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Investigating the Relationship between Academic Burnout, Resilience, and Spiritual Well-being among Medical Students
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Authors Info & Affiliations
Abstract
Background
Considered one of the major problems encountered by students, academic burnout has garnered considerable attention from researchers in the educational system in recent years. The objective of the present study was to investigate the relationship between academic burnout, resilience, and spiritual health among students of Shahroud University of Medical Sciences.
Methods
This cross-sectional study was conducted in 2023. The sample consists of 355 students from Shahroud University of Medical Sciences. A questionnaire was used to examine the relationship between academic burnout, resilience, and spiritual well-being among students. The collected data were then analyzed using the t-test, analysis of variance, and the Chi-square test. The association between endogenous and exogenous latent variables was done using the Structural Equation Model (SEM).
Results
In this study, 252 students (71%) were female. In terms of major, the majority were medical students (142 /355 [40.0%]), and in terms of graduation level, the majority were undergraduates (212 /355 [59.7%]). The mean scores for spiritual well-being, resilience, and academic burnout were reported to be 82.84 ± 17.59, 101.12 ± 12.97, and 34.91 ± 15.87, respectively. The t-test results suggest a significant relationship between academic burnout, marital status, education level, family monthly income, faculty, and interest in the field of study. The results from the regression coefficients of the SEM analysis showed that an increase in the resilience score results in a lower academic burnout score (standardized β = -0.51). Additionally, a positive correlation was observed between two exogenous latent variables (spiritual well-being and resilience). There was no direct effect of spiritual well-being on academic burnout (standardized β = -0.1).
Discussion
Spiritual well-being helps reduce burnout through resilience. Considering the positive association between spiritual well-being and resilience and the fact that resilience can help reduce academic burnout among students, careful identification and interventions based on resilience can emerge as a promising approach to tackling the harmful effects of academic burnout and improving student satisfaction.
Conclusion
Fostering a supportive educational environment, developing time management and organizational skills, and promoting self-care are the main strategies for improvement.
1. INTRODUCTION
Job burnout is defined as an occupational phenomenon caused by chronic stress in the workplace [1, 2]. The word burnout refers to the emergence of negative attitudes, behaviors, and feelings resulting from job-related psychological pressures. It primarily occurs in people who spend long hours interacting with others [3] and is characterized by symptoms including emotional exhaustion, depersonalization, and reduced personal performance [1, 3, 4]. While emotional exhaustion is a state of feeling physically or emotionally depleted, resulting in mental distance from one's job and depersonalization—a condition in which a person feels emotionally and environmentally dissociated (or detached), treats people like an object, and feels worthless, inefficient, and unsuccessful [5]. A person diagnosed with this syndrome performs poorly in the working or studying environment, experiencing lower efficiency and health issues both physically and mentally [6]. In recent years, burnout has sparked considerable discussion in academic environments. Academic burnout is similar to job burnout in terms of characteristics and consequences [7-11]. Fang argues that overwhelming students with schoolwork predisposes them to burnout. Therefore, academic burnout can have negative physical and mental effects on students [11, 12].
Defined as a type of job burnout syndrome affecting students in academic environments [13], academic burnout is characterized by long-term negative attitudes towards studying, inappropriate learning behaviors, and a lack of a sense of academic achievement [13, 14]. The results of several studies suggest that exhausted students become frustrated and demotivated during their studies [15], and not only do they perform poorly in their studies with a high probability of drop-out [16], but are also less prepared for their future career. Even if employed after graduation, they are not competent enough to fulfill nursing tasks, particularly patient care, exposing patients to greater health risks. Furthermore, absenteeism and the desire to quit are more prevalent among such students, especially in the early years of employment [17-19].
Resilience appears to have an effective role in mitigating the effects of stress and academic exhaustion. Resilience, considered as a mechanism to combat academic burnout, has become an intriguing subject among psychologists. Resilience is defined as the ability to adapt in the face of adversity or stress and use it as an opportunity to grow and gain new perspectives. It is also the ability to transform adversity into opportunity, which enables one to persevere and flourish in difficult times [20, 21]. Resilience leads to higher levels of study progress and better academic performance. Resilient students view academic or social challenges positively by increasing effort, developing new strategies, or practicing conflict resolution [22]. Drawing on one's inner ability, along with building social skills and maintaining positive interaction with the environment, can help develop resilience [23-27]. A high level of resilience can ensure better performance among students [28]. The results of some studies suggest a relationship between resilience and academic performance. In addition, resilient students experience less emotional exhaustion and burnout [29, 30] and are less likely to drop out of school [31].
Spiritual well-being is another factor that seems to be related to resilience. Spiritual well-being refers to a person's overall well-being in relation to their personal self, social relationships with others, connection with the natural world, and belief in a higher power (such as God) or a higher purpose [32-35]. Spiritual well-being is one of the 4 dimensions that define health, which includes physical, mental, social, and spiritual health. Therefore, it is an integral part of well-being and not merely an influence [36]. Spirituality is not about withdrawing from the world or escaping it, but rather about being fully present and engaged in daily life while maintaining a sense of equanimity, compassion, and transcendence. The goal is to cultivate such qualities, which can help replace more negative emotions and states of mind like anger, jealousy, and ego [37].
Given the importance of academic burnout as one of the primary problems faced by students in educational systems, the goal of the study was to evaluate the relationship between academic burnout, resilience, and spiritual well-being among students in 2023 upon the reopening of Shahroud University of Medical Sciences following the containment of the COVID-19 pandemic.
2. METHODS
2.1. Study Type and Sample Size Justification
In this cross-sectional study, given the marked rise in academic burnout reported in previous studies [38], the sample size was determined to be 384 participants based on a statistical power of 80 percent, type 1 error of 5 percent, and estimation error of 5 percent. Out of 393 distributed questionnaires, 355 (a response rate of 90 percent) were completed and returned by medical sciences students studying in various schools, including the school of medicine, the school of paramedicine, the school of public health, and the school of nursing and midwifery. The first stage involved stratified proportional sampling, with schools selected proportionally to their student enrollment within the university. The second stage involved cluster sampling according to the list of courses offered by each school, including the field of study and semester. Finally, 25 classes were randomly selected as clusters. Subsequently, the trained interviewers distributed the questionnaires to the students of each class and explained the objectives of the study. Two faculty members trained them in methodology, questioning, and interviewing. All students were Muslims, but they were not questioned about their religious details.
2.2. Inclusion and Exclusion
In this study, the target population consisted of all students enrolled in the 2023 academic year. Consent to participate in the study and proficiency in Persian were the inclusion criteria. Students absent on the sampling day, guest students, international students, and medical students in their internships were excluded from the sample.
2.3. Measurement Tool
In this study, 3 questionnaires, including the academic resilience questionnaire [39], the academic burnout questionnaire [5, 40], and the spiritual well-being scale [41, 42], were used. Each student responded to demographic and socio-economic-related questions regarding age, gender, interesting to his/her field of study, educational stage, academic years experienced, marital status, locality (either local or non-local), current residence, family’s economic status, student's involvement in economic activities during studies, parents' residence, family size, and father's occupation.
2.3.1. Academic Resilience Questionnaire
The original version of this questionnaire consists of 40 questions [39], while the Persian version comprises 29 items, which include three subscales. These subscales include communication skills, future and problem-oriented orientation, and positivity. The questions are rated on a 5-point Likert scale ranging from 1 to 5. Questions 4, 5, 7, 10, 14, 15, 23, 27, 28, and 29 are rated inversely. While questions 15, 14, 13, 11, 10, 7, 5, 29, 28, 27, 26, 25, and 23 try to measure students' communication skills (e.g., There is no one in my life who takes good care of me), questions 4, 6, 8, 12, 16, 17, 18, 19, 20 and 24 seek to measure future orientation (e.g., Most of the problems in my life are too big to be solved). Furthermore, questions 1, 2, 3, 9, 21, and 22 ask students to score their problem-oriented and positivity (e.g., I have been successful in most areas of my life). The results range from 29 to 145. The higher the score, the higher the resilience. The validity and reliability of the Persian version of this questionnaire have been confirmed in Iran [43, 44].
2.3.2. Academic Burnout Questionnaire
This questionnaire is a modified version of the general form of the Maslach burnout scale, which was introduced by Schaufeli et al. for a sample of students [40]. The questionnaire comprises a total of 15 questions (e.g., I feel emotionally drained by my studies) and measures three subscales: emotional exhaustion, doubt and pessimism, and academic self-efficacy. All questions are rated on a Likert scale from 0 to 6, while self-efficacy questions are rated inversely. The higher the scores in the subscales, the better the student's overall condition. The Persian version of this questionnaire was standardized in Iran, and Cronbach's alpha was reported to be 0.89 for the emotional exhaustion subscale, 0.84 for doubt, and 0.67 for academic self-efficacy [45].
2.3.3. Spiritual Well-Being Scale (SWBS)
This scale contains 20 items, of which 10 items measure religious well-being and the remaining items measure a person's existential well-being on a Likert scale of 1 to 6 [41]. The spiritual well-being score is the sum of these two subgroups and ranges from 20 to 120. In questions 20, 19, 17, 15, 14, 11, 10, 8, 7, 4, 3, the “I completely disagree” choice is rated 1, while in questions 18, 16, 13, 12, 9, 6, 5, 2, 1, the “I completely disagree” choice is rated 6. Finally, the spiritual well-being score is divided into three groups: low (score 20-40), medium (score 41-99), and high (score 100-120) [32, 42]. The validity and reliability of the Persian version of SWBS were reported as good for assessing spiritual well-being in the Iranian population [42]. The reported Cronbach's alpha coefficient was 0.85 [42].
2.4. Ethical Considerations
In this study, after explaining the objectives of the research and obtaining informed consent, the questionnaires were distributed to the students of each class by trained interviewers and were subsequently collected in a self-administered manner upon completion. The protocol of this study has been reviewed by the Research Ethics Committee at Shahroud University of Medical Sciences and approved by the ethics code IR.SHMU.REC.1401.191. Questionnaires were completed anonymously, voluntarily, and without any distinguishing marks.
2.5. Statistical Analysis
After collecting and coding, the data were entered into SPSS 22 software and were analyzed using t-tests, Analysis of Variance (ANOVA), Chi-square tests, and Pearson's correlation coefficient at a 5 percent significance level. Structural Equation Method (SEM) was used to examine the relationship between endogenous and exogenous latent variables. In this model, the academic burnout was an endogenous latent variable with three observed indicators. The spiritual well-being and resilience were considered as two exogenous latent variables. The relationship between latent variables and indicators was assessed in a measurement model, and the causal relationship between endogenous and exogenous latent variables was assessed using a structural model, using the regression β coefficient. Within the structural model, standardized regression coefficients quantify the strength and direction of these relationships [46].
3. RESULTS
The results of demographic and socio-economic analysis revealed that 252 respondents (71%) were female and the rest were male. In terms of major, the majority of them were medical students (142 /355 [40.0%]), and in terms of graduation level, the majority of them were undergraduate (212 /355 [59.7%]). 91 percent (323 people) of the participants were single. 306 participants (86.2 percent) were non-native. The family’s monthly income of 166 participants (46.8%) was above 400 dollars per month. 76 participants (21.4%) were involved in economic activities during their studies. 277 participants (78.1%) were very interested in their field of study.
The average age of students was 22.4 ± 2.4. The mean score for spiritual well-being was 82.8 ± 17.6, indicating an average level of spiritual well-being. The mean resilience score was 101.1±12.9 and the mean academic burnout score was 34.9 ± 15.9, both of which represent an average level (Table 1).
A comparison of the mean scores of resilience proved that gender, locality, parents' socio-economic status, students’ residence status, college, and interest in the field of study influence students' resilience. However, marital status, education, father's job, family income, and academic semester are not likely to affect resilience (Table 2).
| Variables | Mean± SD | Minimum | Maximum | |
|---|---|---|---|---|
| Resilience | 101.1±13.0 | 66 | 133 | |
| - | Communication skills | 46.5±7.1 | 29 | 65 |
| - | Future orientation | 34.5±4.9 | 17 | 46 |
| - | Positivity | 20.1±3.7 | 10 | 30 |
| Spiritual well-being | 82.8±17.6 | 25 | 120 | |
| - | Religious well-being | 41.5±9.1 | 11 | 60 |
| - | Existential well-being | 41.3±9.0 | 11 | 60 |
| Academic burnout | 34.9±15.9 | 0 | 78 | |
| - | Emotional exhaustion | 12.5±7.1 | 0 | 30 |
| - | Cynicism | 8.2±6.2 | 0 | 24 |
| - | Academic efficacy | 14.2±6.8 | 0 | 36 |
| Variables | Resilience | Academic Burnout | Spiritual Well-being | ||
|---|---|---|---|---|---|
| Mean ±SD | Mean ±SD | Mean ±SD | |||
| Gender | - | - | |||
| - | Male | 97.87±13.41 | 34.11±16.06 | 82.82±17.10 | |
| - | Female | 102.45±12.57 | 35.23±15.82 | 82.85±17.82 | |
| p-value | *0.002 | *0.54 | *0.99 | ||
| Marital status | - | - | |||
| - | Single | 101.41±13.02 | 34.07±15.80 | 83.14±17.88 | |
| - | Married | 98.19±12.25 | 43.38±14.20 | 79.88±14.28 | |
| p-value | *0.18 | *0.001 | *0.32 | ||
| Locality | - | - | |||
| - | Local | 96.57±11.99 | 34.49±12.70 | 82.16±14.88 | |
| - | Non-local | 101.85±12.99 | 34.97±16.34 | 82.95±18.01 | |
| p-value | *0.008 | *0.84 | *0.77 | ||
| Educational level | - | - | |||
| - | Medicine, MSc & Ph.D. | 100.38±13.31 | 37.33±17.48 | 82.39±19.06 | |
| - | BSc | 101.62±12.75 | 33.31±14.54 | 83.14±16.59 | |
| p-value | *0.38 | *0.02 | *0.70 | ||
| Father's job | - | - | |||
| - | Governmental | 100.80±12.31 | 35.07±16.26 | 82.43±17.21 | |
| - | Non-governmental | 101.51±13.75 | 34.71±15.44 | 83.34±18.09 | |
| p-value | *0.61 | *0.84 | *0.63 | ||
| Parent status | - | - | |||
| - | Both are alive | 101.57±12.76 | 34.82±16.05 | 83.10±17.77 | |
| - | One of them is deceased | 94.74±14.51 | 34.22±13.20 | 79.13±14.61 | |
| p-value | *0.01 | *0.68 | *0.30 | ||
| Income | - | - | |||
| - | ≥400$ | 99.99±12.66 | 36.71±15.76 | 80.52±16.82 | |
| - | ≤400$ | 102.12±13.19 | 33.32±15.85 | 84.88±18.05 | |
| p-value | *0.12 | *0.04 | *0.02 | ||
| Current residency | - | - | |||
| - | Dormitory | 102.15±12.75 | 34.72±16.14 | 83.59±17.76 | |
| - | Personal | 92.82±11.87 | 36.41±13.59 | 76.83±15.04 | |
| p-value | *<0.001 | *0.48 | *0.01 | ||
| Academic semester | - | - | |||
| - | 1-4 | 102.79±13.28 | 32.65±15.65 | 84.59±18.23 | |
| - | 5-8 | 100.05±12.27 | 36.21±15.53 | 81.50±16.78 | |
| - | >8 | 99.39±14.83 | 38.19±17.89 | 82.23±18.91 | |
| p-value | 0.12 | 0.06 | 0.28 | ||
| School | - | - | |||
| - | Public Health | 104.06±11.79 | 29.90±14.06 | 86.33±15.94 | |
| - | Medicine | 100.28±13.24 | 37.33±17.10 | 82.23±18.91 | |
| - | Nursing & Midwife | 97.96±15.02 | 35.63±15.37 | 82.02±18.83 | |
| - | Allied Medical Sciences | 101.99±11.76 | 34.56±15.87 | 81.59±15.79 | |
| p-value | **0.05 | **0.02 | **0.32 | ||
| Interest in the field of study | - | - | |||
| - | High | 102.99±12.35 | 31.80±14.80 | 85.29±17.13 | |
| - | Low | 94.50±13.02 | 45.95±14.64 | 74.15±16.52 | |
| p-value | *<0.001 | *<0.001 | *<0.001 | ||
As shown in Table 2, academic burnout scores do not vary much with respect to marital status, education level, family monthly income, school, and interest in the field of study variables. Nor does academic burnout vary with respect to gender, locality, parents' economic status, student's residence status, semester, education, and father's job. However, mean scores of spiritual well-being vary with respect to students’ residence status, family monthly income, and interest in the field of study. However, no significant difference was observed in mean scores of spiritual well-being with respect to marital status, education level, school, gender, locality, parents' economic status, semester, and father's education and job.
Resilience: CS = Communication Skills, FO = Future Orientation, PO = Positivity
Spiritual well-being: RH = Religious Well-being, EH = Existential Well-being
Academic burnout: EE = Emotional Exhaustion, Cy = Cynicism, AE = Academic Efficacy
The association between the exogenous and endogenous latent variables has been investigated using Structural Equation Modeling (SEM). As shown in Fig. (1), the standardized regression coefficients of relationships between the two exogenous latent variables of resilience and spiritual well-being with academic burnout underline that resilience has a negative and significant effect on academic burnout scores (standardized β = -0.51, p <0.001). In contrast, spiritual well-being has no significant effect on academic burnout (standardized β = -0.1, p = 0.3). Meanwhile, evidence of a positive and significant correlation between the scores of two exogenous latent variables (spiritual well-being and of resilience) was observed.
4. DISCUSSION
This study aimed to contribute to the literature on the impact of academic burnout on resilience and spiritual well-being among students. Regarding academic burnout, we estimated a mean score of 34.91 ± 15.87. A study conducted in China using the Chinese College Student Academic Burnout Inventory (CCSABI) questionnaire, which contains 20 questions with scores ranging from 20 to 100, estimated a mean academic burnout score of 49.72 ± 9.81 [13]. In a study carried out at the University of Amazon in Peru, using a questionnaire composed of 17 questions with scores ranging from 17 to 85, 43.6% and 38.6% of students had middle and low academic burnout, with the remaining 17.8% suffering from high burnout [47]. The difference in the mean burnout scores reported in different studies can be attributed to the use of different tools for measuring academic burnout. Other economic, social, and demographic factors related to academic burnout included marital status, education level, family monthly income, college, and interest in the field of study. The result of Peru study did not show a significant relationship between the type of faculty and academic burnout, which is not consistent with our results [47]. Furthermore, a study conducted in Taiwan detected no significant relationship between marital status and academic burnout, which does not corroborate our findings [48]. All studies confirm the prevalence of academic burnout among students, albeit to varying degrees. The difference in the results can be attributed to different tools adopted and also the socio-cultural environments of the study.
No significant relationship was observed between academic burnout and students’ gender, locality, parents' eco-
Relation between burnout with resonance and spiritual health in students using the structural equation model.
nomic status, students’ residence status, semester, education, and father's job. The result of a study conducted in Maryland, America, highlighted a correlation between academic burnout and the academic semester, which does not confirm our results [49]. Moreover, the study carried out in Peru identified a significant relationship between age, gender, and academic burnout, which is not consistent with our results [47]. In addition, another study conducted in the United States of America found a significant relationship between gender and academic burnout [48]. However, a study conducted in Taiwan found no evidence of a significant relationship between gender and academic burnout, which is in fair agreement with our results. In contrast, a significant relationship was observed between academic semester and academic burnout, which does not support our results [48]. Furthermore, a study carried out in South Korea found no significant relationship between gender and academic burnout [50], which is in line with our results. Variation in results can be attributed to discrepancies in cultural and ideological systems, as well as research environments.
The mean resilience score was reported to be 101.12 ± 12.97, which concurs well with the results of another study carried out using a similar questionnaire in one of Iran's medical sciences universities (103.30 ± 12.23) [38]. In a study performed using a similar questionnaire in one of the other cities of Iran, the mean resilience score was reported to be 85.53 ± 7.32, which is lower than our estimated figure [51]. In a study conducted in China using the Connor-Davidson Resilience Scale (CD-RISC) questionnaire, which contains 25 questions with scores ranging from 25 to 125, the mean resilience score was reported to be 89.09 ± 14.69 [13]. Additionally, in a study carried out in the Philippines using a questionnaire consisting of 10 questions with scores ranging from 0 to 4, the mean resilience score was reported to be 3.49 ± 0.45 [52]. Economic, social, and demographic factors affecting resilience included gender, locality, parents' economic status, students’ residence status, and interest in the field of study. Further, a study undertaken in Iran observed a significant relationship between resilience, gender, and college, but found no evidence of a significant relationship between resilience, semester, and marital status, which is in line with a part of our results [53]. Resilience is defined as the ability to adapt in the face of adversity and use it as an opportunity to grow and gain new perspectives. It is also the ability to transform adversity into opportunity that allows one to persevere and flourish in difficult times [20, 21]. Students with weak resilience often struggle to communicate efficiently with friends and university professors, and also underestimate their abilities due to insufficient experiences, which results in lowered self-confidence in the face of stressful conditions such as exams. Therefore, students fail to meet their parents' expectations and become academically inefficient. The difference in results can possibly be explained by discrepancies in cultural and ideological systems, as well as research environment and related educations.
The mean spiritual well-being score was reported to be 82.84 ± 17.59, which, according to the questionnaire's classification, indicates an average spiritual well-being level. This finding is consistent with some domestic and international research results [54-61]. A study conducted in Iran using the same questionnaire estimated a mean spiritual well-being score of 86.76 ± 17.18 (representing an average spiritual well-being level) [53], which is in line with our results. In a study conducted in Shahroud in 2018, the mean spiritual well-being score was reported to be 89.56 ± 16.11, representing an average spiritual well-being range, which confirms our results [32]. Economic, social, and demographic factors affecting spiritual well-being included students’ residence status, family monthly income, and interest in the field of study. No significant relationship was observed between spiritual well-being and marital status, education level, faculty, gender, locality, parents' socio-economic status, semester, education, and father's job, which concurs with the findings of a previous study conducted at Shahroud University of Medical Sciences [32]. Furthermore, a study carried out in Iran observed a significant relationship between spiritual well-being, gender, and college, which does not corroborate our results. However, the study found no evidence of a significant relationship between spiritual well-being, semester, and marital status, which supports our results [53]. While the different results can be justified by cultural, social and religious discrepancies, the similarity of the tools adopted is a major cause of the similarity in results.
Resilience was found to have a negative and significant effect on academic burnout. The results revealed that an increase in the resilience score results in lower academic burnout, which is in line with the results of another study carried out in Iran [38]. In studies conducted on Chinese medical and nursing students, a negative relationship between resilience and academic burnout has been detected [13, 62]. In addition, a study undertaken at the University of Granada in Spain identified a negative and significant relationship between burnout and resilience [63], which confirms our results. Moreover, the results of a study in Taiwan underlined that enhancing resilience can reduce academic burnout [48]. The result of a study on medical students in northern Portugal found that resilience had a negative and significant effect on burnout [64]. Resilience helps people cope with stress and resist burnout in two ways: (i) it helps people overcome a stressful situation by obtaining information and acquiring problem solving and stress management skills, and (ii) it enables them to bounce back from stressful situations by managing their emotions. Resilient people tend to face problems head-on rather than avoiding them. Therefore, they are less susceptible to burnout [65-67]. The academic life is accompanied by various types of stress arising from the field of study, dormitory life, and especially living far away from family. Students with a good mastery of stress management skills, crisis management, and problem-solving techniques are more resilient as they are flexible and have the capacity to adapt to changes caused by job stress, thereby avoiding academic burnout.
There was a positive and significant relationship between spiritual well-being score and resilience, which is consistent with the results of other studies on students in Iran and other countries [53, 68]. Spiritual well-being helps reduce burnout through resilience. To elaborate on the results, we argue that spiritual well-being and beliefs help clarify the purpose in life and serve as a source of consolation in critical situations, rendering unexpected and adverse events less threatening and easier to tackle. People tend to have more resilience when they believe in a higher power or divine being.
5. LIMITATIONS OF THE STUDY
Given the cross-sectional nature of the study, the causal relationship between academic burnout, resilience, and spiritual well-being might involve reverse causality bias. A further limitation is that the findings on spiritual health might be valid for Muslim students from Iran, but not necessarily for Muslims from other countries and with other socio-economic backgrounds. Whether the findings can be transferred to students with other religious socialization is highly unclear. Good design, coverage of all affiliated schools of the University of Medical Sciences, an appropriate sample size, and a standard questionnaire design are among the major advantages of our study.
6. SUGGESTIONS FOR MANAGEMENT
The results of this study can help educational and university planners improve the situation by determining the state of academic burnout, spiritual well-being, and academic resilience of students at the university level. Lastly, the results of this study at the country and national levels can be used as a basis for policymakers in the health system.
CONCLUSION
Given the positive relationship between spiritual well-being and resilience and the negative association between resilience and academic burnout, we argue that careful identification and interventions based on resilience can help dampen the negative effects of academic burnout and enhance student satisfaction. The connection between having a strong spiritual well-being and being resilient is important. By focusing on cultivating both of these qualities in students, it can help them better cope with stress and avoid academic burnout. Some more effective strategies include:
1- Fostering a supportive educational environment: It is highly recommended to evaluate students' mental and spiritual well-being at the beginning of their university studies and to continue monitoring and screening throughout their time at the university, while also strengthening a support system. Identifying students who may be at risk of academic failure and providing them with academic counseling from experienced professors, as well as mental health counseling from expert psychologists, is crucial for those in need. It is recommended to implement peer support programs, such as study groups or peer-to-peer coaching, to foster a sense of community. For professors, it is recommended to enhance their professional skills by taking part in continuous education courses to improve their teaching methods, educational counseling techniques, and communication with students. Interaction between students, faculty members, and academic managers can help to establish a sound support system.
2- Develop time management and organization skills: Additionally, it is advised to offer health-promoting lifestyle classes, stress management [69], time management techniques, and improving learning and study skills [70].
3- Promote Self-Care: Encourage students to practice healthy habits, such as getting enough sleep, eating a balanced diet, and regularly exercising [71].
AUTHORS’ CONTRIBUTIONS
The authors confirm their contribution to the paper as follows: M.A.: Study conception and design; R.C., A.B.M.: Conceptualization; Z.M.M.: Data collection; A.K.: Analysis and interpretation of results; M.A., E.S., A.B.M.: Draft manuscript. All authors reviewed the results and approved the final version of the manuscript.
LIST OF ABBREVIATIONS
| SEM | = Structural equation modeling. |
| CS | = Communication Skills |
| FO | = Future Orientation |
| PO | = Positivity |
| RH | = Religious Well-being |
| EH | = Existential Well-being |
| EE | = Emotional Exhaustion |
| Cy | = Cynicism |
| AE | = Academic Efficacy |
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
This study was approved by the Ethical Review Board of Shahroud University of Medical Sciences with the code IR.SHMU.REC.1401.191.
HUMAN AND ANIMAL RIGHTS
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or research committee and with the 1975 Declaration of Helsinki, as revised in 2013.
CONSENT FOR PUBLICATION
The purpose of the research and confidentiality of information were explained to the participants, and informed consent was obtained from them.
FUNDING
This study was supported financially by the Deputy of Research, Shahroud University of Medical Sciences, with the code 14010060.
ACKNOWLEDGEMENTS
The researchers are grateful to all Medical Sciences students of Shahroud University of Medical Sciences who participated in this study. In addition, we would like to thank the Deputy of Research, Shahroud University of Medical Sciences. The researchers would like to express their thanks and gratitude to the respected colleagues, Mrs Fatemeh Taherian, who collaborated with us in this study.
