Article Text

Download PDFPDF

A cross-sectional study of burnout and its associations with learning environment and learner factors among psychiatry residents within a National Psychiatry Residency Programme
  1. Qian Hui Chew1,
  2. Lye Poh Ang2,
  3. Lay Ling Tan3,
  4. Herng Nieng Chan4,
  5. Seh Hong Ong5,
  6. Ambrose Cheng6,
  7. Yew Min Lai7,
  8. Ming Yee Tan8,
  9. Phern Chern Tor8,
  10. Kok Peng Gwee8,
  11. Kang Sim8
  1. 1 Research Division, Institute of Mental Health, Singapore, Singapore
  2. 2 General Psychiatry, Tan Tock Seng Hospital, Singapore, Singapore
  3. 3 General Psychiatry, Changi General Hospital, Singapore, Singapore
  4. 4 General Psychiatry, Singapore General Hospital, Singapore, Singapore
  5. 5 Psychological Medicine, Khoo Teck Puat Hospital, Yishun, Singapore
  6. 6 Psychiatry, Ng Teng Fong General Hospital, Singapore, Singapore
  7. 7 Psychological Medicine, National University Hospital, Singapore, Singapore
  8. 8 General Psychiatry, Institute of Mental Health, Singapore, Singapore
  1. Correspondence to Dr Kang Sim; kang_sim{at}


Background Multiple studies have reported high burnout rates among residents, including psychiatry. There is a paucity of studies examining the relationship between burnout and learning context, stress levels, resilience, stigma in healthcare providers and coping methods concurrently within the same cohort.

Objective We examined the rate of burnout among our psychiatry residents in a cross-sectional study and hypothesised that burnout is associated with poorer perception of learning environment, greater perceived stress, stigma levels, lower resilience and specific coping strategies during training.

Methods Ninety-three out of 104 psychiatry residents (89.4%) within our National Psychiatry Residency Programme participated in the study from June 2016 to June 2018. Relevant scales were administered to assess the perception of learning environment, burnout, stress, resilience, stigma levels and coping methods, respectively. We performed comparisons of the above measures between groups (burnout vs no burnout) and within-group correlations for these same measures.

Results Overall, 54.8% of the sample met criteria for burnout. Residents with burnout had poorer perception of the learning environment, greater stress levels (both p<0.001), were less willing to disclose/seek help and employed greater active-avoidance coping strategies. Within the burnout group, greater perceived stress was correlated with poorer perception of learning environment (rs=−0.549) and greater use of active-avoidance coping (rs=0.450) versus additional use of problem-focussed coping within the non-burnout group.

Conclusions Burnout was related to both environment and learner factors. These findings viewed within the transactional, sequential and imbalance models of burnout suggest the need to address stressors, beef up coping, provide continual support and develop resilience among our learners.

  • burnout
  • residency
  • learning environment
  • coping
  • resilience

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors KS and QHC provided substantial contributions to the conception and design of the work, the acquisition of data for the work; interpretation of the data, the drafting of the work as well as revising it critically for important intellectual content; provided approval of the version to be submitted. LPA, LLT, HNC, SHO, YML, AC, MYT, PCT and KPG provided substantial contributions to the interpretation of the data for this work, revising it critically for important intellectual content; and provided final approval of the submitted version to be published.

  • Funding This research is supported by the Singapore Ministry of Health’s National Medical Research Council under the Centre Grant Programme (Grant No: NMRC/CG/004/2013). This study has not been presented, published online or in print, and is not under consideration elsewhere.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Institutional Review Board of the National Healthcare Group, Singapore (NHG DSRB Ref: 2015/01139).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.