Core self-evaluation and learning burnout among first-year medical students: a three-wave longitudinal study on the mediating roles of anxiety-related distress and problematic digital media use.

Background: First-year medical students are at high risk of learning burnout due to the substantial academic and psychological demands of medical education. This study examined whether core self-evaluation (CSE) was prospectively associated with later learning burnout, and whether anxiety-related distress and problematic digital media use served as parallel mediating pathways. Methods: A three-wave longitudinal survey was conducted among 4,890 first-year medical students at 6-months intervals. CSE and baseline learning burnout were assessed at Time 1 (T1), anxiety-related distress and problematic digital media use at Time 2 (T2), and learning burnout at Time 3 (T3). Structural equation modeling was used to test a baseline-adjusted parallel mediation model. Results: After controlling for baseline learning burnout, the direct path from T1 CSE to T3 learning burnout was no longer significant. However, T1 CSE was indirectly associated with T3 learning burnout through both T2 anxiety-related distress and T2 problematic digital media use. Lower CSE was associated with higher anxiety-related distress and greater problematic digital media use, which were in turn associated with higher levels of later learning burnout. Conclusion: After accounting for baseline burnout, the association between CSE and later learning burnout was primarily reflected through emotional and behavioral pathways. Anxiety-related distress and problematic digital media use may therefore represent meaningful targets for the early identification and prevention of learning burnout in first-year medical students.