Medical teacher · 2026
Burnout, resilience, and the cost of learning in medical students: A scoping review informed by professional identity formation theory.
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Goh Suzanne Pei Lin, A Priyadarshini, Tan Le Xuan Shannon, Lee Charmaine Shi Mei, Abdul Hamid Nur Amira Binte, Murugam Vengadasalam, Krishna Lalit Kumar Radha
Аннотация
INTRODUCTION: Medical students routinely encounter emotionally and ethically demanding clinical situations that shape, and sometimes strain, their developing professional identities. This review extends the cost of caring constructs in clinicians to conceptualize the cost of learning in students and examine how it interacts with burnout, resilience, and grit within professional identity formation (PIF).
METHODS: Using a theory-informed scoping review design and a constructivist, relativist lens, five databases (PubMed, Embase, Scopus, ERIC, and PsycINFO) were searched for English-language articles on medical students published between 1 January 2000 and 4 November 2024. The modified Systematic Evidence-Based Approach combined systematic searching, parallel thematic and directed content analyses, and AI-assisted coding. The Ring Theory of Personhood (RToP) provided the analytic lens for an interpretive synthesis examining how all these elements interact within PIF.
RESULTS: Of 11,994 abstracts identified, 387 full-text articles were reviewed, and 63 studies met the inclusion criteria. Across studies, elements of the cost of learning, including moral distress, compassion fatigue, vicarious trauma, secondary traumatic stress, and associated cognitive, emotional, and psychosomatic sequelae, extended beyond core burnout components. Resilience was predominantly conceptualized as an individual trait inversely associated with burnout, though some studies highlighted relational and institutional determinants. Mapping the findings to the RToP indicated that the cost of learning and resilience operate across the Individual, Relational, and Societal Rings, while constructs associated with the Innate Ring were largely absent.
DISCUSSION: Burnout in medical students is better understood as a signal that PIF is under strain than as an isolated symptom cluster. Here, the internal compass refers to the evolving sense of values, purpose, and professional self through which students make meaning of demanding clinical encounters and integrate them into a coherent identity. Supporting this internal compass requires coordinated strategies across the Innate, Individual, Relational, and Societal Rings of Personhood, implemented through curriculum, institutional structures, and faculty development. [Box: see text].
METHODS: Using a theory-informed scoping review design and a constructivist, relativist lens, five databases (PubMed, Embase, Scopus, ERIC, and PsycINFO) were searched for English-language articles on medical students published between 1 January 2000 and 4 November 2024. The modified Systematic Evidence-Based Approach combined systematic searching, parallel thematic and directed content analyses, and AI-assisted coding. The Ring Theory of Personhood (RToP) provided the analytic lens for an interpretive synthesis examining how all these elements interact within PIF.
RESULTS: Of 11,994 abstracts identified, 387 full-text articles were reviewed, and 63 studies met the inclusion criteria. Across studies, elements of the cost of learning, including moral distress, compassion fatigue, vicarious trauma, secondary traumatic stress, and associated cognitive, emotional, and psychosomatic sequelae, extended beyond core burnout components. Resilience was predominantly conceptualized as an individual trait inversely associated with burnout, though some studies highlighted relational and institutional determinants. Mapping the findings to the RToP indicated that the cost of learning and resilience operate across the Individual, Relational, and Societal Rings, while constructs associated with the Innate Ring were largely absent.
DISCUSSION: Burnout in medical students is better understood as a signal that PIF is under strain than as an isolated symptom cluster. Here, the internal compass refers to the evolving sense of values, purpose, and professional self through which students make meaning of demanding clinical encounters and integrate them into a coherent identity. Supporting this internal compass requires coordinated strategies across the Innate, Individual, Relational, and Societal Rings of Personhood, implemented through curriculum, institutional structures, and faculty development. [Box: see text].