critique and FEEDBACK NEEDED only to help me identify what I need to improve in my research paper. I conducted and wrote the research below. I need an expert in statistics to help provide detailed feedback on my research paper. I need to know from an statistical/epidemiological standpoint if I'm missing and key points, data, information, etc. any and all comments and feedback to help improve the paper below is appreciated.

Research Problem Employers seek to identify and minimize the causes and effects of burnout on healthcare workers today. Purpose Statement Within this research proposal, we hope to present a logical design for solving one possible explanation of the research problem stated. It has been found that burnout has many causative factors both externally and internally within the individual. External factors include "high demand, time pressure, bad atmosphere, hierarchy, poor work organization, lack of resources, lack of positive feedback, poor teamwork, absence of social support", and more (De Hert, 2022). Internal factors include "high (idealistic) self-expectations, perfectionism, need for recognition, suppressing own needs, feeling irreplaceable, work as a substitute for social life", and more (De Hert, 2020). It can be inferred that a pandemic can directly bring to light some of the external factors, especially high demand and lack of resources. With recent events of the COVID-19 pandemic, it is essential to establish any correlations to further understand and prevent burnout. Burnout has been seen to have negative impacts on both physical and emotional wellbeings. In the study, burnout in healthcare in relation to pandemics will primarily be evaluated using quantitative methods of data collection from controlled quota sampling through surveying during times with and without the COVID-19 pandemic. Literature Review Burnout is defined as, "the progressive psychological response to chronic work-related stress, involving emotional and psychological symptoms, medical issues, and a feeling of reduced personal accomplishment" (Aragon, 2018). Through previous research burnout has been carefully assorted into the following stages, "Stage 1: Honeymoon Phase, Stage 2" Onset of 2 Stress, Stage 3: Chronic Stress, Stage 4: Burnout, and Stage 5: Habitual Burnout" (De Hert, 2020). Physical exhaustion begins at the start of Stage 2: Onset of Stress. Physical illnesses can be a direct result of burnout including "cardiovascular disease and elevated rates of substance abuse" (Zubairi & Noordin, 2016). This in turn may lead to decreased performance and an increase in medical errors. Arising slightly later at the end of Stage 2: Onset of Stress comes with mental and emotional exhaustion. Maslach and Jackson's three-dimensional syndrome categorizes the feelings of burnout into "emotional exhaustion, desensitization, and personal success" (Sengul et al., 2021). The three-dimensional syndrome has been utilized in several research studies: An emergency department in North India found "more than half of the nurses (54%) reported high and 37% reported a moderate level of burnout in emotional exhaustion", "52%...expressed a moderate level of depersonalization", and "12.5% had a high level of reduced personal accomplishment" (Jose et al., 2020). This design allowed the researchers to identify the level and type of burnout within the population as compared to the causation we seek to determine from pandemics. Previous research has also been conducted comparing burnout within professions, genders, countries, and more. It is notable, that the incidence of burnout among "practicing physicians [in the United States] exceeds 50%" (Rothenberger, 2017). Nurses as discussed previously are also high among those that feel impacted by burnout. As it is known that feelings are unique to each individual it was found overall that females tend to feel higher levels of "emotional exhaustion" and "desensitization" whereas males tend to be impacted greater by a "lower dimension of personal success" (Sengul et al., 2021). This can be attributed to gender roles within society as men are held to a higher standard for success but are not as apt to share emotions. Consider that more developed countries have a lower correlation between stressors 3 leading to burnout than developed countries, with that being said the United States showed a higher correlation between those that felt burnout but "stay in [the] hospital" anyway (Ohue et al., 2021). These differences can be accounted to resources and cultural customs to work through tough times. The findings of past research put an emphasis on the usefulness of the implications of the study as well as helped to determine the methodology for this study, such as the qualifications of the participants. Research Question Our research question is, do pandemics cause a higher incidence of burnout among healthcare professionals? Hypotheses The null hypothesis is there is not a significant difference in the burnout rates of healthcare professionals in the United States during and not during times of a pandemic (ie. COVID-19). The research (alternative) hypothesis is there is a significant difference in the burnout rates of healthcare professionals in the United States during and not during times of a pandemic (ie. COVID-19). Methodology Participants Participants will include groups of critical care physicians, nurses, surgeons, and social workers in the United States of middle age and mid-socioeconomic classes to get a holistic view of our population. There will be 24 males and 76 females that fit these categories surveyed as the population ratio of "76% female professionals, and 24% male professionals" are accurately represented (Gender Equality in the Health Care Industry, 2019). The population wanting to be represented by the sample is healthcare professionals. Choosing several professions within the 4 critical care specialty is intentional as it incorporates the different roles while providing the most efficient way to identify the effects of a pandemic as critical care patients are most likely to have been documented. This is due to the fact that non-critical covid patients likely were not treated as lack of resources and personal desires. A middle-aged group being 30-55 years for the purpose of this study was seen to have a "negative association" with "emotional exhaustion and total burnout" (Marchand et al., 2018). Another reason behind this middle-aged group chosen is the elimination of bias from the two extremes of highly experienced and inexperienced workers that might react differently to a pandemic based on the experience of seeing dangers in healthcare before and not. This is ideal for the study to assure that age as a factor causing burnout is eliminated. Using a mid-socioeconomic class helps to further block out bias from other factors contributing to burnout as well as targets the majority of our population. It is seen that "low socioeconomic status (SES) is known to be associated with more frequent mental health problems" which in turn would be more susceptible to burnout as mental and emotional exhaustion plays a huge role (Kim & Cho, 2020). With that being said, the United States is targeted as being a developed country lack of resources, for example, will not cause as exaggerated results as an underdeveloped country might. Sampling Procedures To receive our sample in which data will be collected from a controlled quota sampling through a survey will be used. Quota sampling can be defined as "a type of non-probability sampling where researchers will form a sample of individuals who are representative of a larger population" (Simkus, 2022). In the study qualifications of the participants were established to best represent the entire population of healthcare workers which is not accessible. Researchers will contact critical care units to provide lists of their healthcare professionals that meet the 5 participant qualifications. Those individuals will then be reached out to directly to answer the survey questions. This will prevent voluntary bias that comes from sending a survey via email link. Data Collection A survey of qualified participants claiming what stage of burnout they felt during times with and without a pandemic. Choosing the same individual to report their experience during both time periods minimizes potential bias from internal factors such as varying interpretations of one's own emotions. The scale will be as follows, Stage 1: Honeymoon Phase, Stage 2: Onset of Stress, Stage 3: Chronic Stress, Stage 4: Burnout, and Stage 5: Habitual Burnout (De Hert, 2020). Note a scale allows feelings that are typically qualitative data to be turned into quantitative data for a statistical value that best suits the goal of this experiment. Data Analysis The average of the numbers during the pandemic and the average of the numbers without the pandemic will be taken. The standard deviation will be calculated to determine any variance that can occur. Which should be heavily considered when using the end inferential statistic for the population. A dependent-sample t-test will be conducted with a significance level of 0.05 and a degree of freedom of 99 (100-1). This test will provide the difference in the mean and standard deviation of the two dependent groups of burnout with and without COVID-19 to provide a t-value and a p-value. As the two means being compared are at differing time periods a dependent sample t-test is appropriate. For this experiment, we will focus on the p-value which indicates when to reject the null hypothesis (p is less than or equal to the significance level) or when to accept the null hypothesis (p is more than the significance level). In other words, if we reject the null hypothesis we accept the research hypothesis concluding that there is a significant 6 difference in burnout in healthcare professionals within COVID-19 versus without and vice versa. Anticipated Results Based on previous research we anticipate the null hypothesis will be rejected. It is predicted that pandemics have a positive correlation to burnout in healthcare professionals as increased patients, decreased resources and high demand for workers feed an ongoing cycle. This cycle will continue until something gives, whether that be the patients get better (or even pass), the resources or the workers quit due to high amounts of burnout. Limitations Limitations to this study can be found in bias, despite efforts of prevention. The major source is the controlled quota sampling procedure. With a population so large that differs in the many qualities previously proven to impact burnout, it is nearly impossible to perform a random sample including everyone while eliminating the varying factors of burnout. To offset some of the bias that may come from such a sampling technique the ratio of the males/females within the population was reflected in the sample. Another source of bias can come from the interpretation of the participant's feelings when placing themselves into stages during the survey. Recall bias can also play a role as participants will be asked to remember their feelings during times of COVID-19, which was at its height in 2019-2020. All limitations should be considered when analyzing the results of the study. Implications If the alternative hypothesis is accepted, pandemics such as COVID-19 lead to increase burnout among healthcare professionals. Careful consideration of this can combat the effects before and during these times. For example, studies have found care pathways "are effective 7 interventions for improving teamwork, increasing the organizational level of care processes, and decreasing risk of burnout for health care teams in an acute hospital setting" (Deneckere et al., 2013). This study can build with those of the past that identify what characteristics are most susceptible to burnout by adding when burnout may be more prevalent (like times of pandemics). The ladder will help employers learn how and when to implement programs like that of care pathways. Ultimately, it is important to improve the statistic that "of U.S. physicians that would recommend medicine careers to younger people [is] 46%" (Michas, 2021). Recommendations for careers stem from overall happiness with a career, which leads to happiness in life in general. Burnout can greatly reduce both mental and physical health and takes a toll. As a society, it is important to help those that help us daily by bringing awareness to, improving knowledge upon, and creating combative action towards burnout in healthcare professionals. Directions for Future Research Further research should explore what best prevents burnout, including the best procedures for care pathways. Discovering how to create a stress-free work environment can be the key to the reduction of burnout. Although research has already looked into how age, sex, nationalities, and social economic status can be additive to the effects of burnout data is ever-changing and should continue to be collected. Conclusion Burnout is ever so present in the world we live in today. It is caused by internal and external factors that contribute to continually stressful environments. Many contributions such as age, sex, nationality, and socioeconomic class have been found to drive burnout. This study aims to find if pandemics cause burnout rates of healthcare professionals to significantly increase through a controlled quota sampling technique. It is predicted that the null hypothesis that states 8 there is not a significant difference in the burnout rates of healthcare professionals in the United States during and not during times of a pandemic (ie. COVID-19) will be rejected. With goals to gain knowledge on when times of extreme burnout within the medical field may occur. The overall happiness of healthcare professionals can be improved through future research on preventative measures during tougher times.