (e.g., cognitive behavioral therapy). In addition, these interventions have been tested across a range of educational levels, but with most studies focused on tertiary levels.

Again, in line with reviews in other contexts, and in medical residents (e.g., Walsh et al., 2019 ), we found some evidence that the reviewed interventions are effective in reducing burnout symptoms in students. Evidence for this comes from both the individual studies and also from the results of the meta-analyses, at least in context of total burnout. The strongest evidence appears to come from those interventions with a strong theoretical foundation. Most notably, this includes rational emotive behavior therapy where all four interventions, all based on randomized controlled designs, were found to be effective, and meta-analytic effect sizes could be considered large (and larger than other intervention types). However, we note that these studies recruited students with high initial levels of burnout and so it is unclear whether such approaches would be beneficial to students with more moderate symptoms. Meta-analytic effects were also significant for mindfulness-based interventions. This finding is similar to research in other occupations (e.g., nursing; Suleiman-Martos et al., 2020 ). Collectively, then, these findings provide promising evidence that we can likely do something to aid students who may be suffering from high levels of burnout.

Critical considerations and recommendations

We now provide recommendations for future work in this area. The first and perhaps most important consideration for future work is to simply conduct more studies testing burnout interventions. Aside from those examining mindfulness and rational emotive behavior therapy, there has not been any systematic examination of specific interventions or intervention types. In addition, conducting controlled studies, especially those with randomized designs, should be prioritized. As illustrated by our study quality analysis, only five studies were deemed to represent high quality designs, analysis, and reporting. Researchers should therefore attempt to design studies of high quality in order to most accurately determine the effectiveness of burnout interventions.

We note that all of the interventions we summarized in the present review implemented interventions based at the individual-level (i.e., providing students with the skills and resources to overcome burnout). Consequently, there is a need for the development and testing of interventions focusing on the organisational-level. Such studies could look to change factors that may be contributing to chronic stress in students, which could include changes in exam structures, contact hours, and social expectations (e.g., Regehr et al., 2013 ). We know that organizational stressors are involved in the development of stress and burnout (e.g., Parrello et al., 2019 ), as such, testing the efficacy of this type of intervention would be extremely useful in offering alternative means to help students and will likely have broader benefits for student mental health.

Implications for practice

Based on the present findings, we now consider several implications for practice. First, professionals concerned with student burnout in their institutions may wish to examine the characteristics and effectiveness of the interventions they use based on the current study findings. For example, they may wish to incorporate different interventions, such as mindfulness, which boasts a growing body of literature that supports its efficacy in reducing stress and burnout in multiple contexts (Luken & Sammons, 2016 ). In addition, for interventions to be most effective, it is important that they are made readily accessible and available by schools and universities, which could be in the form of after school groups or individual school counselling sessions. Given the increased use of technology in our everyday lives, both offline and online forms of support are recommended.

Further to the interventions reviewed here, there have been recent calls to include skills and techniques that have the potential to safeguard student mental health within educational curricula. For example, the OECD has been emphasizing the importance of students’ social emotional competences, and how they are important for students’ immediate and future success, including their mental health and wellbeing (Chernyshenko et al., 2018 ). In much the same manner, integrating social emotional competencies into educational programs and curricula may be useful for preventing and alleviating some of the stress and burnout that readily develops in schools and universities.

In addition, burnout awareness should be promoted to educators and students as a method to prevent and reduce burnout in students (e.g., Salerno, 2016 ). Such awareness programs and methods should include teaching students to recognize the symptoms of burnout and where and how to seek support when necessary. Additionally, teachers should be equipped to understand how to identify and assist students who may be showing symptoms of burnout, and how to refer them to the appropriate professionals, and to even be able to help these students within their own classrooms too. These strategies should encourage students to both help themselves and accept help from those close by, and will possibly reduce the need to intervene altogether.

Finally, in order to assess and ensure optimal benefits from the interventions, policymakers may also wish to examine their cost-effectiveness. Assessing the cost-effectiveness of interventions has been the subject of little conversation in the burnout literature. Once the effectiveness of an intervention has been established, it is important to consider the resources required to deliver that intervention. This can be approached in two ways: first, by achieving maximal health benefits for a fixed amount of resources and second, by identifying a health status objective and the associated minimal amount of resources required to achieve that objective (see Detsky & Naglie, 1990 ). It will be important for public policy to consider which approach should be adopted in relation to burnout when considering which interventions and/or types of interventions are recommended to institutions that serve students. At this stage, however, studies that examine the cost-effectiveness of burnout interventions need to be conducted. Such an evidence base will have many benefits, especially in relation to lobbying schools and universities to adopt relevant interventions.

We provided the first systematic review and meta-analysis of research examining the efficacy of interventions to reduce burnout in students. When the effects were aggregated across interventions, there was evidence for their effectiveness in reducing burnout, at least for total burnout. There was also evidence for specific types of intervention such as those based on rational emotive behavior therapy and mindfulness. Although this study provides initial evidence to inform practice in reducing burnout in students, we note that a more systematic examination of particular intervention types, especially those designed to target the organisational-level, would be useful, as are studies examining the cost effectiveness of such interventions.

This broad classification was based on UNESCO’s International Standard Classification of Education (2012): Secondary (subject-oriented curriculum and employment relevant skills; e.g., high school) and Tertiary levels (intermediate and advanced academic and professional skills, knowledge and competencies; e.g., university).

Awa, W. L., Plaumann, M., & Walter, U. (2010). Burnout prevention: A review of intervention programs. Patient Education and Counseling, 78 , 184–190.

Article   Google Scholar  

Alarco, G. M. (2011). A meta-analysis of burnout with job demands, resources, and attitudes. Journal of Vocational Behavior, 79 , 549–562.

Bakker, A. B., & de Vries, J. D. (2021). Job Demands-Resources theory and self-regulation: New explanations and remedies for job burnout. Anxiety, Stress, & Coping, 34 (1), 1–21.

Billingsley, B., & Bettini, E. (2019). Special education teacher attrition and retention: A review of the literature. Review of Educational Research, 89 , 697–744.

Borenstein, M., Cooper, H., Hedges, L., & Valentine, J. (2009). Effect sizes for continuous data. The Handbook of Research Synthesis and Meta-Analysis, 2 , 221–235.

Google Scholar  

*Bresó, E., Schaufeli, W. B., & Salanova, M. (2011). Can a self-efficacy-based intervention decrease burnout, increase engagement, and enhance performance? A quasi-experimental study.  Higher Education ,  61 , 339-355

Busireddy, K. R., Miller, J. A., Ellison, K., Ren, V., Qayyum, R., & Panda, M. (2017). Efficacy of interventions to reduce resident physician burnout: A systematic review. Journal of Graduate Medical Education, 9 , 294–301.

Cazan, A. M. (2015). Learning motivation, engagement and burnout among university students. Procedia-Social and Behavioral Sciences, 187 , 413–417.

Charbonnier, E., Trémolière, B., Baussard, L., Goncalves, A., Lespiau, F., Philippe, A. G., & Le Vigouroux, S. (2022). Effects of an online self-help intervention on university students’ mental health during COVID-19: A nonrandomized controlled pilot study. Computers in Human Behavior Reports, 5 , 100175

Chernyshenko, O., Kankaraš, M., & Drasgow, F. (2018). Social and emotional skills for student success and well-being: Conceptual framework for the OECD study on social and emotional skills (No. 173). OECD Education Working Papers.

*Clarkson, M., Heads, G., Hodgson, D., & Probst, H. (2019). Does the intervention of mindfulness reduce levels of burnout and compassion fatigue and increase resilience in pre-registration students? A pilot study. Radiography, 25 , 4-9.

Cohen, J. (1992). A power primer. Psychological Bulletin, 112 , 155–163.

Cooley, E., & Yovanoff, P. (1996). Supporting professionals-at-risk: Evaluating interventions to reduce burnout and improve retention of special educators. Exceptional Children, 62 , 336–355.

Daya, Z., & Hearn, J. H. (2018). Mindfulness interventions in medical education: A systematic review of their impact on medical student stress, depression, fatigue and burnout. Medical Teacher, 40 , 146–153.

Detsky, A. S., & Naglie, I. G. (1990). A clinician’s guide to cost-effectiveness analysis. Annals of Internal Medicine, 113 , 147–154.

Dreison, K. C., Luther, L., Bonfils, K. A., Sliter, M. T., McGrew, J. H., & Salyers, M. P. (2018). Job burnout in mental health providers: A meta-analysis of 35 years of intervention research. Journal of Occupational Health Psychology, 23 , 18–28.

Duffy, M. E., Twenge, J. M., & Joiner, T. E. (2019). Trends in mood and anxiety symptoms and suicide-related outcomes among US undergraduates, 2007–2018: Evidence from two national surveys. Journal of Adolescent Health, 65 , 590–598.

Dyrbye, L. N., Thomas, M. R., Massie, F. S., Power, D. V., Eacker, A., Harper, W., ... & Sloan, J. A. (2008). Burnout and suicidal ideation among US medical students.  Annals of Internal Medicine ,  149 , 334–341.

Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315 (7109), 629–634.

*Ezenwaji, I. O., Eseadi, C., Ugwoke, S. C., Vita-Agundu, U. C., Edikpa, E., Okeke, F. C., ... & Njoku, L. G. (2019). A group-focused rational emotive behavior coaching for management of academic burnout among undergraduate students: Implications for school administrators. Medicine, 98 , 1–11.

*Ezeudu, F. O., Nwoji, I. H. N., Dave-Ugwu, P. O., Abaeme, D. O., Ikegbunna, N. R., Agugu, C. V., ... & Nwefuru, B. C. (2020). Intervention for burnout among chemistry education undergraduates in Nigeria. Journal of International Medical Research, 48 , 0300060519867832.

Fanelli, D. (2012). Negative results are disappearing from most disciplines and countries. Scientometrics, 90 , 891–904.

*Fang, C. M., McMahon, K., Miller, M. L., & Rosenthal, M. Z. (2021). A pilot study investigating the efficacy of brief, phone‐based, behavioral interventions for burnout in graduate students.  Journal of Clinical Psychology ,  77 , 2725-2745.

Friedman, I. (1999). Teachers’ burnout: The concept and its measurement . Jerusalem: Henrieta Szold Institute.

Groot, W., & Maassen van den Brink, H. (2007). The health effects of education. Economics of Education Review, 26 , 186–200.

Higgins, J. P., & Green, S. (2011). Cochrane handbook for systematic reviews of interventions (Vol. 4). West Sussex: John Wiley & Sons.

Higgins, J. P., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21 (11), 1539–1558.

Honney, K., Buszewicz, M., Coppola, W., & Griffin, M. (2010). Comparison of levels of depression in medical and non-medical students. The Clinical Teacher, 7 , 180–184.

Iancu, A. E., Rusu, A., Măroiu, C., Păcurar, R., & Maricuțoiu, L. P. (2018). The effectiveness of interventions aimed at reducing teacher burnout: A meta-analysis. Educational Psychology Review, 30 , 373–396.

*Igbokwe, U. L., Nwokenna, E. N., Eseadi, C., Ogbonna, C. S., Nnadi, E. M., Ololo, K. O., ... & Onwube, O. (2019). Intervention for burnout among English education undergraduates: Implications for curriculum innovation. Medicine, 98 , 45–52.

IsHak, W., Nikravesh, R., Lederer, S., Perry, R., Ogunyemi, D., & Bernstein, C. (2013). Burnout in medical students: A systematic review. The Clinical Teacher, 10 , 242–245.

Kabat-Zinn, J. (2003). Mindfulness-based stress reduction (MBSR). Constructivism in the Human Sciences, 8 (2), 73.

Lee, H. F., Kuo, C. C., Chien, T. W., & Wang, Y. R. (2016). A meta-analysis of the effects of coping strategies on reducing nurse burnout. Applied Nursing Research, 31 , 100–110.

Levine, T. R., Asada, K. J., & Carpenter, C. (2009). Sample sizes and effect sizes are negatively correlated in meta-analyses: Evidence and implications of a publication bias against nonsignificant findings. Communication Monographs, 76 , 286–302.

Lipsey, M. W., & Wilson, D. B. (2001).  Practical meta-analysis . SAGE publications, Inc.

Lo, H. H. M., Ngai, S., & Yam, K. (2021). Effects of mindfulness-based stress reduction on health and social care education: a cohort-controlled study. Mindfulness, 12 (8), 2050–2058.

Luken, M., & Sammons, A. (2016). Systematic review of mindfulness practice for reducing job burnout. American Journal of Occupational Therapy, 70 , 7002250020p1-7002250020p10.

Madigan, D. J., & Curran, T. (2021). Does burnout affect academic achievement? A meta-analysis of over 100,000 students. Educational Psychology Review, 33 , 387–405.

Madigan, D. J., & Kim, L. E. (2021a). Towards an understanding of teacher attrition: A meta-analysis of burnout, job satisfaction, and teachers’ intentions to quit. Teaching and Teacher Education, 105 , 103425.

Madigan, D. J., & Kim, L. E. (2021b). Does teacher burnout affect students? A systematic review of its association with academic achievement and student-reported outcomes. International Journal of Educational Research, 105 , 101714.

Maslach, C. (2003). Job burnout: New directions in research and intervention. Current Directions in Psychological Science, 12 , 189–192.

Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2 , 99–113.

Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach Burnout Inventory manual (3rd ed.). Consulting Psychologist Press.

Maslach, C., Leiter, M. P., & Jackson, S. E. (2012). Making a significant difference with burnout interventions: Researcher and practitioner collaboration. Journal of Organizational Behavior, 33 , 296–300.

Maslach, C., Jackson, S. E., Leiter, M. P., Schaufeli, W. B., & Schwab, R. L. (1986).  Maslach Burnout Inventory  (Vol. 21, pp. 3463–3464). Palo Alto, CA: Consulting psychologists press.

May, R. W., Seibert, G. S., Sanchez-Gonzalez, M. A., & Fincham, F. D. (2019). Self-regulatory biofeedback training: An intervention to reduce school burnout and improve cardiac functioning in college students. Stress, 22 , 1–8.

McHugh, M. L. (2012). Interrater reliability: The Kappa statistic. Biochemia Medica, 22 , 276–282.

Meier, S. T., & Kim, S. (2022). Meta-regression analyses of relationships between burnout and depression with sampling and measurement methodological moderators. Journal of Occupational Health Psychology, 27 (2), 195.

Modrego-Alarcón, M., Lopez-del-Hoyo, Y., Garcia-Campayo, J., Perez-Aranda, A., Navarro-Gil, M., Beltrán-Ruiz, M., & Montero-Marin, J. (2021). Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial. Behaviour Research and Therapy, 142,  103866

Noh, H., Seong, H., & Lee, S. M. (2020). Effects of motivation-based academic group psychotherapy on psychological and physiological academic stress responses among Korean middle school students. International Journal of Group Psychotherapy, 70 , 399–424.

Nunnally, J. C. (1978). Psychometric theory . McGraw-Hill.

O’Driscoll, M., Byrne, S., Byrne, H., Lambert, S., & Sahm, L. J. (2019a). An online mindfulness-based intervention for undergraduate pharmacy students: Results of a mixed-methods feasibility study. Currents in Pharmacy Teaching and Learning, 11 , 858–875.

O’Driscoll, M., Sahm, L. J., Byrne, H., Lambert, S., & Byrne, S. (2019b). Impact of a mindfulness-based intervention on undergraduate pharmacy students’ stress and distress: Quantitative results of a mixed-methods study. Currents in Pharmacy Teaching and Learning, 11 , 876–887.

OECD. (2016). Education at a glance 2016: OECD indicators . OECD Publishing.

Book   Google Scholar  

*Ogbuanya, T. C., Eseadi, C., Orji, C. T., Omeje, J. C., Anyanwu, J. I., Ugwoke, S. C., & Edeh, N. C. (2019). Effect of rational-emotive behavior therapy program on the symptoms of burnout syndrome among undergraduate electronics work students in Nigeria. Psychological Reports, 122 , 4-22.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.  International Journal of Surgery ,  88 , 105906.

Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C., ... & Esmail, A. (2017). Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Internal Medicine, 177 , 195–205.

Parrello, S., Ambrosetti, A., Iorio, I., & Castelli, L. (2019). School burnout, relational, and organizational factors. Frontiers in Psychology, 10 , 32–45.

Purvanova, R. K., & Muros, J. P. (2010). Gender differences in burnout: A meta-analysis. Journal of Vocational Behavior, 77 , 168–185.

Regehr, C., Glancy, D., & Pitts, A. (2013). Interventions to reduce stress in university students: A review and meta-analysis. Journal of Affective Disorders, 148 , 1–11.

Rehman, A. U., Bhuttah, T. M., & You, X. (2020). Linking burnout to psychological well-being: The mediating role of social support and learning motivation. Psychology Research and Behavior Management, 13 , 545.

Reis, D., Xanthopoulou, D., & Tsaousis, I. (2015). Measuring job and academic burnout with the Oldenburg Burnout Inventory (OLBI): Factorial invariance across samples and countries. Burnout Research, 2 , 8–18.

Ribeiro, I. J., Pereira, R., Freire, I. V., de Oliveira, B. G., Casotti, C. A., & Boery, E. N. (2018). Stress and quality of life among university students: A systematic literature review. Health Professions Education, 4 , 70–77.

Ridner, S. L., Newton, K. S., Staten, R. R., Crawford, T. N., & Hall, L. A. (2016). Predictors of well-being among college students. Journal of American College Health, 64 , 116–124.

Roeser, R. W., Schonert-Reichl, K. A., Jha, A., Cullen, M., Wallace, L., Wilensky, R., Oberle, E., Thomson, K., Taylor, C., & Harrison, J. (2013). Mindfulness training and reductions in teacher stress and burnout: Results from two randomized, waitlist-control field trials. Journal of Educational Psychology, 105 , 787–804.

Rosales-Ricardo, Y., & Ferreira, J. P. (2022). Effects of physical exercise on Burnout syndrome in university students. MEDICC review, 24 , 36–39.

Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86 (3), 638.

Rothstein, H. R., Sutton, A. J., & Borenstein, M. (2005). Publication bias in meta-analysis (pp. 1–7). Publication bias in meta-analysis.

Salerno, J. P. (2016). Effectiveness of universal school-based mental health awareness programs among youth in the United States: A systematic review. Journal of School Health, 86 , 922–931.

Salmela-Aro, K., Kiuru, N., Leskinen, E., & Nurmi, J. E. (2009). School burnout inventory (SBI) reliability and validity. European Journal of Psychological Assessment, 25 , 48–57.

Salmela-Aro, K., Upadyaya, K., Ronkainen, I., & Hietajärvi, L. (2022). Study burnout and engagement during COVID-19 among university students: The role of demands, resources, and psychological needs. Journal of Happiness Studies, 1–18.

Schaufeli, W. B., & Taris, T. W. (2005). The conceptualization and measurement of burnout: Common ground and worlds apart. Work & Stress, 19 , 256–262.

Schaufeli, W. B., Salanova, M., González-Romá, V., & Bakker, A. B. (2002). The measurement of engagement and burnout: A two sample confirmatory factor analytic approach. Journal of Happiness Studies, 3 , 71–92.

Schmidt, F. L., Oh, I. S., & Hayes, T. L. (2009). Fixed-versus random-effects models in meta-analysis: Model properties and an empirical comparison of differences in results. British Journal of Mathematical and Statistical Psychology, 62 (1), 97–128.

Schramer, K. M., Rauti, C. M., Kartolo, A. B., & Kwantes, C. T. (2019). Examining burnout in employed university students. Journal of Public Mental Health, 19 , 17–25.

Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., & Wilson, G. T. (2009). Mind the gap: Improving the dissemination of CBT. Behaviour Research and Therapy, 47 (11), 902–909.

Shrier, I., Boivin, J. F., Steele, R. J., Platt, R. W., Furlan, A., Kakuma, R., ... & Rossignol, M. (2007). Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles. American Journal of Epidemiology, 166 , 1203–1209.

Shrout, P. E., & Rodgers, J. L. (2018). Psychology, science, and knowledge construction: Broadening perspectives from the replication crisis. Annual Review of Psychology, 69 , 487–510.

Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., ... & Higgins, J. P. (2016). ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 355.

Suleiman-Martos, N., Gomez-Urquiza, J. L., Aguayo-Estremera, R., Cañadas-De La Fuente, G. A., De La Fuente-Solana, E. I., & Albendín-García, L. (2020). The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis. Journal of Advanced Nursing, 76 , 1124–1140.

Suurmond, R., van Rhee, H., & Hak, T. (2017). Introduction, comparison, and validation of meta-essentials: A free and simple tool for meta-analysis. Research Synthesis Methods, 8 , 537–553.

Taris, T. W. (2006). Is there a relationship between burnout and objective performance? A critical review of 16 studies. Work & Stress, 20 , 316–334.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among US adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6 , 3–17.

UNESCO Institute for Statistics. (2012). International standard classification of education: ISCED 2011. Comparative Social Research, 30 .

UNESCO Institute for Statistics. (2016). The world needs almost 69 million new teachers to reach the 2030 education goals (No. 39). http://uis.unesco.org/sites/default/files/documents/fs39-the-world-needs-almost-69-million-new-teachers-to-reach-the-2030-education-goals-2016-en.pdf

*De Vibe, M., Solhaug, I., Tyssen, R., Friborg, O., Rosenvinge, J. H., Sørlie, T., & Bjørndal, A. (2013). Mindfulness training for stress management: a randomised controlled study of medical and psychology students. BMC Medical Education, 13 , 107-115

*Vuori, J., Koivisto, P., Mutanen, P., Jokisaari, M., & Salmela-Aro, K. (2008). Towards working life: Effects of an intervention on mental health and transition to post-basic education. Journal of Vocational Behavior, 72 , 67-80.

Walburg, V. (2014). Burnout among high school students: A literature review. Children and Youth Services Review, 42 , 28–33.

Walsh, A. L., Lehmann, S., Zabinski, J., Truskey, M., Purvis, T., Gould, N. F., ... & Chisolm, M. S. (2019). Interventions to prevent and reduce burnout among undergraduate and graduate medical education trainees: a systematic review. Academic Psychiatry, 43(4), 386–395.

West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet, 388 , 2272–2281.

Williams, D., Tricomi, G., Gupta, J., & Janise, A. (2015). Efficacy of burnout interventions in the medical education pipeline. Academic Psychiatry, 39 , 47–54.

World Health Organization. (2018). EPHO5: Disease prevention, including early detection of illness . World Health Organization.

Zhang, X., Klassen, R. M., & Wang, Y. (2013). Academic burnout and motivation of Chinese secondary students. International Journal of Social Science and Humanity, 3 , 134–142.

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Current Themes of Research:

Burnout in education.

Relevant Publications:

Madigan, D. J., Kim, L. E., Glandorf, H. L., & Kavanagh, O. (2023). Teacher burnout and physical health: A systematic review.  International Journal of Educational Research ,  119 , 102173.

Madigan, D. J., & Curran, T. (2021). Does burnout affect academic achievement? A meta-analysis of over 100,000 students.  Educational Psychology Review ,  33 (2), 387-405.

Madigan, D. J., & Kim, L. E. (2021). Does teacher burnout affect students? A systematic review of its association with academic achievement and student-reported outcomes.  International Journal of Educational Research ,  105 , 101714.

Teacher effectiveness and wellbeing.

Kim, L. E., Oxley, L., & Asbury, K. (2022). “My brain feels like a browser with 100 tabs open”: A longitudinal study of teachers’ mental health and well‐being during the COVID‐19 pandemic.  British Journal of Educational Psychology ,  92 , 299-318.

Kim, L. E., & Burić, I. (2020). Teacher self-efficacy and burnout: Determining the directions of prediction through an autoregressive cross-lagged panel model.  Journal of Educational Psychology ,  112 (8), 1661.

Kim, L. E., Jörg, V., & Klassen, R. M. (2019). A meta-analysis of the effects of teacher personality on teacher effectiveness and burnout.  Educational Psychology Review ,  31 (1), 163-195.

Hanna L. Glandorf

Burnout and health.

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Madigan, D.J., Kim, L.E. & Glandorf, H.L. Interventions to reduce burnout in students: A systematic review and meta-analysis. Eur J Psychol Educ (2023). https://doi.org/10.1007/s10212-023-00731-3

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3 Strategies to Reduce Student Burnout

When students are overwhelmed, they may disengage from school. Asking for their feedback and giving them some autonomy can help.

It’s the first day of school, and Nina cannot help but feel excited. With the pandemic and some tough classes, seventh grade was hard to handle, but now she is on top of the heap. Eighth grade should be much better! The day begins, and Nina moves from one class to the next. Each period starts with the usual course overview or icebreaker activity and ends with a homework assignment. As the day progresses, she begins to deflate.

When Nina finally gets to her last class of the day, her new English teacher asks everyone to write a timed essay on the summer reading text, which feels like an exhausting task after such a long day. As she rides the bus home, Nina pictures herself repeating similar days for the next nine months. At home, her parents ask how the day went. “The same as last year,” Nina says. “I can’t believe it’s only the first day. I’m so tired.”

Burnout is considered an adult affliction, but students experience it as well. A gradual drop-off in student engagement, particularly after fifth grade as accountability measures intensify, is one significant reason that kids lose their enthusiasm for school. However, a consequent feeling of being overwhelmed is the more pressing cause of student burnout and can become severe enough that kids completely disengage from their classes.

To mitigate this sense of learned helplessness, the most effective strategy is to build better structures for incorporating student voice into instruction. That way, students have more input into what approaches work best for them.

Genuine Involvement, Not Just Lip Service

It is important to ask students to share lesson takeaways and suggestions on a regular basis. Why hypothesize about what students need when they can make their thinking visible? However, soliciting feedback is only the first step; following through on what kids reveal is even more important. Nearly every teacher can identify with the frustration of being asked to weigh in on a school-based issue, only to realize that the decision is a fait accompli and the feedback they provide is for the sake of appearances.

Students are apt to feel the same way when they are asked for their thoughts and see little follow-through. Specifically, making transparent changes to instruction and showing students how and why their ideas influence subsequent lessons is key. If students are not given a genuine voice in the classroom, they will feel less invested in whatever is happening.

To help students see their role in the learning process, go over student contributions with a “feedback on feedback” protocol. Whenever I lead a training session or teach a class, participants need to know their voices matter. For students who are less accustomed to being heard, taking the temperature of instruction is doubly important. However, asking for feedback at the end of a class is just the first of two steps we take to gauge the needs of learners.

Even more important is how we follow through on what people tell us. When we use feedback on feedback effectively as a two-way street, the result is mutual trust and engagement, and in turn less burnout for both teachers and students, the latter of whom especially value the open way in which their ideas are acknowledged. Even if teachers cannot fulfill a request expressed in feedback, explaining why that cannot happen is also a trust-building move.

Provide Product-Focused Feedback

Another move that helps build student voice while increasing focus on how to succeed with a specific product or process (an assignment, a presentation, etc.) is to ensure that kids see teacher feedback as objective. Too often, students burn out because they perceive that adults are grading their hard work unfairly, and they lose motivation to strive.

To mitigate this problem, clearly delineate the differences between feedback, guidance, and evaluation. In Educative Assessment: Designing Assessments to Inform and Improve Student Performance , author and education consultant Grant Wiggins defines feedback as objective information free of value.

For example, if a class is assigned a paragraph of between five and eight sentences to write, and a student writes only three sentences, the teacher can provide the neutral feedback that the paragraph is shorter than the stated expectation for the product. However, many teachers confuse feedback for either guidance or evaluation. In the first case, that might look like a suggestion (e.g., “You need to write more and include details”), and in the second, a judgment-based response (like a letter grade or a “Getting there!”).

The advantage of focusing on clear criteria for success is that students see where their work is in relation to the expected product rather than on who they are as individuals. When they see mistakes as part of an objective process, students are less apt to become upset with the feelings of powerlessness that accompany burnout and more likely to continue engaging in the class.

Respect Individual Working Styles

Adults are often encouraged to use their own individual working preferences (i.e., the conditions under which they are most successful) to their advantage. For example, I know that I write best early in the morning and that if I wait until later in the day, my productivity plummets.

Why are students not afforded the same opportunity to play to their strengths? Perhaps not every day can be devoted to honoring individual work preferences, but teachers who create space for students to choose how they use some of the allotted instructional time will reap the benefits of increased interest and productivity. This student-centered approach also gives teachers more flexibility during the class period, which lowers the exhaustion that leads to burnout for everyone.

To structure a class that gives students the leeway to choose not what they work on, but how they work on it, think of an instructional week in which three products have to be submitted by Friday: a short proposal for a research project, two slides that state the project’s purpose, and a list of possible sources to cite. In addition, the class is also reading two chapters from the textbook and the teacher wants to administer a formative assessment on the reading somewhere in the middle of the week. While some days may be devoted to teacher-directed instruction with the whole class, others can be structured into smaller configurations for student-centered learning.

For example, some students may wish to work on reading the assigned chapters either silently or to one another in a corner of the room, while others draft their project proposals in another corner. As they work, the teacher is free to circulate, conference with individuals, or lead small-group learning. This choice-based philosophy of “hover-free” teaching, shared with specific tools for application in my recent book Teach More, Hover Less , reduces burnout for students by giving them the rare chance to complete work in a way that best suits their needs.

Nobody enjoys feeling burned out, regardless of how old they might be. If we save students like Nina from the burnout that leads to disengagement by implementing the strategies outlined above, our own teaching experiences will be that much richer and more invigorating. Students are not just our most valued clientele; they are also our partners in the classroom, and increasing their voice in the classroom will lead to a better experience for everyone involved.

How to prevent burnout at university

What is burnout and how can you avoid it psychologist and mental health adviser gareth furber shares his top tips for dealing with burnout at university.

Dr Gareth Furber

The term “burnout” was coined in 1974 by the psychoanalyst Herbert Freudenberger and Christina Maslach, a professor of psychology at the University of California, Berkeley .

Burnout is a combination of constant stress and exhaustion, leading you to feel disconnected and unable to do your work. It is more than feeling tired out after a hectic day or a busy week. Instead, burnout describes the psychological result of working beyond your means for an extensive period of time.

If you do experience burnout as a student, it’s easy to fall into a vicious cycle of feeling too stressed to work and therefore avoiding work, meaning you quickly fall even further behind.

The ongoing stress of burnout can be a risk to your long-term mental health as well as your short-term happiness, so it is important to take it seriously.

Here are four ways to prevent burnout as a university student.

Why it’s OK if you aren’t being productive right now Tips for studying online and at home for university students How to manage your mental health when the world feels uncertain How to manage your time as a university student

1. If you need to rest, rest

If you are experiencing feelings of burnout, the first thing to ask yourself is whether you’re sleeping enough. An unhealthy sleep cycle will only worsen the stress you’re experiencing and prevent you from recovering properly.

If you are in the throes of burnout, you may find you still feel tired all the time even if you’re sleeping a good amount. This is because your nervous system is working overtime, meaning you may need to sleep longer than normal to feel properly rested.

If this is the case, it’s best to listen to your body. Giving yourself time to sleep now will end up saving you time in the long run, as it will stop you from crashing later down the line.

To properly recover from burnout, it’s also important to make time for restful activities. This may include yoga, meditation and exercise, but it also includes spending time with friends, playing a game or reading a book.

These restful activities give your brain a chance to recharge, process the day and consolidate new knowledge.

2. Scale back your workload where possible

Burnout is a sign that the way you are currently living your life is not sustainable. Because of this, easing the problem often requires a significant re-evaluation of how much work you are taking on and how you are structuring your time.

Have a look over your schedule or reflect on the amount of work you expect yourself to complete in one day. Are you setting yourself unrealistic goals?

If this is the case, consider how you could feasibly scale back your workload.

If you’re struggling to keep up a particular module, try contacting your lecturer or supervisor and explaining the problem.

Often, they will be able to provide some support, answer any questions about your work, or they may offer you an extension to any deadlines you’re struggling with. These conversations can be difficult, but they are often necessary to your recovery.

It’s also worth assessing how you’re spending time outside your studies. Joining societies and clubs can be extremely rewarding, but overcommitting to too many activities can easily lead to burnout.

It may be worth scaling back the number of hours you put into clubs and societies in the short term, until you are feeling less overwhelmed.

3. Consider any underlying causes

Beyond time management issues and having too many things to do, burnout can often be an indication of a deeper underlying problem.

Burnout may well reflect some distorted views about what constitutes success, how well you should perform, how people value your contributions and what others expect of you.

In these situations, burnout is the result of feelings that you’ve let yourself down or failed to live up to the impossibly high standard you’ve set yourself.

This imbalance is often formed when people stop engaging in activities that bring them genuine happiness. You shouldn’t feel guilty about this. It can be easy to get wrapped up in your work and lose sight of yourself and what you really want.

Burnout is an alarm bell sounding to tell you that you need to stop and re-evaluate. You may find counselling or therapy a good context in which to do that evaluation, especially if you’re struggling to understand the underlying cause of your burnout.

4. Don’t hold yourself up to your pre-pandemic productivity levels

The disruption and uncertainty caused by Covid-19 has made everyone more vulnerable to burnout. You may feel disappointed in yourself if you find that you’re unable to keep up with the amount of work you used to be able to achieve before the pandemic.

You may find that you’re trying to compensate for the uncertainty caused by Covid-19 by overworking to feel a sense of control, which can lead to feeling overwhelmed.

For others, the anxiety caused by Covid-19 manifests as indecisiveness, procrastination and avoidance.

It’s important to remember that the pandemic has introduced a great deal of additional stress, from worrying about contracting the virus or falling behind due to illness, feeling isolated or struggling to stay motivated with online learning. That’s OK. We are all processing a unique global event, and having to slow down in other areas is perfectly normal.

Another way to look at the pandemic is to see that we have a unique opportunity as a global community to collectively take a moment and relax some of our normal expectations of ourselves and others.

You may well find more people around you will be receptive to conversations about burnout and mitigating stress, since everybody has been affected in some way.

These steps require you to make some tough decisions and engage in some self-reflection, which is not an easy task. However, if investing some time and work into avoiding burnout will pay off in a happier and healthier lifestyle, it is well worth it.

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FNU Tips How to Prevent Student Burnout

How to Prevent Student Burnout

Getting stressed while attending college is a normal phenomenon, and because it seems normal, sometimes people fail to recognize the signs and symptoms of burnout. While it’s often ignored or downplayed as everyday college stress, student burnout is more severe than day-to-day stress.

If you or someone you know could be suffering from student burnout, read on for tips on next steps. If you’re dealing with stress and are looking for ways to manage it to avoid burnout, read on for prevention tips. First, you should know that it is more common than you think and will get better the sooner you address it.

What is Burnout?

Burnout occurs when you feel overwhelmed and unable to meet constant demands. As the pressure continues, you begin to lose the interest or motivation that led you to take on a specific role in the first place.

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While the exact symptoms differ in every case, student burnout usually appears as extreme exhaustion, depression, negative feelings about oneself, and the inability to attend to necessary tasks. Burnout reduces your productivity and saps your energy, leaving you feeling increasingly helpless, hopeless, cynical, and resentful. Eventually, you may feel like you have nothing more to give. In this fast-paced day and age, we all have many responsibilities and demands on our time and energy.

So, it’s unsurprising that we may feel overwhelmed, overloaded, or unappreciated. Sometimes it feels like all we do goes unnoticed or unrewarded; or just getting out of bed feels like a monumental task. If you feel like this most of the time, this could indicate a more severe condition than daily college stress, and you may be burnt out.

Typical warning signs that maybe overlooked:

Mental burnout.

• Making careless mistakes that you ordinarily wouldn’t make.
• Lashing out at others due to pressure and frustration.
• Lacking opinions or ideas for classroom discussions or group projects.
• Losing confidence, motivation, and otherwise feeling incapable of keeping deadlines.

Physical Burnout

• Constantly feeling exhausted despite getting sleep or not sleeping well at all.
• Habitually stress eating, forgetting to eat, overthinking, or picking up other bad habits.
• Not noticing pain and tension in your body from working or thinking about work constantly.
• Experiencing frequent headaches or dizzy spells.
• Finding yourself getting sick more often with head colds, stomach flu, etc.

Emotional Burnout

• Finding yourself reacting more sensitively over minor issues with others, like comments or criticism.
• Not being able to concentrate or lack of enjoyment of leisure activities like reading or watching a film.
• Constantly feeling bored or uninterested in matters you used to enjoy.

Dealing with Burnout: Getting Help

Suppose you exhibit any of these symptoms and have severe negative moods or are overwhelmed and incapacitated. Then taking this seriously and dealing with burnout is essential. Unfortunately, sometimes people are too close to burnout and can no longer recognize the symptoms. If you recognize the warning signs of impending burnout in yourself or someone else, remember that it will surely only get worse if left alone. These signs and symptoms are your body’s way of getting your attention.

While students should strive do well in college, their health and well-being are also important. If burnout is looming, allow yourself to get support from professionals who can help you transition to a healthier lifestyle that include healthy ways of managing stress, respecting yourself, including your needs, and boundaries. Taking steps to get your life back into balance is a major step towards preventing burnout.

When you start to feel chronic stress from student burnout and emotional exhaustion, employ some stress management techniques that can be researched online. Also, contact family members for help – don’t feel alone! If you don’t feel like your family will be supportive, FNU will be there for you. Just reach out to our staff at the  Student Services Center or utilize the resources in FNU CARES .

Most At-Risk Students for Burnout:

Nursing student burnout.

Nursing school is expected to bring on stressors that not every student can handle. Burnout can manifest even when bright and motivated students are loaded with assignments and high-stakes tests. Long hours of studying, essays, and the constantly evolving nature of medicine all contribute to what feels like insurmountable pressure, yet we are still being told to push through burnout.

Nailing down just one cause of nursing student burnout is unrealistic, as all potential causes of burnout should be recognized and understood by school administrations. Some issues that are unique or especially common to nursing students include:

• Competing demands for the time between nursing school and family/friends.
• Strained finances due to student loans.
• The intense curriculum of heavy course load, high-stakes tests, and extensive reading.
• Unattainable expectations from family, peers, and mentors they admire.
• No incentive for well-being since a culture of ‘push through it’ is more encouraged.

Tip #1: Time Management and Organization

Students are less likely to experience burnout when they keep up with their assignments on time and prepare in advance for exams. Effectively managing time and deadlines using a calendar is very helpful for keeping track of priorities, deadlines, responsibilities, and avoiding procrastination.

Tip #2: Breaking Down Responsibilities

Breaking down long-term goals or massive projects into smaller, more achievable benchmarks can go a long way toward avoiding the stress that occurs with procrastination and pulling all-nighters. Burnout often happens when people do not set smaller goals, achieve them, and feel good about their success before moving on to the next project or step.

Tip #3: Set Reasonable Goals and Stick to Them

Although stress is not the same as burnout, stress certainly can lead to burnout if not managed appropriately. Being unrealistic about goals and your ability to meet them, piling on more courses than you can handle, and having a social life that leaves little time for work can be a recipe for disaster. Scheduling a manageable load of classes and ensuring you have a mix of courses is essential. Even a student passionately interested in psychology may find taking only psych courses taxing. Likewise, setting unattainable goals often results in students throwing in the towel rather than persevering.

Tip #4: Maintain Good Health and Respect Personal Needs

It sounds like common sense advice, and it is. Eating healthily, exercising, and getting enough sleep are imperative to staying healthy and not letting everyday stress leads to burnout. In addition, try to consistently make time for stress-reducing activities such as relaxing walks, swimming, or another physical exercise, doing regular deep breathing, mindfulness or other healthy pleasurable activities. Remember that watching TV or spending idle time on the computer does not relieve stress – it often just lets it sit dormant. The most effective stress-reducing activities are calming, such as meditation, yoga, walking, breathing, physical exercise. Sports are great because they release positive endorphins and aid sleep. Adding these activities to your routine makes a big difference in feeling good and achieving a healthy life balance that will help you avoid burnout.

Tip #5: “Go Dark” with a Social-Media Shutdown

The constant presence of social media and internet updates can add to a sense of overstimulation that can overwhelm us. Taking a break from school is essential, and that doesn’t just mean putting the books aside for a day off from studies. Disconnecting from social media is recommended for students and workers alike. At least one hour before sleep shut off mobile devices and social media. While the excess of information can run you ragged, the light screens on computers, smartphones, tablets, and other devices can interfere with your circadian rhythms and negatively impact rest or sleep through the night. Turning off and tuning out for a while is another way to avoid burnout.

Fight Back Against Burnout

To deal with burnout effectively and safely, you need to use the “Three R” approach:

Watch for and recognize the warning signs of burnout. Meanwhile, learn to say “no” and be OK with it.

Burnout happens when you try to “do it all” and fall short. You can lessen stress by delegating tasks, shifting your priorities, or being realistic about your time in a day. The word “no” helps you set boundaries and begin limiting sources of burnout.

Acknowledge the damage and reverse it by managing stress and seeking support. You don’t always have to move, catch up, or optimize yourself and your surroundings 24/7. Let yourself be and reflect, as this is sometimes exactly what your body and mind need most. Disconnect and take regular breaks where decompressing is the only objective. Doing this regularly gives you more energy to make progress when required.

Build your resilience to stress by caring for your physical and emotional health. Create time for yourself.

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Burnout and dropout intention in medical students: the protective role of academic engagement

Sara abreu alves.

1 Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

Jorge Sinval

2 Business Research Unit (BRU-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal

3 William James Center for Research, ISPA - Instituto Universitário, Lisbon, Portugal

4 Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo, Ribeirão Preto - SP, Brazil

Lia Lucas Neto

João marôco, antónio gonçalves ferreira, pedro oliveira.

5 CiiEM Centro investigação interdisciplinar Egas Moniz, Almada, Portugal

Associated Data

All of the material is owned by the authors and/or no permissions are required. The results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration by another publisher. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Introduction

The influence of burnout, academic engagement, and their interaction in dropout intention among medical students should be further studied. Current research shows its consequences are relevant, however, there is little understanding on burnout and academic engagement moderation in dropout intention. The current study tested a model that relates the effects of coping strategies, social support satisfaction, general distress on academic engagement, burnout, and dropout intention, on medical students.

Through an online survey a non-probabilistic sample of one Medical Faculty's 1st- and 2nd-year students was recruited. Cross-sectional data were collected using psychometric instruments (Maslach Burnout Inventory – Student Survey, Social Support Satisfaction Scale for College Students, Brief COPE Scale for College Students, University Student Engagement Inventory, and Depression, Anxiety and Stress Scale), sociodemographic and academic variables, and analyzed using structural equation modeling.

532 students (76% response rate) enrolled in the study. Latent variables structural model presented a satisfactory fit to the data and confirmed the expected negative path between burnout and dropout intention (β DI<-SB =0.430; p <.001) and the latent moderation burnout x engagement (β DI<-SB*SE =-0.218; p <.001).

Academic engagement attenuates the impact of burnout on dropout intention, working as a protective factor. Social support satisfaction and adaptive coping are associated with increased levels of academic engagement, and general distress and maladaptive coping are associated with burnout. Medical Schools should develop interventions to prevent dropout intention, tackle students' stress and academic challenges, and develop their academic engagement levels.

Student burnout is the triad of exhaustion, cynicism, and feelings of inefficacy [ 1 ]. Exhaustion refers to feelings of exceeding emotional resources due to the requirements of the study. Cynicism is a negative, insensitive, or excessively detached response to the study, colleagues, teachers, and patients. Feelings of inefficacy mean reduced academic achievement as a decline in feelings of competence and achievement as a student. A systematic review of 2021 on the prevalence of burnout syndrome in university students showed estimates of 55.4% for emotional exhaustion, 31.6% for cynicism and 30.9% for academic efficacy. Also, it mentioned that medical students had higher burnout prevalence in contrast with other courses [ 3 ]. Medical students tend to experience student burnout at some point during graduation and later as physicians [ 2 ]. The personal, psychological, and financial consequences of burnout and dropout in medical students have shown to be relevant, such as the emotional suffering and health problems, and the waste of time, resources and money [ 4 ].

Burnout is associated with general distress, poor educational performance, college dropout, suicidal ideation [ 5 ] and substance use [ 6 ], mainly during medical school [ 2 ]. Although depression and burnout overlap to some extent, their correlation strength is not yet fully understood [ 7 ]. Occupational stress and anxiety symptoms can be directly related to burnout, which means the higher the stress and anxiety, the higher the burnout level [ 7 ].

College dropout intention has a wide range of negative consequences on the individual, family, faculty, and community [ 4 ]. For instance, dropout intention is related to an individual’s expectations not being met, symptoms of loss and frustration, and financial costs [ 4 ]. European Commission’s Education and Training Monitor 2020 showed that 10.2% of students are early leavers from education and training [ 8 ]. The Portuguese context is not an exception in terms of higher than desirable dropout rates [ 4 ]. Previous research found that 11% of medical students had serious thoughts of dropping out of medical school each year [ 9 ]. In the USA, resident trainees’ second leading cause of death is suicide (4.1 per each 100,000), and approximately 10 out of 100 medical students report suicidal ideation [ 10 , 11 ].

Some of the causes of medical student burnout are known – high academic requirements, demanding nature of the contents, heavy workload, stress of the exams [ 12 ], however there is an insufficient number of studies on predictive psychological variables of burnout in medical students.

In this regard, there is a need to understand better how student burnout, and academic engagement relate to dropout intention [ 5 ]. Academic engagement outlines student disposition to engage in school activities [ 13 ]. Behavioral, emotional, and cognitive engagement describe academic engagement dimensions [ 5 ]. Behavioral academic engagement encompasses student conduct and participation in classroom tasks and extracurricular activities [ 5 ]. Emotional academic engagement refers to student willingness to invest the necessary efforts to comprehend and master each subject [ 5 ]. Cognitive academic engagement concerns feelings of school belonging, beliefs about the value of schooling, and attention to teacher’s instructions [ 5 ].

Another variable of interest regarding burnout is coping [ 14 ]. Carver et al. [ 15 ] described 14 coping mechanisms. One possible classification of coping strategies splits them into adaptive coping and maladaptive coping. Adaptive coping strategies are seeking help, information, social support, accepting, planning, and reframing problems with faith or humor [ 5 ]. Adaptive coping is associated with academic engagement [ 5 ]. In contrast, non-adaptive coping strategies encompass self-distraction, disengagement, self-blame, denial, and substance use [ 5 ]. Non-adaptive coping is associated with burnout [ 5 ]. Student burnout and general distress (i.e. anxiety, depression, and stress) are negatively associated with adaptative coping strategies as spend time with family and friends [ 16 ]. Not all coping strategies are expected to be equally effective in stress management [ 17 ], some coping strategies can be protective to health (adaptive) while maladaptive strategies are detrimental to health. Being expected, that academic engagement shows a positive association with adaptive coping and a negative relation with maladaptive coping, while student burnout is expected to have the opposite associations (i.e. positively associated with maladaptive strategies, and negatively related with adaptive coping) [ 18 ].

Additionally, social support is a key factor of study. Social support satisfaction is the set of information that one experiences that make him/her believe that he/she is supported, loved, and valued in a communication network and mutual obligations [ 19 ]. Social support is expected to be negatively related to burnout. This association was evident in a meta-analytic study with more than 95,000 students, where support from school or teacher have the strongest negative relationship to student burnout [ 20 ]. Social support showed to be central to student engagement in academic activities [ 21 ] being expected to be positively related to the satisfaction with social support.

Therefore, this study aims to add to the medical education literature that satisfaction with social support, adaptive coping mechanisms, and academic engagement are answers to burnout and dropout intention conundrum in medical students. In general, the hypotheses established in this study are presented in the diagram (Fig.  1 ), which was tested in a sample of medical students to determine potential predictors of student burnout and academic engagement that may be intervened and prevent dropout.

Student burnout and engagement model. SSS=Satisfaction with Social Support, GD=General Distress, AC=Adaptive Coping, MC=Maladaptive Coping, SB=Student Burnout, SE=Academic Engagement, SB*SE=Student Burnout interaction with Academic Engagement, DI=Dropout Intention. Plus sign (+) represents positive expected effect and minus sign (-) represents negative expected effect

Research Hypotheses

As academic workload and high standards in medical schools are not likely an object of change, it is crucial to understand the psychological factors underlying this phenomenon to tackle student burnout [ 12 ] and dropout intention [ 8 ]. This paper aims to test a model that posits psychological variables (coping, satisfaction with social support, and general distress) as predictors of burnout, academic engagement, and its interaction, which predict dropout intention. Hypothesis 1 states that social support satisfaction, adaptive and maladaptive coping, and general distress are significant predictors of student burnout (H1) and while hypotesis 2 states that those predictors impact also academic engagement (H2). Moreover, hypothesis 3 assumes that burnout is a risk factor for dropout intention (H3). In contrast, hypothesis 4 states that academic engagement is a protective factor to dropout intention (H4). Finally, hypothesis 5 assumes that t he latent interaction between academic engagement and burnout is a significant predictor of dropout intention (H5). Figure  1 depicts the research hypotheses.

The Ethics Committee of CHLN-HSM and Faculty of Medicine of the University of Lisbon (FMUL) approved this study (Ref.N.210/20). An online survey was comprised of psychometric scales and a social demographic questionnaire through LimeSurvey software [ 22 ]. The electronic informed consent was presented first, and has been accepted by all the participants, allowing them to proceed further in the questionnaire. All participants could leave the study at any time.

With the intent to improve answers’ quality, a 1st-year class of 28 medical students enrolled in a pilot study to evaluate the platform used and items’ comprehensibility. The 95% trimmed mean of the pilot’s filling time was 12 min and 59 s. These students sent global comments to the research team with feedback about the survey and ideas to improve response rate. Pilot study data are available from the corresponding author on reasonable request.

Afterwards, it was took into consideration that it is essential to carefully choose and justify the data collecting moment of the academic year. For example, proximity to exams, both before and after, can seriously affect the psychological variables considered. Therefore, the data of the main study was collected for ten days, two weeks after classes had started. All potential participants received an invitation on the same day and two reminders during the next few days. Everyone received an automatic report about their answers and their comparison to the overview.

Participants

A minimum sample of 500 observations was defined as recommended by Hair et al. [ 23 ] for models with large number of constructs. The sample included students from the 1st or 2nd-year of the 2020-21 academic year of FMUL. Non-medical students and medical students from other years did not participate. A total of 702 invitations to participate in the study were sent (pilot sample included).

Online self-report psychometric instruments were used together with sociodemographic and academic questions. Each instrument was chosen considering its psychometric properties, frequency of use with higher education students, and cost of use. All instruments had already their adapted versions for Portuguese college students published.

Maslach Burnout Inventory – Student Survey (MBI-SSi)

The Maslach Burnout Inventory — Student Survey with the efficacy dimension reversed (MBI-SSi) was selected to measure students’ burnout levels.[ 24 ] MBI-SSi has 15 items (0 “Never/Not once” to 6 “Always/Every day”). A second-order latent factor, burnout , with three first-order dimensions was used (i.e., emotional exhaustion, cynicism, and inefficacy). A sample item is “I feel used up at the end of a day at university” (Exhaustion).

University Student Engagement Inventory (USEI)

The Portuguese version of the University Student Engagement Inventory (USEI) was used to measure students’ academic engagement as a second-order factor with three first-order dimensions: emotional, cognitive, and behavioral [ 25 ]. It has 15 items (1 “Never” to 5 “Always”). A sample item was “I usually participate actively in group assignments” (Behavioral Engagement).

Social Support Satisfaction Scale for College Students (SSSS)

The Portuguese version of the Social Support Satisfaction Scale (SSSS) for College Students was used to measure students’ satisfaction with their social support as a second-order factor with four first-order dimensions: social activities, satisfaction with family, satisfaction with friendship, and intimacy [ 19 ] The SSSS has 12 items (1 “Strongly disagree” to 5 “Strongly agree”). A sample item is “I am satisfied with the number of friends I have” (Satisfaction with Friendship).

Brief-COPE Scale for College Students (Brief-COPE)

The Portuguese version of the Brief-COPE Scale for College Students (Brief-COPE) was selected to measure students coping strategies [ 26 ]. It operationalizes 14 coping dimensions which had two second-order factors [ 27 ]: adaptive coping strategies (Active Coping, Planning, Use of Instrumental Support, Use of Emotional Support, Religion, Positive Reframing, Acceptance, Humor) and maladaptive coping strategies (Denial, Venting, Behavioral Disengagement, Substance Use, Self-Distraction, Self-Blame). This instrument has 28-items (0 “I never do this” to 4 “I always do this”). A sample item is “I’ve been concentrating my efforts on doing something about the situation I’m in” (Active Coping).

Depression, Anxiety and Stress Scale (DASS-21)

The Depression, Anxiety and Stress Scale (DASS-21) Portuguese version was applied to measure students’ general distress as a second-order factor [ 28 ]. The 21 items (0 “Did not apply to me at all” to 3 “Applied to me very much, or most of the time”) comprise three first-order dimensions: Depression, Anxiety, and Stress. A sample item is “I couldn’t seem to experience any positive feeling at all” (Depression).

Dropout intention

Students answered if they had thought about dropping out of medical school with a dichotomic scale (“Yes” or “No”); i.e. “Have you ever thought about dropping out of medical school?” The selection of this item intends to filter students who considered the possibility of dropping out from medical school independently of the level of seriousness of the thoughts.

Sociodemographic questions

Students answered about their sex, age, and administrative region of origin.

Data analysis

The data analysis was conducted using the R programming language [ 29 ] through the graphical user interface, RStudio [ 30 ]. The skimr package [ 31 ] was used to obtain some of the descriptive statistics (mean, standard deviation, minimum value, 25th percentile, median, 75th percentile, maximum value) and the histogram for each of the instruments’ items. Other descriptive statistics were calculated: the coefficient of variation (CV) through the sjstats package [ 32 ], the standard error of the mean (SEM) through the plotrix package [ 33 ], and the mode through the modeest package [ 34 ]. The skewness using the “sample” method, and the kurtosis using the “sample excess” method, were calculated using the PerformanceAnalytics package [ 35 ]. Severe univariate normality violations were assumed for absolute values of | sk | >3 and | ku | >7 [ 36 , 37 ].

The confirmatory factor analysis (CFA) was used to assess if the collected data confirmed the expected dimensionality of the used instruments. All SEM analysis were done with the lavaan package [ 38 ] using the weighted least squares means and variances (WLSMV) estimation method [ 39 ]. The TLI (Tucker Lewis Index), the SRMR (Standardized Root Mean Square Residual), the RMSEA (Root Mean Square Error of Approximation), NFI (Normed Fit Index), χ 2 / df (ratio chi-square and degrees of freedom), and CFI (Comparative Fit Index) were used as goodness-of-fit indices. The fit of the models was considered good if χ 2 / df < 5, values of SRMR and RMSEA < .08, values of CFI , NFI, and TLI > .95. The reliability of the scores was assessed based on the estimates of internal consistency. The ω based on the polychoric correlation matrices were calculated for first-order factors [ 40 , 41 ]. For second-order factors, the variance of the first-order factors explained by the second-order factor (ω L2 ), the proportion of variance explained by second-order factor after partialling the uniqueness of the first-order factor (ω partial L1 ), the proportion of the second-order factor explaining the total score (ω L1 ) were calculated. All the internal consistency estimates were obtained through the semTools package [ 42 ].

The structural model was analyzed through the structural equation modeling technique using the lavaan package [ 38 ] implemented through a two-step approach [ 37 ]. The latent interaction between student burnout and academic engagement was operationalized with the semTools package [ 42 ] using double-mean centering for the product of the indicators [ 43 ] and a match-paired approach [ 44 ]. Confidence intervals (95%) were provided for all paths. The same criteria established in the evaluation of the measurement models (i.e. CFA) were used to assess the goodness-of-fit of the latent variable structural model. For all statistical tests, α = .05 was used.

This cross-sectional, observational study analyzed 532 medical students of FMUL, 417 were complete ( n 1st year =215; n 2nd year =174; n pilot =28). Most students were females (71%), with a mean age of 19.48-years-old ( SD =2.75), 53% from the Lisbon or Setubal districts. The response rate was 76%. About 78% of participants completely answered. The 95% trimmed meantime of response was 12 min and 46 s.

Measurement Model

Validity evidence based on the internal structure.

For each instrument, the item’s distributional properties were inspected. Then, the dimensionality and the reliability of the scores in terms of internal consistency for first- and second-order factors were analyzed.

Items’ Distributional Properties

As shown in Table 1, all items presented skewness and kurtosis values that were not indicative of severe univariate normality violations [ 36 , 37 ], except two items (Item 25 and Item 26) of Brief COPE, both from the substance use dimension. Those two items were the only items from Brief COPE that did not present the full range of possible answers, as shown in the histograms of Table  1 . All items of the MBI-SSi, DASS-21 and SSSS had the full range of possible answers, while the USEI did not have the maximum possible range of answers in 10 items (i.e., items 1, 2, 3, 5, 7, 8, 9, 13, 14, 15).

MBI-SSi, USEI, SSSS, Brief COPE, and DASS-21 descriptive statistics. Through the histograms, it is possible to visualize the distribution of answers by each item

Dimensionality

The original dimensionality of measuring instruments was verified using CFA to evaluate the data’s fit to the complete measurement model. The student burnout and academic engagement latent interaction variable was operationalized with three manifest variables from the MBI-SSi and three from the USEI. In order to avoid residuals’ negative variances, in six Brief-COPE dimensions (planning, religion, self-blame, venting, substance use, and humor) each pai r of items had their factor loadings constrained to be equal. The residual variance of USEI’s emotional engagement first-order factor was fixed to 0.01 to avoid negative variance. The measurement model presented a satisfactory fit to the data (χ 2 (4,236 ) = 13,308.265; p <.001; χ 2 / df =3.142; n =389; CFI = . 949; NFI = .927; TLI = .948; SRMR = .088; RMSEA = .074; P (RMSEA≤ .05)< .001; 90%CI ] .073; .076[).

Reliability

The reliability of the scores in terms of internal consistency was estimated. Regarding the second-order latent factors, the internal consistency estimates were satisfactory at large: student burnout (ω L2  =  .891; ω L1  =  .865; ω partial L1  =  .955), academic engagement (ω L2  =  .893; ω L1  =  .742; ω partial L1  =  .863), satisfaction with social support (ω L2  =  .785; ω L1  =  .713; ω partial L1  =  .888), adaptive coping (ω L2  =  .783; ω L1  =  .753; ω partial L1  = .942), maladaptive coping (ω L2  =  .618; ω L1  =  .573; ω partial L1  =  .902) and general distress (ω L2  =  .922; ω L1  =  .883; ω partial L1  =  .958). The latent interaction factor presented an internal consistency estimate below the desirable ( ω  =  .581).

Structural Model

The latent variable structural model presented a good fit to the data (Fig.  2 ; χ 2 (4, 32, 9) =13,484.143; p <.001; χ 2 / df =3.115; n =389; CFI = .949; NFI = .927; TLI = .948; SRMR = .088; RMSEA= .074; P (RMSEA≤ .05)< .001; 90%CI ] .072; .075[). The direct effects of social support satisfaction (β SB<−SSS =-0.264; p <.001), general distress (β S B<−GD  = 0.403; p <.001) and maladaptive coping (β SB<−MC  = 0.272; p =.005) on burnout were statistically significant. The direct effects of social support satisfaction (β SE<−SSS  = 0.334; p =.002) and adaptive coping (β SE<−AC  = 0.352; p <.001) on academic engagement, revealed statistically significant paths. The effect of both coping latent variables on the latent moderation between burnout and academic engagement were statistically significant (β SB*SE<−AC =-0.189; p =.014; β SB*SE<−MC =-0.451; p =.004). Both student burnout (β DI<−SB  = 0.430; p <.001) and the latent moderation burnout x academic engagement (β DI<−SB*SE =-0.218; p <.001) presented a statically significant effect on dropout intention. While academic engagement did not present a statistically significant effect on dropout intention, however, the effect size was not negligible (β DI<−SB*SE =-0.203; p =.085). Table  2 presents all regression paths with a 95% confidence interval. The variance of the endogenous variables explained by the model presented large to low effect sizes ( r 2 SB = . 729; r 2 SE = .459; r 2 SB*SE = .125; r 2 DI = .447). Figure  2 illustrates the standardized structural coefficients and their significance (α =  .05).

Path diagram with the regression paths, their statistical significance and r 2 for the endogenous variables. SSS=Satisfaction with Social Sup port, AC=Adaptive Coping, MC=Maladaptive Coping, GD=General Distress, SB=Student Burnout, SE=Academic Engagement, SB*SE=Student Burnout interaction with Academic Engagement, DI=Dropout Intention. ns – p >.05; * – p ≤.05; ** – p <.01; *** – p <.001

Structural model’s regression paths

This study adds to medical education literature as it was the first time this structural model was applied to medical students. It showed that the higher the social support satisfaction, adaptive coping mechanism s, and academic engagement, the smaller the dropout intention. Academic engagement attenuates the impact of burnout on dropout intention, working as a protective factor. Also, it demonstrated that the higher the maladaptive coping mechanisms, general distress, and burnout, the higher the dropout intention. Additionally, every participant had the chance to reflect on the report of their answers and compare them with the overview, thus being able to take action if they had alarming results.

The model successfully allowed to verify the established hypothesis. The H1, partially confirmed, showed that adaptive coping did not significantly affect burnout. In contrast, social support satisfaction, general distress, and maladaptive coping presented a significant positive relation to burnout. It shows that the lack of adequate social support, depression, anxiety, stress, and not functional coping strategies are associated with higher levels of burnout. These findings highlight both the importance of peers in the academic path of medical students and the harmful impact that maladaptive behaviors can have on students’ mental health.

Adaptive coping strategies did not seem to be quite essential to prevent burnout. However, adaptive coping presented a meaningful relationship with academic engagement, as did social support satisfaction. Maladaptive coping and general distress did not show significant association, which allows to partially confirm H2. This fact underlines an exciting tendency as positive coping strategies are related to a positive construct (i.e., academic engagement). In contrast, maladaptive coping strategies are associated with a negative construct (i.e., student burnout). Social support satisfaction as burnout and academic engagement predictor presents a statistically significant relationship with both.

In this study, the direction of social support satisfaction to burnout was negative, while social support satisfaction to academic engagement was positive. Therefore, social support satisfaction can directly prevent burnout and promote academic engagement. Such finding emphasizes the substantial role that family, friends, and other peers have in medical students (particularly in the first year). It is known social support seems to have a solid association with student burnout [ 20 ] Nevertheless such association might depend on cultural factors, as the findings by Marôco et al. [ 5 ] suggest, where satisfaction with social support presented statistically significant relation with academic engagement and/or student burnout in some countries (e.g. Brazil, UK), while in others, no (e.g. Finland, Mozambique).

Depression-specific symptoms include dysphoria, discouragement, devaluation of life, self-deprecation, lack of interest or involvement, anhedonia, and inertia [ 45 ]. Stress may be beneficial in moderate levels, but the likelihood of illness is more significant in extreme levels [ 46 ]. Distress is the set of difficulty in relaxing, nervous excitement, easily agitated, overreaction, and impatience [ 45 ]. The general distress construct positively predicted burnout, as the model [ 47 ] posited it, but it did not present a meaningful effect on academic engagement. A negative relationship was expected; that is, the higher the distress, the lower the academic engagement. Moreover, the path from general distress and the interaction of burnout and academic engagement is significant. Nonetheless, this result deserves a more profound explanation in future studies. The role of general distress as a predictor is not clear because, in the absence of a longitudinal approach, it is impossible to know if it is a cause or an effect of burnout. All these relationships are multifactorial, and it is not easy to detect the main predictors to be intervened, and future investigation should focus on these main conclusions through longitudinal studies.

Burnout is a phenomenon that medical students face through college and later in their professional life. It is associated with risk factors such as maladaptive coping, general distress, and protective factors like social support satisfaction, adaptive coping, and academic engagement. Besides confirming this, this study demonstrated that these factors indirectly influence dropout intention. Academic engagement correlates to attending classes, submitting asked essays, and following teachers’ recommendations in class [ 13 ]. Burnout and engagement are negatively associated concepts as both can either be a cau se or a consequence of each other [ 5 ].

Burnout’s direct effect on dropout intention was statistically significant, confirming H3. However, academic engagement direct effect on dropout intention was not statistically significant, not confirming H4. Even though the regression path has the expected negative direction with a considerable magnitude and a statistical significance close to α (β = -0.203; p = .085).The observed findings (i.e. absence of a statistically significant effect) are identical to the results obtained by Marôco et al. [ 5 ] in a sample of eight countries and regions. Nevertheless, the moderation between academic engagement and burnout showed a meaningful path as expected (H5) [ 5 ]. Higher levels of burnout were related to higher dropout intention levels. The interaction of burnout and academic engagement represents the conjugated effect of these two variables, which indicated that academic engagement attenuates the effect of burnout (or vice-versa) on the dropout intention.

Despite the stress one is submitted to, it also comes to the response to tackle its source. On the one hand, people who tend to attribute an external locus of control prefer avoidant maladaptive strategies, which might show a higher tendency to develop burnout and disengagement [ 5 ]. On the other hand, people who claim outcomes result from one’s efforts tend to use adaptive coping strategies, which may have less tendency to develop burnout and disengagement. In this study, it was found that the path of maladaptive coping to burnout was positive, as was the path of adaptive coping to academic engagement. This idea favors ensuring that medical students who do not drop out are genuinely committed to being a doctor [ 48 ]. Also, one might assume that avoidance of maladaptive coping can be a focal point of intervention in preventing burnout and dropout intention. Whereas the positive path of adaptive coping to academic engagement, objected in this study, can predict that the development of adaptive coping directly influences academic engagement, which in turn will negatively impact burnout and dropout intention.

Burnout has educational and economic consequences, as it is associated with dropout intention [ 9 ]. Dropout is an indicator of the universities’ quality [ 49 ], and European Commission set the proportion of early leavers from education and training (the 18–24 year-olds) to be below 10% for Europe in 2020. However, it stood at 10.2% in 2019 [ 8 ]. Unfortunately, Portugal’s 2019 overview still has a worrying dropout rate in public universities [ 4 ]. Dropouts have costs for the individual and universities because the lower the number of students and graduates, the lower the financing received by universities [ 4 ]. Besides social-economic consequences of dropout, it is associated with personal seque ls, such as emotions of personal inadequacy, social stigm a, self-doubts, and ultimately a waste of time and resources [ 50 ]. Despite these facts, it should not be aimed to reduce the medical school dropo ut rate to 0% if it means postponing the dropout as doctors [ 48 ] or unprofessional behavior. Dyrbye et al. [ 51 ] described the association between unprofessional conduct and student burnout, as well as less altruistic values in medical students with burnout. Moreover, it is crucial to understand how students who suffer from burnout in college are more predisposed to develop job burnout [ 2 ], as heart disease, impaired cognitive performance, and other health conditions are associated with job burnout. Also, healthcare professionals with burnout showed more tendency to commit errors in the workplace, and compromised patients’ health resulted [ 52 ]. Considering future doctors’ performance link to healthcare conditions and quality of care in general, the goal is to prevent medical students’ tendency to job burnout acting primarily during their studies. To accomplish this, it means developing approaches to intensify social support satisf action of students, promoting their adaptive coping mechanisms, diminishing general distress and maladaptive coping strategies, which will promote academic engagement, and tackle burnout and dropout intention.

Ultimately, this study helps medical educators to guide them through tackling burnout and dropout in medical schools. Strategies that could implement a healthier individual status preventing burnout and dropout intention in medical schools are, for instance: a student support office that helps integrate students, especially the displaced ones, upgrading their social support satisfaction, having a psychology-psychiatric office that makes early diagnosis and treatment of depression and anxiety, and having workshops about preferring adaptive coping instead of maladaptive strategies. Longitudinal experimental studies should focus on the main results.

Limitations

The critical weakness is the non-longitudinal approach of this study. It allows the study of correlations and must not necessarily lead to a causation interpretation as longitudinal and experimental studies would do. The lack of certainty regarding both the stability of the measures and the control of the process of potential generation of burnout drastically decreases the study’s internal validity.

Also, the data were collected during the SARS-CoV-2 pandemic and non-random sampling. As a result, the conclusions might have been affected by the context lived in Portugal. At the beginning of the academic year, as a period away from the exams, it is assumed that there should be no exacerbation effects. However, considering that the sample has first-year medical students, there may be adverse effects due to incorporation into the University environment.

Improvement of the comprehensibility and length of the survey, development of an individual report with overview comparison, the collection and analysis processes helped to make the sample more representative, which contributes to higher internal validity. However, the sample contains only 1st and 2nd-year students of a 6-years-course. Each year’s sample was insufficient and did not allow multigroup analysis (i.e., multigroup structural equation modeling). Also, this study was conducted in only one medical school of one country. Future research should study the application of this model and comparison in different universities and countries, therefore assessing the external validity of these results. If similar results are obtained, medical schools should apply longitudinal prospective studies with the implementation of supportive strategies of promotion of social support, adaptive coping and academic engagement, and prevention of maladaptive coping, general distress, burnout, and dropout intention.

Conclusions

All in all, this cross-sectional study confirmed that burnout is a reality in Portuguese Medical students and that this structural model applies to these students and the relationship between variables was as expected. Regarding dropout intention, the relationship of social support satisfaction and adaptive coping is negative, while maladaptive coping and general distress is positive.

Considering that this country has a high need for doctors in the national health service, medical schools should implement strategies that focus on these psychological predictors and promote academic engagement to diminish burnout and dropout intention.

Future investigation should elaborate longitudinal and experimental studies to understand and tackle burnout and dropout intention. There is a lack of understanding on which interventions have the best results. In the future, the focus should be on these predictors and test prevention strategies of burnout and dropout rates and their consequences in medical schools.

Acknowledgements

First of all, the authors would like to thank the Ethics Committee of CHLN-HSM and Faculty of Medicine of the University of Lisbon for having approved this study, as well as to all students who participated in the study. Also, the authors would like to thank INCD and FCT IP for supporting this work.

Authors’ contributions

Sara Alves, Jorge Sinval, Lia Neto, João Marôco, António Gonçalves Ferreira and Pedro Oliveira contributed to the conception and design of the study. Jorge Sinval organized the database. Jorge Sinval and João Marôco performed the data analysis. Sara Alves and Jorge Sinval wrote the first draft of the manuscript. Lia Neto, João Marôco, António Gonçalves Ferreira and Pedro Oliveira wrote sections of the manuscript. All authors contributed to manuscript revision, read and approved the submitted version.

This work was produced with the support of INCD and it was funded by FCT I.P. under the project Advanced Computing Project CPCA/A0/7417/2020, platform Stratus.

Availability of data and materials

Declarations.

All methods were performed in accordance with the relevant guidelines and regulations of BMC Medical Education ’s policies. The Ethics Committee of CHLN-HSM and Faculty of Medicine of the University of Lisbon (FMUL) approved this study (Ref.N.210/20). The electronic informed consent was presented first and must have been accepted by the participant to proceed further in the questionnaire. All participants could leave the study at any time.

Not Applicable.

The authors declare that there are no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Sara Abreu Alves, Email: tp.lu.supmac@arassevla .

Jorge Sinval, Email: moc.liamg@lavnisegroj .

Lia Lucas Neto, Email: tp.lu.supmac@otenail .

João Marôco, Email: tp.apsi@ocorampj .

António Gonçalves Ferreira, Email: tp.aobsilu.anicidem@refnogja .

Pedro Oliveira, Email: tp.lu.supmac@1op .

Impacts of Nursing Student Burnout on Psychological Well-Being and Academic Achievement

• PMID: 34232812
• DOI: 10.3928/01484834-20210616-02

Background: Burnout, depression, and suicide among health care professionals and learners have reached a rampant level. This systematic review aimed to synthesize literature findings of nursing student burnout and its impact on psychological well-being and academic performance.

Method: This systematic review followed PRISMA guidelines and included data-based studies on nursing student burnout published in peer-reviewed journals between January 2015 and January 2020.

Results: This review included 17 articles. Four major themes were identified: 1) a negative relationship between burnout and student self-concept, 2) a negative association between burnout and student engagement, 3) risk factors contributing to student burnout, and 4) interventions to mitigate student burnout. Promoting positive self-concept, engagement, and resilience may alleviate student academic burnout.

Conclusion: Student burnout has negative influences on health and academics, and interventions to mitigate burnout should be considered early in nursing programs. Nurse educators can create an engaging learning environment to build resilience and reduce burnout. [ J Nurs Educ . 2021;60(7):369-376.] .

Publication types

• Systematic Review
• Academic Success*
• Burnout, Professional*
• Burnout, Psychological
• Faculty, Nursing
• Resilience, Psychological*
• Students, Nursing*

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The Morning

A crisis of school absences.

Fewer children are attending school, across rich and poor districts.

By Sarah Mervosh

A few years ago, a troubling phenomenon began to spread in U.S. education: Students were not showing up to school.

This was not particularly surprising. Schools had shut down in the spring of 2020, at the start of the pandemic, and some did not fully reopen until fall 2021. Quarantines for Covid symptoms and exposures were still common. It would take time, many thought, to re-establish daily routines.

What is surprising is how little the numbers have budged since, an issue my colleague Francesca Paris and I explore in depth in a new article published today .

Before the pandemic, about 15 percent of U.S. students were chronically absent, which typically means missing 18 days of the school year, for any reason. By the 2021-22 school year, that number had skyrocketed to 28 percent of students. Last school year, the most recent for which national estimates are available, it held stubbornly at 26 percent.

In interviews, many educators say the problem is continuing this school year.

Perhaps most strikingly, absenteeism has increased across demographic groups, according to research by Nat Malkus, a senior fellow at the American Enterprise Institute. Students are missing more school in districts rich and poor, big and small.

Increase in chronic absenteeism

All students

By child poverty rates

Richest districts

By lengh of school closures

Most remote

Most in-person

By length of school closures

Even the length of school closures during the pandemic was not a particularly useful predictor of absenteeism. On average, districts that were closed longest have experienced similar increases as those that opened sooner.

What is going on here?

I spoke with school leaders, counselors, researchers and parents. They offered many reasons for the absences: illness, mental health, transportation problems. But underlying it all is a fundamental shift in the value that families place on school, and in the culture of education during the pandemic.

“Our relationship with school became optional,” said Katie Rosanbalm, a psychologist and associate research professor at Duke University.

A cultural shift

To some degree, this is a problem facing society at large since the pandemic. Anyone who works in an office with a flexible remote-work policy will be familiar with the feeling: You diligently show up, but your co-workers aren’t there. What’s the point?

Something similar may be going on in schools.

Though school buildings are open, classes are in person and sports and other extracurricular activities are back in full, the stability of school seems to have shifted.

For one thing, teachers are also missing more school , often because of professional burnout or child care challenges — or because, since the pandemic, more people are actually staying home when they’re sick.

Some schools have kept their pandemic policies around online class work, giving the illusion that in-person attendance is not necessary.

And widespread absenteeism means less stability about which friends and classmates will be there. This can beget more absenteeism. For example, research has found that when 10 percent of a student’s classmates are absent on a given day, that student is nearly 20 percent more likely to be absent the following day. “We are seeing disengagement spreading,” said Michael A. Gottfried, a professor at the University of Pennsylvania who has studied this issue.

Sign of other problems

This cultural shift is not simply a hit to perfect attendance records.

The share of students missing many days of school helps explain why U.S. students, overall, are nowhere close to making up their learning losses from the pandemic . Students who are behind academically may resist going to school, but missing school also sets them further back. These effects are especially pernicious for low-income students, who lost more ground during the pandemic and who are more negatively affected by chronic absence.

Absenteeism is also closely linked to other challenges schools have faced since the pandemic, including a rise in student anxiety and behavioral problems.

“The pandemic increased stress in every way in our lives, but it really embedded ourselves in our stress response system — fight, flight or freeze,” Dr. Rosanbalm, the Duke psychologist, said.

An increase in behavioral problems in schools is an example of the “fight” response, she said. On the other hand, she added, “flight is absenteeism.”

For more: A tool in our article lets you see the absenteeism numbers for public school districts in most states.

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Bankman-fried sentencing.

Sam Bankman-Fried, the cryptocurrency mogul convicted of stealing billions from customers, was sentenced to 25 years in prison .

The sentence is among the longest imposed on a white-collar defendant in recent years. Bankman-Fried was also ordered to forfeit about $11 billion in assets.

Barack Obama and Bill Clinton joined President Biden for a fund-raiser at Radio City Music Hall in New York. Biden also gathered major donors privately .

Donald Trump was also in New York City yesterday. He attended a wake for a police officer who was killed this week during a traffic stop.

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The disaster killed six men who were immigrants from Latin America . It has shaken Baltimore’s Hispanic community.

War in Ukraine

The Wall Street Journal reporter Evan Gershkovich has been detained in Russia for a year. Read an interview with his parents .

Vladimir Putin dismissed claims that Russia planned to invade other countries but warned nations against hosting warplanes meant for Ukraine.

If the U.S. abandons Ukraine, that would embolden China to move against Taiwan , Taiwan’s foreign minister said.

The last two coal-fired power plants in New England are set to close . New England will be the second region in the U.S., after the Pacific Northwest, to stop burning coal.

Garbage dumps release methane , a powerful greenhouse gas, at higher rates than previously estimated, a study found.

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A judge is expected to rule on whether the U.S. government must provide shelter and food to migrant children as they wait in outdoor holding areas .

In California, a $20 minimum wage for fast-food workers , America’s highest, is about to take effect.

Lawsuits accuse two county jails in Michigan of banning in-person family visits for inmates as a way to bolster revenue through phone calls and messages.

An 8-year-old girl was the sole survivor of a bus crash in South Africa that killed 45. The bus fell off a bridge and burst into flames.

The Supreme Court is “traditionalist,” meaning justices interpret the Constitution by enduring political and cultural norms, Marc De Girolami argues.

Antiracism is commendable in art. At universities, it can distort curiosity , John McWhorter writes.

Here are columns by David Brooks on the rise and fall of liberalism and David French on minors using social media .

MORNING READS

Accent chair: See the most influential pieces of furniture from the last 100 years.

Hilarity and wonder: Meta’s glasses are becoming artificially intelligent. We tried them .

Dogs: A German breeding bill could lead to bans for the beloved Dachshund .

Modern Love: “ How I learned to trust (some) men .”

Lives Lived: Linda Bean was a granddaughter of L.L. Bean. She used her wealth to support right-wing causes and politicians, to amass paintings and properties associated with the Wyeth art family and to become an entrepreneur in her mid-60s. She died at 82 .

March Madness: Alabama upset the No. 1 seed North Carolina to reach its first men’s Elite Eight in 20 years.

M.L.B.: Commissioner Rob Manfred said he hoped the league’s investigation into the gambling allegations surrounding Shohei Ohtani’s former interpreter would be “short.”

N.H.L.: A Russian hockey player is expected to finally come to North America after being drafted nearly nine years ago. During the wait, he was arrested and forced into military service .

U.S. Soccer: Korbin Albert, a rising star, apologized yesterday after Megan Rapinoe criticized anti-L.G.B.T.Q. content that Albert had reposted on social media.

Caitlin Clark : The Iowa star was among the 14 players selected for Team USA’s training camp in Cleveland.

ARTS AND IDEAS

A new album: Beyoncé has gone country. Her just-released album, “Cowboy Carter,” has plucked banjos, lines about hoedowns and cameos from Dolly Parton and Willie Nelson.

But “that’s only the half of it,” Ben Sisario writes. The 27-track album is a tour of popular music with a Beatles cover and features from Miley Cyrus and Post Malone. “The album’s range suggests a broad essay on contemporary pop music, and on the nature of genre itself,” Sisario adds. Read more about the album .

More on culture

The music producer Metro Boomin helped shape rap over the last decade. Next week, he is poised to claim his fourth No. 1 album. Here’s a guide to his music .

Alessandro Michele, the designer who brought profits and plenty of buzz to Gucci, was named creative director of Valentino .

Seth Meyers joked about Trump Media’s stock .

THE MORNING RECOMMENDS …

Roast salmon with peas and radishes for a quick dinner .

Jog with these strollers .

Give a good gift to a frequent traveler .

Make over your foyer .

Take our news quiz .

Here is today’s Spelling Bee . Yesterday’s pangram was galumph .

And here are today’s Mini Crossword , Wordle , Sudoku and Connections .

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Sarah Mervosh covers education for The Times, focusing on K-12 schools. More about Sarah Mervosh