Self-determination, motivation and burnout among residents in Lebanon

In the highly stressful environment of graduate medical residency, residents often grapple with anxiety, depression, and burnout. Those with intrinsic motivation, self-determination (SD), effective coping skills, and mindfulness may exhibit resilience against burnout and its negative effects on well-being. Using the SD theory framework, our study aims to explore the intricate relationship between motivation, stressors, and individual traits, aiming to predict burnout and mental distress among residents in training. We collected data from multispecialty residents through standardized questionnaires assessing SD, motivation, burnout, and mental distress. Structural equation models (SEM) were employed, on subsamples of high and low SD; model fits were checked. Various forms of motivation were tested as mediators between stressors, personality, and the three dimensions of burnout. In the overall sample of 112 participants, extrinsic motivation fully mediates the relation between stressors and low sense of personal accomplishment (indirect Beta = 0.02; p = 0.04). In the introject model, motivation fully mediates the relation between maladaptive coping and depersonalization (indirect Beta = 0.10; p = 0.03). In the intrinsic motivation model, motivation fully mediates the relation between adaptive (indirect Beta = 0.13; p < 0.001), maladaptive coping (indirect Beta = - 0.15; p = 0.01) and depersonalization (indirect Beta = - 0.31; p > 0.001). Among the low SD subgroup, a full mediation effect was found for extrinsic motivation between stressors and depersonalization (indirect Beta = 0.07; p = 0.027) and for intrinsic motivation between adaptive coping and depersonalization (indirect Beta = 0.150; p = 0.014). In the high SD subgroup, mindfulness has a moderation effect on burnout dimensions, positively on the relation between maladaptive coping and depersonalization and negatively on maladaptive coping and emotional exhaustion in the intrinsic and introject models. In both the low and high SD subgroups, regardless of motivation type, emotional exhaustion correlates with anxiety and depression, while depersonalization negatively correlated with mental distress. The presence of SD moderated the effect of stressors on burnout. Mindfulness plays a crucial role in buffering the effect of maladaptive coping on the various dimensions of burnout, linked in its turn to depression and anxiety symptomatology. Mindfulness also exerts a direct inverse effect on personal exhaustion in the low SD subgroup. Further studies are suggested to confirm these findings.