From Service Burden to Burnout: The Protective Role of Supervisory Support Among Internal Medicine Postgraduate Residents in Punjab Teaching Hospitals A Cross-Sectional Survey Running head: Service burden, supervisory support, and burnout in Punjab Intern

Abstract

Background: Internal Medicine postgraduate residents in teaching hospitals carry a dual responsibility: providing frontline clinical care and engaging in structured postgraduate training. Prolonged working hours, frequent night duties, and limited supervisory support may raise burnout risk, particularly in high-volume public-sector hospitals. Local evidence from Punjab on burnout in Internal Medicine residents, viewed through the lens of service burden and supervision, remains limited.

Objective: To determine the association between service burden and burnout among Internal Medicine postgraduate residents in Punjab teaching hospitals, and to assess whether perceived supervisory support plays a protective role.

Method: A Google Forms-based cross-sectional survey was conducted among 340 Internal Medicine postgraduate residents in Punjab teaching hospitals. The questionnaire gathered demographic, training, and workload data and measured supervisory support and burnout using Likert-type items (six items for supervisory support, nine for burnout). Descriptive statistics, reliability analysis, Pearson correlation, and multivariable linear regression were performed. Weekly working hours and monthly night duties served as service burden indicators.

Results: Mean age was 30.05 (±2.52) years; 53.2% were male and 77.6% worked in government teaching hospitals. Mean weekly working hours were 78.56 (±10.89) and mean monthly night duties were 6.56 (±1.74). Mean burnout score was 3.03 (±0.84), with high burnout observed in 32.6% of residents. Mean supervisory support score was 2.90 (±0.62). Weekly working hours showed a positive correlation with burnout (r = 0.23, P < .001). Supervisory support showed a moderate-to-strong negative correlation (r = −0.55, P < .001). In adjusted regression, longer working hours, government hospital placement, and lower supervisory support were significant independent predictors of burnout. The service burden-by-supervisory support interaction was not statistically significant.

Conclusions: Burnout was common among Internal Medicine postgraduate residents in Punjab teaching hospitals. Longer working hours and public-sector placement were associated with higher burnout, while stronger supervisory support was consistently associated with lower burnout. Improving resident well-being requires both workload review and strengthened supervision in Internal Medicine training programmes.