no intervention, this is an observational cross sectional study

(PHQ-9) score, a self-report questionnaire that is commonly used as a screening tool for depression. It is composed of 9 questions assessing the frequency of depressive symptoms on a 4-point Liker-scale ranging from 0 (never) to 3 (nearly every day). The total score was calculated for each patient and was interpreted as follows: minimal (1-4), mild (5-9), moderate (10-14), moderately severe (15-21), severe (20-27). A standard cutoff of score of 10 was used, indicating a diagnosis of depression.

The aMBI is a 9-item questionnaire each question is rated on a 7-point Liker scale ranging from 0 to 6, which indicates the frequency of symptoms in question. Response options include; Every day, A few times a week, Once a week, A few times a month, Once a month, A few times a year, or Never. The questions grouped into 3 subscales (emotional exhaustion EE, depersonalization D and personal accomplishment PA) are evaluated and scored separately with each score ranging from 0 to 18. We used the cut off points set by Lebares et al. for EE and D. The cut off points for high burnout among U.S. surgery residents were: EE score ≥ 9 and D score ≥ 6. A PA score ≤ 12 was chosen as a cut-off for high burnout.