Perceived value, structural barriers, and academic burnout under the "hard science" versus "soft skills" paradox: a cross-sectional study among Chinese medical students

Background Medical education systems worldwide often grapple with a "hidden curriculum" that prioritizes biomedical knowledge over humanistic training, potentially fostering academic burnout. While this tension between "hard science" and "soft skills" is a global phenomenon, little is known about how students' specific cognitive appraisals of medical humanities courses—specifically the tension between their perceived value and perceived barriers—impact their psychological well-being. This study aims to deconstruct this "cognitive paradox" and investigate the multivariate relationship between humanities cognition and academic burnout among clinical medical students. Methods A cross-sectional study was conducted among 165 undergraduate clinical medical students in Shaanxi, China. Participants completed the Medical Humanities Cognition Scale (assessing perceived value and structural barriers) and a modified Maslach Burnout Inventory – Student Survey . Data were analyzed using descriptive statistics, Pearson correlation, and Canonical Correlation Analysis (CCA) to evaluate the holistic mechanism between the cognition variable set and the burnout variable set. Results Students demonstrated a "cognitive dissonance" profile: high recognition of humanities' value ( M  = 4.25) coexisting with moderate perceived barriers ( M  = 3.06). Crucially, bivariate analysis revealed no significant correlation between perceived value and perceived barriers ( r = -0.075, P  > 0.05), indicating these are independent constructs. The CCA identified a significant primary pathway ( r _c = 0.502, P  < 0.001). Structure coefficients revealed that a cognitive profile of "High Value (0.760) combined with Low Barriers (-0.705)" served as a strong predictor buffering burnout. Notably, within the burnout set, Cynicism carried the highest structural weight (-0.796), surpassing Emotional Exhaustion (-0.678). This suggests that cognitive barriers primarily precipitate psychological detachment rather than mere fatigue. Conclusions The independence of perceived value and barriers suggests that current educational strategies focusing solely on "ideological persuasion" (increasing value) are insufficient to mitigate burnout. Instead, structural barriers in the curriculum actively foster cynicism. Therefore, medical education reform must shift from an "additive" model to an "integrative" one, embedding humanities into clinical practice to lower structural barriers, thereby safeguarding the professional integrity and empathy of future physicians, particularly within high-intensity medical curricula globally.