## 3 Results of the Literature Review
### MRI and fMRI Studies  
In this study, researchers investigated how burnout modulates brain activity during clinical reasoning in doctors. Using functional magnetic resonance imaging (fMRI), the brain activity ofinternal medicine residents was assessed:  
* In the study group: N = 17 (15 men and 2 women);
* In the control group: N = 17 (10 men and 7 women) [21];  
who answered multiple-choice questions while pondering the answers. All subjects completed the Maslach Burnout Inventory (MBI) [28] prior to fMRI. Whole-brain analysis of covariance was used to examine the blood-oxygen-dependent signal (BOLD) during response and reflection on clinical problems in relation to burnout scores. Higher scores in the area of depersonalization in the test group were reflected in lower BOLD signals in the right dorsolateral prefrontal cortex and middle frontal cortex during responses to clinical problems and, in the control group, lower BOLD signals in the bilateral prefrontal cortex during responses to clinical problems. In contrast, higher scores in the area of emotional exhaustion were associated in the control group with stronger BOLD signals in the right posterior cingulate cortex and middle frontal cortex. The study group (described above [21]: 40 burnout subjects (38 \(\pm\) 6 years, range 19-46 years, 15 males, 25 females)) did not show any significant effect of burnout on brain activity. They were more susceptible to the effects of burnout on clinical reasoning, which may indicate that, as less experienced, they may need both cognitive and emotional support to improve their quality of life and optimize their performance and learning. In the samples studied, an imbalance in gender wasobserved. These findings organize the understanding of stress, cognitive control, and the theory of cognitive load [21]. The aim of the study by [PERSON] et al. was to investigate structural changes in the brain related to occupational stress. The study compared the thickness of the cortex and the subcortical volume in 40 patients with burnout and 40 in the control group. Stress severity was measured using MBI. Patients with occupational burnout showed significant thinning of the medial frontal cortex. By examining the correlation between age and cortex thickness, we found that the effect of thinning of the frontal cortex was more pronounced in burnout patients. The results also showed that the volume of their amygdala increased bilaterally, while the volume of the caudate cortex decreased, accompanied by impaired motor function. Patients with burnout positively correlated with amygdala volume. This study found that burnout was associated with thinning of the cortex as well as selective changes in the subcortical volume with behavioral correlates. The results of this study support the hypothesis that stress-related excitotoxicity may be the underlying mechanism, and that the described condition is a stress-related disease [22]. [PERSON] et al. conducted a comparative MRI study of brain volumes in the grey (GM) and white matter (WM) between patients with chronic occupational stress and healthy controls. The study also included volume analysis of structures known to be susceptible to neurotoxic changes of the hippocampus, caudate, and striatum (skin), but not the amygdala. The study group consisted of 30 right-handed, non-smoking patients (23 women and seven men) who were diagnosed with \"coping with stress response and adjustment disorder\" according to the International Classification of Diseases (ICD-10). Subjects were also required to have a mean stress burnout score >3.0 on the Maslach Stress-Burnout Inventory-General Survey (MBI-GS) [29]. The control group consisted of 68 healthy, right-handed, non-smoking volunteers (53 women and 15 men) without a history of chronic stress or hereditary neuropsychiatric disorders. The results of the study showed that the GM volume of the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex was significantly reduced in the stressed subjects.