Indian Journal of Private Psychiatry
Volume 15 | Issue 2 | Year 2021

Effect of Stress Coping on Burnout: A Prospective Study with First-year Postgraduate Medical Students

Darshankumar Dharaiya1, Kamlesh Dave2, Pradhyuman Chaudhary3https://orcid.org/0000-0001-9493-0556

1Department of Psychiatry, RD Gardi Medical College, Ujjain, Madya Pradesh, India

2Department of Psychiatry, Government Medical College, Surat, Gujarat, India

3Department of Psychiatry, GMERS Medical College and Civil Hospital, Ahmedabad, Gujarat, India

Corresponding Author: Pradhyuman Chaudhary, Department of Psychiatry, GMERS Medical College and Civil Hospital, Ahmedabad, Gujarat, India, Phone: +91 9825411772, e-mail: drpradhyuman@gmail.com

How to cite this article: Dharaiya D, Dave K, Chaudhary P. Effect of Stress Coping on Burnout: A Prospective Study with First-year Postgraduate Medical Students. Ind J Priv Psychiatry 2021;15(2):62–68.

Source of support: Nil

Conflict of interest: None


Background: Many studies have recognized that the first postgraduate year (PGY-1) of residency training is the most stressful. Failing to cope with the stress will have a negative impact on their work performance and the quality of patient care.

Aims and objectives: To investigate stress and burnout in PGY-1 residents and to explore the relationship between stress, coping strategies, and burnout.

Methods: Fifty-four PGY-1 residents completed the Perceived Stress Scale, the Copenhagen Burnout Inventory and Coping Inventory at baseline and after 6-month follow-up. The association among stress, burnout, and coping strategies was examined by paired t-test.

Results: PGY-1 resident students had an increase in the level of perceived stress, level of personal burnout, work-related burnout, and patient-related burnout from baseline to 6-month follow-up (p >0.05). In male resident doctors, only work-related burnout increased significantly with the duration of residency, while in females, a significant increase in the level of personal, work-related and patient-related burnout was observed.

Conclusion: The present study revealed high levels of stress that are predictor of burnout, which increases with the duration of the residency program.

Keywords: Burnout, Coping strategies, First-year resident, Perceived stress.


Residency is a particularly stressful time; the trainee is tasked with a tremendous responsibility of consistently providing high-quality care while learning and integrating new skills. Adapting to these job demands has a direct consequence on one’s emotional and intellectual reserve, and the ability to establish a healthy home–work interface.1 Postgraduate trainees and registrars working in a tertiary care teaching hospital experience stress in day-to-day life because of a heavy workload, long duty hours, night shift, little vacation time, inadequate time to sleep, eat, and study; this is compounded by the expectations of teachers, parents, and patients, which are higher in a tertiary care institute.2 Being exposed to the sudden level of workload and stress can cause psychological distress in resident doctors, and there are studies to show that stress level is significantly higher in resident doctors.35 There is evidence suggesting a high prevalence of burnout in medical trainees.6,7 The global prevalence of burnout among postgraduate medical students was recently estimated to be 47.3% (95% confidence interval, 43.1–51.5%) according to a meta-analysis of 114 studies from 47 countries.8 Numerous studies, including Indian data, have recognized that the first postgraduate year (PGY-1) of residency training is the most stressful year for physicians under professional training and assuming the responsibility of patient care.3,913

Stress can be defined as a stability imbalance that occurs when an individual is emotionally activated and perceives that cognitive and/or performance requirements outweigh the available resources.14 Exposure to stressful working conditions in the absence of adequate stress-coping strategies may lead to burnout or depression.15

Stress in students could be caused by their academic life, both from internal and external demands. These demands require students to adapt and overcome their problems.16 Additionally, poorly managed stress experiences could lead to burnout in junior doctors and result in diminished patient care.17 One way for individuals to overcome stress is to employ a suitable coping mechanism. Coping mechanisms include all forms of cognitive and emotional efforts carried out by individuals to overcome stressors of the presenting situation. Using appropriate coping mechanisms may reduce burnout symptoms,18 while poor coping mechanism over time can develop into depressive symptoms.19

In India and abroad, various studies have conducted about coping, stress, and burnout among resident doctors. Nevertheless, the majority of them are all cross-sectional studies, they all include postgraduate students of all years, and intern doctors have been included in some studies. The first-year resident doctors are the one doing most of the physical work and handling other multiple responsibilities in the ward, outpatients, academic activities, and other work. This study aimed to systematically examine coping strategies among PGY-1 and their relationship with the level of perceived stress, burnout, and psychological well-being over time.


This was a follow-up, observational, noninterventional, classroom study. It took place in a single center at a tertiary care general civil hospital in Surat, India. The study was conducted between April 2019 and October 2019. Ethical approval was granted by the ethics committee. Informed written consent was required and was obtained by the principal or coinvestigator.


All the first-year residents who joined the residency program in the year 2019–2020 and gave valid and informed consent were included in the study, and those posted in different preclinical, paraclinical, and clinical speciality departments were considered as the study population.

Data Collection Tools

Semistructured Performa

Self-reported Performa filled up by the study participants containing background characteristics, such as demographic details, like name (optional), age, gender, department, marital status, and children, living arrangements as well as past and present history of psychiatric illness and medical illness, any substance use at present.

General Health Questionnaire 28 (GHQ-28)

Goldberg and Hiller developed this questionnaire in 1979. This tool involves 28 questions and 4 subscales, each of which contains 7 questions. Domains of the four subscales are somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression.20 The scoring of this questionnaire is as follows: The score for each subscale ranges from 0 to 21, and total score range is 0–84. A score of 22 has been considered as the cutoff point of this study. Scores higher than 22 are indicative of psychiatric disorders, whereas scores below 22 are considered to be normal.

Perceived Stress Scale-1021

It is a 10-item self-report measure of global perceived stress. A total score ranging from 0 to 40 is computed by reverse-scoring the four positively worded items and then summing all the scale items. Higher scores indicate greater levels of perceived stress. Subscale scores were computed by summing the six negatively worded items (Items 1, 2, 3, 6, 9, and 10) for Factor 1 (negative) and the four positively worded items (Items 4, 5, 7, and 8) for Factor 2 (positive), with higher scores indicating greater negative distress/stress feelings and greater positive stress feelings and coping abilities, respectively.

Copenhagen Burnout Inventory (CBI)22

The CBI is a 19-item questionnaire that measures three burnout subdimensions: personal burnout (six items), work-related burnout (seven items), and client-related burnout (six items). The original version presented a good internal consistency for all three subscales: personal burnout (α = 0.87), work-related burnout (α = 0.87), and client-related burnout (α = 0.85). All items use a five-point scale score with a range between 0 (low burnout) and 100 (severe burnout). A score between 50 and 74 represents a moderate level of burnout and a score between 75 and 99 represents a high level of burnout, while a score of 100 represents severe burnout. When comparing the Maslach Burnout Inventory and CBI scales, Winwood and Winefield23 found the CBI (1) accurately conceptualized burnout as a fatigue phenomenon, (2) had good reliability and validity, (3) distinguished between work and personal factors, and (4) was suitable for use with health professionals because of the inclusion of client-related burnout. The CBI was therefore chosen in the current study.

COPE inventory was developed by Carver et al.24 The COPE consists of 60 statements representing 15 strategies, 4 items per strategy. The COPE inventory measures the following strategies: active coping, planning, use of instrumental social support, use of emotional social support, suppression of competing activities, turning to, positive interpret interpretation, restraint, acceptance, focus on and venting of emotions, denial, mental disengagement, behavioral disengagement, substance use, and humor.


Baseline data were collected at the end of 1 month of Residency Performa containing demographic details, GHQ-28, Perceived Stress Scale (PSS), CBI, and COPE inventory. After 6 months of residency, they were approached and asked to fill the same proforma again (postassessment data).

All first-year residents were approached during their postgraduate induction program out of which 75 residents filled the baseline assessment form. Ten forms were excluded because they were incompletely filled. Out of the remaining 65 residents, 54 (83.08%) residents filled and returned the follow-up assessment form after 6 months. Therefore, the final sample analyzed for the result was 54.

Data Analysis

Statistical analysis was done with SPSS version 22.0 (IBM, New York, USA) and Spearman’s rank correlation coefficient method. p <0.05 was considered statistically significant.


Demographics Details

Out of 54 participants, 16 (29.6%) were male with a mean age of 26.56 ± 6.74, and 38 (70.4%) were female with a mean age of 25.26 ± 1.87; the mean age of all participants was 25.65 ± 3.96. Only one participant was of 51 years, and all others were between the age of 24–30 years so we did not compare the change in the level of stress and burnout with age.

All the 54 participants were grouped according to the branch in preclinical, clinical medical, and clinical surgical. Preclinical branches included physiology, biochemistry, pharmacology, and preventive and social medicine. The clinical medical branches included medicine, pathology, microbiology, skin and venereal diseases, emergency medicine, immunohematology and blood transfusion medicine. Clinical surgical branches included surgery, otorhinolaryngology, ophthalmology, and anesthesia.

Maximum participants were from the clinical medical branch (N = 26) while the minimum were from preclinical branches (N = 10). Department-wise analysis of stress and burnout parameters was not done because of a small number of participants from individual departments.

Only five (9.3%) participants were married while only one participant had a child so we did not compare the relationship between those parameters and change in the level of stress and burnout.

Three participants (5.6%) gave a history of having a prior psychiatric illness but all denied having current psychiatric illness and only one participant reported having a current chronic medical condition. Because of a small number of participants with medical illness and none with present psychiatric illness, correlational analysis was not done with these parameters.

Almost half of the participants were working in the branch of their choice (28; 51.9%). The remaining 26 (48.1%) could not get admission to their first branch of choice (Table 1).

Table 1: Sociodemographic profile of PGY-1 (n = 54)
    n (%)
Age (years, mean ± SD) Whole sample 25.65 ± 3.96
  Male 26.56 ± 6.74
  Female 25.26 ± 1.87
Sex Male 16 (29.6)
  Female 38 (70.4)
Department Preclinical 10 (18.5)
  Clinical medical 26 (48.1)
  Clinical surgical 18 (33.3)
Living arrangement Hostalite 39 (72.2)
  Localite 15 (27.8)
Marital status Married 05 (9.3)
  Unmarried 49 (90.7)
Having child Yes 01 (1.9)
  No 53 (98.1)
Psychiatric illness At past At present
  03 (5.6) 0 (0)
Medical illness At past 02 (3.7)
  At present 01 (1.9)
Branch of first choice Yes 28 (51.9)
  No 26 (48.1)


In our study, participants with psychological distress were 21 (38.88%) at baseline which increased to 28 (51.54%) at follow-up which was not statistically significant (df = 1; p = 0.189).

Perceive Stress and Burnout

Overall, the mean score of perceived stress of PGY-1 residents was 17.07 ± 7.55 and 19.52 ± 6.60, respectively, at baseline and follow-up. The baseline value of perceived stress was 18 (33.33%), 29 (53.77%), and 7 (12.96%) representing mild, moderate, and severe categories, respectively. The follow-up evaluation showed the value of 13 (24.07%), 33 (61.11%), and 8 (14.81%) for level of perceived stress in categories of mild, moderate, and stress, respectively, [t(4) = 8.032, p = 0.090].

When we compared the mean of the sample, there was a significant increase in the levels of perceived stress and the three parameters of burnout in all the participants at follow-up (Tables 2 and 3).

Table 2: Change in level of stress and burnout in sample (n = 54)
  Mean (SD) baseline Mean (SD) follow-up Mean difference of pair Paired sample t-test, p value
GHQ total 3.78 (4.69) 5.54 (6.09) −1.76 −2.167; 0.035*
Personal burnout 38.50 (16.31) 47.53 (21.98) −9.03 −3.160; 0.003**
Work-related burnout 27.84 (23.32) 41.86 (24.95) −14.02 −5.254; 0.000**
Patient-related burnout 21.60 (19.99) 29.24 (22.07) −7.64 −2.719; 0.009**
Burnout total 87.95 (52.26) 118.64 (59.09) −30.69 −4.375; 0.000*
Perceived level of stress 17.07 (7.55) 19.52 (6.60) −2.44 −2.512; 0.015*
Problem-solving 50.72 (7.76) 50.81 (8.74) −0.926 −0.083;0.934
Emotional 49.20 (8.87) 50.19 (5.82) −1.556 −1.322;0.192
Less useful 24.13 (5.82) 26.20 (7.22) −2.074 −2.532; 0.014*
Humor 7.00 (2.65) 7.48 (2.42) −0.481 −1.179;0.244
**p <0.01 level (two-tailed); p <0.05 (two-tailed) df = 53
Table 3: Change in level of stress and burnout according to gender in whole sample (n = 54)
Domain Mean at baseline Mean at follow-up Mean difference Paired sample t-test; p value
Male participants (n = 16)
Personal burnout 41.41 40.89 0.520 0.090; 0.930
Work-related burnout 31.03 43.08 −12.054 −2.488; 0.025*
Patient-related burnout 32.55 31.77 0.781 0.162; 0.873
Perceived level of stress 17.75 20.31 −2.563 −1.684; 0.113
Female participants (n = 38)
Personal burnout 37.28 50.33 −13.049 −4.259; 0.000**
Work-related burnout 26.50 41.35 −14.850 −4.599; 0.000**
Patient-related burnout 17.00 28.18 −11.184 −3.377; 0.002**
Perceived level of stress 16.79 19.18 −2.395 −1.935; 0.061
Participants working in branch of first choice
Personal burnout 36.76 43.30 −6.548 −1.790; 0.085
Work-related burnout 22.19 35.97 −13.776 −3.656; 0.001**
Patient-related burnout 22.47 28.27 −5.804 −1.762; 0.089
Perceived level of stress 16.32 18.68 −2.357 −2.111; 0.044*
Participants not working in branch of first choice (n = 28)
Personal burnout 40.38 52.08 −11.699 −2.628; 0.014*
Work-related burnout 33.93 48.21 −14.286 −3.709; 0.001**
Patient-related burnout 20.67 30.29 −9.615 −2.058; 0.050*
Perceived level of stress 17.88 20.42 −2.538 −1.540; 0.136
Change in stress and burnout in preclinical branch (n = 26)
Personal burnout 28.75 25.42 3.333 0.519; 0.616
Work-related burnout 13.21 17.86 −4.643 −0.929; 0.377
Student-related burnout 15.00 18.75 −3.750 −0.612; 0.556
Perceived level of stress 15.70 15.50 0.200 0.065; 0.949
Change in stress and burnout in clinical medical branch (n = 26)
Personal burnout 39.10 52.40 −13.302 −4.414; 0.000**
Work-related burnout 28.71 43.13 −14.423 −4.152; 0.000**
Patient-related burnout 22.60 32.05 −9.455 −2.590; 0.016*
Perceived level of stress 17.31 19.96 −2.654 −2.226; 0.035*
Change in stress and burnout in clinical surgical branch (n = 28)
Personal burnout 43.06 52.78 −9.723 −1.570; 0.135
Work-related burnout 34.72 53.37 −18.651 −3.435; 0.003**
Patient-related burnout 23.84 31.02 −7.176 −1.237; 0.233
Perceived level of stress 17.50 21.11 −3.611 −2.171; 0.044*
**p <0.01 level (two-tailed); p <0.05 (two-tailed) for male, df = 15; for female, df = 37

Among those who were working in the branch of the first choice, the level of perceived stress [t(27) = −2.111, p = 0.044] and work-related burnout [t(27) = −3.656; p = 0.001] was significantly increased, but personal burnout and patient-related burnout did not change significantly. In males, a significant increase was observed in work-related burnout [t(15) = −2.448, p = 0.025] while the other three parameters were not significantly changed in male resident doctors. In females, all three levels of burnout were statistically significantly increased [t(37) = −4.259, p = 0.000; t(37) = −4.599, p = 0.000; t(37) = −3.377, p = 0.002] while a change in the level of stress was not statistically significant.

Among those participants working in the branch, which is not of their first choice, all three parameters of burnout were increased [t(25) = −2.628, p = 0.014; t(25) = 0.379, p = 0.001; t(25) = −2.025, p = 0.050] and statically significant, but the level of perceived stress was not statistically significantly increased.

No significant change in the level of stress and all parameters of burnout were observed among participants from preclinical departments. In clinical medical department, change in level of perceived stress and all parameters of burnout was significant [t(25) = −4.414, p = 0.000; t(25) = −4.152, p = 0.000; t(25) = −2.590, p = 0.016; t(25) = −2.226, p = 0.035]. In participants working in the clinical surgical department, a significant increase in the level of perceived stress [t(17) = −2.171, p = 0.044] and work-related burnout [t(17) = −3.435, p = 0.003] was observed, but an increase in personal burnout and patient-related burnout was not significant.


No statistically significant change was found from baseline to follow-up in the entire sample in ways of coping skills with stress.

The multiple regression model with all predictor variables was statistically significant (F = 3.537, p <0.001) and accounted for 40.1% of the variance in the PGY-1 resident. (R2 = 0.559; adjusted R2 = 0.401) (additional Table 1). Focus on and venting of emotions were significant factors influencing burnout. An increase of one in the venting of emotion scores corresponded to point increase in the burnout score (p <0.015, 95% CI = 0.57, 4.95).

Correlation of Burnout with GHQ, Stress, and Coping Strategy

Table 4 demonstrates that all the dimensions of burnout positively correlated with GHQ, stress, and less useful coping strategy. We found that problem-solving coping strategy was correlated with Person burnout (r = 0.353, p = 0.000) and work-related burnout (r = 0.287, p = 0.000). Emotion coping strategy was correlated with patient-related burnout (r = 0.288, p = 0.034).

Table 4: Intercorrelation between GHQ, burnout, and coping style at baseline (T1) and follow-up (T2), n = 54
      1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Baseline   GHQ total 1                                  
  Burnout Personal burnout 0.688** 1                                
    Work-related burnout 0.715** 0.801** 1                              
    Patient-related burnout 0.528** 0.483** 0.641** 1                            
    Perceived stress 0.804** 0.743** 0.682** 0.544** 1                          
  Coping Problem focus coping −0.169 −0.102 −0.117 −0.081 −0.060 1                        
    Emotion focus coping 0.024 0.124 .094 .083 0.125 0.792** 1                      
    Less useful 0.027 0.034 0.060 0.132 0.044 0.272* 0.454** 1                    
    Humor 0.058 0.251 0.162 −0.080 0.090 0.643 0.069 −0.024 1                  
Follow-up (6 months)   GHQ total 0.411** 0.498** 0.564** 0.376** 0.410** −0.019 0.221 0.070 0.019 1                
  Burnout Personal burnout 0.220 0.430** 0.387** 0.160 0.223 −0.046 0.129 0.076 0.251 0.718** 1              
    Work-related burnout 0.444** 0.617** 0.672** 0.455** 0.425** −0.165 0.082 0.095 0.248 0.746** 0.808** 1            
    Patient-related burnout 0.179 0.291* 0.303* 0.522** 0.328* −0.029 −0.015 0.098 0.016 0.430** 0.438** 0.534** 1          
    Perceived stress 0.455** 0.564** 0.499** 0.313* 0.496** −0.229 −0.015 0.073 0.192 0.735** 0.729** 0.754** 0.475** 1        
  Coping Problem focus coping 0.008 −0.039 0.017 0.206 0.130 0.507** 0.422** 0.428** −0.156 0.020 −0.085 0.016 0.209 −0.020 1      
    Emotion focus coping 0.095 0.079 0.117 0.282* 0.250 0.483** 0.484** 0.374** −0.167 0.157 0.091 0.141 0.263 0.037 0.860** 1    
    Less useful 0.029 0.144 0.125 0.252 0.126 0.251 0.290* 0.593** −0.122 0.213 0.221 0.241 0.382** 0.232 0.567** 0.643** 1  
    Humor 0.234 0.105 0.208 0.135 0.118 −0.047 −0.063 0.168 0.301* 0.068 0.146 0.158 0.132 0.154 0.203 0.220 0.359** 1
**p <0.01 level (two-tailed); p <0.05 (two-tailed)

Predictors to Burnout

The results of hierarchical multiple regression analyses are shown in Table 5. In Model 1, gender had no predicting power. In Model 2, gender and GHQ accounted for 55.1% of variance in burnout. GHQ had significant predicting power (β = 0.725, p <0.001) and explained 56.8% of variance. In Model 3, the predictors explained 61.2% of variance and PSS accounted for 63.4%. PSS was significant predictors (β = 0.430, p >0.01). The final model demonstrated the set of predictors explained 60.3% of variance while coping strategies accounted for 65.3% of variance. Overall, after controlling factors, GHQ and PSS indicated increasing tendency of burnout.

Table 5: Cross-sectional and prospective hierarchical multiple regression analyses predicting burnout (n = 54)
  Cross-sectional analyses Prospective analyses
  β t value; p value β t value; p value
Gender −0.213 −1.576; 0.121 0.032 0.232; 0.817
GHQ total 0.725 7.860; 0.000** 0.340 2.575; 0.013*
PSS 0.430 2.986; 0.004** 0.327 1.492; 0.142
Problem-solving −0.178 −1.176; 0.246 −0.259 −1.132; 0.264
Emotional focus 0.170 1.047; 0.301 0.199 0.809; 0.423
Less useful 0.043 0.431; 0.609 0.074 0.492; 0.625
Humor 0.082 0.933; 0.356 0.171 1.282; 0.206
Cross-sectional model summarye R R2 Adjusted R2 SE of the estimate
Model 1a 0.213 0.046 0.027 51.34
Model 2b 0.754 0.568 0.551 34.00
Model 3c 0.796 0.634 0.612 32.56
Model 4d 0.810 0.656 0.603 32.91
Durbin-Watson: 1.930        
Prospective model summarye R R2 Adjusted R2 SE of the estimate
Model 1a 0.032 0.001 −0.018 59.63
Model 2b 0.341 0.116 0.081 56.64
Model 3c 0.392 0.154 0.103 55.97
Model 4d 0.460 0.212 0.092 56.31
Durbin-Watson: 1.611        
aPredictors: (constant), gender,
bPredictors: (constant) gender, GHQ,
cPredictors: (constant) gender, GHQ, PSS,
dPredictors: (constant) gender, GHQ, PSS, problem-solving,
eDependent variable: burnout; GHQ, General Health Questionnaire; PSS, Perceived Stress Scale;
**p <0.01 level (two-tailed); p <0.05 (two-tailed)


The present study found that PGY-1 resident students had an increase in the level of perceived stress, level of personal burnout, work-related burnout, and patient-related burnout from baseline to 6-month follow-up (p >0.05).

In male resident doctors, only work-related burnout increased significantly with the duration of residency, while in females, a significant increase in the level of personal, work-related, and patient-related burnout was observed. In those residents who were working in a branch of their choice, a statistically significant increase in work-related burnout and perceived level of stress was observed whereas no significant increase was found for personal burnout and patient-related burnout. In a cross-sectional study carried out in Colombo, Sri Lanka, the mean score of personal burnout was 48.6, which is close to the result in our study (47.53); work-related burnout was 42.9, which is close to our study (41.87), but the result for client-related burnout was low (31.8) in contrast to our study (41.87).25

Mean perceived stress measured by PSS-10 was 17.07 and 19.52, respectively, at baseline and follow-up, which is very close to prevalence of stress that was found by Datar et al. in postgraduate medical students from Pune, Maharashtra.26

In those who were working in a branch that had not been their first choice, all three parameters of burnout were statistically increased while perceived stress showed no significant change in follow-up. For participants working in preclinical branches, the perceived level of stress and personal burnout was reduced while work-related burnout and student-related burnout were increased, but any change observed in parameters of stress and burnout was not statistically significant for this preclinical group.

In participants from clinical medical departments, a statistically significant increase in the level of perceived stress and all three parameters of burnout was observed.

In participants from the clinical surgical department, a statistically significant increase in perceived stress and work-related burnout without any statistically significant rise in personal burnout and patient-related burnout was observed.

There was no statistically significant change in the coping mechanism used by participants at baseline or follow-up, in the whole sample or either gender. In contrast, a previous study by Moffat et al. has reported substance use as a way of coping in males, while in our study, all participants denied for use of any substance,27 in contrast to other study showing a high prevalence of substance use among resident doctors in India.28

The level of distress measured on GHQ is similar to that of other studies conducted by Vankar et al., which had found stress level to be 37%,5 and Kasi et al., which found psychological distress in 55.1% participants (GHQ >3).29

Even with an increasing level of stress, increasing level of burnout, and increasing level of psychological distress, no change was observed in methods of coping used by participants. This observation indicates a need to find out what keeps them going through with their residency despite the rise in stress and burnout.

Overall, several participants who were distressed on GHQ did not change significantly at the baseline and the follow-up. At baseline, one-third of participants were distressed as per GHQ, but that number increased to half the participants at follow-up. This increase in number was not statistically significant, but the fact that after 6 months of first-year residency almost half of the participants were having psychological distress needs attention. An increase in many participants having burnout in parameters of personal, work-related, and patient-related burnout from baseline to follow-up was statistically significant. At baseline, almost one-fifth of the participants were experiencing personal burnout that increased to half of the participants experiencing burnout at follow-up. Similarly, for patient-related burnout, there was a rise from around one-tenth at baseline to half of the participants at follow-up.


This is a follow-up study, which gives a better longitudinal perspective as compared to other cross-sectional studies. Five-month long exposure to stressful situations of residency has been considered in our study. All instruments used are standardized and validated. All three aspects, such as stress, burnout, and coping strategies, have been examined which have been used separately or in combination with previous studies.


First, it is a single-center study with a small sample size. Second, possibility of underreporting of distress by sample population due to fear of discrimination by their colleagues on being discovered as distressed. Third, small sample size and residents from all departments did not participate in the study. Fourth, only first year were included so the same parameters cannot be assessed for second and third years. Fifth, nature of stressors/professional factors associated with stress/burnout was not studied.

In conclusion, the present study revealed high levels of stress are predictor of burnout which increases with the duration of the residency program. These findings support the need for organizational interventions to cope with burnout in postgraduate resident doctor.


Pradhyuman Chaudhary https://orcid.org/0000-0001-9493-0556


1. CMA National Physician Health Survey: a national snapshot. Ottawa: Canadian Medical Association; 2018.

2. Larsson L, Rosenqvist U, Holmstrom I. Being a young and inexperienced trainee anesthetist: a phenomenological study on ought to working conditions. Acta Anaesthesiol Scand 2006;50(6):653–658. DOI: 10.1111/j.1399-6576.2006.01035.x.

3. Sahasrabuddhe AG, Suryawanshi SR, Bhandari S. Stress among doctors doing residency: a cross-sectional study at a tertiary care hospital in the city of Mumbai. Natl J Community Med 2015;6(1):21–24.

4. Agrawal S. Prevalence of stress among resident doctors working in Medical Colleges of Delhi. Indian J Public Health 2010;54(4):219–223. DOI: 10.4103/0019-557X.77266.

5. Vankar GK, Bhadania S, Parikh M. Stress and coping among resident doctors. 2011.

6. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ 2016;50(1):132–149. DOI: 10.1111/medu.12927. PMID: 26695473.

7. Wu F, Ireland M, Hafekost K, et al. National mental health survey of doctors and medical students. Melbourne, Victoria: Beyond Blue; 2013.

8. Naji L, Singh B, Shah A, et al. Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. CMAJ Open 2021;9(1):E189–E200. DOI: 10.9778/cmajo.20200068.

9. Alexander D, Monk JS, Jonas AP. Occupational stress, personal strain, and coping among residents and faculty members. J Med Educ 1985;60(11):830–839. DOI: 10.1097/00001888-198511000-00002.

10. Butterfield PS. The stress of residency. A review of the literature. Arch Med 1988;148(6):1428–1435. PMID: 3288162.

11. Hsu K, Marshall V. Prevalence of depression and distress in a large sample of Canadian residents, interns, and fellows. Am J Psych 1987;144(12):1561–1566. DOI: 10.1176/ajp.144.12.1561.

12. Navines R, Olive V, Ariz J, et al. Stress and burnout during the first year of residence training in a university teaching hospital: preliminary date. Dual Diagn Open Acc 2016;1:17. DOI: 10.21767/2472-5048.100017.

13. Saini N, Agrawal S, Bhasin S, et al. Prevalence of stress among resident doctors working in Medical Colleges of Delhi. Indian J Public Health 2011;54(4):219. DOI: 10.4103/0019-557X.77266.

14. Phitayakorn R, Minehart RD, Hemingway MW, et al. Relationship between physiologic and psychological measures of autonomic activation in operating room teams during a simulated airway emergency. Am J Surg 2015;209(1):86–92. DOI: 10.1016/j.amjsurg.2014.08.036.

15. Selye H. The stress of my life: a scientist’s memoirs. 2nd ed. New York, USA: Van Nostrand Reinhold; 1979.

16. Bittner JGt, Khan Z, Babu M, et al. Stress, burnout, and maladaptive coping: strategies for surgeon well-being. Bull Am Coll Surg 2011;96(8):17–22. PMID: 22319907.

17. Shanafelt TD, Bradley KA, Wipf JE, et al. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136(5):358–367. DOI: 10.7326/0003-4819-136-5-200203050-00008.

18. Gan Y, Shang J, Zhang Y. Coping flexibility and locus of control as predictors of burnout among Chinese college students. Soc Behav Pers 2007;35(8):1087–1098. DOI: 10.2224/sbp.2007.35.8.1087.

19. Fresco DM, Williams NL, Nugent NR. Flexibility and negative affect: examining the associations of explanatory flexibility and coping flexibility to each other and to depression and anxiety. Cogn Ther Res. 2006;30(2): 201–210. DOI: 10.1007/s10608-015-9702-8.

20. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979;9(1):139–145. DOI: 10.1017/s0033291700021644.

21. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24(4):385–396. PMID: 6668417.

22. Kristensen TS, Borritz M, Villadsen E, et al. The Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work Stress 2005;19(3):192–207. DOI: 10.1080/02678370500297720.

23. Winwood PC, Winefield AH. Comparing two measures of burnout among dentists in Australia. Int J Stress Manag 2004;11(3):282–289. DOI: 10.1037/1072-5245.11.3.282.

24. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 1989;56(2):267–283. DOI: 10.1037//0022-3514.56.2.267.

25. Fernando BMS, Samaranayake DL. Burnout among postgraduate doctors in Colombo: prevalence, associated factors and association with self-reported patient care. BMC Med Educ 2019;19(1):373. Available from: https://doi.org/10.1186/s12909-019-1810-9

26. Datar MC, Shetty JV, Naphade NM. Stress and coping styles in postgraduate medical students: a medical college-based study. Indian J Soc Psychiatry 2017;33(4):370–374. DOI: 10.4103/ijsp.ijsp_59_16.

27. Moffat KJ, McConnachie A, Ross S, et al. First-year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 2004;38(5):482–491. DOI: 10.1046/j.1365-2929.2004.01814.x.

28. Goel N, Khandelwal V, Pandya K, et al. Alcohol and tobacco use among undergraduate and postgraduate medical students in India: a multicentric cross-sectional study. Cent Asian J Glob Health 2015;4(1):187. DOI: 10.5195/cajgh.2015.187.

29. Kasi PM, Khawar T, Khan FH, et al. Studying the association between postgraduate trainees’ work hours, stress and the use of maladaptive coping strategies. J Ayub Med Coll Abbottabad 2007;19(3):37–41. PMID: 18444589.

© The Author(s). 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.