Factors at medical school and work related to exhaustion among physicians in their first postgraduate year.

Background: Burnout and stress is frequently reported in young physicians but longitudinal studies are sparse. Exhaustion is a core facet of burnout.

Aims: To study individual and environmental medical school predictors and associated working conditions of postgraduate exhaustion, with a reference to gender.

Methods: Two cohorts of junior doctors (n=253, 58% women) graduated from Karolinska Institutet were assessed in medical school (2002 and 2005) and in their first postgraduate year (2003 and 2006). Baseline measures were: Performance-based self-esteem (PBSE), study conditions (Higher Education Stress Inventory, HESI) and exhaustion, and at follow-up exhaustion (Oldenburg Burnout Inventory, OLBI) and Learning climate in the clinic. Regression analyses on postgraduate exhaustion (OLBI) were performed in four steps. First PBSE gender and age was entered, second study conditions (HESI), third working conditions (Learning climate in the clinic), and finally we controlled for exhaustion at final year of medical school.

Results: Response rate was 73%. Worries about future endurance/capacity (WFEC; HESI) predicted postgraduate exhaustion, but not PBSE, when baseline exhaustion was controlled for. Women's higher exhaustion scores were explained by their higher WFEC. A positive Learning climate was negatively associated with exhaustion.

Conclusions: High WFEC was a risk factor of exhaustion to which women were more subjected. Students with high doubts of themselves may benefit from specific programmes in medical school, addressing this risk. A positive Learning climate at follow-up seemed protective, although no conclusions on direction of causality can be made. The effect of PBSE needs further study.