COVID-19 pandemic and its impact on medical interns’ mental health of public and private hospitals in Guadalajara

ABSTRACT

Introduction

Burnout syndrome is a global burden characterized by exhaustion, work detachment, and a sense of ineffectiveness. It affects millions of individuals worldwide, with a particularly high prevalence among medical students. Factors such as demanding education, exposure to suffering, and the COVID-19 pandemic have contributed to elevated stress levels. Addressing this issue is crucial due to its impact on well-being and health-care quality.

Materials and methods

This cross-sectional survey study assessed fear of COVID-19 and burnout levels among medical student interns in hospitals in Guadalajara, Jalisco. The study used validated scales and collected data from September 2021 to September 2022. A snowball sampling method was employed and a minimum sample size of 198 participants was calculated.

Results

This study included 311 medical students (62.1% female and 37.9% male with a mean age of 23.51 ± 2.21 years). The majority were in their second semester of internship (60.5%) and from public hospitals (89.1%). Most students believed that the COVID-19 pandemic affected the quality of their internship (82.6%). Female students had higher personal burnout scores, while male students had higher work-related burnout scores. The mean score for fear of COVID-19 was 13.71 ± 6.28, with higher scores among women (p = 0.004) and those from public hospitals (p = 0.009). A positive weak correlation was found between COVID-19 scores and burnout subscales.

Conclusion

Our study emphasizes the significant impact of various factors on burnout levels among medical students and health-care professionals during the COVID-19 pandemic. Prolonged exposure to COVID-19 patients, reduced staffing, and increased workload contributed to burnout, affecting well-being and quality of care. Targeted interventions and resilience-building strategies are needed to mitigate burnout and promote well-being in health-care settings.

KEYWORDS:

• COVID-19
• burnout syndrome
• mental health
• medical student
• pandemic
• workload

Introduction

Burnout syndrome is referred to as a psychological prolonged response to chronic occupational stressors characterized by overwhelming exhaustion, job disengagement, sense of ineffectiveness, and lack of professional achievement [1]. It is a global burden for millions around the globe, with frequencies reported as high as 4.2% in the general population [2] and as high as 12.1% in university students from high- and middle-income countries [3] Of the latter, medical students are especially susceptible [4].

One of the primary responsibilities of medical schools is to educate future physicians, such as helping them to develop clinical competence in patient diagnosis and treatment through intensive theoretical and clinical instruction. Taken together with academic aspirations, learning environment, personal life events, exposure to human suffering and educational debt, this extensive training contributes to heightened levels of stress, overwhelm, and poor mental health [5]. Some occupations are more vulnerable than others to the effects of burnout, such as health-care workers and students [6]. Forty-nine percent and 28%–61% of US and Australian medical students have reported burnout, respectively [7]. In Mexico, medical students in clinical rotations experience great amounts of emotional distress leading to burnout [4].

This susceptibility to burnout has been increasing in recent years since the beginning of the COVID-19 pandemic [8,9]. Pandemic-related reasons for burnout, such as the withdrawal of medical students from clinical rotations during the initial peak phase as well as fear of infection [10] contributed to an increase in fear and anxiety in a population that was already susceptible [11]. As a result of the pandemic, medical students suffered significant disruptions to their education and the majority experienced heightened burnout and stress [12].

In a global event such as the COVID-19 pandemic, stress may increase when facing a new disease where the mechanism of transmission, treatment, or complications in the short or long term are unknown. In addition to being in mandatory quarantine, this situation has profoundly serious psychological consequences [13–16]. Among hospital personnel, the absence of protective equipment, long working hours, isolation from families and loved ones, and the constant fear of contagion increased the frequency of depressive episodes, suicidal ideation, anxiety, insomnia, substance abuse, and burnout syndrome, which all decreased emotional well-being [17–21].

In the medical field, chronic stress can manifest as disengagement from patients, decreased dedication, disregard for patient emotions, and a lack of tact when delivering care. These behavioral changes frequently coincide with feelings of inadequacy and decreased motivation to maintain high-quality service delivery, which can fundamentally alter physicians’ baseline disposition. These stress manifestations can occur at various stages of a medical practitioner’s career and tend to worsen as practitioners approach retirement. The issue of chronic stress among health-care professionals has been addressed inadequately; hence, underestimating its significance is a significant concern in the field, despite its high prevalence.

A recent study on the psychological experience of health-care personnel who interact with patients with COVID-19 discovered that the prevalence of fear and anxiety significantly increased during the early stages of the outbreak, primarily due to the high intensity of work and concern for patients and their families [22]. A meta-analysis of 44 studies revealed that hospital staff exhibited greater fear than the general population [10]. Concerning the mental health of medical students on average, an increase in anxiety, fear, and a poor mental state have been discovered [11]. Locally, an analysis of hospital personnel in the metropolitan area of Guadalajara in Jalisco, Mexico, revealed that medical students experienced higher levels of fear than professional medical personnel [17].

Materials and methods

Aims

The objective of this study was to characterize the association between burnout syndrome and fear of COVID-19 on the quality of interns among a sample of undergraduate medical interns who worked in Guadalajara hospital units as part of their studies. In addition, we aimed to identify whether the internship semester and student gender or vaccination status had any association with the presence of burnout syndrome, levels of fear toward COVID-19, and the interns’ perception of the quality of their internship.

Study design

We used a cross-sectional analytical survey design in this study, where the validated Spanish versions of the Fear of COVID-19 Scale [23] and the Copenhagen Burnout Inventory (CBI) scale [24], were applied to medical students performing their internship year in hospital units in Guadalajara, Jalisco, from September 2021 to September 2022. The survey included questions about their age, gender, the internship semester they were in, vaccination status, and if they thought the pandemic had affected the quality of their internship.

To create a snowball sampling effect, we encouraged the participants to distribute the survey to other undergraduate and graduate students. We included all medical students who were attending their undergraduate internship in hospital units in Jalisco. We excluded those students who did not answer the survey completely, those who were still studying before completing their undergraduate internship semester and those who had previously completed their undergraduate internship. Participants who returned an incomplete survey or mentioned wanting to leave the study were also excluded.

Sample size

The sample size was calculated using a formula for calculating frequency in finite populations, considering that the estimated population of medical interns in the hospitals to be studied was 1000. Miranda-Ackerman et al. [4], observed that 20% of undergraduate medical interns reported burnout, while Maske et al. [2], found that 4.2% of the general population experienced burnout syndrome. Taken together, these data suggest that a minimum of 198 interns were needed to respond to this survey for the study results to be validated.

Instruments

Copenhagen burnout inventory

The CBI is a 19-item questionnaire that measures the prevalence of burnout. The CBI scale was created as an alternative to the Maslach Burnout Inventory scale [25], which emphasizes different burnout categories, rather than focusing on the syndrome construct. The CBI scale comprises six items for personal burnout, six items for work-related burnout, and seven items for patient-related burnout. Participants must choose which options represent their perceptions of the statements presented in each section. The options and scores were: ‘never’ (0 points), ‘only sometimes’ (25 points), ‘sometimes’ (50), ‘many times’ (75), and ‘always’ (100 points). We found high reliability in the personal burnout subscale (i.e., 0.880), work-related burnout subscale (i.e., 0.891), and patient-related burnout (i.e., 0.865). The proposed cutoff scores for assessing burnout levels were as follows: a mean score of 50 indicated no/low burnout, a mean score of 50–74 indicated moderate burnout, a mean score of 75–99 indicated high burnout, while a score of 100 indicated severe burnout [26].

Fear of COVID-19 scale (FCV-19S)

The FCV-19S scale is a seven-item questionnaire that measures the amount of fear experienced by the participant toward COVID-19 [27]. The questionnaire comprises seven questions using a five-point Likert scale (i.e., 1 = ‘strongly disagree,’ 2 = ‘disagree,’ 3 = ‘neither agree nor disagree,’ 4 = ‘agree,’ and 5 = ‘strongly agree’). Participants must choose which options correctly represent their perceptions of the statements presented in each section.

Data analysis

The descriptive analyses included proportions, means, and standard deviations. We performed an inferential analysis using the chi-squared test, analysis of variance (ANOVA), and Student’s t-test. In addition, we performed a post hoc analysis using Tukey’s honestly significant difference and Bonferroni tests. A probability level of p < 0.05 was considered significant. All variables were assessed using Levene’s test for equality of variances, assuming that all variables had a parametric distribution. We used Pearson’s correlation to determine whether there was a significant relationship between CBI and FCV-19 scores. We conducted the data analysis using SPSS Statistics software.

Ethical considerations

We obtained written authorization from each participant. The surveys were anonymous to guarantee the confidentiality of each participant. This study follows national committees’ ethical standards for human experimentation and the 2013 Declaration of Helsinki. We submitted the study protocol to ClinicalTrials.gov and it was registered (NCT04420416). The National Ethics Committee and the National Scientific Research Committee authorized the study protocol (R-2021–1301–188).

Results

We included 311 students, of whom 193 (62.1%) were women and 188 (37.9%) were men with a mean age of 23.51 ± 2.21 years. Most students (188, 60.5%) were in their second semester of internship, while 123 (39.5%) were in their first internship semester. Most students (277, 89.1%) were from public hospitals, while 34 (10.9%) were from private hospitals. Two hundred fifty-seven students (82.6%) believed that the COVID-19 pandemic affected the quality of their internship, while 54 (17.4%) believed that the pandemic did not impact the quality of their internship. Regarding COVID-19 vaccinations, most students (270, 86.8%) had received two immunization shots. Table 1 presents the students’ demographic characteristics.

Table 1. Patient demographic information.

Gender, n (%)
Female	193 (62.1%)
Male	118 (37.9%)
Age, mean ± SD	23.51 ± 2.31
Semester, n (%)
1^st semester	123 (39.5%)
2^nd semester	188 (60.5%)
Type of hospital, n (%)
Public hospital	277 (89.1%)
Private	34 (10.9%)
The COVID-19 pandemic affected the quality of internship, n (%)
Yes	257 (82.6%)
No	54 (17.4%)
Hospital attendance, n (%)
Service + calls	269 (86.5%)
Only call	42 (13.5%)
Year of medical internship, n (%)
2021	256 (82.3%)
2022	55 (17.7%)
COVID-19 vaccination status, n (%)
One dose	19 (6.1%)
Two doses	271 (87.1%)
Three doses or more	21 (6.7%)

Considering CBI subscale scores, the mean personal burnout score was 75.01 ± 15.68 and the mean work-related burnout score was 61.02 ± 19.81, while the mean patient-related burnout score was 37.13 ± 21.39.

When comparing genders and CBI subscales, female students reported higher personal and work-related burnout scores, but only the personal burnout score was statistically significant (p = 0.001). Personal and work-related burnout scores were higher among first-semester students, but the difference was not statistically significant. When comparing hospital types, students from public hospitals had higher scores on all CBI subscales, but this was also not statistically significant. When comparing CBI subscale scores and whether students believed the COVID-19 pandemic affected the quality of their internship, students who believed COVID-19 affected internship quality showed higher scores on all subscales. Only the difference in patient-related burnout scores was statistically significant (p = 0.001). When comparing the CBI subscale scores and hospital attendance, those students who attended during their service and stayed on-call had overall higher scores in all subscales. The difference between personal and work-related burnout scores was statistically significant (p = 0.002). Finally, when comparing the CBI subscale mean scores with the year of their medical internship, students who began their internship in 2022 reported higher scores in all subscales, but only patient-related burnout subscale scores were statistically significant (p = 0.001). Table 2 presents a complete comparison of personal and work- and patient-related burnout mean scores.

Table 2. Comparison between demographic variables and CBI mean scores.

Characteristics	Personal burnout	P value	Work-related burnout	P value	Patient-related burnout	P value
Gender
Female	77.28 ± 14.18	0.001	62.65 ± 17.54	0.063	36.16 ± 20.48	0.304
Male	71.29 ± 17.31		58.35 ± 22.87		38.73 ± 22.79
Semester
1^st semester	76.62 ± 16.37	0.143	62.42 ± 20.37	0.313	35.63 ± 22.06	0.318
2^nd semester	73.95 ± 15.17		60.10 ± 19.43		38.12 ± 20.94
Type of hospital
Public hospital	75.43 ± 15.85	0.175	61.62 ± 20.19	0.124	37.93 ± 21.62	0.060
Private hospital	71.56 ± 14.04		56.09 ± 15.69		30.63 ± 18.37
The COVID-19 pandemic affected the quality of internship
Yes	75.21 ± 15.78	0.629	61.43 ± 19.81	0.424	38.89 ± 21.41	0.001
No	74.07 ± 15.32		59.06 ± 19.85		28.78 ± 19.36
Hospital attendance
Service + calls	76.08 ± 15.38	0.002	62.37 ± 19.37	0.002	37.73 ± 20.55	0.216
Only call	68.15 ± 16.09		52.38 ± 20.60		33.33 ± 26.09
Year of medical internship
2021	74.60 ± 15.88	0.328	60.26 ± 19.73	0.147	35.25 ± 20.44	0.001
2022	76.89 ± 17.73		64.54 ± 19.96		45.90 ± 23.61
COVID-19 vaccination status
One dose	75.87 ± 19.22	0.887	61.65 ± 22.73	0.823	40.57 ± 21.05	0.023
Two doses	74.89 ± 15.47		60.67 ± 19.61		35.91 ± 21.18
Three or more doses	77 ± 16.14		69.14 ± 18.32		51.13 ± 18.86

Considering severity, 20 (6.4%) students had no or low burnout on the personal burnout subscale, 113 (36.3%) had moderate burnout, 154 (49.5%) had high burnout, and 24 (7.7%) had severe burnout. Concerning work-related burnout, 73 (23.5%) students displayed no or low burnout, 154 (49.5%) displayed moderate burnout, 79 (25.4%) displayed high burnout, and 5 (1.6%) displayed severe burnout. Regarding the patient-related burnout subscale, 229 (73.6%) students demonstrated no or low burnout, 62 (19.9%) demonstrated moderate burnout, 16 (5.1%) demonstrated high burnout, and 4 (1.3%) demonstrated severe burnout.

Overall, 291 (93.56%) students reported moderate to severe burnout on the personal burnout subscale, 238 (76.52%) on the work-related burnout subscale, and 82 (26.36%) on the patient-related burnout subscale. When comparing gender and personal burnout severity, we found a greater proportion of high and severe burnout among female students that was statistically significant (p = 0.004). Similarly, a significant difference was found among first-semester students (p = 0.028) and student interns in public hospitals (p = 0.018), who showed high and severe burnout, respectively. Regarding work-related burnout, male students had a greater proportion of high and severe burnout when compared with female students; this difference was statistically significant (p = 0.006). In addition, the students who attended their hospital internship and stayed on-call had a greater proportion of high and severe burnout when compared with those who only attended calls (p = 0.002). Finally, when comparing the severity of patient-related burnout among the students, most students had no or low burnout. Only those who started their hospital internship in 2022 had statistically significant higher proportions of moderate, high, or severe burnout when compared to those who started their internship in 2021 (p = 0.020). Table 3 shows the complete comparison of burnout severity.

Table 3. Comparison between demographic variables and burnout severity.

	No or low burnout	Moderate burnout	High burnout	Severe burnout	P value
	Personal burnout
Gender
Female	7 (3.6%)	62 (32.1%)	108 (56%)	16 (8.3%)	0.004
Male	13 (11%)	51 (43.2%)	46 (39%)	8 (6.8%)
Semester
1^st semester	10 (8.1%)	33 (26.8%)	67 (54.5%)	13 (10.6%)	0.028
2^nd semester	10 (5.3%)	80 (42.6%)	87 (46.3%)	11 (5.9%)
Type of hospital
Public hospital	20 (7.2%)	93 (33.6%)	143 (51.6%)	21 (7.6%)	0.018
Private hospital	0	20 (58.8%)	11 (32.4%)	3 (8.8%)
The COVID-19 pandemic affected the quality of internship
Yes	3 (5.6%)	18 (33.3%)	30 (55.6%)	3 (5.6%)	0.773
No	17 (6.6%)	95 (37%)	124 (48.2%)	21 (8.2%)
Hospital attendance
Service + calls	14 (5.2%)	97 (36.1%)	135 (50.2%)	23 (8.6%)	0.083
Only call	6 (14.3%)	16 (38.1%)	19 (45.2%)	1 (2.4%)
Year of medical internship
2021	18 (7%)	94 (36.7%)	123 (48%)	21 (8.2%)	0.584
2022	2 (3.6%)	19 (34.5%)	31 (56.4%)	3 (5.5%)
Gender	Work-related burnout
Female	35 (18.1%)	109 (56.5%)	47 (24.4%)	2 (1%)	0.006
Male	38 (32.2%)	45 (38.1%)	32 (27.1%)	3 (2.5%)
Semester
1^st semester	23 (18.7%)	63 (51.2%)	35 (28.5%)	2 (1.6%)	0.417
2^nd semester	50 (26.6%)	91 (48.4%)	44 (23.4%)	3 (1.6%)
Type of hospital
Public hospital	62 (22.4%)	136 (49.1%)	74 (26.7%)	5 (1.8%)	0.295
Private hospital	11 (32.4%)	18 (52.9%)	5 (14.7%)	0
The COVID-19 pandemic affected the quality of internship
Yes	13 (24.1%)	30 (55.6%)	10 (18.5%)	1 (1.9%)	0.629
No	60 (23.3%)	124 (48.2%)	69 (26.8%)	4 (1.6%)
Hospital attendance
Service + calls	54 (20.1%)	136 (50.6%)	74 (27.5%)	5 (1.9%)	0.002
Only call	19 (45.2%)	18 (42.9%)	5 (11.9%)	0
Year of medical internship
2021	62 (24.2%)	127 (49.6%)	63 (24.6%)	4 (1.6%)	0.868
2022	11 (20%)	27 (49.1%)	16 (29.1%)	1 (1.8%)
Gender	Patient-related burnout
Female	145 (75.1%)	39 (20.2%)	7 (3.6%)	2 (1%)	0.441
Male	84 (71.2%)	23 19.5%)	9 (7.6%)	2 (1.7%)
Semester
1^st semester	92 (74.8%)	23 (18.7%)	7 (5.7%)	1 (0.8%)	0.881
2^nd semester	137 (72.9%)	39 (20.7%)	9 (4.8%)	3 (1.6%)
Type of hospital
Public hospital	209 (72.6%)	58 (20.9%)	14 (5.1%)	4 (1.4%)	0.531
Private hospital	28 (82.4%)	4 (11.8%)	2 (5.9%)	0
The COVID-19 pandemic affected the quality of internship
Yes	47 (87%)	4 (7.4%)	3 (5.6%)	0	0.055
No	182 (70.8%)	58 (22.6%)	13 (5.1%)	4 (1.6%)
Hospital attendance
Service + calls	196 (72.9%)	58 (21.6%)	12 (4.5%)	3 (1.1%)	0.167
Only call	33 (78.6%)	4 (9.5%)	4 (9.5%)	1 (2.4%)
Year of medical internship
2021	197 (77%)	46 (18%)	11 (4.3%)	2 (0.8%)	0.020
2022	32 (58.2%)	16 (29.1%)	5 (9.1%)	2 (3.6%)

The mean FCV-19 score was 13.71 ± 6.28. When comparing gender and FCV-19 scale mean scores, female students had significantly higher mean scores (p = 0.004). In addition, when comparing the type of hospital, students in public hospitals had higher mean scores; this difference was statistically significant (p = 0.009). However, there were no significant differences when comparing semesters and whether COVID-19 affected the quality of their internship, hospital attendance, and year of medical internship. Table 4 compares the FCV-19 mean scores.

Table 4. Comparison between demographic variables and FCV-19 scale mean scores.

	Fear of COVID-19 scale	P value
Gender
Female	14.51 ± 6.29	0.004
Male	12.41 ± 6.05
Semester
1^st semester	13.67 ± 6.68	0.930
2^nd semester	13.74 ± 6.01
Type of hospital
Public hospital	13.96 ± 6.44	0.009
Private hospital	11.71 ± 4.29
The COVID-19 pandemic affected the quality of internship
Yes	13.83 ± 6.31	0.482
No	13.17 ± 6.15
Hospital attendance
Service + call	13.77 ± 6.28	0.674
Only call	13.33 ± 6.31
Year of medical internship
2021	13.59 ± 6.09	0.454
2022	14.29 ± 7.11
COVID-19 vaccination status
One dose	14.11 ± 7.25	0.622
Two doses	13.57 ± 6.13
Three doses	15.67 ± 7.36

Pearson’s correlation coefficient was computed to assess the linear relationship between CBI subscales and FCV-19 scale mean scores. There was a weak correlation between personal FCV-19 scale mean scores and personal burnout (r (309) = 0.32, p = 0.001), work-related burnout (r (309) = 0.28, p = 0.001), and patient-related burnout (r (309) = 0.19, p = 0.001).

Discussion

This investigation aimed to ascertain the correlation between burnout syndrome and fear of COVID-19 on the quality of undergraduate interns, in addition to determining whether their demographic characteristics were linked to these variables. Within the categories of personal and work- and patient-related burnout out of a sample of 311 individuals, a total of 20 (6.4%), 73 (23.5%), and 229 (73.6%) individuals, respectively, exhibited either no or low levels of burnout. Substantial discrepancies were observed among the burnout subscales across different demographic groups. Personal burnout was found to be more prevalent among women, first-semester college students, and public hospital employees. The highest prevalence of high and severe occupational burnout was observed among men and those undertaking 24-hour shifts. Although the occurrence of patient-related burnout was relatively low within our sample, the prevalence of moderate, high, and severe burnout was significantly greater among students who began their rotation in 2022 compared to those who began in 2021. These findings align with prior research conducted in the United Kingdom [28] and Malaysia [29], which identified a significant surge in burnout among health-care personnel, particularly frontline workers, in the context of the COVID-19 pandemic.

Considering the COVID-19 fear scale, there was a notable increase in scores among women and public hospital employees. A positive, albeit weak, correlation was observed between the FCV-19 scale and CBI. This finding is consistent with earlier research conducted by García [30], which highlights health-care personnel as a vulnerable group in the pandemic response, with 20% of COVID-19 cases attributed to frontline health-care workers. Our study also aligns with the literature, such as Sheehan et al. [31], Ferro et al. [32], and Caillet et al. [33], who reported a higher prevalence of characteristics related to burnout symptoms among female undergraduate interns. Variations in specific staffing characteristics were noted, such as those based on residential care workers, emergency department staff, or intensive care unit staff.

When examining the CBI subscales in relation to demographic variables, we observed that second-semester students working in public hospitals had higher personal and work-related burnout scores. This finding contrasts with a study conducted by Rosas-Paez et al. [34], which did not identify a significant association between these characteristics when comparing them with items from the Utrecht Work Engagement Scale and the Maslach Burnout Inventory.

The COVID-19 pandemic subjected many medical students to elevated levels of stress and uncertainty, along with disruptions to their education and clinical training. Concerns for their personal safety have further compounded these challenges, which have likely contributed to an increased susceptibility to burnout among medical students.

Stress is an adaptation mechanism to the environment resulting from cognitive and organic processes. When stress is experienced continuously or repeatedly, it can develop into a chronic condition. This phenomenon is known to result in a variety of maladaptive mechanisms, which can eventually lead to neurological, metabolic, hormonal, and even cardiovascular alterations [35].

As a form of chronic stress, work-related stress is of the utmost importance to Mexico. In 2019, the World Health Organization reported that up to 75% of the Mexican population experiences high levels of work-related stress. This can lead to the development of burnout syndrome [36], which has been associated with high-stress occupations, caregiving occupations, and jobs with long working hours [37].

Isolation has led to a rise in stress and anxiety among the general population and hospitalized patients in particular [18,19,38,39]. Both institutional and individualized interventions for student physicians within medical institutions to address burnout could reduce the incidence of this syndrome and early strategies for treatment and prevention could be planned.

Implementing targeted interventions to reduce burnout and promote well-being is essential for maintaining the resilience and effectiveness of health-care providers in delivering high-quality care to patients, while also nurturing a supportive learning environment for medical students. Future research should focus on identifying effective strategies to mitigate burnout and enhance resilience in health-care settings, not only during pandemics but also ordinary circumstances.

It is important to acknowledge the limitations of our study. The findings may not be generalizable to other populations or settings due to the specific sample of medical students from a particular region. The reliance on self-report measures and the cross-sectional design restricts our ability to establish causality or temporal relationships. The use of convenience sampling and the potential for response bias may have influenced the results. Despite these limitations, our study provides valuable insights for future research and interventions addressing burnout among medical students.

Acknowledgments

The authors would like to thank all physicians, nurses, and other health-care professionals who are battling COVID-19 pandemic consequences, as well as all educators and teachers who endeavor to maintain order in education during times of chaos.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This project did not require financing because it was conducted using the researchers’ own resources.