Research on the relationships among teachers’ paternalistic leadership style, learning motivation and learning burnout of medical students on a standardized residency training

Abstract

Background

Paternalistic leadership refers to strict discipline and supreme authority in the environment of human governance and a style of leadership derived from both paternalistic love and incorruptible law. Paternalistic leadership has received less attention from researchers than other potential causes of student burnout in education field. Few studies have reported the perspectives of students, treated paternalistic leadership style as an independent variable, or conducted in-depth research on the relationships between this factor and students’ learning motivation and learning burnout. This study explores the relationships among paternalistic leadership style and medical students’ learning motivation and learning burnout as well as the mediating role of learning motivation.

Methods

A total of 403 valid questionnaires were completed by Chinese medical students on a standardized residency training (SRT) with the paternalistic leadership style scale, the learning motivation scale and the learning burnout scale. Data analysis was conducted using SPSS 28.0 and AMOS 28.0 software.

Results

Both teachers’ paternalistic leadership and learning motivation were significantly negatively correlated with learning burnout among medical students on the SRT; Learning motivation plays a mediated the relationship between paternalistic leadership and learning burnout; Specifically, moral and benevolent leadership have significant negative effects on learning burnout, whereas authoritarian leadership has a significant positive effect on learning burnout.

Conclusions

Enhancing the teachers’ paternalistic leadership of medical college teachers and promoting students’ learning motivation through certain training and activities can effectively alleviate learning burnout among medical students on the SRT and promote a positive academic atmosphere in medical colleges. The results provide reference suggestions and intervention guidance for reducing learning burnout and improving the quality of training for medical students.

Introduction

Standardized residency training (SRT) is an indispensable stage of medical education that plays an important role in cultivating high-quality doctors with independent working ability. The practice of medical education at home and abroad has shown that training is fundamental to strengthening the quality of health personnel and improve the quality and level of medical services [1]. The ultimate goals of SRT are to cultivate high-level and high-quality medical residents, enrich and expand their professional knowledge, enhance their practical operation skills, and improve the quality of the professional care they provide [2]. However, SRT has several problems, such as a relatively weak team of training teachers, weak training management, low learning enthusiasm in students, and insufficient humanistic quality of traditional Chinese medicine [3]. At present, in China, SRT for medical students is mainly a “5 + 3” training model, that is, undergraduate education for 5 years and SRT for 3 years. During the 3-year period of SRT, students mainly perform rotations in clinical departments. Under the guidance of superior teachers, medical students on the SRT carry out clinical diagnosis and treatment activities; receive education and training that combine theory and practice; and focus on cultivating and improving their ability for clinical medical prevention, health care and rehabilitation.

While the demanding nature of SRT is designed to build competence, it also creates an environment where trainees are particularly vulnerable to professional burnout. Learner burnout in medical education is a critical issue, characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment resulting from sustained academic and clinical pressures [4]. Its importance to the discipline cannot be overstated, as it not only jeopardizes the well-being of residents during their training but also has profound implications for the future healthcare workforce. Burnout among medical learners is associated with increased rates of depression and suicidal ideation [5], and it can negatively impact the quality of patient care and professionalism [6]. Therefore, understanding SRT and mitigating learner burnout is essential for fostering a sustainable and effective medical workforce and for upholding the core mission of medical education: to produce compassionate and competent physicians.

In the study of learning burnout in college students, scholars have focused on learning engagement, social support, academic self-efficacy, school belonging [7–10]. There are some papers on the topic of medical students’ learning burnout, with a focus on factors like social support and resilience. Cheng et al. emphasized the buffering role of resilience and social support in mitigating burnout and depression during the early stages of medical education [7]. It was found that adequate support networks, both academic and personal, could help alleviate feelings of burnout [8]. A study highlighted that students with higher empathy levels experienced less burnout due to their enhanced ability to cope with academic pressures [9]. Moreover, Xie et al. explored how the “fear of missing out” contributed to learning burnout among medical students and how the fear could be moderated by personal factors such as resilience and social support [10]. But there are fewer studies have combined paternalistic leadership, learning motivation, and learning burnout together to conduct a deep study among medical students. This study aimed to explore the internal mechanism and external conditions affecting medical students on the SRT in a tertiary hospital, with learning burnout in students as the dependent variable, teachers’ paternalistic leadership style as the independent variable, and learning motivation in students as the mediating variable, to better understand the influencing factors and mechanisms of learning burnout in students and to provide reference suggestions for improving the education of medical students on the SRT.

Theoretical review and research hypotheses

Paternalistic leadership and learning burnout

The concept of paternalistic leadership emerged from Silin’s study of Taiwanese enterprises, which found that their leadership behaviors differed significantly from Western models, marked by high power centralization and hierarchical distance between superiors and staff [11]. These leaders were seen as “parents,” guiding employees with authority and care. Building on this, Redding’s exploration of Chinese enterprises in Hong Kong, Taiwan, and Southeast Asia further outlined characteristics of paternalistic leadership, emphasizing the need for staff’ obedience and leaders as role models [12]. Westwood later proposed a model for Chinese family businesses, identifying didactic leadership and the focus on reputation and power as key aspects [13]. Zheng Boxun’s three-dimensional model of paternalistic leadership—moral, benevolent, and authoritarian leadership—further refined the theory, positioning paternalistic leadership as a style rooted in strict discipline and the dual aspects of affection and authority [14]. In paternalistic leadership, benevolent leadership involves leaders who regard their staff as relatives and show tolerance, love, help, care and encouragement to their staff in work and life, reflecting flexibility; Moral leadership emphasizes strong moral cultivation and restraint in leaders, which means that leaders are strict with themselves, separate their public and private lives, provide correct reference and set a good example for their staff by showing normative behavior; Authoritarian leadership emphasizes the use of power by leaders to control staff’ behavior, often with a strong authoritarian style, an unwillingness to delegate, downlink communication, strict control, and absolute obedience from staff [14]. This definition of paternalistic leadership was adopted in the present study for follow-up research.

While these studies have helped shape the concept of paternalistic leadership, they predominantly focus on organizational and business contexts. The application of this leadership style in educational settings, especially in high-stress environments like medical education, remains underexplored. This gap in the literature becomes critical when examining its relationship with learning burnout, a phenomenon first introduced by Zhang Zhiyao in 1989, which he defined as emotional exhaustion and low personal accomplishment due to academic pressures [15]. However, Zhang’s initial definition did not consider external environmental factors like leadership style, which could either mitigate or exacerbate burnout. Later, Lian Rong’s 2005 definition, which localized the concept to the Chinese context, emphasized physical and mental exhaustion but still failed to account for the influence of leadership styles in educational settings, particularly in medical schools [16].

Lian’s definition is widely adopted in China, yet it does not consider how paternalistic leadership could influence burnout. Leadership interactions, especially in hierarchical academic environments, are significant in shaping students’ experiences of burnout. Research in other fields—such as business and sports—has shown that leadership styles can play a pivotal role in burnout, yet this is not sufficiently addressed in educational research. For instance, Wang Xiaoxin et al. found that self-esteem partially mediated the relationship between academic self-efficacy and burnout, but their study overlooked the role of external leadership factors, including paternalistic leadership [17]. This highlights a crucial gap, particularly in medical residency training, where students face compounded stress from both academic and clinical demands.

Similarly, Liu Xiaohong’s work on teacher-student support identified a negative correlation between supportive teacher-student interactions and burnout, reinforcing the importance of supportive relationships [18]. However, her study did not delve into broader leadership dynamics, such as paternalistic leadership, which includes a combination of authoritarian, benevolent, and moral elements. In medical education, where power dynamics are particularly pronounced, this gap is especially critical.

Recent studies in other domains have explored paternalistic leadership’s effect on burnout. For example, research on Taiwanese athletes found that paternalistic leadership reduced burnout, with benevolent and moral leadership styles providing a protective effect [19]. Similarly, a meta-analysis showed that while authoritarian leadership increases burnout, benevolent and moral leadership styles help alleviate it [20]. However, these studies focus largely on sports and general workplaces, failing to investigate how paternalistic leadership in academic settings—especially in structured, high-pressure environments like medical residency—affects burnout.

In healthcare education, a study applying the Job Demands-Resources (JD-R) model in Malaysia found that benevolent leadership increased work engagement and reduced burnout, while authoritarian leadership had the opposite effect [21]. While these findings suggest that benevolent leadership can be protective against burnout, it remains unclear whether the same holds true in educational settings like medical schools, where students face unique challenges.

A study of special education teachers found that higher perceptions of paternalistic leadership, especially its benevolent aspects, reduced burnout [22]. While this research underscores the potential benefits of supportive leadership, it does not address the unique challenges faced by medical students, nor does it explore the distinct facets of paternalistic leadership. These limitations point to the need for further investigation into how each dimension of paternalistic leadership—authoritarian, benevolent, and moral—affects burnout in medical education.

Given these gaps, the present study aims to critically examine how paternalistic leadership, especially its benevolent and moral dimensions, influences learning burnout in medical students. The study also seeks to investigate how authoritarian leadership, prevalent in medical education, may exacerbate burnout through heightened emotional demands. Thus, Hypothesis H1 posits: Paternalistic leadership has a significant effect on the learning burnout of medical students in the residency training setting. Specifically, moral and benevolent leadership are expected to have a significant negative effect, while authoritarian leadership is expected to have a significant positive effect on learning burnout.

Paternalistic leadership style and learning motivation

In the field of educational psychology, there is no consensus on the definition of learning motivation. The Dictionary of Social Psychology points out that “Learning motivation is a kind of internal power that directly encourages people to learn, is a kind of learning need, which is manifested as learning intention or desire, and plays a role in promoting learning.” Woolfolk defines learning motivation as “a tendency to seek the meaning of learning activities and strive to gain benefits from these learning activities [23]”. Huang Xiting et al. suggested that learning motivation is a type of internal motivation that can motivate people to participate in learning activities that meet individual needs [24]. Feng Zhongliang, on the other hand, suggested that learning motivation motivates individuals to learn, maintain existing learning activities, and participate in learning activities to work toward certain learning goals [25]. Zhang Chunxing used a similar definition by combining the teaching objectives and educational principles of schools; that is, “learning motivation is an internal psychological process, which can cause and maintain learning activities, and make the learning activities address the teaching objectives set by teachers“ [26].

Research indicates that the benevolent and moral dimensions of paternalistic leadership positively influence employee motivation and performance. For instance, a study found that benevolence and morality increased staff’ deference to supervisors and work motivation, while authoritarianism did not significantly affect these outcomes [27]. Several mediating factors influence the relationship between paternalistic leadership and learning motivation. Trust in leadership is a critical mediator, as it fosters a positive emotional connection between leaders and staff, thereby enhancing motivation [28]. Additionally, workaholism and trust in leadership have been identified as pathways through which paternalistic leadership can increase employee work engagement, which is closely related to learning motivation [29]. The effectiveness of paternalistic leadership in enhancing learning motivation can vary across cultural contexts. In Eastern cultures, where paternalistic leadership is more common, it has been found to be as effective as transformational leadership in eliciting positive employee outcomes, including intrinsic motivation [30]. This cultural alignment suggests that paternalistic leadership may be particularly effective in contexts where hierarchical and familial relationships are valued. Paternalistic leadership has been compared with transformational leadership (TL) and leader-member exchange (LMX) in predicting follower outcomes. In the Turkish cultural context, both paternalistic and transformational leadership styles were found to enhance trust in leaders, which in turn boosted employees’ intrinsic motivation to perform OCB [30].

Paternalistic leadership, with its unique blend of authoritarianism, benevolence, and morality, plays a significant role in shaping employee motivation and performance. The positive effects of benevolence and morality, mediated by trust and social connections, highlight the potential of this leadership style in enhancing learning motivation and overall organizational outcomes.

A study suggested that teaching style is a kind of teaching activity that is interactively influenced by various factors, including curriculum teaching objectives, leadership style, and personal image and influence [31]. As a component of teachers’ teaching styles, teacher leadership is bound to have an impact on students’ learning psychology and behavior. In the process of students’ learning and practice, the influence of teachers on students is the most profound and direct, and the teaching style of teachers, whether direct or indirect, profoundly affects students’ learning status and teaching objectives. Thus, Hypothesis H2 was proposed in this study: Paternalistic leadership has a significant effect on learning motivation of medical students on the SRT. Specifically, moral and benevolent leadership have significant negative effects on learning motivation, whereas authoritarian leadership has a significant positive effect on learning motivation.

The mediating role of learning motivation

On the basis of existing studies, numerous studies have investigated the correlation between learning motivation and learning burnout among different student groups, and many scholars agree that learning motivation can effectively predict learning burnout through empirical data regression analysis; thus, it is necessary to further construct a corresponding mediating regulation model. Relevant studies have shown that students with high learning motivation actively ask questions, seek advice, master learning strategies, participate in class, and experience less learning burnout during the learning process [32]. An individual’s learning motivation affects their learning goals, attitude, method and strategy and can encourage them to carry out learning activities [33]. Students with low learning motivation lack interest in learning, disconnect from classroom activities, fail to obtain answers to academic questions, and feel that academic activities are meaningless, which leads to unsatisfactory academic performance and learning burnout [34]. Students with high motivation take pride in their achievements, are actively engaged in academic tasks, and are less likely to experience academic burnout [35, 36]. Self-determination theory also holds that learning motivation is a key factor in students’ completion of learning tasks, which can promote certain behaviors to improve their sense of achievement and realize their self-worth [37]. Learning motivation is the internal force that promotes students’ learning, which promotes their participation in learning activities [38]. Individuals with high learning motivation use more cognitive strategies in the learning process to better absorb learning materials, adapt to the learning environment, reduce stress, improve attendance and are less likely to dropout, thus reducing learning burnout [39]. According to the studies of Rehman U and Alhadabi A, students with high learning motivation are more active in learning, more involved in class, and less prone to learning burnout [32, 33]. Research revealed that students with low learning motivation lack interest in learning, do not interact in class and are more prone to burnout in class [34]. On the basis of existing studies, numerous studies have investigated the correlation between learning motivation and learning burnout among different student groups, and many scholars agree that learning motivation can effectively predict learning burnout through empirical data regression analysis; thus, it is necessary to further construct a corresponding mediating regulation model. Therefore, Hypothesis H3 was proposed: Learning motivation plays a mediating role in the relationship between teachers’ paternalistic leadership style and learning burnout of medical students on the SRT.

Research methods

Research participants

In this study, three medical universities were selected using convenience sampling, and 440 medical students on the SRT from these three universities were chosen as the study participants, and questionnaires were collected on site. The three medical universities are similar in terms of leadership structures, supervisory hierarchies, institutional governance models, clinical workload requirements, and SRT programs. There are no obvious differences that would be expected to affect the results of this study. A total of 403 valid questionnaires were collected. The sample size of 440 questionnaires was determined based on a power analysis (assuming 80% power, 5% margin of error, and 50% response distribution) to ensure statistical robustness, accounting for an anticipated 10% non-response/invalid rate. Participants were randomly selected through the university administration (student counselors or class advisors) using a computer-generated randomization list stratified by department and major to ensure proportional representation. The study was approved by the Ethics Committee of Youjiang Medical University for Nationalities. On-site data collection was conducted by trained research assistants at designated university locations (e.g., classrooms or meeting rooms) during scheduled sessions. Participants completed paper-based questionnaires in private booths to ensure anonymity; no identifying information was collected, and questionnaires were immediately sealed in opaque envelopes upon completion. Participants provided informed consent, were briefed on risks/benefits, and could withdraw anytime without penalty. Generalizability may be limited to similar medical institutions due to the homogeneous professional background of respondents.

Research instruments

Paternalistic leadership scale

In this study, a short version of the Paternalistic Leadership Scale (PLS) [14], compiled by Professor Zheng Boxun et al., Taiwan University was adopted. The scale includes three dimensions with a total of 15 items, namely, the authoritarian leadership (5 items), benevolent leadership (5 items) and moral leadership (5 items). Each item is scored via a five-point Likert scale. In this study, the Cronbach’s α coefficients for all dimensions of the scale were above 0.85, indicating that the scale demonstrates good internal consistency and high data reliability.

Learning burnout scale

This scale was developed by Lian Rong et al. containing a total of 20 items in 3 dimensions [16], including the low mood (8 items), low sense of accomplishment (6 items), and improper behavior (6 items) dimensions. Each item is scored from 1 ~ 5, of which some items are reverse scored. The higher the score is, the greater the degree of learning burnout. In this study, the Cronbach’s α coefficients for all dimensions of the scale were above 0.85, indicating that the scale demonstrates good internal consistency and high data reliability.

Learning motivation scale

The learning motivation scale compiled by Professor Huang Xiting of Southwest University [24], which contains 26 items and is scored via a five-point Likert scale, was adopted in this study. The scale has 6 dimensions, namely, the enterprising (6 items), social orientation (6 items), material pursuit (4 items), fear of failure (4 items), personal achievement (3 items) and small group orientation (3 items) dimensions. In this study, the Cronbach’s α coefficients for all dimensions of the scale were above 0.85, indicating that the scale demonstrates good internal consistency and high data reliability.

Data processing

Regarding the handling of missing data, questionnaires with more than 20% missing values were excluded from the analysis. For the remaining datasets with minor random missing values, mean imputation was employed.

In this study, data analysis was conducted using SPSS 28.0 and AMOS 28.0 software. Common method bias was assessed using Harman’s single-factor test. First, reliability analysis was performed using Cronbach’s α coefficient to examine the internal consistency of each scale. Second, Pearson correlation analysis was employed to explore the relationships among variables, providing preliminary evidence for subsequent hypothesis testing. Third, confirmatory factor analysis (CFA) was conducted to assess the reliability and validity of the measurement model, including composite reliability (CR), average variance extracted (AVE), and discriminant validity. Subsequently, a structural equation model (SEM) was constructed to examine the path relationships among variables. Parameters were estimated using the maximum likelihood (ML) method, and model fit was evaluated using multiple fit indices (χ²/df, GFI, AGFI, RMR, CFI, NFI, RFI, TLI, IFI). Finally, the Bootstrap method for testing mediating effects (with 5,000 resamples and a 95% confidence interval) was applied to verify the mediating role of self-efficacy between paternalistic leadership and work engagement. This method provides robust testing of mediation effects without relying on normal distribution assumptions.

Research innovation

First, the study of learning burnout has attracted the attention of many scholars, but the current academic focus has mostly been on factors such as learning self-efficacy, learning engagement, and academic stress, with less emphasis on leadership style [35]. Although paternalistic leadership has received increasing attention over the past two decades, empirical research on its impact in educational settings, particularly in relation to learning burnout, remains limited. Most previous studies have primarily concentrated on the relationship between paternalistic leadership and staff’ attitudes, such as job satisfaction and organizational commitment [36]. In the field of education, the literature on the relationship between teachers’ paternalistic leadership style and students’ learning burnout is notably insufficient. In China, a large country where Confucian culture prevails, a “paternalistic” behavior style is deeply rooted in the management of enterprises, schools, and hospitals. Despite the prevalence of paternalistic leadership in Chinese culture, the academic community has given little attention to its role in educational management, particularly in the context of medical education. This study explores the relationship between teachers’ paternalistic leadership and learning burnout in medical students during residency training. Second, the study includes learning motivation as a mediating variable in the relationship between teachers’ paternalistic leadership and learning burnout in medical students. While there is a substantial body of research on learning burnout, few studies have explored how paternalistic leadership influences students’ learning burnout through learning motivation. Some research suggests that leadership styles significantly affect students’ motivation and, in turn, their burnout levels [37]. This study contributes to the literature by expanding the exploration of mediating factors in the relationship between paternalistic leadership and learning burnout. By including learning motivation as a mediator, it provides a more nuanced understanding of the pathways through which leadership influences burnout, offering valuable practical insights for the education and management of residency training programs in medical colleges and hospitals.

Research results

Demographic characteristics

Descriptive statistical analysis of the sample’s basic information was conducted using SPSS 28.0. A total of 403 participants were included in the study, among whom 232 were male (57.57%) and 171 were female (42.43%). Regarding years of residency training, 180 participants (44.66%) were in their first year, 114 (28.29%) in their second year, and 109 (27.05%) in their third year. In terms of educational background, 346 participants (85.86%) held a bachelor’s degree, and 57 (14.14%) held a master’s degree.

Common method bias

In this study, SPSS 28.0 was used to conduct a common method bias test, and Harman’s single-factor test was applied through exploratory factor analysis. The results in Table 1 showed that 12 factors with eigenvalues greater than 1 were extracted in the unrotated factor analysis, with the first factor accounting for 28.438% of the variance, which did not exceed the critical threshold of 40%. In the extraction sums of squared loadings, the 12 factors collectively explained 71.111% of the total variance, with the first factor still accounting for 28.438%. After rotation, the variance explained by the first factor decreased to 8.637%, while the 12 factors continued to explain 71.111% of the total variance. These results indicate that there is no serious common method bias in this study, and the data quality is adequate for subsequent statistical analyses.

Table 1.

Total variance explained

Factor	Initial Eigenvalues			Extraction Sums of Squared Loadings			Rotation Sums of Squared Loadings
	Total	% of Variance	Cumulative %	Total	% of Variance	Cumulative %	Total	% of Variance	Cumulative %
1	17.347	28.438	28.438	17.347	28.438	28.438	5.268	8.637	8.637
2	5.880	9.640	38.078	5.880	9.640	38.078	4.393	7.202	15.838
3	2.975	4.877	42.956	2.975	4.877	42.956	4.264	6.990	22.828
4	2.601	4.264	47.219	2.601	4.264	47.219	4.109	6.736	29.564
5	2.474	4.056	51.275	2.474	4.056	51.275	4.020	6.589	36.153
6	2.420	3.966	55.242	2.420	3.966	55.242	3.708	6.079	42.233
7	2.109	3.458	58.700	2.109	3.458	58.700	3.684	6.039	48.272
8	1.955	3.205	61.904	1.955	3.205	61.904	3.668	6.014	54.285
9	1.640	2.688	64.592	1.640	2.688	64.592	3.045	4.992	59.277
10	1.543	2.529	67.122	1.543	2.529	67.122	2.976	4.879	64.157
11	1.282	2.102	69.224	1.282	2.102	69.224	2.178	3.570	67.727
12	1.151	1.887	71.111	1.151	1.887	71.111	2.064	3.384	71.111

Extraction method: Principal component analysis (PCA)

Reliability analysis

In this study, SPSS 28.0 was used to conduct reliability testing of each scale, and Cronbach’s α coefficients were calculated to assess internal consistency reliability. The results in Table 2 showed that the Cronbach’s α coefficients for benevolent leadership (5 items), moral leadership (5 items), and authoritarian leadership (5 items) were all 0.895. The Cronbach’s α coefficient for negative emotions (8 items) was 0.920, for inappropriate behavior (6 items) was 0.903, and for reduced personal accomplishment (6 items) was 0.894. The coefficients for achievement striving (6 items), social orientation (6 items), material pursuit (4 items), fear of failure (4 items), personal achievement (3 items), and small-group orientation (3 items) were 0.899, 0.895, 0.892, 0.867, 0.852, and 0.864, respectively. All Cronbach’s α coefficients exceeded 0.85, indicating that the scales demonstrated good internal consistency and high data reliability.

Table 2.

Cronbach reliability analysis

Variable	Items	Sample size	Cronbach α
Benevolent leadership	5	403	0.895
Moral leadership	5	403	0.895
Authoritarian leadership	5	403	0.895
Low mood	8	403	0.92
Improper behavior	6	403	0.903
Low sense of achievement	6	403	0.894
Enterprising	6	403	0.899
Social orientation	6	403	0.895
Material pursuits	4	403	0.892
Fear of failure	4	403	0.867
Personal achievement	3	403	0.852
Small group orientation	3	403	0.864

Correlation analysis

In this study, Pearson correlation analysis was conducted for each variable using SPSS 28.0. The results in Table 3 showed that benevolent leadership was significantly negatively correlated with learning burnout (r = − 0.405, p < 0.001) and significantly positively correlated with learning motivation (r = 0.303, p < 0.001). Moral leadership was significantly negatively correlated with learning burnout (r = − 0.419, p < 0.001) and significantly positively correlated with learning motivation (r = 0.395, p < 0.001). Authoritarian leadership was significantly positively correlated with learning burnout (r = 0.464, p < 0.001) and significantly negatively correlated with learning motivation (r = − 0.362, p < 0.001). Learning burnout was significantly negatively correlated with learning motivation (r = − 0.436, p < 0.001). These correlation results provide preliminary support for the subsequent structural equation modeling analysis.

Table 3.

Pearson correlation analysis

	Mean Value	SD	Gender	Year of SRT	Education level	Benevolent leadership	Moral leadership	Authoritarian leadership	Learning burnout	Learning motivation
Gender	1.424	0.495	1
Year of SRT	1.824	0.829	-0.096	1
Education level	1.141	0.349	0.069	-0.034	1
Benevolent leadership	3.311	0.856	0.053	-0.009	0.087	1
Moral leadership	3.470	0.856	0.027	-0.053	-0.053	0.322***	1
Authoritarian leadership	2.486	0.892	-0.055	0.043	-0.058	-0.337***	-0.347***	1
Learning burnout	2.422	0.608	-0.010	0.126*	-0.047	-0.405***	-0.419***	0.464***	1
Learning motivation	3.448	0.656	0.032	-0.019	0.079	0.303***	0.395***	-0.362***	-0.436***	1

* p < 0.05 ** p < 0.01 *** p < 0.001

Validity analysis

In this study, AMOS 28.0 was used to conduct confirmatory factor analysis (CFA) on the measurement model to examine the structural validity of the scales. As shown in Table 4, the model fit results indicate that the chi-square to degrees of freedom ratio (χ²/df) is 1.267, which is below the standard threshold of 3; the Goodness-of-Fit Index (GFI) is 0.855, approaching the acceptable criterion of 0.9; the Root Mean Square Residual (RMR) is 0.033, below the standard value of 0.05; the Comparative Fit Index (CFI) is 0.971, exceeding the standard threshold of 0.9; the Normed Fit Index (NFI) is 0.876, close to the acceptable value of 0.9; the Relative Fit Index (RFI) is 0.867, also close to 0.9; the Tucker–Lewis Index (TLI) is 0.969, above the standard threshold of 0.9; the Adjusted Goodness-of-Fit Index (AGFI) is 0.839, approaching the acceptable value of 0.9; and the Incremental Fit Index (IFI) is 0.971, exceeding the standard value of 0.9. Overall, the combination of all fit indices demonstrates that the measurement model has a good overall fit, indicating that the scales possess strong structural validity.

Table 4.

Confirmatory factor model Fit

Indicator	χ²/df	GFI	RMR	CFI	NFI	RFI	TLI	AGFI	IFI
Standard	< 3	> 0.9	< 0.05	> 0.9	> 0.9	> 0.9	> 0.9	> 0.9	> 0.9
Value	1.267	0.855	0.033	0.971	0.876	0.867	0.969	0.839	0.971

In this study, AMOS 28.0 was used to assess the convergent validity of each latent variable. As shown in Table 5, the factor loadings for benevolent leadership, moral leadership, authoritarian leadership, negative emotion, misconduct, reduced personal accomplishment, enterprising spirit, social orientation, material pursuit, fear of failure, personal achievement, and small-group orientation were all greater than 0.5. The AVE values for all constructs exceeded 0.5, and the CR values were all above 0.7. These results indicate that each scale demonstrates good convergent validity.

Table 5.

Convergent validity

Factor	Item	Standardized Coefficient	AVE	CR
Benevolent leadership	BL1	0.774	0.648	0.902
	BL2	0.77
	BL3	0.879
	BL4	0.797
	BL5	0.801
Moral leadership	ML1	0.774	0.638	0.898
	ML2	0.799
	ML3	0.812
	ML4	0.764
	ML5	0.843
Authoritarian leadership	AL1	0.763	0.642	0.9
	AL2	0.82
	AL3	0.757
	AL4	0.816
	AL5	0.846
Low mood	LD1	0.873	0.601	0.923
	LD2	0.82
	LD3	0.774
	LD4	0.81
	LD5	0.812
	LD6	0.725
	LD7	0.757
	LD8	0.596
Improper behavior	IB1	0.73	0.624	0.909
	IB2	0.804
	IB3	0.809
	IB4	0.841
	IB5	0.803
	IB6	0.748
Low sense of achievement	LSA1	0.76	0.592	0.897
	LSA2	0.795
	LSA3	0.76
	LSA4	0.82
	LSA5	0.77
	LSA6	0.708
Enterprising	ENT1	0.828	0.616	0.906
	ENT2	0.805
	ENT3	0.816
	ENT4	0.743
	ENT5	0.752
	ENT6	0.761
Social orientation	SO1	0.804	0.594	0.898
	SO2	0.75
	SO3	0.745
	SO4	0.766
	SO5	0.785
	SO6	0.773
Material pursuits	MP1	0.777	0.685	0.897
	MP2	0.792
	MP3	0.888
	MP4	0.849
Fear of failure	FF1	0.753	0.635	0.874
	FF2	0.796
	FF3	0.801
	FF4	0.835
Personal achievement	PA1	0.842	0.668	0.858
	PA2	0.823
	PA3	0.787
Small group orientation	SGO1	0.812	0.681	0.865
	SGO2	0.857
	SGO3	0.807

In this study, discriminant validity was assessed using AMOS 28.0 by comparing the square root of the AVE for each latent variable with the Pearson correlation coefficients among the variables. The results in Table 6 show that the diagonal values represent the square roots of the AVE for each variable, including: benevolent leadership (0.805), moral leadership (0.799), authoritarian leadership (0.801), negative emotion (0.775), misconduct (0.790), reduced personal accomplishment (0.770), enterprising spirit (0.785), social orientation (0.771), material pursuit (0.828), fear of failure (0.797), personal achievement (0.818), and small-group orientation (0.826).

Table 6.

Discriminant validity: pearson correlations vs. square roots of AVE

	Benevolent leadership	Moral leadership	Authoritarian leadership	Low mood	Improper behavior	Low sense of achievement	Enterprising	Social orientation	Material pursuits	Fear of failure	Personal achievement	Small group orientation
Benevolent leadership	0.805
Moral leadership	0.322	0.799
Authoritarian leadership	-0.337	-0.347	0.801
Low mood	-0.390	-0.384	0.432	0.775
Improper behavior	-0.302	-0.322	0.339	0.513	0.790
Low sense of achievement	-0.309	-0.328	0.375	0.582	0.433	0.770
Enterprising	0.235	0.313	-0.346	-0.293	-0.222	-0.318	0.785
Social orientation	0.225	0.342	-0.315	-0.309	-0.213	-0.370	0.540	0.771
Material pursuits	0.217	0.280	-0.298	-0.315	-0.233	-0.319	0.527	0.527	0.828
Fear of failure	0.150	0.258	-0.243	-0.240	-0.141	-0.237	0.416	0.529	0.415	0.797
Personal achievement	0.238	0.250	-0.182	-0.287	-0.251	-0.231	0.459	0.529	0.460	0.444	0.818
Small group orientation	0.299	0.352	-0.280	-0.316	-0.303	-0.297	0.483	0.579	0.442	0.462	0.458	0.826

All AVE square root values were greater than the correlations between each variable and all other variables. For example, the correlations between benevolent leadership and other variables ranged from − 0.390 to 0.322, all of which were lower than its AVE square root value of 0.805. These results indicate strong discriminant validity among the latent variables, confirming the validity of the measurement model.

Structural equation modeling

In this study, AMOS 28.0 was used to construct a structural equation model (SEM) to test the research hypotheses. As shown in Table 7 and Fig. 1, the results indicate that the chi-square to degrees of freedom ratio (χ²/df) is 1.292, which is below the standard threshold of 3; the Goodness-of-Fit Index (GFI) is 0.940, exceeding the acceptable value of 0.9; the Root Mean Square Residual (RMR) is 0.031, below the standard value of 0.05; the Comparative Fit Index (CFI) is 0.986, greater than the standard of 0.9; the Normed Fit Index (NFI) is 0.942, above the 0.9 threshold; the Relative Fit Index (RFI) is 0.933, above 0.9; the Tucker–Lewis Index (TLI) is 0.984, exceeding 0.9; the Adjusted Goodness-of-Fit Index (AGFI) is 0.926, higher than the acceptable standard of 0.9; and the Incremental Fit Index (IFI) is 0.984, also above 0.9. Taken together, these fit indices demonstrate that the structural equation model exhibits excellent overall fit, indicating a high degree of consistency between the model and the observed data and confirming that the model effectively explains the relational structure among the variables.

Table 7.

SEM Fit Indices

Indicator	χ²/df	GFI	RMR	CFI	NFI	RFI	TLI	AGFI	IFI
Standard	< 3	> 0.9	< 0.05	> 0.9	> 0.9	> 0.9	> 0.9	> 0.9	> 0.9
Value	1.292	0.940	0.031	0.986	0.942	0.933	0.984	0.926	0.984

Fig. 1.

SEM path diagram

In this study, AMOS 28.0 was used to examine the path coefficients and analyze the direct effects among variables. As shown in Table 8, the results indicate that benevolent leadership has a significant positive effect on learning motivation (β = 0.141, S.E. = 0.037, C.R. = 2.472, p = 0.013). Moral leadership also has a significant positive effect on learning motivation (β = 0.310, S.E. = 0.040, C.R. = 5.224, p < 0.001). In contrast, authoritarian leadership has a significant negative effect on learning motivation (β = − 0.250, S.E. = 0.037, C.R. = − 4.242, p < 0.001).

Table 8.

Path coefficients

Path			Unstandardized coefficients	Standardized coefficients	S.E.	C.R.	P
Learning motivation	<---	Benevolent leadership	0.141	0.092	0.037	2.472	0.013
Learning motivation	<---	Moral leadership	0.310	0.206	0.040	5.224	***
Learning motivation	<---	Authoritarian leadership	-0.250	-0.159	0.037	-4.242	***
Learning burnout	<---	Learning motivation	-0.250	-0.281	0.069	-4.061	***
Learning burnout	<---	Benevolent leadership	-0.227	-0.168	0.041	-4.135	***
Learning burnout	<---	Moral leadership	-0.198	-0.148	0.043	-3.438	***
Learning burnout	<---	Authoritarian leadership	0.289	0.207	0.041	5.034	***

Learning motivation has a significant negative effect on learning burnout (β = − 0.250, S.E. = 0.069, C.R. = − 4.061, p < 0.001). Benevolent leadership has a significant negative effect on learning burnout (β = − 0.227, S.E. = 0.041, C.R. = − 4.135, p < 0.001), and moral leadership also shows a significant negative effect (β = − 0.198, S.E. = 0.043, C.R. = − 3.438, p < 0.001). In contrast, authoritarian leadership exhibits a significant positive effect on learning burnout (β = 0.289, S.E. = 0.041, C.R. = 5.034, p < 0.001). These path analysis results support the research hypotheses, indicating that leadership styles exert indirect effects on learning burnout through learning motivation.

Mediation effect analysis

In this study, the Bootstrap procedure in AMOS 28.0 (with 5,000 resamples and a 95% confidence interval) was used to test the mediating effect of learning motivation between leadership styles and learning burnout. As shown in Table 9, the indirect effect of benevolent leadership on learning burnout through learning motivation was − 0.026, with a 95% confidence interval of [–0.072, − 0.002]. Since the confidence interval does not contain zero, the mediating effect is significant (p = 0.030).

Table 9.

Mediation effect

Parameter	Estimate	Lower	Upper	P
Benevolent leadership-> Learning motivation-> Learning burnout	-0.026	-0.072	-0.002	0.030
Moral leadership-> Learning motivation-> Learning burnout	-0.058	-0.112	-0.022	0.001
Authoritarian leadership-> Learning motivation-> Learning burnout	0.045	0.017	0.090	0.001

The indirect effect of moral leadership on learning burnout through learning motivation was − 0.058, with a 95% confidence interval of [–0.112, − 0.022], indicating a significant mediating effect (p = 0.001). The indirect effect of authoritarian leadership on learning burnout through learning motivation was 0.045, with a 95% confidence interval of [0.017, 0.090], and the interval does not include zero, demonstrating a significant mediating effect (p = 0.001). Overall, the mediation analysis results indicate that learning motivation plays a significant mediating role between all three leadership styles and learning burnout, supporting the hypothesized mediating effect of learning motivation.

Discussion

The relationship between teachers’ paternalistic leadership style and learning burnout in medical students on the SRT

The results of this study showed that paternalistic leadership is significantly related to learning burnout. Both benevolent leadership and moral leadership have a negative effect on learning burnout, whereas authoritarian leadership has a positive effect on learning burnout, and this aligns with the result of previous research [38]. These findings can be explained through several mechanisms. First, moral leadership, by demonstrating exemplary values, ensuring organizational fairness, and maintaining high standards of behavior, can enhance residents’ perception of organizational justice and professional meaning, strengthen intrinsic motivation and professional self-identity, and thereby reduce burnout—particularly by alleviating emotional exhaustion and depersonalization [39]. Previous studies have also shown that moral or ethical leadership can significantly reduce emotional exhaustion and burnout among nurses and resident physicians [40].

Second, benevolent leadership, characterized by care, emotional support, and practical resources (e.g., guidance, schedule adjustments, and psychological support), addresses staff’ needs and serves as an important job resource, buffering the stress caused by high job demands and enhancing self-efficacy and psychological capital. As a result, it significantly reduces learning and work-related burnout [41]. Empirical studies in both nursing and medical contexts have consistently found that benevolent or caring leadership is associated with lower emotional exhaustion, higher work engagement, and stronger organizational commitment [42]. In contrast, authoritarian leadership, emphasizing control, commands, strict punishment, or preferential treatment, restricts residents’ autonomy, reduces decision-making participation, and undermines perceptions of organizational justice. Over time, this can trigger feelings of powerlessness, emotional exhaustion, and occupational burnout. Additionally, an authoritarian climate may erode psychological capital, such as hope, optimism, and self-efficacy, making individuals more susceptible to burnout cycles [43].

Furthermore, from the perspective of the Job Demands–Resources (JD-R) model, moral and benevolent leadership provide job resources (social support, guidance, and clear values) that activate the “motivational pathway,” enhancing satisfaction and resilience and reducing burnout. Conversely, authoritarian leadership increases psychological and emotional demands while reducing resource accessibility, thereby activating the “health impairment pathway” and increasing burnout. Recent theoretical and empirical studies also support incorporating different leadership styles into the JD-R framework to explain their divergent effects on employees’ mental health and occupational behaviors [42–43].

The relationship between teachers’ paternalistic leadership style and learning motivation in medical students on the SRT

The results showed that teachers’ paternalistic leadership style is significantly related to — and has a significant influence on — the learning motivation of medical students undergoing SRT. Both benevolent leadership and moral leadership positively influence learning motivation, whereas authoritarian leadership negatively influences it. These findings align with previous research [44]. These findings can be further understood through multiple mechanisms.

First, benevolent and moral leadership provide important job resources such as emotional support, guidance, and moral modeling, which enhance individuals’ sense of meaning, self‑efficacy, and commitment, and thereby bolster motivation and engagement rather than burnout or disengagement [45]. Similarly, in a healthcare context, benevolent and moral leadership have been shown to positively predict constructive behaviors (e.g., innovative or helping behaviors) and reduce harmful behaviors, supporting the idea that they promote adaptive motivation and functioning [41].

Second, under benevolent or moral leadership, staff tend to perceive higher psychosocial safety and stronger supervisor support, which fosters psychological empowerment and resilience in the face of high demands — a condition particularly relevant for medical students in SRT who face steep learning curves and heavy clinical pressures [42]. By contrast, authoritarian leadership tends to emphasize control, demands obedience, and often neglects subordinate autonomy and psychological needs; such a leadership climate may heighten stress, reduce intrinsic motivation, and undermine self‑determination, leading to reduced learning motivation or even motivation avoidance [46].

Third, the protective effect of benevolent and moral leadership — and the detrimental effect of authoritarian leadership — aligns with the logic of the Job Demands–Resources (JD-R) model: benevolent/moral leadership acts as a resource that buffers demand and supports engagement and motivation, while authoritarian leadership increases job demands without providing corresponding resources, thus impairing well‑being and lowering motivation [47].

The mediating role of learning motivation in the relationship between paternalistic leadership style and learning burnout

This study showed that learning motivation plays a mediating role in the relationship between paternalistic leadership style and learning burnout, suggesting that a paternalistic leadership style can reduce learning fatigue by improving learning motivation. This finding aligns with previous research [48]. Therefore, the mediating role of learning motivation identified in this study reveals a key psychological pathway through which paternalistic leadership influences learning burnout [49]. This mechanism aligns with self-determination theory and social–cognitive perspectives, which both highlight the protective value of intrinsic motivation and perceived competence in buffering against burnout [50].

Empirical evidence supports this pathway. Prior studies demonstrate that academic motivation, often together with hope, meaning, or engagement, predicts lower levels of learning burnout [51]. Furthermore, complementary findings show that learning motivation can mediate the relationship between stressors, social support, and well-being [52]. In broader educational and sport contexts, research also indicates that coaches’ or principals’ paternalistic leadership exerts cross-level effects on followers’ burnout, partly transmitted through motivational or psychological resource mechanisms [48]. Taken together, these findings suggest that enhancing learning motivation is not only a key psychological route through which paternalistic leadership reduces learning burnout but also a practical strategy for academic leaders and medical educators seeking to foster healthier and more sustainable learning environments. Future studies may further test this causal chain using longitudinal or experimental designs while distinguishing the differential effects of benevolent, moral, and authoritarian leadership behaviors.

Implications

Systematically incorporating training on paternalistic leadership styles into the qualification certification and continuous development system for residency training supervisors

Research findings clearly indicate that moral leadership and benevolent leadership exhibits a significant negative correlation with learning burnout, whereas authoritarian leadership produces negative effects. Therefore, medical education management should prioritize the development of supervisors’ leadership styles as a core teaching competency. Specifically, dedicated “Teaching Leadership” modules can be established within both pre-service training and annual refresher courses for supervisors. These modules should be grounded in the theoretical framework of paternalistic leadership. Utilizing methods such as role-playing, case analysis, and reflective discussion, they should guide supervisors to understand the differential impacts of the three leadership dimensions. Supervisors should be encouraged to deliberately practice specific behaviors associated with moral leadership (e.g., leading by example, fairness, and impartiality) and benevolent leadership (e.g., individualized consideration, emotional support), while consciously recognizing and reducing authoritarian leadership behaviors (e.g., dictatorial decision-making, excessive control). By incorporating the demonstration of leadership styles into the assessment and recognition system for supervisors, teaching behaviors can be institutionally steered towards positive directions [53]. This approach is strongly supported by organizational behavior research, which shows that targeted leadership training can effectively change managers’ behavioral patterns and ultimately improve staff’ psychological states and performance [54].

Constructing a dynamic assessment and early intervention mechanism with learning motivation as a key monitoring indicator

Given the pivotal mediating role of learning motivation in the “paternalistic leadership style-learning burnout” pathway, its continuous monitoring and proactive intervention are more forward-looking and effective than solely focusing on the outcome of burnout. Educational management departments should reform the existing assessment methods, which often rely on single end-of-term evaluations, and establish a dynamic assessment mechanism for learning motivation that spans the entire rotation cycle. For instance, drawing on established psychological scales such as the Academic Motivation Scale (AMS) to assess learning motivation [55], and the Paternalistic Leadership Scale to evaluate perceptions of supervisors’ leadership styles [56], brief electronic questionnaires can be developed to anonymously survey students at the mid-point and end of rotations. These questionnaires can quickly assess students’ levels of learning motivation and their perceptions of their supervisors’ leadership styles, providing valuable insights into their educational experiences.

When data indicates a significant decline in motivation levels among a student group within a specific department or under a particular supervisor, the educational management should not remain passive but instead activate an early warning and support system. This involves providing timely communication and feedback to the relevant supervisor or offering academic tutoring and psychological support to the affected students. The theoretical basis for this data-driven, precise intervention lies in Self-Determination Theory, which emphasizes that satisfying individuals’ needs for autonomy, competence, and relatedness is key to maintaining high-quality motivation [57]. Dynamic monitoring serves to ensure these psychological needs are continually met.

Fostering a supportive organizational climate through a “University-Department-Supervisor” tri-level linkage to mitigate burnout risks at the systemic level

Students’ learning experiences are influenced not only by their immediate supervisors but are also deeply embedded within the culture and climate of the entire training organization. Therefore, alleviating learning burnout requires building a multi-level support system. At the university level, clear policies should be established that prioritize caring for students’ physical and mental health and promoting their professional growth as core teaching values. This can be reinforced by instituting awards for “Excellent Supervisors” (specifically highlighting moral and benevolent leadership behaviors) to role-model positive practices. At the department level, department heads play a crucial role in fostering an open, inclusive, and collaborative team atmosphere. Regularly organizing academic activities such as teaching rounds and case discussions can enhance students’ sense of belonging and competence. At the supervisor level, the establishment of “teaching communities” should be encouraged, providing platforms for supervisors to exchange ideas, collaboratively address teaching challenges, and share the burden of student support. This systemic support can effectively counteract the potential negative effects of authoritarian leadership and provide fertile ground for the growth of moral and benevolent leadership [58]. Research confirms that organizational-level support is one of the most significant protective factors against professional burnout among healthcare workers, and positive leadership alongside a supportive culture can significantly enhance employee well-being and retention intentions [59].

Limitations

Although this study provides valuable insights into the relationships among teachers’ paternalistic leadership, learning motivation, and learning burnout among medical students on SRT, its limitations that should be acknowledged. Firstly, this study is confined to three medical colleges, which limits the generalizability of the findings. To enhance generalizability, future studies should replicate the current analysis across multiple medical schools and SRT training bases with diverse student populations from different regions or countries. Secondly, this study relied on self-reported data, which may introduce biases, such as social desirability and recall bias. Future research should incorporate mixed-method approaches, such as interviews or focus groups, to triangulate self-reported data and capture more nuanced perspectives. Thirdly, this study uses a cross-sectional design, which limits its ability to infer causality or observe changes over time. Future studies could adopt a longitudinal design to explore how teachers’ paternalistic leadership and learning motivation influence learning burnout over different stages of medical education.

Conclusion

This study demonstrates that the paternalistic leadership style of teachers significantly influences both learning burnout and motivation among medical students on the SRT. Moral and benevolent leadership styles are negatively correlated with burnout and positively correlated with motivation, whereas authoritarian leadership shows the opposite effects. Additionally, learning motivation serves as a mediating factor between leadership styles and burnout, highlighting its pivotal role in mitigating adverse outcomes. These findings underscore the importance of adopting ethical and supportive leadership approaches to enhance resident well-being and educational engagement. Therefore, enhancing the teachers’ moral and benevolent leadership of teachers and promoting students’ learning motivation through certain training and activities could effectively alleviate learning burnout among medical students on the SRT and promote a positive academic atmosphere in medical universities. This study provided strong practical reference value for the education and management of residential training hospitals and medical colleges.

Future studies could explore several avenues to build on these findings. For example, longitudinal research could examine how changes in teacher leadership over time affect student motivation and burnout. Further research might also investigate the role of cultural, institutional, or disciplinary differences in shaping these relationships. Additionally, studies could consider other potential mediating or moderating factors, such as peer support, self-efficacy, or coping strategies, to provide a more comprehensive understanding of how leadership styles impact medical students’ learning outcomes.

Authors’ contributions

Dongdong Wang: acquisition, conception and design of the study, analysis and interpretation of the data, and drafting of the article, critical revision of the article for important ideological content; Baitong Zhu: analysis and interpretation of the data, critical revision of the article for important ideological content; Chunyu Song: analysis and interpretation of the data; Dandan Xie: acquisition, analysis and interpretation of the data and drafting of the article, critical revision of the article for important ideological content; Zhuangnian Lu: acquisition, analysis and interpretation of the data and drafting of the article, critical revision of the article for important ideological content. All authors reviewed the manuscript.

Funding

Not applicable.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethical approval and consent to participate

The study passed a medical ethics review, and the entire process of the project was supervised by the Medical Ethics Committee of Youjiang Medical University for Nationalities. The study was approved by the Ethics Committee of Youjiang Medical University for Nationalities. The study is in compliance with the Helsinki Declaration. Written informed consent was obtained from the participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.