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. 2025 May 13;14(1):274-285.
doi: 10.5334/pme.1468. eCollection 2025.

Factors Influencing Burnout in Croatian Medical Students: The roles of Lifelong Learning and Loneliness

Ivan P Gradiski  1 , Ana Borovecki  2 , Marko Curkovic  2 , Esperanza García-Gómez  3 , Roberto C Delgado Bolton  4 , Luis Vivanco  5   6
Affiliations

Factors Influencing Burnout in Croatian Medical Students: The roles of Lifelong Learning and Loneliness

Ivan P Gradiski et al. Perspect Med Educ. .

Abstract

Background: Burnout and engagement are seen as opposite ends of a continuum. In medical education, engagement reflects motivation and social belonging, while burnout signifies a lack of interest in learning and social detachment. This study aimed to investigate the influence of lifelong learning and loneliness on these dynamics.

Methods: A cross-sectional study involving a culture back-translation procedure was performed. Participants were medical students enrolled in a Croatian medical school. The Maslach Burnout Inventory (MBI-GS), Jefferson Scale of Physician lifelong learning (JeffSPLL-MS), and the Scale of Social and Emotional Loneliness Scale for Adults (SELSA-S), were used as main measures. Sex, age, grade point average, and year of study, were collected in a complementary form. Confirmatory Factor Analyses (CFAs), followed by correlation, comparative and multiple linear regression analyses were performed to assess the above-mentioned variables.

Results: The sample consisted of 1,371 medical students (872 women), all native Croatian speakers. A model including lifelong learning, loneliness and sex variables accounted for 17% of the variance in the global MBI-GS score. This model showed a medium-to-large effect size and fulfilled conditions required for statistical inference. Additionally, differences by sex appeared in loneliness (p < 0.001), but not in lifelong learning abilities. Furthermore, the Croatian versions of the JeffSPLL-MS and the SELSA-S exhibited good psychometric properties, as confirmed by CFAs.

Conclusions: These findings highlight the influence of lifelong learning abilities and loneliness on the burnout-engagement continuum. Additionally, findings indicate that female medical students are at heightened risk of experiencing burnout.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Models obtained from the Confirmatory Factor Analyses of the 3-factor structure of: (A) the Medical Student Version of the Jefferson Scale of Physicians Lifelong Learning (JeffSPLL-MS), including “motivations”, “attention”, and “skills” domains; and (B) the Social and Emotional Loneliness Scale for Adults (SELSA-S), including the domains of “family”, “romantic”, and “social” loneliness
Figure 1
Models obtained from the Confirmatory Factor Analyses of the 3-factor structure of: (A) the Medical Student Version of the Jefferson Scale of Physicians Lifelong Learning (JeffSPLL-MS), including “motivations”, “attention”, and “skills” domains; and (B) the Social and Emotional Loneliness Scale for Adults (SELSA-S), including the domains of “family”, “romantic”, and “social” loneliness.
Comparisons between female (F) and male (M) medical students according to: (A) global score of “burnout” (MBI-GS), “loneliness” (SELSA-S), and “lifelong learning” (JeffSPLL-MS); and (B) “exhaustion”, “cynicism”, and “professional efficacy” domains. MBI-GS, Maslach Burnout Inventory – General Survey; JeffSPLL-MS, Jefferson Scale of Physicians Lifelong Learning – Medical student version; SELSA-S, Social and Emotional Loneliness Scale for Adults; ** p<0.01; ***p<0.001
Figure 2
Comparisons between female (F) and male (M) medical students according to: (A) global score of “burnout” (MBI-GS), “loneliness” (SELSA-S), and “lifelong learning” (JeffSPLL-MS); and (B) “exhaustion”, “cynicism”, and “professional efficacy” domains. MBI-GS, Maslach Burnout Inventory – General Survey; JeffSPLL-MS, Jefferson Scale of Physicians Lifelong Learning – Medical student version; SELSA-S, Social and Emotional Loneliness Scale for Adults; ** p < 0.01; ***p < 0.001.
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