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This review compared literature on burnout levels in postgraduate medical trainees published before and after COVID, with consideration of group differences (e.g., specialty and country).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This systematic review and meta\u2010analysis was registered on PROSPERO (CRD42023404618) and followed the updated PRISMA statement. Embase, Ovid Medline, Ovid PsycInfo and the Cochrane Collaborative were searched until April 2025. These results were supplemented with pearling and citation searching of included articles and previous reviews. Studies that administered the Maslach Burnout Inventory \u2013 Human Services Survey (MBI) to postgraduate medical trainees were eligible. Where studies met eligibility criteria but did not provide required data (i.e., sample size, means and standard deviations), authors were contacted to supply these data. Methodological reporting quality (QualSyst tool) and publication bias were assessed (funnel plots, trim\u2010and\u2010fill method), and between\u2010group heterogeneity explored (subgroup analyses, meta\u2010regression). Differences in burnout levels pre\u2010 and intra\u2010COVID (i.e., before and after March 2020, respectively) were quantified using Hedges' <jats:italic>g<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 3 930 unique studies identified, 245 were included, comprising 48\u2009698 trainees. Impacts of the COVID\u201019 pandemic on burnout levels varied: although trainees' emotional exhaustion remained stable, reported levels of depersonalisation (from <jats:italic>g<\/jats:italic><jats:sub><jats:italic>w<\/jats:italic><\/jats:sub>\u2009=\u20090.611 to 0.430, <jats:italic>p<\/jats:italic>\u2009=\u20090.045) and personal accomplishment fell (from <jats:italic>g<\/jats:italic><jats:sub><jats:italic>w<\/jats:italic><\/jats:sub>\u2009=\u2009\u22120.348 to \u22120.626, <jats:italic>p<\/jats:italic>\u2009=\u20090.009). Specialty and country variations were evident, with emergency medicine trainees trainees reporting worse burnout during COVID, whereas anethesiology, psychiatry and urology trainees felt less burnt out by their work.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Wellbeing supports should be prioritized for front\u2010line specialty trainees, who were vulnerable to work\u2010related stressors that emerged during COVID. Interventions should focus on fostering a sense of competence and mastery, both of which can enhance personal accomplishment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/medu.15760","type":"journal-article","created":{"date-parts":[[2025,6,29]],"date-time":"2025-06-29T11:03:55Z","timestamp":1751195035000},"page":"1156-1171","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Burnout before and during COVID: A systematic review and meta\u2010analysis of 48\u2009698 trainees"],"prefix":"10.1111","volume":"59","author":[{"given":"Shaun","family":"Prentice","sequence":"first","affiliation":[{"name":"School of Psychology Faculty of Health &amp; Medical Sciences, The University of Adelaide  Adelaide Australia"},{"name":"General Practice Training Research Team Royal Australian College of General Practitioners  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana 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