Belinda Balhatchet¹
Heike Schutze¹, Nicole Williams^2,3 and Bruce Ashford⁴
1 University of New South Wales
2 University of Adelaide
3 Women & Children's Hospital Adelaide
4 Illawarra Shoalhaven Local Health District

Background
Burnout and poor psychological wellbeing are common in postgraduate medical trainees. However, data relating to Australian trainees are lacking. This systematic review aimed to identify and synthesise relevant research on the factors that influence burnout and psychological wellbeing in Australian postgraduate medical trainees. 

Methods
A systematic PRISMA search was conducted across eight databases from January 2000 to September 2021. Empirical peer-reviewed studies were included if they focused on one or more factors influencing burnout and psychological wellbeing in Australian postgraduate medical trainees. Screening was independently conducted by two reviewers at each stage of the process. Results were synthesised and analysed using a convergent qualitative synthesis process structured according to the Job Demands-Resources model of occupational stress. 

Results
Forty-eight papers were included in the final review. Factors impacting burnout and/or wellbeing (job demands) fell under four themes: (i) working hours and workload; (ii) the work and learning environment; (iii) inappropriate behaviour; and (iv) examinations and academic stress. A small number of job resources were identified.


Conclusion
Burnout and poor psychological wellbeing in Australian postgraduate medical trainees are most associated with long working hours and poor work and learning environments. There is limited research into resources that can protect against burnout and promote wellbeing. More longitudinal and qualitative research is needed to support systemic, long-term interventions that will improve the wellbeing of trainees, reduce the prevalence of burnout and ensure optimal patient care. 

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