Physiology of school burnout in medical students: Hemodynamic and autonomic functioning

•Hemodynamic and autonomic function was related to medical school burnout.•Medical school burnout was associated with cardiovascular reactivity.•Burnout biomarkers were established for undergraduate and graduate medical students.

This study investigated the relationship between burnout and hemodynamic and autonomic functioning in both medical students (N = 55) and premedical undergraduate students (N = 77). Questionnaires screened for health related issues and assessed school burnout and negative affect symptomatology (anxiety and depression). Continuous beat-to-beat blood pressure (BP) through finger plethysmography and electrocardiogram (ECG) monitoring was conducted during conditions of baseline and cardiac stress induced via the cold pressor task to produce hemodynamic, heart rate variability, and blood pressure variability indices. Independent sample t-tests demonstrated that medical students had significantly higher school burnout scores compared to their undergraduate counterparts. Controlling for age, BMI, anxiety and depressive symptoms, multiple regression analyses indicated that school burnout was a stronger predictor of elevated hemodynamics (blood pressure), decreased heart rate variability, decreased markers of vagal activity and increased markers of sympathetic tone at baseline for medical students than for undergraduates. Analyses of physiological values collected during the cold pressor task indicated greater cardiac hyperactivity for medical students than for undergraduates. The present study supports previous research linking medical school burnout to hemodynamic and autonomic functioning, suggests biomarkers for medical school burnout, and provides evidence that burnout may be implicated as a physiological risk factor in medical students. Study limitations and potential intervention avenues are discussed.