Burnout for each clinical specialty rotation

In our study, participant burnout was measured using the Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 scale [28]. This scale covers several constructs, such as compassion satisfaction, burnout, and secondary traumatic stress [28], and has been gradually adopted in medical studies [29–31]. Burnout is a negative emotion associated with feelings of hopelessness and difficulty in managing work or performing a job effectively, and was measured using 10 items answered on a 5-point scale for our study [32]. The 10 items enquired how frequently participants experienced various emotions, and the responses were 1 (never), 2 (seldom), 3 (sometimes), 4 (often), and 5 (always). The Cronbach alpha value was 0.770. The burnout score calculation comprises the following steps: (1) reversing the necessary items for burnout, and (2) summing the items for burnout [32]. The summed score was used for further analysis. Participant burnout was regularly measured after each clinical specialty rotation during clerkship training from September 2013 to April 2015.