There has been growing recognition in recent years that healthcare professionals across many specialties are prone to burn-out – a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment.

Since the first introduction of the occupational phenomenon in 1974 by the American psychologist Herbert J. Freudenberger, there has been an increasing attention to it over the past few decades [1].

Burn-out has already reached the epidemic levels with some studies indicating the statistics exceeding 50% of medical trainees or doctors in practice [2].

In May 2019 the burn-out syndrome was specified in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon in the chapter: ‘Factors influencing health status or contact with health services’.

ICD defined burn-out as ‘a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy [3].

Healthcare is intrinsically demanding field with high responsibility and workload, multitasking at the workplace, and tremendous emotional pressure when dealing with patient’s pain and death [4]. Such conditions conform to the Jobs Demands-Resources Model of burn-out, where high professional demands cause exhaustion, while low resources are connected with cynicism and reduced personal efficacy [5].

Burn-out phenomenon is an important contributor to an increased risk of medical errors, low compliance, negative effects on patient care and doctors’ own health. Though burn-out was originally thought to come later in a medical career a systematic review of Ishak et al. indicated high levels of syndrome in medical students as well: starting in medical school burn-out persists beyond the residency, however, being less prevalent in senior clinicians than in early-career professionals [6]. In 2007 a cross-sectional longitudinal cohort study of 4287 medical students from 7 medical schools in the U.S reported almost 50% of trainees having burn-out that proved even to be a significant independent predictor of suicide ideation [7].

Across a variety of burn-out causative factors the individual’s personality features appeared to play not the last role. In the United Kingdom a 12-year longitudinal study that involved students from 5 medical schools showed that the perception of stress and burn-out are predicted by certain personality traits [8].

In the context of medical education and patient care the studies suggest that personality attributes can complicate doctor-patient communication, contributing to suboptimal clinical outcomes [9,10,11].

However, most data on burn-out is still grounded on the studies of practicing clinicians, while the research on the syndrome in medical trainees is insufficient.

The present study aimed to determine the association between personality structure and burn-out in 6-year medical graduates (n = 61).

The research objectives were to:

1) Identify the personality structure in 6-year medical students related to gender and chosen clinical specialty;

2) Estimate the level, stage and internal structure of emotional burn-out;

3) Reveal the association between personality and burn-out in future doctors.

This was an observational cross-sectional study conducted at the Crimea State Medical University (CSMU), where the education programme is divided into four years of pre-clinical, two years of clinical content (pre-residency) and two or three years of resident training. A total of 61 6-year medical students in their final year of studies (or pre-residency) of both genders (36 females, 24 males), aged 22-24, took part in present study. Respondents’ profiles were also estimated with regard to primary medical specialties, which included physicians, obstetricians and gynecologists, surgeons, psychiatrists and neurologists. The research was performed in accordance with the international ethical standards. We administered the next psychometric instruments: • Cattell’s 16 personality factor test was used to determine 16 primary and 5 secondary global personality factors. Cattell’s inventory has shown to be highly reliable and valid methodology that provides the most detailed analysis of personality structure and is the subject of more than 4000 published articles worldwide. The test consists of 186 questions, which result in 16 primary factors as Warmth, Reasoning, Emotional Stability, Dominance, Liveliness, Rule Consciousness, Social Boldness, Sensitivity, Vigilance, Abstractedness, Privateness, Apprehension, Openness to Change, Self-Reliance, Perfectionism, Tension. These primary traits conform to 5 global personality scales – Anxiety, Self-Control, Intro/Extraversion, Independence and Receptivity [12]. • Maslach Burnout Inventory (MBI) – is a 22-item instrument, considered as the gold standard for measuring of burn-out and its subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) [13]. The burn-out is indicated by high domain scores for EE and DP, along with a low score for PA [13,14]. • Statistical methods: descriptive statistics, Whitney-Mann U test, Spearmen correlation test (program package STATISTICA 8.0, Stat-Soft, 2009).

Results of Cattell’s test indicated the average values of all primary personality factors in students with only Perfectionism and Vigilance belonging to high stens. The vigilance as the readiness to respond to danger and perfectionism (“to be first at all costs”) are usually accompanied by nervous system overstrain, making students especially receptive to burn-out. The internal structure of MBI demonstrates that majority of students experienced average level of emotional exhaustion (n=46), depersonalization (n=47) and personal accomplishment reduction (n=31). 25% of students already suffer from emotional burnt-out, having high scores in all components. In accordance with burn-out model of Golembiewski and Munzenrieder [15] CSMU graduates fall under 4th- 5th stage of syndrome that corresponds to average level. Female respondents were significantly more dominant and emotive than males (p<0.05). The reduction of personal accomplishment was higher in the group of students who didn’t attain the desired specialty (p<0.05). Future physicians were more pedant but less lively and emotionally stable than obstetricians, less reasonable and outgoing than neurologists and more exhausted, dominant and prone to perfectionism than surgeons. The latter had lower values of abstractedness and perfectionism than neurologists. Results of correlation analysis suggest students with higher tension to show higher levels of depersonalization and emotional exhaustion, that in turn affects reasoning and makes them seek privacy (0,05

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