Training through trauma: A multivariate analysis of burnout and associated factors among physician trainees in Guatemala.

OBJECTIVE: Burnout is a pervasive occupational hazard in medicine, beginning early in training and linked to depression, suicide, medical errors, and attrition. While extensively studied in high-income countries, little is known from Latin America. Guatemala faces scarce mental health resources, social inequities, and limited residency regulation. This study aimed to characterize burnout, psychological distress, and moral injury among Guatemalan physicians in postgraduate medical training ("residents"). METHOD: We conducted a cross-sectional survey of residents in Guatemala (September-October 2024). Surveys included demographics and validated Spanish-language instruments assessing burnout, depression, anxiety, stress, self-compassion, impostor syndrome, and moral injury. Logistic regression identified demographic and occupational risk factors. RESULTS: Of 1,729 eligible residents, 589 (34.1%) responded; 504 (29.1%) completed surveys. Respondents averaged 30.6 years; 54.5% were female, and 95.6% Guatemalan. Most trained at the University of San Carlos (89.6%), with a minority at Universidad Mariano Galvez and "other." Distress prevalence was high: 83% reported high emotional exhaustion, 90% high depersonalization, and 95% low personal accomplishment. Moderate-to-severe depression affected 32.7%, anxiety 40.7%, stress 49.2%, and impostor syndrome 41.2%. Moral injury was nearly universal (89.3%). Harassment and frequent 24-hr shifts were strongly associated with greater burnout, depression, anxiety, and stress. Female and lesbian, gay, bisexual, transgender, queer+ residents reported higher exhaustion, stress, impostor syndrome, and lower self-compassion. Mid-level trainees had an elevated risk of exhaustion. CONCLUSION: Guatemalan residents face unprecedented levels of burnout and moral injury, exceeding global rates. Modifiable factors, including harassment and workload, compound structural inequities. Findings underscore the urgent need for residency reform, standardized protections, and culturally responsive mental health infrastructure. (PsycInfo Database Record (c) 2026 APA, all rights reserved).