Understanding dropout intentions in medical education: The role of burnout, demands, and resources

INTRODUCTION: Medical education is associated with considerable demands, often resulting in increased burnout risk and higher dropout intentions. However, longitudinal evidence on how these factors evolve and interact across different stages of training remains limited. This study examines the evolution of dropout intentions throughout medical education, identifies the learning stages most at risk, and investigates the roles of demands, resources, and burnout (i.e. emotional exhaustion and cynicism) in influencing these dropout intentions.

METHODS: In a longitudinal cohort study, medical students and residents (n = 1.257) from five Flemish universities completed annual online surveys over three consecutive years (T0-T2). Dropout intentions were assessed as the outcome variable, with emotional exhaustion and cynicism integrated as mediators. Key demands and resources included workload, work-home conflict, meaningfulness, learning opportunities, and the learning environment. Linear Mixed-Effects Models examined changes in dropout intentions across stages, and Structural Equation Modelling tested direct and indirect pathways via emotional exhaustion and cynicism.

RESULTS: The results showed a progressive increase in dropout intentions, with the highest levels during residency. Workload and work-home conflict were consistently associated with emotional exhaustion and cynicism, while meaningfulness showed protective effects. Cynicism was the strongest determinant of dropout intentions among students, whereas both cynicism and emotional exhaustion were related to intentions among residents. Indirect effects indicated that workload, work-home conflict, and meaningfulness influenced dropout intentions primarily through cynicism in students, and through both burnout complaints in residents.

CONCLUSION: Dropout intentions in medical education are influenced by distinct stage-specific pathways of demands, resources, and burnout complaints. Interventions should target reducing workload and work-home conflict and enhancing meaningful tasks with academic and clinical tasks.