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1477Rev Esc Enferm USP

2012; 46(6):1477-82www.ee.usp.br/reeusp/

Burnout Syndrome in multiprofessional

residents of a public universityGuido LA, Silva RM, Goulart CT, Bolzan MEO, Lopes LFD

RESUMOOs Programas de Residência Mulprossio-

nal buscam romper com os paradigmas emrelação à formação de prossionais para oSistema Único de Saúde (SUS) e contribuirpara qualicar os serviços de saúde a parrde ações inovadoras. Assim, alguns aspec-tos podem ser avaliados como estressorese, posteriormente, levarem à Síndrome deBurnout. Dessa forma, vericou-se a ocor-rência da Síndrome de Burnout nos Resi-dentes Mulprossionais da UniversidadeFederal de Santa Maria. Este estudo trata--se de um estudo descrivo, transversal equantavo. Aplicaram-se um formuláriode dados sociodemográcos e o MBI-HSSem 37 residentes, entre abril e junho de

2011. Observou-se que 37,84% apresen-taram Alta Exaustão Emocional; 43,24%,Alta Despersonalização; e 48,65%, BaixaRealização Prossional. Na associação dosdomínios, vericou-se que 27% apresenta-ram indicavo para Síndrome de Burnout.Os residentes pesquisados estão expostosaos estressores da prossão e da forma-ção, o que pode favorecer a ocorrência dasíndrome nesses prossionais.

DESCRITORESEstresse

Esgotamento prossionalInternato e residênciaCapacitação em ServiçoEducação em enfermagem

Burnout Syndrome in multiprofessionalresidents of a public university

ORI GI NALA

RTI CLE

ABSTRACTThe mulprofessional residency programs

seek to break paradigms regarding theeducaon and training of professionals forthe Unied Health System (Sistema Únicode Saúde - SUS) and contribute to qualifyhealth services by promong innovavestrategies. Therefore, some aspects maybe evaluated as stressors, and later lead toburnout syndrome. Therefore, we assessedthe occurrence of burnout syndromeamong the mulprofessional residents atthe Federal University of Santa Maria. Thisis a descripve, cross-seconal and quan-tave study. A sociodemographic dataform and the MBI-HSS were administeredto 37 residents between April and June of

2011. It was observed that 37.84% pre-sented with High Emoonal Stress, 43.24%with High Depersonalizaon and 48.65%with Low Professional Fulllment. In termsof the associaon between domains, it wasfound that 27% of the residents presentedwith signs of Burnout Syndrome. The stud-ied residents will be exposed to the stress-ors of the profession and educaon/train-ing, which may favor the occurrence of thesyndrome in these professionals.

DESCRIPTORS Stress

Burnout, professionalInternship and residencyInservice trainingEducaon, nursing

RESUMENLos Programas de Residencia Mulpro-

fesional buscan romper los paradigmasrelavos a la formación de profesionalespara el Sistema Único de Salud (SUS) y con-tribuir a calicar los servicios de salud conacciones innovadoras. Algunos aspectospueden ser evaluados como estresores yllevar al Síndrome de Burnout. Se vericóla presencia de Síndrome de Burnout enlos Residentes Mulprofesionales de laUniversidad Federal de Santa Maria. Estu-dio descripvo, transversal, cuantavo.Se aplicó un formulario de datos sociode-mográcos y el MBI-HSS a 37 residentesde abril a junio de 2011. Se observó que37,84% presentaba Alto Agotamiento

Emocional, 43,4% Alta Despersonalizacióny 48,65% Baja Realización Profesional. Enla asociación de dominios, se vericó que27% presentaba indicavo de Síndrome deBurnout. Los residentes invesgados estánexpuestos a los estresores de la profesión yde la formación, lo cual puede favorecer laaparición del síndrome entre ellos.

DESCRIPTORES Estrés

Agotamiento profesionalInternado y residenciaCapacitación en servicioEducación en enfermería

Laura de Azevedo Guido1 Rodrigo Marques da Silva2, Carolina Tonini Goulart3,

Maria Elaine de Oliveira Bolzan4, Luiz Felipe Dias Lopes5

SÍNDROME DE BURNOUT EM RESIDENTES MULTIPROFISSIONAIS DE UMAUNIVERSIDADE PÚBLICA

SÍNDROME DE BURNOUT EN RESIDENTES MULTIPROFESIONALES DE UNAUNIVERSIDAD PÚBLICA

1PhD in Nursing. Associate Professor, Federal University of Santa Maria. Director of the Work, Health, Education and Nursing Research Group. Line ofResearch Stress, Coping and Burnout. Santa Maria, RS, Brazil. [email protected] 2RN. MSc, Graduate Nursing Program, Federal University of SantaMaria. Santa Maria, RS, Brazil. [email protected] 3RN. MSc in Rural Extension. Master’s student in the Graduate Nursing Program, FederalUniversity of Santa Maria. Fellowship FAPERGS/CAPES, Santa Maria, RS, Brazil. [email protected] 4RN. MSc in Nursing. Specialist inPedagogy of Medical-Surgical Nursing, Professional Education in Health and Occupational Health. Nurse at the University Hospital of Santa Maria. SantaMaria, RS, Brazil. [email protected] 5PhD in Production Engineering. Specialist in Statistics and Quantitative Modeling. Associate Professor,Federal University of Santa Maria. Santa Maria, RS, Brazil. [email protected]

Received: 12/01/2011 Approved: 05/04/2012Português / Inglêswww.scielo.br/reeusp

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INTRODUCTION

Stress is currently indicated as a factor causing heartdiseases, psychological and gastrointesnal disorders(1). Itis present in the daily roune of people and impacts one’squality of life, a fact conrmed by the World Health Orga-nizaon (WHO)(1).

The concept of stress in the biological sciences was de-veloped by Hans Selve in the 20th century and highlightsneuroendocrine manifestaons that occur in individualsas a response to internal or external smuli. Based on thestudies of Claude Bernard and Walter Cannon on organichomeostasis, Hans dened stress as the organism’s un-specic response to any type of smulus(2).

Stress is also conceptualized based on the interacon-ist model, which asserts that the relaonship betweenthe environment and a person or group is acve and is re-sponsible for the process(3). In this model, stress is denedas any smulus that makes demands of the external orinternal environment and taxes or exceedsthe adapve sources of an individual or so-cial system with a determinant factor of thestressor’s severity(3).

We note that, according to the interac-onist model, a cognive evaluaon takesplace, which is a mental process in whichone locates the event or situaon in a seriesof evaluave categories that are related tothe person’s representaon of wellbeing(3).This categorizaon process allows evalua-ons that result in responses (primary, sec-ondary evaluaons and re-evaluaons). In

the rst evaluaon, the individual idenesthe demands of a given situaon and denesthe meaning of such an event, which mayresult in acon. This event may represent achallenge, a threat or be irrelevant to the individual(2-3).

If the stressor is idened as a threat (negave) or aschallenge (posive), a response to the stress takes placeand the individual will then perform a second evaluaon.This second evaluaon veries alternaves and copingand/or adaptaon strategies to deal with the stressfulevent. The use of these strategies to deal with the situ -aon, cognively idened as a stressor, is called coping.

If these strategies are not used or if they fail, the stressorremains and stress may become chronic and lead to theBurnout Syndrome(2).

Burnout syndrome is an occupaonal disorder and isseen as a process that takes place in response to chronicstress, with potenal negave consequences at the indi-vidual, professional, family and social levels(4).

Burnout, as a consequence of the work process, is ob-served in the health eld. For this reason, the predomi-nance of nurses wring scienc papers on this subject

may be linked to the occurrence of this syndrome in thisprofession. Burnout syndrome may be linked to nursingbecause it is a profession characterized by a lack of pro-fessionals, which leads to work overload, by proximity topaents and families experiencing stressful events, directcontact with illnesses, and by a lack of autonomy and au-thority in the decision-making process(5).

There are also situaons experienced during edu-caon, both in undergraduate and graduate programs,which can be seen as stressful. In this context, we notethat Muldisciplinary Residency Programs in the Brazilianhealth eld, regulated as non-degree programs, seek tobreak with the tradional paradigm in relaon to the edu-caon of professionals preparing for the Brazilian UniedHealth System (SUS) and contribute to the qualicaon ofthe local health services oered to communies. Theseprograms present a variety of methodological designs butall of them are unanimous in defending the implementa-on of acve and parcipatory methodologies and con-nuous educaon as the pedagogical axis(6,7).

Addionally, the intrinsic interdisci-plinary characterisc confers an innova-ve character onto the programs, which ismainly shown through the inclusion of 14professions in the eld of health. This wayof proceeding with ‘inter-categories’ aimsfor collecve educaon included in thesame ‘eld’ of pracce while giving prior-ity to and acknowledging the specic ‘core’of each profession(7). The populaon, socialcontrol, the unit’s sta, and schools in theneighborhood are invited to think and pro-duce health spaces and quality of life in the

teaching-learning process of residents(6).

The muldisciplinary residency programin the studied instuon began in 2009 and

was oered for the following professions: Nursing, Psy-chology, Nutrion, Social Work, Physical Therapy, SpeechTherapy, Pharmacology, Occupaonal Therapy, and Den-stry. Physical Educaon was included in 2010 (6).

In the rst year, the program was nanced by theMinistry of Health and focused on three concentraons:Health Management and Policies, Family Primary Health

Care, and Hospital Care. In 2010, the Ministry of Educa-on and Culture (MEC) started nancing residency pro-grams in university hospitals and the original programwas divided into two concentraons. Hence, the programlinked to the Ministry of Health was then composed of:Family Primary Health Care and Health Surveillance. Theconcentraon Hospital Management and Care was thenlinked to and nanced by MEC(6).

Given this context, in which we observed the philoso-phy of the educaonal process in the health eld with in -novave acons, some aspects can be seen as stressors,especially because they are not included in the tradional

Burnout, as aconsequence of the

work process, isobserved in the healtheld. For this reason,

the predominance ofnurses writing scientic

papers on this subjectmay be linked tothe occurrence of

this syndrome inthis profession.

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educaonal model. Among them, the following stand out:teamwork, acve and parcipatory methodologies, inter-personal relaonships established with other profession-als, and the responsibility to deliver integral and human -ized care.

Stress can also be associated with professionaliza-on and the role of the professional within society (suchas managing professional liability, dealing with paentsand problem situaons, managing the growing volume ofknowledge, and establishing the limits of one’s personaland professional identy)(8). Addionally, stress can be aresult of the characteriscs of training programs, sleep de-privaon, fague, heavy workload, excessive administra-ve work, problems related to the quality of teaching, andthe educaonal environment per se. Individual character-iscs and personal contexts such as gender, personalityand psychological vulnerabilies can also be related tostress(8). Depression and sleep deprivaon are describedin the literature as the most signicant problems aect-ing residents(8). Therefore, we ask: Is there an occurrence

of burnout syndrome among muldisciplinary residentsin a Federal University in the interior of the state of RioGrande do Sul, Brazil?

The objecve of this study was to verify the occur-rence of burnout syndrome in muldisciplinary residentsfrom a public university in Rio Grande do Sul, Brazil.

METHOD

This is a descripve, cross-seconal, quantavestudy. Descripve studies analyze facts and/or phenom-ena, provide a detailed descripon of how they are pres-

ent and address broad aspects of a society(9)

. In a cross-seconal study, invesgated phenomena are learned asthey manifest, during data collecon, at a certain point inme(10-11). The quantave approach is widely used and,in principle, represents the intenon to ensure results areprecise, avoid distorons of analysis and interpretaon,and consequently provide a margin of safety against in -terference(11).

The study was conducted in a Federal University in theinterior of the state of Rio Grande do Sul, Brazil. Residentsfrom the concentraons Family Primary Health Care,

Health Surveillance, and Hospital Management and Care, including all the professions in the program, regularly en-rolled in the classes 2009, 2010, and 2011 were includedin the study. Residents on leave were not included. Therewere 85 residents enrolled in the program at the me ofdata collecon. All met the inclusion criteria, however,47.07% did not consent to parcipate and 9.41% did notcomplete the quesonnaires, totaling 37 parcipants.

Data were collected from April to June 2011 through aform addressing sociodemographic and professional dataand the Maslach Burnout Inventory – Human ServicesSurvey (MBI-HSS)(12), aer the respondents were informed

of the study’s objecves and voluntarily consented to par-cipate in the study. The parcipants were inially invitedto meengs and individually approached when necessary.

The sociodemographic and professional form ad-dressed the following variables: age, whether they hadchildren and the number of children, gender, marital sta-tus, and living condions. The MBI-HSS was elaboratedby Chrisna Maslach and Susan Jackson in 1981 and wastranslated and adapted for the Brazilian culture by LianaLautert in 1995(12).

It is a self-applied quesonnaire with a ve-point Likertscale that ranges from 0 to 4: 0 – never, 1 – a few mes ayear, 2 – a few mes a month, 3 – a few mes a week, 4 –daily. Hence, the minimum value is zero and the maximumis four to convey the individuals’ experience at work. Theinstrument is composed of 22 items distributed in threesubscales: Emoonal Exhauson (EE), composed of items1, 2, 3, 6, 8, 13, 14, 16 and 20; Depersonalizaon (DP),composed of items 5, 10, 11, 15 and 22; and ProfessionalIncompetence (PI), composed of items 4, 7, 9, 12, 17, 18,

19 and 21(12). A more recent denominaon, however, isused in this study: Emoonal Exhauson (EE), Deperson-alizaon (DP), and Professional Realizaon (PR)(13).

Emoonal Exhauson reects the individuals’ feelingstoward their jobs and is characterized as emoonal over-load. It is the inial trait of burnout, marked by psycholog-ical and physical manifestaons, with a reduced capacityfor producon. Depersonalizaon is the specic charac-terisc of the Syndrome, dened as insensivity and de-humanizaon in care pracce and treang clients and col-leagues with coldness and indierence. Low ProfessionalRealizaon corresponds to low eciency and producvity

at work(14)

.High scores in Emoonal Exhauson and Depersonali-

zaon associated with a low score in Professional Realiza-on indicate the individual is experiencing burnout(12). It isworth nong that the score on the Professional Realizaonsubscale presents a reverse score, that is, the higher thescore in this dimension, the more posive the individuals’percepons concerning their professional realizaon(12).

Aer collecon, data were organized and stored inan electronic spreadsheet in Excel 2007 (Oce XP) to beanalyzed later using the Stascal Analysis System, (SAS)version 8.02. The qualitave variables were presented in

absolute (n) and relave (%) values and the quantavevariables in descripve measures, such as minimum andmaximum values, average and standard deviaon.

The MBI-HSS scores assigned to each item were to-taled and then divided by the total number of items in thesubscale, which resulted in an average per subscale. Basedon this average, the subscales were divided into high andlow . Thus, values above the subscale’s average were clas-sied as high and below the average were considered tobe low . Addionally, the classicaons obtained by each

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individual on the three subscales were associated. Hence,when this associaon was concomitantly High EmoonalExhauson, High Depersonalizaon and Low ProfessionalRealizaon, the resident was considered to be experienc-ing Burnout Syndrome. Cronbach’s Alpha Coecient wasused to analyze the instruments’ internal consistency.

In order to meet the Brazilian Naonal Health Coun-cil’s guidelines and standards(15) as established for studiesinvolving human subjects, the parcipants voluntarily con-sented to parcipate in the study by signing two copies offree and informed consent forms (one for the parcipantand another for the researcher), aer being informed ofthe study’s objecves.

This study is part of the project Stress, Coping, Burn-out, Depressive Symptoms and Hardiness in Medicaland Muldisciplinary Residents, approved by the Eth-ics Research Commiee at the University (protocol No.23081.020160/2010-06).

RESULTS

The sociodemographic prole of the MuldisciplinaryResidents shows a predominance of single (81.08%), wom-en (83.78%) without children (94.6 %), between 25 and 29years old (51.35%), living with their families (51.35%).

The internal consistency analysis of the items compos-ing the MBI-HSS subscales presented a Cronbach’s alphaof 0.82 for Emoonal Exhauson and 0.635 for Deper-sonalizaon. Since the Cronbach’s alpha for the subscaleProfessional Realizaon was 0.248, items 9 and 21 wereincluded, which increased the coecient to 0.606. Ac-cording to the authors(16), these values are sucient toaest to the instrument’s sasfactory internal reliability.The subscales’ averages are presented in Table1.

Table 1 – Distribution of Multidisciplinary Residents according

to the averages obtained on the Maslach Burnout Inventory - RS,

Brazil 2012

Subscales Average SD* Min. Max.

Emotional Exhaustion 2.55 0,71 14 39

Depersonalization 2.72 0,80 8 20

Professional Realization 3.42 0,73 14 33

*SD: Standard Deviation

The average obtained for the subscale Professional Re-alizaon was 3.42 (±0.76), which shows low professional

sasfacon. The distribuon of the populaon according tothe classicaon by MBI subscale is presented in Table 2.

Table 2 – Distribution of Multidisciplinary Residents according

to the classication by the subscales of the Maslach Burnout In -

ventory – RS, Brazil 2012

SubscalesHigh Low Total

N % N % N

Emotional Exhaustion 14 37.84 23 62.16 37

Depersonalization 16 43.24 21 56.76 37

Professional Realization 19 51.35 18 48.65 37

A total of 27% of the parcipants presented an indica-on they were experiencing burnout syndrome aer thedomains were associated.

DISCUSSION

Burnout syndrome has been dened as a psychosocialphenomenon that emerges as a chronic response to in-terpersonal stressors that take place in the work environ-ment(13). In addion to the common stressors observed inpracce, the residents also experience situaons in Mul-disciplinary Residencies that can be seen as stressful, suchas wring academic papers and nal papers, taking testsand theorecal classes, etc.

In this context, we observe that the average popula-on scores on the Professional Realizaon subscale were3.42 (SD = 0.73), 2.72 (SD= 0.80) for Depersonalizaon,and 2.60 (SD = 0.71) for Emoonal Exhauson. A studyconducted with medical residents in a federal universityreported an average of 28.6 for Emoonal Exhauson,

10.4 for Depersonalizaon, and 36.0 for Professional Re-alizaon(17). A study(18) invesgang burnout syndrome in105 psychologists reported the following averages: 18.57for Emoonal Exhauson, 5.24 for Depersonalizaon and38.10 for Professional Realizaon. We note that the high-est averages are concentrated in the Professional Realiza-on domain, also called Professional Incompetence orReduced Professional Realizaon by some authors(12,17-18).Hence, we observe that percepons of low eciency andproducvity at work prevail among the professionals in-cluded in the studies. The state that beer translates thisdomain is when the professionals start quesoning theirchoices and doubt their aptude for their profession. The

individual no longer becomes involved with the work andstarts feeling personally and professionally inadequate.This behavior aects one’s ability to perform well at workand to relate with people, harming producvity (19).

A total of 27% of the Muldisciplinary Residents pre-sented an indicaon of experiencing burnout syndrome.The incidence of burnout among medical residents was20.8%(17). A study(14) invesgang burnout syndromeamong nursing residents in the four periods of the pro-gram reported one resident (6.3%) in the fourth period ofthe program showed alteraons on the three subscales,indicang the presence of burnout syndrome

It is known that burnout is mainly related to organiza-onal factors and occurs when a professional has to dealwith frustraons and work overload and has to expendextra eort to deal with challenges. Hence, one compen-sates for psychological suering with extra eort(20).

Addionally, poor working condions, low salaries,heavy workload, and an unfavorable workplace favor theemergence of burnout among health workers, interferingin the therapeuc relaonship between professionals andpaents(21).

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In this context, a study with nursing residents reportedthat these professionals provide direct care to more thanone paent per shi while not being totally familiarizedwith the job and not having all the tools required to as-sume a greater paent load; for this reason they feel over-whelmed(14). Addionally, there are frequent complaintsof nurses concerning lack of autonomy, work overload,and consequent demovaon of the sta. Paents waitincreasingly longer to be cared for, there are diculesdue to scarce economic resources, the law does not fa-vor access to all, the limited system of promoon andvalorizaon of personnel in the health eld, a tendency tomedicalize human experience, and lack of professionals,among other issues(13).

Thus, the presence of burnout among health profes-sionals can negavely aect the quality of care delivery andthe lives of workers, leading to depression and dicult fam-ily and social relaonships, also aecng the organizaonwith absenteeism and presenteeism(21) - the act of aend-ing work while sick. For these reasons, burnout syndrome isconsidered the syndrome of giving up because the aectedindividuals no longer invest in their work and aecve re-laonships and apparently become incapable of becomingemoonally involved with their workplace(21).

We veried that 37.84% present High Emoonal Ex-hauson, 43.24% High Depersonalizaon, and 48.65%Low Professional Realizaon. A total of 17.2% of the nurs-ing residents presented changes in the Emoonal Exhaus-on and Depersonalizaon subscales and 18.8% present-ed alteraons in the Professional Realizaon subscale(14).Among medical residents: 65% of which presented HighEmoonal Exhauson; 61.7% High Depersonalizaon, and30% Low Professional Realizaon (17).

A comparison among the scores obtained on the MBI

by physicians, nursing technicians and nurses revealedthat physicians presented greater Emoonal Exhauson(66.7%) and Low Professional Realizaon (50%), whilenurses presented greater Depersonalizaon (42.9%)(22). Astudy(18) invesgang burnout among psychologists, pro-vided evidence that 22.9% of the sample presented val-ues above the average on Emoonal Exhauson, 23.8%reported high levels of Depersonalizaon, while 24.8%manifested dissasfacon and feelings of ineciency re-garding the professional acvies they were performing(Low Professional Realizaon). Studies conducted withdierent populaons always show a poron of profession-als with high emoonal exhauson, depersonalizaon and

low professional realizaon.The residency program is an exhausng professional

experience and such a fact is well documented in stud -ies(8,14,17). Nursing residents complain about the workingcondions during professional training, manifest dissat-isfacon in relaon to the policy of how employees arereplaced during days o, vacaons, sick leave, and dueto a deviaon from their funcons, low remuneraon,physical, mental and emoonal exhauson, no me forleisure, and a conicve lack of professional identy inparcular(14).

The idencaon of populaons with a high percentageof Depersonalizaon deserves aenon due to two mainreasons(13). The rst is that depersonalizaon is considered aspecic element of burnout syndrome when compared to theother two dimensions. The second reason is that deperson-alizaon reects an atude of estrangement and negavefeelings toward one’s job, which aects both the paents andthe sta (13). In relaon to Professional Realizaon, a study(14) ofnursing residents reported that this newly graduated, youngand professionally inexperienced professional sought theo-recal and praccal tools in the residency program. For thisreason, they may inially present feelings of incompetenceand devaluaon, but gradually these give space to personaland professional reconstrucon and competence(14). In rela-on to medical residency, we note that a state of ancipatoryexcitement predominates at the beginning of the program,which is followed by insecurity and recurrent depression. Thisdepressive state is then replaced by feelings of competence atthe end of the rst year of residency(8).

There are, however, nurses who consider that virtuallyall acvies they perform correspond to their qualica-on and also consider themselves professionals with theautonomy to make decisions, with freedom of acon, andare sased with their work(13). This is conrmed by nurs-ing residents, who, when discussing professional realiza-on, report that to avoid uncomfortable situaons with thenursing sta, assume the care of more severe paents andalso manage the unit(13). When they advance in the programand through roune and daily experiences in each unit/specialty they experience, these feelings are minimized andreplaced by greater self-condence and technical ability(14).

Therefore, we verify that the factors related to burn-out among residents and professionals in the health eldseem to be numerous. We also highlight that in addionto sociodemographic, occupaonal and behavioral charac-teriscs, there is individual variability in the nature of othercharacteriscs and suscepbility to burnout-related factorsin the face of certain situaons, which frequently inuenceand determine changes of behavior and atudes(14).

Stressors indicated during the educaonal processcoupled with those arising from the profession, expose resi-dents to stress. When appropriate strategies to minimizeor eliminate such stressors are not implemented or are notavailable, these professionals become exposed to burnoutsyndrome. In this context, individuals may be negavely af -fected at the personal, family, instuonal and social levels.

CONCLUSION

This study allowed us to measure the dimensions ofburnout and relate them to the educaon of professionalsfor the Unied Health System (SUS). Hence, we concludethat the studied residents are exposed to stressors arisingfrom their profession and its educaonal process, whichmay favor the occurrence of the syndrome among theseprofessionals. Burnout takes place when stress becomeschronic; it is mul-causal, and may begin during the un-dergraduate program.

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It was also possible to determine that young and nurs-ing residents predominate, while some present an indicaonof burnout syndrome. It is known that people develop andrevise strategies to cope with stressors based on their expe-riences. Thus, young individuals may possess fewer skills toovercome the exhauson that emerges from personal andprofessional contexts. It is also important to consider thatnursing is considered a stressful profession and is also includ-

ed in the studied Muldisciplinary Residency Program.Therefore, we highlight the need to promote educa-

onal acvies and instruct individuals about stress, cop-ing strategies and burnout syndrome to enable peopleto acquire knowledge about these constructs. It permits

the idencaon of stressors and the establishment ofmore eecve strategies to cope with them in order toavoid burnout. We also suggest further studies to deepenknowledge about this syndrome and its occurrence duringeducaonal processes.

A limitaon of this study is the number of parcipants.Even though the results are reliable, further data could beobtained with a greater number of parcipants. It was alsonot possible to analyze the professionals separately or theconcentraons that compose muldisciplinary residenciesbecause some professions have only one spot in that spe-cic concentraon, which would permit the idencaonof individual parcipants, thus violang condenality.

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