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Article

Emotional Intelligence, Perceived Stress, and Burnout in Undergraduate Medical Students: A Cross-Sectional Correlational Study

1
Medical Education Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
2
Medical Internship Training, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
3
Clinical Pharmacology Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
*
Author to whom correspondence should be addressed.
Int. Med. Educ. 2025, 4(2), 23; https://doi.org/10.3390/ime4020023
Submission received: 4 May 2025 / Revised: 16 June 2025 / Accepted: 17 June 2025 / Published: 19 June 2025

Abstract

:
Medical education is inherently demanding, requiring students to balance intense academic workload, clinical training, and emotional resilience. High levels of stress and burnout among medical students have been associated with decreased empathy, poorer academic performance, and increased risk of mental health problems. This cross-sectional, correlational study examined the relationships between emotional intelligence (EI), perceived stress, and burnout among undergraduate medical students at the Alexandria Faculty of Medicine. Participants completed self-report questionnaires: the Mind Tools Emotional Intelligence Test, the Perceived Stress Scale, and the Maslach Burnout Inventory. Descriptive statistics, bivariate correlations, and multivariate regression models were used for analysis. Among the 264 participants (88% response rate), the majority (73.4%) demonstrated average EI with no statistically significant differences across gender and academic year. Higher perceived stress was strongly correlated with emotional exhaustion and depersonalization, and it was also inversely correlated with personal accomplishment. Regression analysis indicated that gender, academic year, and academic grade were not independent predictors of stress or burnout (R2 = 0.054). Approximately 30.3% of the students met the criteria for burnout. These findings highlight the complex interplay between emotional functioning and burnout, and they also suggest that interventions targeting emotional regulation and resilience may be beneficial in reducing stress and promoting well-being among medical students.

1. Introduction

According to the World Health Organization, approximately 75% of mental disorders develop before the age of 24, making university students more vulnerable to mental distress than working adults as they often face particular pressures during this critical developmental period, including the transition from adolescence to adulthood, academic demands, and, in some cases, the added responsibilities of part-time work and financial burdens [1]. Medical students experience greater stress than their peers because of the extensive theoretical learning, high-pressure clinical practice, and constant development of the critical thinking and decision-making skills that they undertake [2]. While striving for academic excellence and professional competence, they frequently encounter emotionally challenging experiences, such as patient suffering and death [3]. The combination of these factors and the emotional demands of patient care and rigorous assessments requires significant personal resilience, emotional adaptability, and effective interpersonal skills [1,4]. However, despite the growing global interest in these issues, few studies have examined the interaction between emotional intelligence, perceived stress, and burnout within medical student populations in the Middle East and North Africa (MENA), where socio-cultural and educational factors may shape these experiences in unique ways.
A growing body of literature has consistently documented elevated rates of psychological distress, anxiety, and depression among medical students, with potential long-term consequences for academic achievement, professional conduct, and overall well-being [5,6,7]. Therefore, it is crucial to address these mental health challenges in order to create a supportive educational environment that fosters the development of competent and empathetic physicians.
In recent years, emotional intelligence (EI) has received attention as a potential protective factor against the adverse effects of stress and burnout in medical education [8]. Emotional intelligence is defined as “the set of abilities (verbal and non-verbal) that enable a person to generate, recognize, express, understand, and evaluate their own, and others, emotions to guide thinking and action that successfully handles the environmental demands and pressures” [9] (p. 1). EI encompasses the ability to perceive, understand, and manage one’s own emotions and those of others, facilitating effective communication and empathy in clinical settings [10]. Higher levels of EI have been associated with improved coping mechanisms, reduced psychological distress, and improved academic performance in medical students. Emotional intelligence is negatively correlated with academic stress in undergraduate medical students [11,12]. In addition, EI training programs have demonstrated efficacy in promoting resilience and emotional well-being, suggesting that EI is not only a trait, but also a skill that can be cultivated [13,14,15,16].
Perceived stress refers to an individual’s assessment of how unpredictable, uncontrollable, or overwhelming life circumstances are [17]. In the context of medical education, high levels of perceived stress are commonly reported and have been associated with maladaptive coping, academic underperformance, and poor self-care behaviors. Recent studies have found that emotional intelligence partially mediates the effects of personality traits on perceived stress and mental health, suggesting that internal regulation of emotions plays an important role in how students perceive and cope with academic pressures [10,18]. Despite various institutional efforts to support well-being, the persistence of high levels of perceived stress suggests the need for more targeted, evidence-based interventions.
Burnout is a psychological syndrome characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. It is defined as an inappropriate response to chronic emotional and interpersonal stressors in the workplace or in activities that are psychologically similar to work, such as university education [19]. Among medical students, burnout has been associated with impaired empathy, increased substance use, and early dropout from medical programs [20,21]. Evidence shows that nearly 40% of medical students have moderate-to-high levels of burnout, particularly in the early clinical years [20,22,23]. Extracurricular engagement has been found to slightly reduce, but not eliminate, burnout symptoms [23].
While several studies have examined either emotional intelligence or burnout independently, few have examined how EI, perceived stress, and burnout interact simultaneously. In addition, most existing research has also focused on Western or high-income settings, leaving a gap in understanding how these variables operate in different educational and socio-cultural settings, particularly in Middle Eastern or North African (MENA) contexts, where educational systems and cultural dynamics may influence both stress perception and coping strategies [24]. This gap is particularly evident in Egypt, where recent competency-based education reforms emphasize non-technical competencies, such as EI, stress management, and interpersonal skills, but practical implementation in the curricula remains inconsistent.
The National Academic Reference Standards (NARS) provide a consistent framework for competency-based education across all Egyptian medical faculties. These standards emphasize not only clinical knowledge and technical skills, but also a range of non-technical competencies, including emotional intelligence, self-awareness, stress management, and effective interpersonal communication [25]. Despite the formal inclusion of these domains in the national competency framework, most medical schools in Egypt have not yet fully integrated the teaching and assessment of emotional intelligence or stress regulation into their formal undergraduate curricula. To address this gap, the present study examines the relationships between emotional intelligence, perceived stress, and burnout among undergraduate medical students attending a co-curricular program of personal development.
In recent years, the Alexandria Faculty of Medicine has implemented a reformed undergraduate program aligned with the competency-based education model. To address gaps in non-technical skills development, the faculty has introduced targeted co-curricular programs, such as the Quality for Personal Development (QPD) initiative. This program, which was designed and implemented jointly by the Quality Assurance Unit and the Department of Medical Education, focuses on fostering students’ emotional intelligence, leadership, time management, and interpersonal skills. The present study is guided by the following research questions: What are the relationships among emotional intelligence, perceived stress, and burnout among medical students? To what extent do demographic or academic factors influence these relationships? To address these questions, this study aimed to assess levels of emotional intelligence, perceived stress, and burnout in a representative cohort of undergraduate medical students. In addition, this study aimed to examine the correlations between emotional intelligence and the dimensions of perceived stress and burnout, as well as to determine whether gender, academic year, or academic performance significantly predict levels of stress or burnout. Ultimately, this study aimed to generate evidence that can inform the design of tailored, culturally appropriate interventions to enhance emotional well-being and promote academic success in the context of medical education in Egypt.

2. Materials and Methods

2.1. Study Setting and Participants

This study was conducted at the Alexandria Faculty of Medicine, a leading medical institution in Egypt, and it involved undergraduate medical students participating in a two-week Quality for Personal Development (QPD) training initiative: an extracurricular program designed to enhance non-technical skills and competencies. The QPD program involved 300 undergraduate medical students at all stages of medical education, including preclinical, clinical, and final internship year. In this context, ‘interns’ refers to medical students in their final clerkship or practical year. During this year, they undertake full-time clinical rotations in order to consolidate their competencies prior to practicing independently.
The QPD curriculum covers skill areas such as emotional intelligence, conflict resolution, leadership, intercultural communication, and time management, equipping students with essential non-technical competencies required for effective medical practice. Upon successful completion, the participants were awarded 10 continuing medical education (CME) credits. The integration of QPD into the broader medical curriculum aims to complement traditional medical training by promoting essential personal and professional development skills. Participants were voluntarily recruited from students enrolled in the program, and the eligibility criteria for inclusion in this study were as follows: (1) current enrollment as an undergraduate medical student (Years 1–6 or internship year) at the Alexandria Faculty of Medicine; (2) participation in the Quality for Personal Development (QPD) training initiative; and (3) completion of all lectures in the QPD program. Although voluntary participation could introduce selection bias that could affect generalizability, efforts were made to recruit participants broadly from all academic levels (Years 1–6 and interns) through official university communication channels. As the study only included students enrolled in the Quality for Personal Development (QPD) program, there was a risk of selection bias as these students may have different interests or baseline competencies relating to emotional intelligence and personal development compared to the wider medical student population.

2.2. Study Design and Data Collection

We used a cross-sectional, correlational design, which was chosen for its feasibility in examining the distribution and relationships among emotional intelligence, perceived stress, and burnout at a single point in time. Data were collected from November 2023 to October 2024 using an online structured self-report questionnaire administered via Google Forms. Four reminders were sent to participants to maximize response rates. All instruments were administered in English.
The survey included the following four sections.
Demographic Data: Participants provided information about their gender, nationality, place of residence, academic year, and academic performance (defined as the grade achieved in the previous academic year and categorized as follows: Excellent (85–100%), Very Good (75–84%), Good (65–74%), Fair (50–64%) and Fail (<50%)).
Emotional Intelligence (EI): Emotional intelligence was measured using the Mind Tools Emotional Intelligence Test, a brief self-assessment tool previously used with similar student populations [26]. This tool categorizes EI into three levels: low (15–34), average (35–55), and high (56–75). In addition, subdomains of EI were analyzed, including self-awareness, self-regulation, motivation, empathy, and social skills.
Perceived stress: Stress levels were assessed using the Cohen et al. Perceived Stress Scale (PSS), a widely validated measure in educational settings [27].
Burnout: This was assessed using the Maslach Burnout Inventory–Student Survey (MBI-SS), which measures three dimensions: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) [28]. In line with established thresholds, high levels of burnout were defined as scores of at least 14 on the EE subscale and/or at least 6 on the DP subscale, and these were combined with scores of no more than 23 on the PA subscale.

2.3. Statistical Analysis

Statistical analyses were performed using R statistical software (version 4.2.1) [29]. Normality of distribution for EI, perceived stress, and burnout scores was assessed using the Shapiro–Wilk test. Continuous data were summarized as the mean ± standard deviation (SD) or median and interquartile range (IQR) as appropriate. Independent comparisons (sex, study year, etc.) were performed using independent t-tests or Mann–Whitney U tests depending on the data distribution. Chi-squared tests were used to assess the differences in categorical burnout variables. Pearson’s correlation coefficients were used to quantify the associations between the emotional intelligence, stress, and burnout dimensions. Formal multiplicity corrections (e.g., Bonferroni adjustments) were not applied due to the exploratory nature of this study. Confidence intervals were calculated for key findings to enhance interpretability.
In addition to descriptive and bivariate analyses, multivariable regression techniques were used to explore independent predictors of perceived stress. A multiple linear regression model was constructed with the Perceived Stress Scale (PSS) total score as the dependent variable and gender, academic year, and academic performance as independent variables. Statistical significance was set at p < 0.05.

2.4. Ethical Approval and Consent

Ethical approval for this study was granted by the Ethics Committee of the Faculty of Medicine, Alexandria University on 8.10.2023 (approval serial number: 0306336; IRB No.: 00012098; FWA No.: 00018699). All procedures followed were in accordance with the ethical standards of the relevant institutional research committee and the guidelines detailed in the Declaration of Helsinki. Prior to participation, each student provided electronic informed consent after reading a clear statement detailing the purpose of this study, the voluntary nature of participation, the right to withdraw at any time without penalty, and measures to ensure confidentiality. Given the potentially sensitive nature of questions related to stress and burnout, participants were informed of the psychological and academic support services available at Alexandria University. The data collection and analysis conducted strictly protected the participants’ anonymity, confidentiality, and privacy through using secure, password-protected electronic platforms that were only accessible to authorized researchers. No personally identifiable information was collected or stored.

3. Results

3.1. Participants

A total of 264 undergraduate medical students participated in this study (88% response rate), with an almost even gender distribution (50.38% male). The majority of participants were Egyptian (84.47%) and residents in Alexandria (68.18%). Academic performance was generally high, with 35.23% scoring 85% or higher, 40.91% scoring between 75% and 85%, and only one case of academic failure. Of the participants, 172 (65.15%) were in preclinical and clinical academic years (1–6), while 92 (34.85%) were interns in their final year of practice. The demographics of the study participants are shown in Table 1.

3.2. Emotional Intelligence

The distribution of emotional intelligence (EI) in the sample was analyzed using the total EI score, with a mean score of 50.58 ± 7.235 (low: 15–34; average: 35–55; high: 56–75) [26]. The overall distribution of the emotional intelligence (EI) scores indicates that most of the students were in the average range, as defined by the Mind Tools classification system. A much smaller subset demonstrated high or low EI. As shown in Figure 1, Panel A, the majority of students demonstrated average EI (73.4%), followed by high EI (23.7%), and low EI (2.9%). There were no statistically significant differences when examined across gender and academic year. Panel B of Figure 1 shows that the mean EI scores were comparable between males (M = 37.70, 95% CI: 36.97–38.43) and females (M = 37.64, 95% CI: 36.89–38.39) with no meaningful difference (p = 0.91). Similarly, Panel C shows that the EI scores did not differ significantly between students in Years 1–6 (M = 37.76, 95% CI: 37.09–38.42) and those in their intern years (M = 37.51, 95% CI: 36.67–38.35; p = 0.65). These findings suggest a relatively homogeneous EI profile across gender and stage of training, which may reflect common educational exposures or selection factors within the program.
Empathy and self-awareness emerged as the most frequently practiced skills as shown in Appendix A (Table A1), with the majority of participants reporting that they engage in these behaviors “often” or “very often” (Figure 2). In contrast, motivation and self-regulation were less frequently endorsed, with a larger proportion of responses falling in the “sometimes” or lower categories. Social skills showed a more balanced distribution, with fewer participants selecting the highest frequency categories compared to empathy. These response trends highlight relative strengths in interpersonal awareness and suggest potential gaps in emotional control and self-directed drive.

3.3. Perceived Stress

The overall mean perceived stress score among the participants was 21.5 (SD = 5.5). As shown in Figure 3, female students reported significantly higher stress levels than males (M = 22.3, SD = 5.8 vs. M = 20.7, SD = 5.2; p = 0.023). No significant difference was observed between the students in Grades 1–6 (M = 21.8, SD = 5.3) and those interning (M = 20.9, SD = 5.9; p = 0.271). To further explore the patterns of perceived stress, Figure 4 presents the mean responses to selected items from the Perceived Stress Scale (PSS). Students most frequently reported feeling nervous and stressed (M = 2.66, SD = 1.04), which was followed by difficulty controlling important aspects of life (M = 2.35, SD = 1.02) and feeling overwhelmed (M = 2.16, SD = 1.06) (Appendix B, Table A2). In contrast, higher mean scores were observed for coping-related items, such as confidence in dealing with personal problems (M = 2.38, SD = 0.90) and ability to control irritation (M = 2.20, SD = 0.78). These results suggest that while perceived stress is prevalent, many students also report the use of basic coping strategies.

3.4. Burnout

Nearly one-third of the participants met the overall criteria for burnout, with no statistically significant differences by gender or academic level found. However, there were marked differences in the individual subdomains of burnout (Table 2). High levels of emotional exhaustion and depersonalization were reported by approximately half of the students, with a significantly higher prevalence among students in Years 1–6 compared to those interning. Although no statistically significant gender differences were observed in these domains, males tended to report higher levels of depersonalization, while females reported slightly higher levels of emotional exhaustion.
The most common burnout dimension was low personal accomplishment, which affected more than 80% of the sample. Gender differences approached statistical significance, with females more likely to report low accomplishment. No significant differences were observed between academic levels for this sub-dimension. These findings suggest that, while overall burnout rates were stable across groups, pre-internship students experienced disproportionately high levels of emotional detachment and exhaustion, highlighting a critical period for targeted interventions.

3.5. Correlation Between Emotional Intelligence, Perceived Stress, and Burnout

Pearson’s correlation analysis revealed several statistically significant associations between the study variables (Figure 5). Emotional intelligence did not show a significant correlation with perceived stress (r = 0.076, p > 0.05), indicating that higher emotional intelligence scores did not correspond to lower stress levels. However, emotional intelligence was modestly and positively correlated with both emotional exhaustion (r = 0.201, p < 0.05) and personal accomplishment (r = 0.177, p < 0.05). This finding may appear counterintuitive as it contradicts the common assumption that emotional intelligence (EI) protects against stress-related outcomes. However, this result can be understood in the context of heightened emotional awareness. Those with higher EI may be more attuned to the emotional demands of their environment and the distress of others, resulting in greater emotional investment and, consequently, emotional fatigue.
Perceived stress showed a strong positive correlation with emotional exhaustion (r = 0.551, p < 0.001) and a moderate positive correlation with depersonalization (r = 0.305, p < 0.001). Additionally, a significant negative correlation was observed between perceived stress and personal accomplishment (r = −0.302, p < 0.001), suggesting an inverse relationship between stress and professional self-efficacy. These correlation patterns underscore interrelated trends between emotional functioning and burnout dimensions and are visually summarized in the heat map (Figure 5).
Multivariable linear regression indicated that gender, academic year, and academic grade together explained a small proportion of the variance in perceived stress scores (R2 = 0.054, p = 0.21) (Table 3). While males had slightly lower stress scores than females, the difference was not statistically significant (β = −1.06, p = 0.068). Similarly, logistic regression modelling perceived stress as a binary outcome but did not identify any statistically significant predictors. These findings suggest that demographic and academic variables may have limited explanatory power for perceived stress in this cohort.

4. Discussion

This study examined the relationships between emotional intelligence (EI), perceived stress, and burnout among undergraduate medical students in a competency-based educational setting in Egypt. The findings contribute to a growing body of research on student well-being and provide region-specific insights into the psychological challenges faced by future healthcare professionals. The majority of students in this sample reported average levels of emotional intelligence, which is consistent with previous studies using similar measures with medical students [26,30,31]. Notably, no significant gender or academic year differences in EI scores were observed. At the domain level, students reported high frequencies of empathy and self-awareness, while motivation and self-regulation were less developed. These findings are consistent with previous studies suggesting that medical curricula emphasize patient-centeredness and interpersonal awareness, but they may also neglect the development of internal emotional regulation strategies [31,32].
The overall mean perceived stress score in our sample was moderate, lower than several studies that have been conducted in similar settings, i.e., where the prevalence of stress among medical students was consistently high, ranging from 86.5% to 89.3% in some cohorts [31,33]. In our sample, stress was significantly higher among female students, a finding that mirrors many studies conducted in non-Western settings, including those in the Middle East and South Asia [34,35,36]. These gender differences in stress may be due to a combination of factors, including sociocultural expectations, academic and family responsibilities, and heightened emotional reactivity. Female students often report greater vulnerability to stress related to interpersonal dynamics, patient care responsibilities, and academic perfectionism [18,37,38]. In contrast, other studies report similar perceived stress among male and female medical students [18,39,40,41]. These mixed findings suggest that the experience of stress may vary across cultural contexts and highlight the need for targeted support services for both male and female medical students.
Although there is evidence that stress levels tend to increase as students progress through their education, with final-year students often experiencing the highest levels of stress, our data did not reveal significant differences in stress levels across academic years [42,43]. The lack of year-to-year increases in our study may reflect the presence of baseline stress from the beginning of training or may point to institutional factors, such as early integration of clinical exposure. Nonetheless, the persistence of moderate levels of stress across all academic stages underscores the need for longitudinal support strategies throughout medical education.
Approximately 30% of participants met the criteria for burnout, which is consistent with previous studies in Egyptian and international contexts [4,44]. Emotional exhaustion and depersonalization were significantly more prevalent among students in the academic years prior to internship, highlighting the early stages of training as critical periods for intervention [4]. The extremely high prevalence of low personal accomplishment (over 80%) indicates that, even in the absence of severe emotional exhaustion, many students feel professionally inadequate.
In contrast to some previous studies [26,45], emotional intelligence did not show a statistically significant inverse correlation with perceived stress in this sample. This finding may be influenced by the self-report nature of the EI instrument or by the cultural and contextual variables that moderate the role of EI in stress perception. Compared to similar studies in other regions, our findings are consistent with the evidence suggesting consistently high levels of burnout and stress among medical students worldwide, but they contrast with respect to the protective effect of EI against stress. For example, Shahin (2020) [26] and Jahan et al. (2022) [45] found significant inverse relationships between EI and perceived stress among medical and dental students, respectively, whereas our data showed no such clear inverse relationship. This divergence may reflect cultural differences in emotional literacy or the role of context-specific stressors. Therefore, cross-cultural comparative studies are recommended to clarify these nuances and to better understand the role of EI in different socio-cultural educational settings.
Interestingly, the positive correlation between emotional intelligence (EI) and emotional exhaustion identified in our study could be indicative of the dual impact of emotional sensitivity. Research suggests that individuals with higher emotional awareness (EA) and environmental sensitivity experience emotions more intensely, which can lead to increased emotional distress [46,47]. Students with higher EI tend to be more attuned to their own and others’ emotions, potentially leading them to engage more deeply in emotionally demanding situations. While this heightened emotional awareness is beneficial for empathy and interpersonal relationships, it may also increase the risk of emotional fatigue. Conversely, individuals with high EI may possess better tools for processing and understanding these emotional experiences, enabling them to maintain a stronger sense of personal accomplishment over time. Therefore, while emotional sensitivity can initially contribute to exhaustion, it can also foster longer-term resilience by promoting deeper emotional insight and adaptive coping strategies. While increased emotional sensitivity may initially contribute to greater distress, it may also facilitate deeper emotional processing and adaptation over time. In this context, the modest positive correlation between emotional intelligence and personal accomplishment observed in our study may suggest a potential buffering role in maintaining self-efficacy despite ongoing stressors.
Similar to our findings, there is consistent evidence of a strong relationship between perceived stress and burnout, particularly the emotional exhaustion and depersonalization components [48]. The negative correlation between stress and personal accomplishment further highlights the erosive effect of chronic stress on students’ sense of accomplishment. Taken together, these patterns confirm the need for early, structured interventions that target both stress management and emotional literacy. Regression analyses revealed that demographic and academic variables (gender, year, class, etc.) accounted for only 5.4% of the variance in stress scores, suggesting limited predictive power. This finding reflects the complexity of stress and burnout, which are likely influenced by a broader set of psychological, interpersonal, and institutional factors not captured in this model. These findings are consistent with studies that have found demographic characteristics to be weak predictors of student well-being [49,50].
The low R2 value (0.054) indicates that academic and demographic characteristics, such as gender, year of study, and performance grades, do not sufficiently explain the differences in stress levels among students. This finding supports the idea that psychological stress in medical education is influenced by many nuanced and personal factors, such as personality traits, coping strategies, emotional skills, social support networks, and how the learning environment is perceived. Institutional culture, hidden curricula, and the quality of peer and faculty interactions may also play a critical role in modulating stress, yet these factors are often overlooked in models that rely on basic demographic predictors. The weak predictive value of these variables emphasizes the need for more holistic, context-sensitive approaches to identifying and addressing sources of student distress.
Our findings can be interpreted through the lens of the transactional model of stress and coping [51], which emphasizes that stress arises from a transactional interaction between individuals and their environment, in which the individual’s appraisal of demands and coping resources is central. Although our study did not find a direct inverse relationship between emotional intelligence (EI) and perceived stress, the observed relationship between EI and burnout dimensions, particularly emotional exhaustion and personal accomplishment, underscores the nuanced role of EI in appraisal and coping processes. Individuals with higher EI may more readily recognize emotional distress, potentially heightening initial emotional responses (e.g., exhaustion), but, over time, these individuals may use their emotional insights for more effective long-term coping and adaptation, thereby sustaining personal accomplishment despite ongoing stressors.
While our findings provide important insights, several methodological considerations should be acknowledged. First, the cross-sectional design limited the ability to draw causal inferences regarding the relationships among emotional intelligence, perceived stress, and burnout. Second, the use of self-reported questionnaires may have introduced response biases, such as social desirability or recall bias, which could affect the accuracy of the data. Although the Mind Tools Emotional Intelligence Test was administered in English, which is consistent with the language of instruction at our Faculty of Medicine and in Egyptian medical education, the test has not been formally validated in Arabic or among Egyptian medical students. This may limit the generalizability of the findings, a factor that should be considered when interpreting the results. Finally, the study sample consisted of students who voluntarily participated in a co-curricular personal development program, which may introduce selection bias and limit the generalizability of the findings to the broader student population.
Despite these methodological limitations, our findings have important implications for medical education practice. The high prevalence of burnout symptoms and the uneven development of EI subdomains suggest the need for formal curricular integration of emotional regulation, self-reflection, and resilience training. The findings support the expansion of programs such as the QPD initiative and the creation of institutional support systems that normalize psychological challenges and promote help-seeking behaviors. Future research should explore longitudinal designs to track changes over time and consider qualitative approaches to capture the lived experiences behind quantitative trends. Investigation of moderating factors, such as the learning environment, peer dynamics, and faculty support, could deepen understanding of the stress–burnout nexus.

5. Conclusions

This study highlights the psychological complexity of the medical student experience, emphasizing the interplay between emotional intelligence, stress, and burnout within a competency-based education system. By examining these relationships in a Middle Eastern context, the findings provide contextually relevant insights that challenge assumptions based solely on demographic factors. The findings support the value of embedding emotional and personal development in medical education as a core, rather than peripheral, component of professional preparation. For curriculum designers and medical educators in Egypt and similar regions, these results highlight the need to systematically integrate structured emotional intelligence and stress management training into medical programs to better support students’ personal and professional development. As medical education continues to evolve, attention to students’ emotional competencies will be essential not only for their individual well-being, but also for shaping empathetic, effective future physicians.

Author Contributions

Conceptualization, M.S. and A.B.; methodology, M.S., H.M.G. and A.B.; software, H.M.G.; validation, H.M.G. and M.S.; formal analysis, H.M.G.; investigation, M.S.; data curation, M.S.; writing—original draft preparation, M.S.; writing—review and editing, M.S., H.M.G. and A.B.; visualization, M.S.; supervision, A.B. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the guidelines detailed in the Declaration of Helsinki and was approved by the Ethics Committee of Alexandria Faculty of Medicine, Alexandria University (approval serial number: 0306336; IRB No.: 00012098; FWA No.: 00018699).

Informed Consent Statement

Informed consent was obtained from all the subjects involved in this study.

Data Availability Statement

The data sets generated and analyzed in the current study are available from the corresponding authors upon reasonable request.

Acknowledgments

The authors wish to sincerely thank all the medical students who participated in this study. Their time, openness, and thoughtful participation were invaluable to the completion of this study. During the preparation of this manuscript, the authors used ChatGPT 4.5 for the purposes of language editing. The authors have reviewed and edited the output and take full responsibility for the content of this publication.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
EIEmotional Intelligence
NARSNational Academic Reference Standards
QPDQuality for Personal Development
MENAMiddle East and North Africa
CMEContinuous Medical Education
PSSPerceived Stress Scale
MBIMaslach Burnout Inventory

Appendix A

Table A1. Emotional intelligence (EI) domain scores. Responses were rated on a scale from 0 (Rarely) to 4 (Very often).
Table A1. Emotional intelligence (EI) domain scores. Responses were rated on a scale from 0 (Rarely) to 4 (Very often).
EI DomainMeanStandard Deviation (SD)
Self-awareness2.890.81
Self-regulation2.470.89
Motivation2.500.99
Empathy2.970.84
Social skills2.680.87

Appendix B

Table A2. Perceived Stress Scale (PSS) key items. Responses were rated on a scale from 0 (Never) to 4 (Very often).
Table A2. Perceived Stress Scale (PSS) key items. Responses were rated on a scale from 0 (Never) to 4 (Very often).
PSS ItemMeanStandard Deviation (SD)
Feeling nervous and stressed2.661.04
Unable to control important aspects of life2.351.02
Difficulties piling up too high to overcome2.161.06
Confidence in handling personal problems2.380.90
Ability to control irritation in life2.200.78

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Figure 1. The distribution and subgroup comparisons of the emotional intelligence (EI) scores (N = 264): (A) The EI levels across the sample. (B) The gender differences in the mean EI scores. (C) The comparison of mean EI scores between medical students (Years 1–6) and interns.
Figure 1. The distribution and subgroup comparisons of the emotional intelligence (EI) scores (N = 264): (A) The EI levels across the sample. (B) The gender differences in the mean EI scores. (C) The comparison of mean EI scores between medical students (Years 1–6) and interns.
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Figure 2. The results of the emotional intelligence domains (normalized).
Figure 2. The results of the emotional intelligence domains (normalized).
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Figure 3. The mean perceived stress scores by gender and academic stage.
Figure 3. The mean perceived stress scores by gender and academic stage.
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Figure 4. The Perceived Stress Scale (PSS) key item means.
Figure 4. The Perceived Stress Scale (PSS) key item means.
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Figure 5. Correlation heatmap of the relations between the emotional intelligence, perceived stress, and burnout dimensions. Pearson correlation coefficients are displayed in each cell, with values ranging from −1.0 to +1.0. Positive correlations are shown in shades of red and negative correlations in shades of blue; deeper colors indicate stronger relationships.
Figure 5. Correlation heatmap of the relations between the emotional intelligence, perceived stress, and burnout dimensions. Pearson correlation coefficients are displayed in each cell, with values ranging from −1.0 to +1.0. Positive correlations are shown in shades of red and negative correlations in shades of blue; deeper colors indicate stronger relationships.
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Table 1. Demographic data of the study participants (n = 264).
Table 1. Demographic data of the study participants (n = 264).
VariableCategoryN (%)
GenderFemale131 (49.62%)
Male133 (50.38%)
NationalityEgyptian223 (84.47%)
Non-Egyptian41 (15.53%)
ResidenceIn Alexandria180 (68.18%)
Outside Alexandria (commute)82 (31.06%)
Not reported2 (0.76%)
Study YearAcademic years 1–6172 (65.15%)
Internship92 (34.85%)
Last Academic GradeExcellent (85–100%)93 (35.23%)
Very good (75–85%)108 (40.91%)
Good (65–75%)52 (19.70%)
Pass (60–65%)10 (3.79%)
Fail (<60%)1 (0.38%)
The data are presented as frequency (N) and valid percentage (%).
Table 2. The distribution of the burnout dimensions and overall burnout prevalence by gender and academic stage.
Table 2. The distribution of the burnout dimensions and overall burnout prevalence by gender and academic stage.
Burnout CategoryMaleFemaleYears 1–6Internsp-Value (Gender)p-Value (Year)
Emotional Exhaustion
High45.9%48.1%51.7%38.0%0.7380.011 *
Moderate36.1%37.4%36.6%37.0%
Low18.0%14.5%11.6%25.0%
Depersonalization
High54.9%43.5%53.5%41.3%0.0570.029 *
Moderate30.8%31.3%31.4%30.4%
Low14.3%25.2%15.1%28.3%
Personal Accomplishment
Low77.4%88.5%82.6%83.7%0.0540.537
Moderate18.8%9.2%14.0%15.1%
High3.8%2.3%3.0%2.3%
Burnout (Overall)
Burnout29.3%31.3%30.8%29.3%0.830.915
No Burnout70.7%68.7%69.2%70.7%
* p-values were calculated using Pearson’s chi-square test of independence.
Table 3. Multivariable linear regression results predicting perceived stress.
Table 3. Multivariable linear regression results predicting perceived stress.
Predictorβ (Beta Coefficient)95% Confidence Intervalp-Value
Gender (Male vs. Female)−1.06[−2.21, 0.08]0.068
Academic Year (Intern vs. Years 1–6)−0.07[−1.37, 1.22]0.910
Academic Grade (Very Good vs. Excellent)0.34[−0.96, 1.63]0.609
Academic Grade (Good vs. Excellent)1.04[−0.51, 2.60]0.188
Academic Grade (Pass vs. Excellent)−0.36[−3.26, 2.53]0.805
Academic Grade (Fail vs. Excellent)2.34[−9.82, 14.49]0.705
Academic Year (Sixth Year (new) vs. First Year)2.04[−0.27, 4.35]0.084
Academic Year (Sixth Year (old) vs. First Year)1.69[−0.22, 3.60]0.083
Academic Year (Second Year vs. First Year)3.16[−1.21, 7.52]0.155
Academic Year (Fourth Year vs. First Year)1.64[−2.78, 6.05]0.467
Academic Year (Third Year vs. First Year)−2.96[−11.60, 5.68]0.501
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Schumann, M.; Ghorab, H.M.; Baraka, A. Emotional Intelligence, Perceived Stress, and Burnout in Undergraduate Medical Students: A Cross-Sectional Correlational Study. Int. Med. Educ. 2025, 4, 23. https://doi.org/10.3390/ime4020023

AMA Style

Schumann M, Ghorab HM, Baraka A. Emotional Intelligence, Perceived Stress, and Burnout in Undergraduate Medical Students: A Cross-Sectional Correlational Study. International Medical Education. 2025; 4(2):23. https://doi.org/10.3390/ime4020023

Chicago/Turabian Style

Schumann, Marwa, Hossam M. Ghorab, and Azza Baraka. 2025. "Emotional Intelligence, Perceived Stress, and Burnout in Undergraduate Medical Students: A Cross-Sectional Correlational Study" International Medical Education 4, no. 2: 23. https://doi.org/10.3390/ime4020023

APA Style

Schumann, M., Ghorab, H. M., & Baraka, A. (2025). Emotional Intelligence, Perceived Stress, and Burnout in Undergraduate Medical Students: A Cross-Sectional Correlational Study. International Medical Education, 4(2), 23. https://doi.org/10.3390/ime4020023

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