This study targeted all undergraduate medical students at UKM involved in both lecturer and peer mentorship programmes. It employed a cross-sectional study design using a structured questionnaire as the primary data collection instrument. As peer mentors are typically assigned from Year 2 onwards, the study comprised students from Year 2 to Year 5 (N = 629). Sample size was calculated using the prevalence formula with finite population correction (2), based on a 67.9% prevalence rate (p = 0.68), precision (d) = 0.05 and Z = 1.96. The resulting sample size was 216. To account for non-responses and missing data, a 45% increase was applied, resulting in a final target sample size of 313.

Data collection was conducted from 1 February 2024 to 30 June 2024. A weekly online survey link was distributed through group leaders and a QR code was made available before or after teaching sessions. Inclusion criteria were (i) involvement in both lecturer and peer mentorship programmes, (ii) provision of written consent and (iii) proficiency in English. Exclusion criteria were (i) involvement in only one mentorship programme due to year of entry into medical school, (ii) non-consent to respond to the questionnaire and (iii) student researchers conducting the study. Eligibility was assessed through sociodemographic screening embedded within the questionnaire. To ensure one response per individual, access was restricted to official university email logins. Anonymity was maintained, however, as no email data were stored.

Data were collected using a structured, self-administered online questionnaire consisting of five sections: (i) sociodemographic information, (ii) burnout levels, (iii) mentorship experiences, (iv) strength of motivation and (v) professional values.

Burnout was assessed using the Copenhagen Burnout Inventory (CBI), which has been validated for local use. It comprises 19 items across three domains: personal, work-related (adapted to academic activities) and client-related (adapted to clinical interactions), rated on a 5-point Likert scale ranging from “always” to “never/almost never” (41). The CBI demonstrates high internal consistency (Cronbach’s alpha: personal = 0.87; work = 0.87; client = 0.85). A cut-off score of ≥50 was used to indicate high burnout, consistent with the original developers’ recommendations (42). This threshold has been applied in a few local studies among university and medical student populations, demonstrating that sizeable proportions exceed this level, suggesting a substantial burnout burden among Malaysian students (2, 3).

Lecturer mentorship for medical students was measured using a 25-item questionnaire adapted from Sparshadeep et al. (43), encompassing five domains: programme structure, mentor’s approachability, professional development, mentor’s attitude and future expectations. Responses were recorded on a 5-point Likert scale. The instrument demonstrated excellent internal consistency (Cronbach’s alpha = 0.97) (33).

Peer mentorship was assessed using a 12-item questionnaire developed by Mohd Shafiaai et al. (44), focusing on four domains: pedagogical skills, leadership, personal attributes and communication. The questionnaire was validated locally for use in medical students and employed a 5-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. It demonstrated acceptable internal consistency (Cronbach’s alpha = 0.797) (34).

Motivation in medical students was measured using the Strength of Motivation for Medical School-Revised (SMMS-R) scale (45), comprising 15 items across three subscales: willingness to sacrifice (α = 0.70), readiness to start (α = 0.67) and persistence (α = 0.55) (45, 46). Some items were reverse-scored, and responses were recorded on a six-point Likert scale. Despite the lower internal consistency of the persistence subscale, it was retained as a key factor in motivation because it taps students’ willingness to continue studying medicine despite difficulties, which is conceptually close to grit and academic resilience and is strongly linked to burnout and engagement in the literature (33).

Professional values were assessed using the Physician Values in Practice Scale (PVIPS), specifically the “Prestige” and “Service” subscales (47). The PVIPS has demonstrated strong construct validity and internal consistency (α = 0.85–0.86) and has been validated for use among medical students (47).

Data were analysed using IBM SPSS Statistics, version 29. Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarise participant characteristics, burnout levels, mentorship measures, strength of motivation, and professional values. For bivariate analyses, Pearson’s chi-squared tests were applied to examine associations between categorical variables and burnout categories, while independent-samples Student’s t-tests were used to compare continuous variables across low and high burnout groups for each of the CBI dimensions.

The three CBI dimensions (personal burnout, work related burnout, and client related burnout) were treated as outcome variables in all inferential analyses. Sociodemographic characteristics, lecturer mentorship variables, peer mentorship variables, strength of motivation subscales and professional values were treated as independent variables. Student’s t-tests and Pearson’s chi-squared tests were used to examine univariate associations between independent variables and each burnout dimension. Binary logistic regression was then conducted to identify factors independently associated with high burnout for each CBI dimension, adjusting for relevant covariates. Statistical significance was set at p < 0.05 for all analyses.

Our study confirmed that female students were more likely to experience personal and work-related burnout, consistent with other local studies (2, 3). This finding aligns with international research showing higher burnout prevalence among female medical students, often attributed to additional academic, societal and cultural pressures (14, 55, 56). The dual burden of academic responsibilities and societal expectations, particularly in patriarchal cultures, may contribute to this disparity. Female students are also more likely to adopt emotion-focused coping strategies, such as rumination, which increase vulnerability to burnout and depression, whereas male students more frequently use problem-focused strategies that are generally more effective for stress management (55, 56). Furthermore, reports indicate that up to 50% of female medical students experience sexual harassment, which may exacerbate psychological burden and increase the risk of depression and post-traumatic stress disorder (PTSD) (57). Such harassment has also been linked to academic disengagement and burnout (56). These findings underscore the need for trauma-sensitive and gender-aware mentorship, including flexible mentor–mentee matching and supportive institutional policies, to help mitigate gender-specific stressors and reduce burnout risk.

Parental occupation was significantly associated with burnout in our study, with students whose parents worked in non-medical fields reported higher levels of client-related burnout. This contrasts with prior research in collectivist cultures, which often emphasises that students with healthcare professional parents experience greater stress due to high parental expectations (58–61). One potential explanation is that students from medical families are often exposed earlier to clinical narratives, professional norms and coping strategies such as boundary setting or debriefing about difficult cases, which can normalise distress and reduce emotional shock when first encountering real patients (62, 63). In contrast, students from non-medical backgrounds may enter clinical settings with fewer concrete role models for managing suffering, conflict, or complaints, making these experiences feel more overwhelming or personally threatening (8, 64). Additionally, parental expectations and guidance may differ. Parents with medical experience can frame difficult patient interactions as expected professional challenges, whereas non-medical parents may focus more on grades or prestige, offering less tailored advice on coping with emotionally demanding situations (65, 66). According to Self-Determination Theory (SDT), autonomy, competence and relatedness are essential for psychological well-being (67). When these psychological needs are eroded, students may become more vulnerable to anxiety, low mood and maladaptive coping. This suggests that burnout often overlaps with broader mental health concerns, rather than being confined to academic performance. Mental health educators can mitigate these effects by introducing family-focused psychoeducation programmes aimed at aligning parental expectations with students’ mental health needs.

Lecturer mentorship helps reduce burnout, as evidenced in our findings. Students who view mentors as approachable report less academic burnout, consistent with findings from another qualitative study (43). Mentorship quality is often undermined by gender bias, poor communication, infrequent meetings and mentors’ blaming attitudes (43, 68, 69). Such negative dynamics weaken trust and discourage help-seeking, leading to increased stress, low self-esteem and burnout (69). Strengthening mentor-student relationships, particularly by enhancing approachability, may therefore reduce burnout. Improving mentor approachability can be facilitated through open communication and the creation of a supportive environment. Regular check-ins help to build trust and rapport, allowing students to feel safe in expressing concerns. Virtual meetings may also reduce barriers for students during out-of-campus postings (32). Empathy and emotional intelligence are central to effective mentorship, enabling students to feel heard and supported while reducing burnout (34). Mental health educators can enrich mentorship programmes by integrating emotional intelligence, empathy and reflective communication training, alongside personalised approaches like mentorship contracts and reflective sessions to foster resilience, leadership and coping skills, which are often absent from traditional clinical training (70).

Peer mentorship also reduced burnout, consistent with findings by Mohd Shafiaai et al., who demonstrated that personal attributes were strongly associated with lower personal and work-related burnout (44). Existing evidence suggests that peer and near-peer mentorship programmes are associated with reduced stress and burnout risk among medical students, mainly by lowering anxiety, enhancing coping and work-life balance, and strengthening a sense of connection rather than directly shifting burnout scores (30, 71). Structured programmes, where mentors are trained and meetings are regular, appear particularly effective in fostering community, belonging and professional identity, which are protective against burnout (72, 73). Peer mentorship helps students build organisational and time management skills while fostering competence and a sense of belonging, which reduce stress, prevent loneliness and enhance resilience (70). Mentorship provides emotional support, normalises difficulties, and facilitates help-seeking, addressing social isolation and lack of support, which are known correlates of burnout (18). Well-designed programmes with clear expectations and structured contact further enhance benefits for both mentees and mentors, supporting resilience and long-term sustainability (73, 74). Mental health educators could enhance peer mentorship programmes by supervising training workshops, teaching mental health first aid and ensuring clear referral pathways for at-risk students.

Motivation emerged as a key protective factor against burnout. Students who demonstrated higher persistence reported significantly lower levels of client- and work-related burnout. This aligns with research showing that intrinsic motivation protects against burnout, while low or externally driven motivation is associated with higher burnout among medical students (75, 76). Intrinsic motivation correlates with lower emotional exhaustion and higher personal accomplishment, whereas low motivation predicts higher burnout even after controlling for other factors (10, 77). Within the framework of Self-Determination Theory (SDT), achievement motivation fosters a sense of purpose, resilience and effective coping (78–80). These effects operate through supporting autonomy, competence and relatedness, which help students perceive academic and clinical demands as meaningful challenges rather than draining pressures. Controlling environments that undermine these needs increase extrinsic motivation or amotivation, linked to higher burnout (81). Conversely, students with lower motivation may struggle to derive meaning from their responsibilities, making them more vulnerable to burnout. Curricula that strengthen intrinsic motivation through autonomy-supportive teaching, meaningful feedback, choice in learning activities and alignment with professional values can help prevent burnout. Monitoring students’ motivation alongside burnout measures may identify at-risk groups and guide targeted interventions (82, 83).

Our study also highlighted that students with higher levels of commitment to professional values, particularly service, experienced lower client-related burnout. This suggests that integrating professional values into medical education could reduce emotional strain associated with patient interactions. Similar patterns have been observed in other research. At UKM, professional values are integrated into the curriculum through the Personal and Professional Advancement (PPA) module, which promotes skills such as effective communication, ethical practice, bedside manners, critical thinking and professional judgement. Beyond shaping professional conduct, these competencies foster emotional intelligence and self-reflection, both protective against stress and disengagement. Teaching strategies include lectures, reflective learning, role-play of real-life scenarios and outdoor camps, all designed to help students internalise and apply professional values.

To specifically cultivate the value of service, integrating service-learning programmes, which combine community engagement with academic objectives, can reduce client-related burnout while strengthening students’ sense of purpose and professional identity (84, 85). In such programmes, mental health educators play a role in linking psychiatric education with community engagement, promoting mental health awareness, social–emotional learning and resilience (86–88). At UKM, compulsory elective postings of at least two weeks (international) or four weeks (local) provide students with opportunities for community-based service placements, offering them additional life skills and values. Such exposure may reduce cynicism and compassion fatigue while fostering resilience and fulfilment, particularly when learning goals emphasise meaningful service.

Our findings align with prior research showing that higher levels of professionalism and professional behaviour are associated with lower burnout scores and better mental health among medical students (89, 90). Professional values such as service, altruism and commitment to patients appear to buffer burnout by strengthening professional identity, enhancing meaning in work and promoting healthier coping and empathy (91, 92). Students who more fully internalise the values and role of “being a doctor” report lower levels of emotional exhaustion and cynicism and higher academic efficacy, suggesting that a clear, valued professional identity protects against burnout (93, 94). Professionalism framed around service, responsibility to society and care for the underserved can make demanding training feel purposeful, which is associated with lower burnout and better mental well-being (89). Higher professionalism and professional behaviour correlate with greater empathy, more positive coping strategies and less use of negative coping, which in turn are linked to lower burnout (95).

Conversely, students with higher burnout are more likely to report dishonest or unprofessional behaviours and less altruistic views about physicians’ responsibilities to society, indicating that erosion of professional values accompanies, and likely reinforces, burnout (92, 96). Greater engagement in values-based behaviour and less avoidance of personal values are associated with lower emotional exhaustion and depersonalisation (97).

Our findings carry important implications for medical education policy, particularly in Malaysia and other low- and middle-income contexts, highlighting the role of mental health educators in advancing students’ mental health. Institutions should implement structured mentor training to improve approachability and emotional intelligence, ensuring students feel supported. At UKM, outcomes could be strengthened by formalising peer mentorship as part of the curriculum, with measurable learning goals and structured mentor–mentee sessions.

Universities must also normalise mental health discussions, expand access to culturally sensitive counselling and create safe spaces that reduce stigma. Curriculum planners involving mental health educators, should adopt modular, flexible designs that promote autonomy, reduce stress and build intrinsic motivation.

Mental health educators can contribute by leading mentorship curriculum design, resilience workshops and mentor training in empathetic communication and distress recognition. They may also support the development of trauma-informed and gender-sensitive mentoring practices, as well as family-focused psychoeducation to realign parental expectations with student well-being. Ultimately, linking professional development with resilience will nurture of graduates who are not only clinically competent but also better equipped for long-term psychological health.

This study has several limitations. First, it was conducted at a single institution, which restricts the generalisability of our findings to other medical schools and stages of training. In addition, the use of convenience sampling may limit the representativeness of the sample and generalisability of the results. Second, the peer mentorship programme examined was less structured than the formal lecturer mentorship at UKM, which may have affected its perceived effectiveness. Moreover, mentorship structures vary across Malaysian medical universities. For instance, at USM, the mentoring programme has evolved from involving all academic staff, to senior students, and now to volunteer lecturers (34). Such variability in mentor-mentee selection processes and programme design limits the applicability of our findings to other institutions. Third, our study relied on post-test questionnaires to evaluate the impact of peer mentorship on burnout, without pre-test assessments, which restricted our ability to measure changes over time. Furthermore, the cross-sectional design of the study prevents any causal inferences. Fourth, secondary assessments of related psychological constructs, such as anxiety, depression or PTSD symptoms, were not included, limiting the depth of mental health evaluation. Fifth, our study relied on self-reported questionnaires, which may be subject to social desirability or recall bias. Finally, the Persistence subscale from the SMMS-R demonstrated a low Cronbach’s alpha of 0.5 (45, 46), indicating limited internal consistency, which may have affected the reliability of findings related to motivation.

Future research should adopt longitudinal designs to better capture causal pathways and the sustained impact of interventions on burnout. Studies could evaluate curriculum-based interventions involving mental health educators, such as revisions to assessment strategies, structured reflective practices and early screening, to determine their effectiveness in strengthening resilience. Additionally, developing gender-sensitive and culturally grounded mentorship models may provide more tailored support, particularly in collectivist contexts such as Malaysia, and help identify which components of mentorship most effectively mitigate burnout.