Stress, coping and health: enhancing well-being during medical school

Physical literacy and health of Chinese medical students: the chain mediating role of physical activity and subjective well-being

Background/objective

While Physical Literacy has been highlighted as a determinant in health in recent study, there is a dearth of studies examining its effect on physical health, and there is a little in the way of empirical data linking Physical Literacy to health outcomes. Accordingly, further empirical research is needed to clarify the mechanisms by which Physical Literacy affects physical health. The purpose of this study was to verify the role of medical students' Physical Literacy on Health-related quality of life as well as to explore the chain mediating role of Physical Activity and Subjective Well-being in it.

Methods

This study utilized a cross-sectional study design. The Physical Literacy, Health-related Quality of Life, Physical Activity ratings, and Subjective Well-being of students at Shanxi Medical University were all measured using an online survey administered in September 2023. A total of 1968 valid questionnaires were returned. First, descriptive statistics and correlation analysis were performed using SPSS software. Second, PROCESS was used to test the mediating role. Finally, we used structural equation modeling (Amos) to test the model fit.

Results

There is a significant correlation between all variables. After mediation effects analysis, we found that there were three indirect pathways of physical literacy on health-related quality of life: a single mediating effect of physical activity, a single mediating effect of subjective well-being, and a chained mediating effect of physical activity-subjective well-being.

Conclusion

The mediating role of physical activity and subjective well-being on the relationship between physical literacy and health-related quality of life has been confirmed. Our research results support the integration of physical literacy into physical education teaching and the modification of curriculum content by physical education teachers as part of efforts to enhance students' physical activity levels, subjective well-being levels, and overall health. This study provides a new perspective for intervention in improving the health of medical students.

Exploring the Relationship Between Imposter Phenomenon and Myers-Briggs Personality Types in Pharmacy Education

OBJECTIVE

To investigate the relationship between imposter phenomenon (IP) and Myers-Briggs Type Indicator (MBTI) personality types in pharmacy students.

METHODS

This was a retrospective, observational study of doctor of pharmacy students who had previously completed MBTI and Clance Imposter Phenomenon Scale (CIPS) assessments. CIPS scores and categories were compared between the 4 MBTI personality type dichotomies using independent samples t tests and chi-square.

RESULTS

Mean CIPS score for included pharmacy students (N = 668) was 62.52 (SD 14.82). Clance Imposter Phenomenon Scale scores were significantly higher in students with MBTI of introversion (mean 64.14, SD 14.27), intuition (mean 63.80, SD 15.78), and perceiving (mean 64.38, SD 15.55) as compared to their dichotomous counterparts. No significant difference in mean CIPS scores was found within the thinking/feeling dichotomy. When analyzing IP risk associated with the various MBTI personality dichotomies, introverts were at a 1.8 times greater risk of high/severe IP than extroverts. Additionally, students with perceiving personality types were at a 1.4 times greater risk of high/severe IP than those with judging personality types.

CONCLUSION

Our study suggests that pharmacy students with introversion, intuitive, and perceptive personality types exhibit higher CIPS scores, and those with introversion or perceptive personality types are at risk for high/severe IP. Given the common MBTI types and a high degree of IP in pharmacy students, our findings underlie the need for open, targeted discussions about IP and proactively incorporating strategies and resources within a curriculum to support students in normalizing and easing anxiety.

The prevalence of stress among medical students in Syria and its association with social support: a cross-sectional study

INTRODUCTION

Chronic stress can interrupt personal life and cause fatigue, inability to concentrate, and irritability. This study aims to determine the prevalence of stress and its associated factors among medical students in Syria and whether social support could be a protective factor against stress.

METHODS

A cross-sectional study was conducted in the faculty of medicine of five Syrian universities. The Medical Student Stressor Questionnaire (MSSQ) was used to evaluate the stress caused by the possible sources of stress. And Social Support Questionnaire - short version (SSQ - short version) was used to assess the social support that medical students received from family, friends, and their fellow medical students using six questions.

RESULTS

A total of 1472 medical students participated in the study. Among the total participants, 671 (45.6%) were males, and 801 (54.4%) were females. The majority of the participators had mild (50.6%; n = 745) and moderate (37.0%; n = 545) stress levels. Academic-related stressors were the most important cause of stress among undergraduate medical students. Social support was provided equally to both genders, and genders reported the same degree of satisfaction.

CONCLUSION

Our results emphasize the importance of improving the curricula, providing mental health consultants for students, and paying more attention to the mental health of female students. Finally, students in their clinical years should also receive mental health care, decreasing their duties and providing more self-free time.

The Appraisal of Self-Care Agency Scale-Revised (ASAS-R): Reliability and Validity among Portuguese Medical Students

Self-care agency plays an important role in an individual's health. Considering the particularities of their education, it can be a protective factor for the mental health of medical students. This study aims to validate the Portuguese version of the Appraisal of Self-care Agency Scale-Revised (ASAS-R) in Portuguese medical students. A cross-sectional, quantitative, and analytical online study was conducted between 23 April 2021, and 15 July 2021. Exploratory factor analysis (EFA) was performed to test the internal structure of the ASAS-R. Correlations with the SHS (Subjective Happiness Scale), SWLS (Satisfaction with Life Scale), and MHI (Mental Health Inventory) were calculated using Pearson's coefficient so as to test convergent validity. Internal consistency was evaluated using inter-item correlation, corrected item-total correlation, and Cronbach's alpha. The total sample included 781 individuals. EFA yielded a 3-factor solution accounting for 53.9% of the explained variance. Pearson's coefficients obtained between the 3 factors of ASAS-R and the total scores of the 3 construct-related scales demonstrated adequate convergent validity. Total Cronbach's alpha value was 0.85, while the Cronbach's alpha of the three factors was 0.81, 0.55, and 0.83, respectively. This study demonstrated that ASAS-R is a valid and reliable instrument for measuring self-care agency among Portuguese medical students.

Somatization symptoms-prevalence and risk, stress and resilience factors among medical and dental students at a mid-sized German university

Objective

Previous studies have shown that an increased prevalence of mental illness can be found among medical and dental students. Among these, somatization symptoms are severely understudied. The present study examined the prevalence of somatization symptoms in a subpopulation of medical and dental students and aimed at finding associated risk and resilience factors.

Methods

A cross-sectional survey was conducted using a self-reporting questionnaire, including the SOMS-2, the Becks-Depression-Inventory-II (BDI-II), the NEO-Five-Factor-Inventory, and a questionnaire on socio-demographics for possible risk and resilience factors. A total of 271 medical and dental students of a mid-sized German university completed the questionnaire.

Results

The Somatization index yielded a mean of 9.12 symptoms for the total sample, which is 1.2 SD higher than the reported norm. A total of 50.7% of the medical students and 63.6% of the dental students transcend a critical somatization score. Significant positive associations for eight general risk factors, four university related stress factors, and a significant negative association for seven resilience factors were found.

Conclusion

Medical and even more dental students at the studied university showed a high burden of somatoform complaints. Also, factors were found that could be of etiological relevance and others that could be used to enhance resilience. Both could present an opportunity for the prevention of somatization disorders but prospective and multicenter studies with an aged-matched comparison group are needed to obtain a more accurate overview.

Impact of COVID-19 Pandemic on Academic Stress and Perceived Classroom Climate in Spanish University Students

The COVID-19 pandemic has caused several changes in society, especially in the educational context, where several learning methodologies and social interactions have been modified significantly. This fact could have had a negative impact on academic stress levels of students and the classroom climate, especially in the university context. The main aim of the present study was to identify changes in academic stress and the perceived classroom climate caused by COVID-19 in a sample of Spanish university students. Academic stress was evaluated trough the Stressor Academic Scale (SAS) and perceived classroom climate employing the Perceived Classroom Responsibility Climate (PCRC) questionnaire. A longitudinal study was conducted. 135 students (97 females and 38 males) from the Gastronomy (n = 31) and Criminology (n = 104) degrees were evaluated before and after the COVID-19 lockdown in Spain. Academic stress levels and perceived classroom climate were analyzed before (Time 1) and after (Time 2) the lockdown declaration. An increase in academic stress was found, especially in the categories regarding Teachers' Methodological Deficiencies, Academic Over-Burden and Beliefs About Performances. Females and final year students suffered higher levels of academic stress. No differences were found between Time 1 and 2 in perceived classroom climate. The obtained results point out a significant increase of academic stress in university students due to the COVID-19 pandemic in Spain. The implemented educational changes and the uncertainty that resulted from the pandemic could have a significant negative impact on mental health in this population, resulting in higher levels of academic stress, especially in females and final year students. Future studies should analyze the strategies that students are employing to cope with these educational challenges and intervention strategies to promote them in the context of higher education.

Medical student's perception of the COVID-19 pandemic effect on their education and well-being: a cross-sectional survey in the United States

BACKGROUND

The effects of drastic curricular changes necessitated by the COVID-19 pandemic on medical students' education and wellbeing have remained largely unstudied. Out study aimed to characterize how medical students were affected by the pandemic, specifically how limitations introduced by the pandemic may have affected the quality, delivery, and experience of medical education.

METHODS

Three hundred students from 5 U.S. allopathic medical schools were surveyed to determine students' perceptions about their quality of medical education, professional development, and mental health during the COVID-19 pandemic (October 2020-December 2020).

RESULTS

A large majority of students report that while lecture-based learning has not been significantly affected by the pandemic, small-group and clinical learning have greatly declined in quality. Students also reported higher levels of depression, anxiety, and uncertainty with regards to their futures as physicians.

CONCLUSIONS

The COVID-19 pandemic has greatly affected the medical student education and wellbeing. Although medical schools have implemented measures to continue to train medical students as effectively as they can, further strategies must be devised to ensure the well-being of students in the present and for future national emergencies.

Personality traits and quality of life among Lebanese medical students: any mediating effect of emotional intelligence? A path analysis approach

BACKGROUND

Medicine is an incredibly demanding career that appears to leave many medical students at risk of fatigue, anxiety, depression and burnout. Since adaptation and lifestyle changes are important, quality of life (QOL) of students during medical school could be impaired. Personality traits and emotional intelligence (EI) facets may be both linked to medical student's QOL. To our knowledge, no studies have been done on the concurrent and prospective relationship between QOL-related personality traits and EI in Lebanese medical students. This study aimed to investigate the role of EI as a mediator between personality traits and QOL among a sample of Lebanese medical students.

METHODS

This research is a descriptive cross-sectional survey study involving 293 Lebanese medical students recruited from all 7 Faculties of Medicine in Lebanon (June-December 2019). Structural equation modeling (SEM) was performed using SPSS AMOS v.24 to examine the structural relationship between each personality trait taken as independent variables, QOL as the dependent variable, and emotional intelligence as the mediator, among university students. The relative Chi-square (χ²/df), root mean square error of approximation (RMSEA) statistic, Tucker Lewis Index (TFI) and the comparative fit index (CFI) were used to evaluate the goodness-of-fit of the model.

RESULTS

Higher conscientiousness was significantly associated with more EI (Beta = 0.38; p < 0.001) and lower QOL (Beta = - 0.14; p = 0.025). The indirect relationships between conscientiousness, EI and QOL showed that EI mediated the association between conscientiousness and QOL (Beta = 0.17; 95% CI - 0.73 to - 0.004; p = 0.037). The fit indices of this model were adequate for χ²/df, RMSEA and CFI but not TLI. Higher openness to experience was significantly associated with more EI (Beta = 0.48; p < 0.001) and lower QOL (Beta = - 0.38; p < 0.001). The indirect relationships between openness to experience, EI and QOL showed that EI mediated the association between openness to experience and QOL (Beta = 0.30; 95% CI - 1.11 to - 0.03; p = 0.04). The fit indices were adequate for χ²/df and CFI but not RMSEA and TLI. EI did not mediate the association between the other three personality traits (extroversion, agreeableness and neuroticism) and QOL.

CONCLUSION

This current research has shed considerable light on the nexus of associations between EI, personality traits and well-being, nonetheless, led to the creation of more puzzling questions. On the whole, it seems that EI and its components can be used as an evaluation instrument in relates with Lebanese medical students' personality profile as a means of future training to improve quality of life during medical education.

Medical and nonmedical use of psychiatric medications among medical students in Riyadh, Saudi Arabia

Introduction:

Psychiatric medication use has increased recently among college students. This includes antidepressants, opioids, stimulants, analgesics, sedatives, and anxiolytics, which could be self-administered without medical supervision.

Objectives:

To determine the prevalence of medical and nonmedical use of psychiatric prescription medications and its correlation with academic performance, demographic data as well as the motives for the nonmedical use.

Methods:

A cross-sectional study aims to assess the psychiatric medication use with or without prescription with the motives behind it, and demographic data of the students at medical colleges in Riyadh, Saudi Arabia.

Results:

A total of 1268 responded to the questionnaire. 251 (20%) of the participants reported using some psychiatric medications in their lifetime, while 191 (15%) participants used some psychiatric medications in the last 12 months. Antidepressants were most used in the surveyed population 144 (57%), followed by opioids/pain relief medications 62 (24%) and anxiolytics 39 (15%). Only 44 surveyed students (3.5%) reported nonmedical use of these psychiatric medications. As for the motives of nonmedical use, the greatest portion reported to use it for “relax or relieve tension” 12 (29%), followed by “relieve pain caused by other health problems” 8 (20%), and “medication to get through the day” 6 (15%).

Conclusion:

Nonmedical use of psychiatric medications among medical students in Riyadh is several times lower than reports by other researchers. Future research should focus on collecting more participants who are using medications without prescription and conduct cross-cultural studies to examine factors contributing to such low rates of illicit psychiatric medication use.

The prevalence of educational burnout, depression, anxiety, and stress among medical students of the Islamic Azad University in Tehran, Iran

BACKGROUND

Psychological disorders have negative consequences on students' learning and academic performance. In addition, academic burnout is one of the common challenges that affects students' motivation and academic eagerness; however, the determinant is not clear. Medical students, meanwhile, demand special attention due to their professional responsibilities. In this regard, this study is conducted to investigate the academic burnout, rate of depression, anxiety and stress as well as related factors among undergraduate medical students at the Tehran Medical Sciences Islamic Azad University.

METHODS

This cross-sectional and descriptive study was performed on medical students of Islamic Azad University of Tehran in 2017. In phase I, conducted on all stager students, Maslach Burnout questionnaire was used. In phase II, the DASS-42 questionnaire was provided for 123 students, 120 of whom met the inclusion criteria. In addition, another questionnaire including gender, age, lifestyle, marital and financial status, nutrition style, vitamin D deficiency, smoking, study hours per week, work efficiency and distance from the place of residence to the teaching hospital was used. Finally, the data extracted by SPSS version 23 was analyzed at the significance level of 0.05.

RESULTS

In phase I of the study, 17 subjects showed academic burnout (16.3%). Out of all, 76.5% of students with academic burnout did not focus on the study and students' academic burnout was associated with a decrease in their focus (P < 0.05). However, the relationship between academic burnout and other factors was not significant. In phase II, the prevalence of depression, anxiety and stress was 37.5, 41.1 and 30.3%, respectively. The prevalence of severe and very severe degrees that required psychiatric follow-up were 10.5, 10.5 and 7% for depression, anxiety and stress, respectively. According to statistical analyzes, there is a significant direct relationship between anxiety and the distance from the place of residence to the teaching hospital (P = 0.040).

CONCLUSION

The present study estimated the prevalence of academic burnout to be between 9.2 and 23.4%, considering the 5% error in the calculation, and the level of anxiety was related to the distance from the place of residence to the hospital.

Medical students' relative immunity, or lack thereof, against COVID-19 emotional distress and psychological challenges; a descriptive study from Jordan

Background: Emotional distress is a major impact of COVID-19 among not only the general public but also healthcare workers including medical students. This study aimed at describing self-reported changes in emotional reactions associated with COVID-19 among medical students in Jordan and to assessing the potential effect of social media utilization on emotional distress among this group. Methods: A cross-sectional design was utilized to collect data early on during the outbreak in Jordan. All medical students in Jordan were eligible to complete an online questionnaire assessing self-reported emotional reactions to COVID-19 that covered four main domains: negative emotion (anxiety, worry, depression, panic, loneliness, and nervousness), positive emotion (happiness, joy, and excitement), sleep disorders (insomnia, shallow sleep, nightmares, and insufficient sleep), and aggression (verbal argument and physical fighting). The frequency of social media utilization as a main source of COVID-19 information was also assessed. Results: 59.9% of participants were females, 64.9% were enrolled at the two major medical schools in Jordan, and 59.6% were in the pre-clinical stage (years). A significant proportion of participants self-reported increased negative emotional levels of anxiety (49.2%), worry (72.4%), depression (23.1%), panic (22.6%), and nervousness (38.2%) and decreased positive emotional levels of happiness (44.8%), joy (47.3%), and feelings of excitement (45.1%). Self-reported sleep disorders were not as common (less than 15% for any of the four items), while arguing with others was at 26.7%. Significant differences by gender and academic year were detected. Almost half of participants reported using social media as a main source of COVID-19 information "most/all-the-times" with a significant effect of such on reducing emotional distress. Conclusion: The results suggest a potential effect of COVID-19 on the emotional distress of medical students. Addressing and mitigating such effects is crucial. The potential buffering effect of social media should be further investigated.

Predictive factors of quality of life among medical students: results from a multicentric study

Background

Medical students have a worse perception of Quality of Life (QoL) and a high prevalence of psychosocial suffering when compared to the general population. The objective of this study was to investigate associated factors with Quality of Life of Brazilian medical students from an exploratory analysis in a cross-sectional study described in accordance with the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines.

Methods

This is a cross-sectional and multicenter study with national sample randomized by sex and year of the course. Data were collected between August 2011 and August 2012, using an electronic platform (VERAS platform). Our outcomes included: personal quality of life (QoLp) and quality of life related to medical course activities (QoLmc), both measured using a score ranging from 0 (worst) to 10 (best). Variables as predictors: the World Health Organization Quality of Life Assessment abbreviated version (WHOQOL-BREF); VERAS-Q (a questionnaire created to evaluate the QoL of students in health professions); Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maslach Burnout Inventory (MBI), Resilience Scale (RS-14), Interpersonal Reactivity Multidimensional Scale (IRMS) and Dundee Ready Education Environment Measure (DREEM).

Results

Our sample is comprised of 1350 (81.8%) medical students. When comparing predictors and both quality of life outcome measures, we found a negative correlation between QoL and the BDI, PSQI and ESS scores. Through a multiple linear regression mode we identified the median of significant predictors to higher QoL. We then run a tree regression model that demonstrated that the VERAS-Q—physical health domain (a domain assessing self-care, self-perception of health, sleep, leisure, physical activity and appearance) was the most important factor predicting QoL. Students with a VERAS-Q-physical health score ≥ 60.9 and a VERAS-Q-time management (address the management of the student's time, free time and whether he can dedicate himself to other activities besides the course) score ≥ 55.7 presented the best QoLmc (score: 8.08–9.63%). Students with a VERAS-Q-physical health score ≥ 79.7 presented the highest QoLp (score 8.93–8.74%).

Conclusion

Physical symptoms, self-perception of health and self-care assessed by the VERAS-Q physical domain had association with both final outcomes. Time management seems to have a protective role for better Quality of Life. These variables should be taken in consideration when designing interventions to improve Quality of Life among medical students.

The Impact of the SARS-COV-2 Pandemic on the Mental Health and Employment Decisions of Medical Students in North China

Background: The outbreak of severe respiratory syndrome coronavirus 2 (SARS-COV-2) has led to long periods of social isolation for individuals across the world. Although medical students generally have a high prevalence of mental health problems, they have received less attention than other groups concerning the impact of SARS-COV-2. Therefore, the present study investigated the mental health status, risk factors, and protective factors for mental health problems in medical students in North China during the SARS-COV-2 pandemic. Methods: A WeChat-based survey, which included the Depression Anxiety Stress Scale-21 and measures of social demographics, was performed twice. Risk and protective factors were identified by binary logistic regression analysis. Results: A total of 702 effective questionnaires were collected in two separate surveys. In total, 24.55% of medical students were suffering anxiety to different degrees of severity, 13.18% were suffering depression in the first survey, and 3.71% wanted to give up working in primary medical care during the SARS-COV-2 pandemic in the second survey. In contrast, during the SARS-COV-2 pandemic, a risk factor for anxiety and depression was gender which is male, while being knowledgeable about the SARS-COV-2 pandemic and having a lower academic burden were both protective factors. Conclusions: Measures are required to prevent increases in mental health problems in medical students. Our findings suggest that increasing knowledge about the SARS-COV-2 pandemic and reducing academic burden in medical students is extremely important during the SARS-COV-2 pandemic.

A National Survey of Self-Prescription of Beta-Blockers and Their Relation to Undiscovered Anxiety Among Medical and Pharmacological Students in Saudi Arabia

BACKGROUND

The development of beta-blocker (BB) medications is considered one of the most critical milestones of drug research. Several trials showed possible anti-anxiety effects of BBs. Our primary goal is to investigate the prevalence of anxiety disorder and the use of BBs as anxiolytic without medical prescription among medical and pharmacological students in Saudi Arabia.

METHODS

A cross-sectional study was conducted at multiple universities in Saudi Arabia. Students were given a questionnaire containing 44 questions that included demographic data, school location, BB usage behavior, GPA status before and after using BBs, and a GAD-7 anxiety screening questionnaire.

RESULTS

A total of 3326 mainly female senior students participated in the study with a mean age of 21.9±1.7 years. According to the GAD-7 score, half of the sampled students did not meet criteria indicative of anxiety disorder, and one-third were considered to have mild anxiety with a significant positive correlation between the BB usage and the GAD-7 score. A total of 6.4% of the sample reported usage of BBs. Therapeutics and Internal Medicine were the most common subjects for which BBs were used. When compared to pharmacy students, medical students were more likely to be male, smokers, diagnosed with psychiatric illness, having a higher mean GAD-7 score, report BB usage, and correctly identified common and serious BB side effects.

CONCLUSION

The inappropriate use of BB drugs without medical advice might have short- and long-term effects, and those may be more vulnerable to have psychological issues in the future. Our findings shed light on the need to identify students who are taking BBs as being at high risk of underlying anxiety disorders.

Toward Resilience: Medical Students' Perception of Social Support

Context

There is strong evidence that social support—particularly perceived social support—functions as a protective factor for health. Few studies have investigated how medical students perceive the types of social support they experience.

Objective

To determine how osteopathic medical students perceive social support, understand the factors that influence their perceptions, and explore how group participation in a cocurricular, academic program could affect student perceptions.

Methods

In this cross-sectional study of 983 medical students at a multicampus osteopathic medical school in the Midwest, potential respondents were invited by email in March 2018 to participate in a self-reported evaluation of their perceived social support using a 40-question Interpersonal Support Evaluation List (ISEL). The demographic variables included gender, race, age, current phase in medical school, Hispanic heritage, campus assignment, and hometown population type. A total score for each type of social support and a summative score for overall perceived social support were calculated. Descriptive statistics were applied to provide a summary of the distribution of study variables. Bivariate analyses were conducted using student t test and analysis of variance (ANOVA) statistic to determine distribution of 4 social support constructs and overall social support by all the study variables; α < .05 was considered statistically significant. Linear regression analysis was performed to determine the association between all study variables and 4 social support constructs. Pairwise interactions were calculated to determine whether the association differed by any of the study variables.

Results

Self-esteem support was the lowest type of perceived social support overall in the total sample (mean [SD], 23.5[2.0]). Hispanic students reported lower overall mean perceived social support than those who did not identify as Hispanic (100 vs 104; P=.04). Older study participants had higher mean tangible support compared with their younger counterparts (26.25 vs. 25.60, P=.018; t [264]=1.18). Older study participants also had higher mean appraisal support compared with their younger counterparts (26.57 vs. 25.92, P=.06; t [266]=1.27). Female medical students reported lower levels of belonging support overall (mean [SD] 26.79, [2.10]). Students from rural hometowns reported a higher sense of belonging support than any other group. Female students from suburban and urban hometowns reported lower levels of belonging support compared with women from rural hometowns (Adj. β=−0.96, P=.01). Students who participated in the rural and urban underserved program had higher self esteem support compared with those who did not participate in the rural and urban underserved program (Adj. β=−1.30, P=.05). Students in the clinical phase of medical education reported lower levels of belonging support than students in the preclinical phase (26.14 vs. 26.69, P=.05; t[256]=1.07).

Conclusions

It is critical to understand the ways medical students experience social support and the factors that contribute to it. Longitudinal studies following medical students over time would contribute to a more complete understanding of social support in medical students as they move from preclinical to the clinical phases of medical school.

Psychological Impact of the Civil War and COVID-19 on Libyan Medical Students: A Cross-Sectional Study

Objective

We aim to determine the psychological status of medical students during the COVID-19 outbreak and civil war in Libya.

Methods

A cross-sectional study was conducted among medical students from 15 medical schools between April 20 and May 1, 2020. The demographic characteristics, generalized anxiety disorder 7-item (GAD-7) scale, and patient health questionnaire (PHQ-9) results were collected.

Results

Of the 3,500 students, 2,430 completed the survey. The mean (± SD) score of anxiety symptoms determined by the GAD-7 was 7.2 (5.1). A total of 268 (11%) students had a GAD-7 score of ≥15, which is indicative of moderate to severe anxiety. A total of 1,568 (64.5%) students showed different degrees of anxiety: mild, 910 (37.5%); moderate, 390 (16%); and severe, 268 (11%). Anxiety was significantly associated with living status and internal displacement (P < 0.05). The mean (+ SD) score of depressive symptoms determined by the PHQ-9 was 9.7 (6.3). A total of 525 (21.6%) students had a PHQ-9 score of ≥15, which is indicative of moderate to severe depression. A total of 1,896 (88%) students were diagnosed with mild (PHQ ≥ 5) depression. Suicidal ideation was present in 552 patients (22.7%). Depression was only statistically associated with the year of study (P = 0.009).

Conclusion

These data highlight that medical students in Libya are at risk for depression, especially under the current stressful environment of the civil war and the COVID-19 outbreak.

Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: a prospective longitudinal study

Background

The COVID-19 pandemic is found to affect the mental health of the population. Undergraduate medical students are especially prone to mental health disorders and hence could be more vulnerable to the impact of the pandemic.

Methods

A prospective longitudinal study was conducted on 217 undergraduate medical students in a medical college at Chennai, India. Depression, anxiety, and stress levels were recorded using Depression Anxiety Stress Scale 21 Items (DASS21) before and during the COVID-19 outbreak in India in December 2019 and June 2020, respectively. In the follow-up survey, in addition to DASS21, the Pittsburgh Sleep Quality Index to assess sleep quality and a self-administered questionnaire to assess the impact of COVID-19 related stressors were used. The self-administered questionnaire assessed the status of COVID-19 testing, interactions with COVID-19 patients, self-perceived levels of concerns and worries related to academics (COVID-19-AA (academic apprehensions)) and those pertaining to the self and family/friends (COVID-19-GA (general apprehensions)). Cross-sectional and longitudinal comparison of overall scores of depression, anxiety, and stress and scores stratified by gender, year of study, place of residence and monthly family income were performed. Predictors for depression, anxiety, and stress during COVID-19 were investigated using adjusted binary logistic regression analysis and results were expressed as adjusted odds ratio with 95% confidence interval (CI). A P value < 0.05 was considered statistically significant.

Results

The average scores of depression, anxiety, and stress during the baseline survey were 7.55 ± 7.86, 4.6 ± 6.19 and 7.31 ± 7.34 with the prevalence (95% Cl) of 33.2% [27-39.9%], 21.2% [16-27.2%] and 20.7% [15.5-26.7%]; in follow-up survey, the mean scores were 8.16 ± 8.9, 6.11 ± 7.13 and 9.31 ± 8.18 with the prevalence being 35.5% [29.1-42.2%], 33.2% [27-39.9%] and 24.9% [19.3-31.2%] for depression, anxiety, and stress respectively. There was a significant increase in both the prevalence and levels of anxiety and stress (P < 0.001), with depression remaining unchanged during COVID-19, irrespective of gender, year of study, place of residence and family's monthly income. Poor sleep quality, higher levels of baseline depression, anxiety, and stress, higher COVID-19-GA, COVID-19 patients in family/friends and direct interactions with COVID-19 patients were found to be significant predictors of negative mental health in undergraduate medical students. COVID-19-AA was not significantly associated with depression, anxiety, and stress.

Conclusion

The COVID-19 pandemic appears to negatively affect the mental health of the undergraduate medical students with the prevalence and levels of anxiety and stress being increased, and depression symptoms remaining unaltered. Addressing and mitigating the negative effect of COVID-19 on the mental health of this population is crucial.

Assessment of academic stress and its coping mechanisms among medical undergraduate students in a large Midwestern university

Academic stress is the most common mental state that medical students experience during their training period. To assess academic stress, to find out its determinants, to assess other sources of stress and to explore the various coping styles against academic stress adopted by students. Methods: It was a cross sectional study done among medical students from first to fourth year. Standard self-administered questionnaires were used to assess academic stress and coping behaviour. Mean age of the 400 participants was 20.3 ± 1.5 years. 166(41.5%) of them were males. The academic stress was found to be of mild, moderate and severe level among 68(17%), 309(77.3%) and 23(5.7%) participants respectively. Overall coping with stress was found to be poor, average and good among 15(3.8%), 380(95%) and 5(1.2%) participants respectively. Passive emotional (p = 0.054) and passive problem (p = 0.001) coping behaviours were significantly better among males. Active problem coping behaviour (p = 0.007) was significantly better among females. Active emotional coping behaviour did not vary significantly between genders (p = 0.54). Majority of the students preferred sharing their personal problems with parents 211(52.7%) followed by friends 202(50.5%). Binary logistic regression analysis found worrying about future (p = 0.023) and poor self-esteem (p = 0.026) to be independently associated with academic stress. Academic stress although a common finding among students, the coping style to deal with it, was good only in a few. The coping behaviours were not satisfactory particularly among male participants. This along with other determinants of academic stress identified in this study need to be addressed during counselling sessions.

Student pharmacist personal and work experiences with people displaying warning signs of suicidal ideation

Introduction

Student pharmacists, in their roles as trainees, technicians, and peers, may interact with people displaying suicide warning signs. Providing suicide gatekeeping training to student pharmacists may prepare them to engage people at risk. Measuring the extent to which student pharmacists have encountered people displaying warning signs of suicide may help contextualize the potential importance of training student pharmacists in suicide gatekeeping. The objective was to describe student pharmacists' awareness of someone they know having attempted or died by suicide and whether they have heard statements suggesting suicide risk in their personal and work life.

Methods

An anonymous electronic survey was administered to 111 student pharmacists before engaging in question-persuade-refer training as part of their second-year pharmacy curriculum. Respondents were asked for demographics and if Someone ever told you something concerning where you wondered if they were thinking about suicide for both work and one's personal life. Descriptive statistics and chi-squared tests were used to compare items by gender.

Results

There were 111 responses to the survey for a 100% response rate. Concerning statements related to suicide were reported by 71.2% of respondents in their personal life and by 34.2% of students while at work. There were no differences based on gender.

Discussion

A significant proportion of student pharmacists have personal, peer, and professional exposure related to people with potential suicidal ideation. These findings emphasize the need for broad approaches for training students and pharmacists in suicide gatekeeping as a new public health role.

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Background

The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem.

Objectives

Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.

Design

Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.

Data sources

Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites.

Review methods

We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations.

Results

A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective.

Limitations

Variable quality of included literature; limited UK-based studies.

Future work

Use this evidence synthesis to refine, implement and evaluate interventions.

Study registration

This study is registered as PROSPERO CRD42017069870.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.

The Silent Epidemic: Causes and Consequences of Medical Learner Burnout

PURPOSE OF REVIEW

Clinician burnout has significant socioeconomic, health, and quality of life implications. However, there has been little attention directed at medical students and house officers (i.e., medical learners). This review provides pertinent evidence regarding burnout as it relates to medical learners including risk factors and potential interventions. We conclude with recommendations on future research directions and potential approaches to address this epidemic of medical learner burnout.

RECENT FINDINGS

Burnout is a significant issue among medical learners that is impacted both by interpersonal and environmental factors. There are points of heightened vulnerability for medical learners throughout their training. However, studies are unable to reach consensus regarding effective interventions to mitigate the impact of burnout. Furthermore, some elements of burnout are not readily reversible even after removing risk factors. Burnout is a significant concern for medical learners with wide-ranging physical, emotional, and psychosocial consequences. However, the current body of literature is sparse and does not provide consistent guidance on how to address burnout in medical learners. It is clear additional attention is needed in understanding burnout among learners and establishing proactive approaches to minimize its negative impact.

Improved quality of life and reduced depressive symptoms in medical students after a single-session intervention

OBJECTIVE

Anxiety and depression are prevalent among medical students. Brazilian medical students have higher levels of depression and lower quality of life than their U.S. counterparts, and no preventive intervention exists for this risk group in Brazil. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral treatment protocol for neuroticism, was recently adapted into a single-session, preventive intervention. This study tested the impact of this protocol on psychiatric symptoms and quality of life in Brazilian medical students.

METHODS

In this open trial, the intervention protocol was translated and adapted to Brazilian Portuguese. Medical students over 18 years of age without psychotic symptoms, severe depressive episodes, or acute psychiatric risk were included, undergoing a psychiatric clinical interview (Mini-International Neuropsychiatric Interview [MINI]) and evaluation at baseline and at 7 and 30 days after a single-session UP that included experimental avoidance, quality of life, self-esteem, empathy, and anxiety symptom scales. A new evaluation was performed 90 days after the intervention.

RESULTS

Sixty-two students participated. Ninety days after the intervention, there were significant reductions in the number of students who met the criteria for social anxiety disorder (p = 0.013) or panic disorder (p = 0.001). There were also significant improvements in depressive symptoms (Beck Depression Inventory, p < 0.001) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire, p < 0.001).

CONCLUSION

UP improved anxiety and depressive symptoms in medical students. The single-session group format could reduce costs and facilitate application. Future placebo-controlled studies are necessary to confirm these findings.

Health-Related Quality of Life of Medical Students in a Chinese University: A Cross-Sectional Study

Thus far, there have been no studies adapting the Mandarin 36-Item Short Form Health Survey (the SF-36) questionnaire for assessment of the health-related quality of life (HRQOL) of medical students in China. This study aimed to explore the feasibility of that form and analyse its impact factors. The study involved 498 randomly sampled medical students stratified by their academic majors, and general information was collected. The effective response rate was 83.53%. Split-half reliability coefficients and Cronbach's α coefficients of seven dimensions were more than 0.7 with the exception of the social function (SF) dimension. Spearman's correlation analysis results were basically in accord with the theoretical construction of the SF-36. The HRQOL of the students was scored from 43.83 (the RE dimension) to 93.34 (the PF dimension). The primary impact factors affecting the HRQOL of medical students included major, sleep quality, degree of physical exercise, post-exercise status, relationship with roommate, and satisfaction with family. These findings suggested that the Mandarin SF-36 was reliable for measuring the HRQOL, that the HRQOL of medical students in a Chinese university was relatively poor, and that its improvement requires concerted efforts.

The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis

Anxiety, although as common and arguably as debilitating as depression, has garnered less attention, and is often undetected and undertreated in the general population. Similarly, anxiety among medical students warrants greater attention due to its significant implications. We aimed to study the global prevalence of anxiety among medical students and the associated factors predisposing medical students to anxiety. In February 2019, we carried out a systematic search for cross-sectional studies that examined the prevalence of anxiety among medical students. We computed the aggregate prevalence and pooled odds ratio (OR) using the random-effects model and used meta-regression analyses to explore the sources of heterogeneity. We pooled and analyzed data from sixty-nine studies comprising 40,348 medical students. The global prevalence rate of anxiety among medical students was 33.8% (95% Confidence Interval: 29.2–38.7%). Anxiety was most prevalent among medical students from the Middle East and Asia. Subgroup analyses by gender and year of study found no statistically significant differences in the prevalence of anxiety. About one in three medical students globally have anxiety—a prevalence rate which is substantially higher than the general population. Administrators and leaders of medical schools should take the lead in destigmatizing mental illnesses and promoting help-seeking behaviors when students are stressed and anxious. Further research is needed to identify risk factors of anxiety unique to medical students.

Is Student Stress Related to Personality or Learning Environment in a Physician Assistant Program?

PURPOSE

The purpose of this research was to study the impact of students' personalities and 2 different learning environments-lecture-based learning (LBL) and problem-based learning (PBL)-on the stress perceived by 5 cohorts of physician assistant (PA) students.

METHODS

Students rated their stress related to family obligations, financial concerns, schoolwork, relocation, and overall stress on 6 occasions over the course of the 2-year program. Personalities of students were assessed using the California Psychological Inventory 7 months into the program. Students' expectations and observations of their learning environments were measured using the PA School Learning Environment Survey at the beginning and end of the didactic year.

RESULTS

Personalities of LBL and PBL students were very similar, but LBL students who scored higher on the Independence concept were less stressed about their schoolwork. The LBL students, in general, were more discontented with their learning environment, but this finding was not related to higher schoolwork-related stress. In contrast, PBL students' personalities were not related to stress, and PBL students also rated some dimensions of their learning environment higher than they had expected. However, those PBL students who rated the PBL environment less favorably also reported higher schoolwork-related stress.

CONCLUSIONS

High stress perceived by LBL students was related to some personality concepts but not to the students' learning environment, despite their overall disappointment with that environment. The PBL students were more stressed by schoolwork, although their stress was not related to personality. Problem-based learning students, except for those most highly stressed, tended to rate their learning environment more favorably.

Correlation between Internet addiction, depression, anxiety and stress among undergraduate medical students in Azad Kashmir

Objective:

To find out the correlation between internet addiction and depression, anxiety, and stress among undergraduate medical students in Azad Kashmir.

Methods:

A cross-sectional study including 210 undergraduate medical students (first to the fifth year) was done in Poonch Medical College, Azad Kashmir. The data collection tools were DASS21 questionnaire and Young’s internet addiction questionnaire. Spearman rank correlation test was done to see the correlation between internet addiction and depression, anxiety, and stress. Data were analyzed by SPSS v23 at a 95% confidence interval.

Results:

A very high prevalence (52.4%) of moderate to extremely severe internet addiction was observed among the respondents. The mild positive correlation between internet addiction and depression was identified (p <.001) and similar type of correlation was observed between internet addiction and stress (p .003). However, anxiety and internet addiction were not significantly correlated. The prevalence of anxiety and depression among the males were higher than the females, whilst the stress level was almost the same across gender.

Conclusion:

Internet addiction has been found to be associated with various psychiatric diseases. In this study, we also observed such correlation. We have also observed a very high level of internet addiction among medical students. The prevalence of internet addiction may further increase in the coming years as the internet will become more cheap, available and include more high quality psychologically addictive contents.

Predictors of fitness to practise declarations in UK medical undergraduates

BACKGROUND

Misconduct during medical school predicts subsequent fitness to practise (FtP) events in doctors, but relatively little is known about which factors are associated with such issues during undergraduate education. This study exploits the newly created UK medical education database (UKMED), with the aim of identifying predictors of conduct or health-related issues that could potentially impair FtP. The findings would have implications for policies related to both the selection and support of medical students.

METHODS

Data were available for 14,379 students obtaining provisional registration with the General Medical Council who started medical school in 2007 and 2008. FtP declarations made by students were available, as were various educational and demographic predictor variables, including self-report 'personality measures' for students who participated in UK Clinical Aptitude Test (UKCAT) pilot studies. Univariable and multivariable logistic regression models were developed to evaluate the predictors of FtP declarations.

RESULTS

Significant univariable predictors (p < 0.05) for conduct-related declarations included male gender, white ethnicity and a non-professional parental background. Male gender (OR 3.07) and higher 'self-esteem' (OR 1.45) were independently associated with an increased risk of a conduct issue. Female gender, a non-professional background, and lower self-reported 'confidence' were, among others, associated with increased odds of a health-related declaration. Only 'confidence' was a significant independent predictor of a health declaration (OR 0.69). Female gender, higher UKCAT score, a non-professional background and lower 'confidence' scores were significant predictors of reported depression, and the latter two variables were independent predictors of declared depression.

CONCLUSIONS

White ethnicity and UK nationality were associated with increased odds of both conduct and health-related declarations, as were certain personality traits. Students from non-professional backgrounds may be at increased risk of depression and therefore could benefit from targeted support. The small effect sizes observed for the 'personality measures' suggest they would offer little potential benefit for selection, over and above those measures already in use.

Mental health problems among medical students in Brazil: a systematic review and meta-analysis

Objective:

To provide a comprehensive picture of mental health problems (MHPs) in Brazilian medical students by documenting their prevalence and association with co-factors.

Methods:

We systematically searched the MEDLINE/PubMed, SciELO, LILACS, and PsycINFO databases for cross-sectional studies on the prevalence of MHPs among medical students in Brazil published before September 29, 2016. We pooled prevalences using a random-effects meta-analysis, and summarized factors associated with MHP.

Results:

We included 59 studies in the analysis. For meta-analyses, we identified the summary prevalence of different MHPs, including depression (25 studies, prevalence 30.6%), common mental disorders (13 studies, prevalence 31.5%), burnout (three studies, prevalence 13.1%), problematic alcohol use (three studies, prevalence 32.9%), stress (six studies, prevalence 49.9%), low sleep quality (four studies, prevalence 51.5%), excessive daytime sleepiness (four studies, prevalence 46.1%), and anxiety (six studies, prevalence 32.9%). Signs of lack of motivation, emotional support, and academic overload correlated with MHPs.

Conclusion:

Several MHPs are highly prevalent among future physicians in Brazil. Evidence-based interventions and psychosocial support are needed to promote mental health among Brazilian medical students.

Leisure time physical activity and quality of life in medical students: results from a multicentre study

BACKGROUND/AIM

We evaluated the association between leisure time physical activity (PA) and quality of life (QoL) in medical students. Our hypothesis was that there was a positive association between volume of PA and various domains of perception of QoL.

METHODS

Data were evaluated from a random sample of 1350 medical students from 22 Brazilian medical schools. Information from participants included the WHO Quality of Life questionnaire-short form (WHOQOL-BREF), a questionnaire specifically designed to evaluate QoL in medical students (VERAS-Q) and questions for both global QoL self-assessment and leisure time PA. According to the amount of metabolic equivalents (METs) spend during PA, volunteers were divided into four groups, according to the volume of PA: (a) no PA; (b) low PA, ≤540 MET min/week; (c) moderate PA, from 541 to 1260 MET min/week and (d) high PA, > 1261 MET min/week.

RESULTS

Forty per cent of the medical students reported no leisure time PA (46.0% of females and 32.3% of males). In contrast, 27.2% were classified in the group of high PA (21.0% of females and 34.2% of males). We found significant associations between moderate and high levels of PA and better QoL for all measurements. For low levels of PA, this association was also significant for most QoL measurements, with the exceptions of WHOQOL physical health (p=0.08) and social relationships (p=0.26) domains.

CONCLUSION

We observed a strong dose-effect relationship between the volume of leisure time PA and QoL in both male and female medical students.

Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters

Summary Objective: To compare the prevalence of anxiety, depression, and stress in medical students from all semesters of a Brazilian medical school and assess their respective associated factors. Method: A cross-sectional study of students from the twelve semesters of a Brazilian medical school was carried out. Students filled out a questionnaire including sociodemographics, religiosity (DUREL - Duke Religion Index), and mental health (DASS-21 - Depression, Anxiety, and Stress Scale). The students were compared for mental health variables (Chi-squared/ANOVA). Linear regression models were employed to assess factors associated with DASS-21 scores. Results: 761 (75.4%) students answered the questionnaire; 34.6% reported depressive symptomatology, 37.2% showed anxiety symptoms, and 47.1% stress symptoms. Significant differences were found for: anxiety - ANOVA: [F = 2.536, p=0.004] between first and tenth (p=0.048) and first and eleventh (p=0.025) semesters; depression - ANOVA: [F = 2.410, p=0.006] between first and second semesters (p=0.045); and stress - ANOVA: [F = 2.968, p=0.001] between seventh and twelfth (p=0.044), tenth and twelfth (p=0.011), and eleventh and twelfth (p=0.001) semesters. The following factors were associated with (a) stress: female gender, anxiety, and depression; (b) depression: female gender, intrinsic religiosity, anxiety, and stress; and (c) anxiety: course semester, depression, and stress. Conclusion: Our findings revealed high levels of depression, anxiety, and stress symptoms in medical students, with marked differences among course semesters. Gender and religiosity appeared to influence the mental health of the medical students.

Factors associated to depression and anxiety in medical students: a multicenter study

BACKGROUND

To evaluate personal and institutional factors related to depression and anxiety prevalence of students from 22 Brazilian medical schools.

METHODS

The authors performed a multicenter study (August 2011 to August 2012), examining personal factors (age, sex, housing, tuition scholarship) and institutional factors (year of the medical training, school legal status, location and support service) in association with scores of Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI).

RESULTS

Of 1,650 randomly selected students, 1,350 (81.8 %) completed the study. The depressive symptoms prevalence was 41 % (BDI > 9), state-anxiety 81.7 % and trait-anxiety in 85.6 % (STAI > 33). There was a positive relationship between levels of state (r = 0,591, p < 0.001) and trait (r = 0,718, p < 0.001) anxiety and depression scores. All three symptoms were positively associated with female sex and students from medical schools located in capital cities of both sexes. Tuition scholarship students had higher state-anxiety but not trait-anxiety or depression scores. Medical students with higher levels of depression and anxiety symptoms disagree more than their peers with the statements "I have adequate access to psychological support" and "There is a good support system for students who get stressed".

CONCLUSIONS

The factors associated with the increase of medical students' depression and anxiety symptoms were female sex, school location and tuition scholarship. It is interesting that tuition scholarship students showed state-anxiety, but not depression and trait-anxiety symptoms.

The coping strategies during medical education predict style of success in medical career: a 10-year longitudinal study

BACKGROUND

The stress associated with the physician's work is generally acknowledged and is related to well-being and life satisfaction. The presented study was designed to extract the role of coping strategies in identifying differentiated styles of success in a medical career during medical education.

METHODS

The participants were examined when they applied to medical school and each subsequent academic year. The final study took place four years after graduation. The baseline questionnaire measured coping strategies. The follow-up questionnaire consisted of measures of: quality of life, work stress and burnout, satisfaction with medicine as a career, and professional competency.

RESULTS

Based on coping strategies assessed during admission and preclinical years of medical study, some aspects of success in the participants' future medical career can be predicted. Students who take action and deal directly with a problem, neither accept resignation, nor reduce tension by expressing feelings would most probably resist future burnout. However, despite the fact that they obtain the highest quality of life or earn the highest income they would be, at the same time, the least satisfied with chosen career, as well as being more likely to be characterised by a low level of competence.

CONCLUSIONS

Assessment of coping strategies at the beginning of medical education could be taken into consideration as an instrument to diagnose a specific trend in physicians' career development.

A Comparison of Students' Perceptions of Stress in Parallel Problem-Based and Lecture-Based Curricula

PURPOSE

A 6-year longitudinal study was conducted to compare the perceived stress experienced during a 2-year master's physician assistant program by 5 cohorts of students enrolled in either problem-based learning (PBL) or lecture-based learning (LBL) curricular tracks. The association of perceived stress with academic achievement was also assessed.

METHODS

Students rated their stress levels on visual analog scales in relation to family obligations, financial concerns, schoolwork, and relocation and overall on 6 occasions throughout the program. A mixed model analysis of variance examined the students' perceived level of stress by curriculum and over time. Regression analysis further examined school work-related stress after controlling for other stressors and possible lag effect of stress from the previous time point.

RESULTS

Students reported that overall stress increased throughout the didactic year followed by a decline in the clinical year with statistically significant curricular (PBL versus LBL) and time differences. PBL students also reported significantly more stress resulting from school work than LBL students at some time points. Moreover, when the other measured stressors and possible lag effects were controlled, significant differences between PBL and LBL students' perceived stress related to school work persisted at the 8- and 12-month measurement points. Increased stress in both curricula was associated with higher achievement in overall and individual organ system examination scores.

CONCLUSION

Physician assistant programs that embrace a PBL pedagogy to prepare students to think clinically may need to provide students with additional support through the didactic curriculum.

Mental health among currently enrolled medical students in Germany

OBJECTIVES

The study identifies the prevalence of common mental disorders according to the patient health questionnaire (PHQ) and the use of psychotropic substances in a sample of currently enrolled medical students.

STUDY DESIGN

A cross-sectional survey with a self-administrated questionnaire.

METHODS

All newly enrolled medical students at the University of Dusseldorf, with study beginning either in 2012 or 2013, respectively, were invited to participate. The evaluation was based on 590 completed questionnaires. Mental health outcomes were measured by the PHQ, including major depression, other depressive symptoms (subthreshold depression), anxiety, panic disorders and psychosomatic complaints. Moreover, information about psychotropic substances use (including medication) was obtained. Multiple logistic regression analysis was used to estimate associations between sociodemographic and socio-economic factors and mental health outcomes.

RESULTS

The prevalence rates, measured by the PHQ, were 4.7% for major depression, 5.8% for other depressive symptoms, 4.4% for anxiety, 1.9% for panic disorders, and 15.7% for psychosomatic complaints. These prevalence rates were higher than those reported in the general population, but lower than in medical students in the course of medical training. In all, 10.7% of the students reported regular psychotropic substance use: 5.1% of students used medication 'to calm down,' 4.6% 'to improve their sleep,' 4.4% 'to elevate mood,' and 3.1% 'to improve cognitive performance.' In the fully adjusted model, expected financial difficulties were significantly associated with poor mental health (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.31-3.48), psychosomatic symptoms (OR:1.85; 95% CI: 1.11-3.09) and psychotropic substances use (OR: 2.68; 95% CI: 1.51-4.75).

CONCLUSION

The high rates of mental disorders among currently enrolled medical students call for the promotion of mental health, with a special emphasis on vulnerable groups.

Stress, Burnout and Coping Strategies in Preclinical Medical Students

It is acknowledged that physicians do not seek the same expert aid for themselves as they would offer their patients. In their preclinical years, medical students appear to espouse comparable behavior. To many, medicine is described as a never-ending path that places the student under heavy stress and burnout from the beginning, leaving him/her vulnerable and with insufficient coping methods. Hence, the objective of this study is to 1) explore the prevalence of stress and burnout among preclinical medical students, and 2) propose solutions to decrease stress and burnout and improve medical education in the preclinical years. A detailed scholarly research strategy using Google Scholar, Scopus, Embase, MEDLINE and PubMed was implemented to highlight key themes that are relevant to preclinical medical students' stress and burnout. Stress varied among different samples of medical students and ranged between 20.9% and 90%. Conversely, burnout ranged between 27% and 75%. Methods that help in reducing the incidence of stress and burnout by promoting strategies that focus on personal engagement, extracurricular activities, positive reinterpretation and expression of emotion, student-led mentorship programs, evaluation systems, career counseling and life coaching should be adopted.

Predictors of Depression Stigma in Medical Students: Potential Targets for Prevention and Education

INTRODUCTION

Suicide rates are higher among U.S. physicians than the general population. Untreated depression is a major risk factor, yet depression stigma presents a barrier to treatment. This study aims to identify early career indications of stigma among physicians-in-training and to inform the design of stigma-reduction programs.

METHODS

A cross-sectional student survey administered at a large, Midwestern medical school in fall 2009 included measures of depression symptoms, attitudes toward mental health, and potential sources of depression stigma. Principal components factor analysis and linear regression were used to examine stigma factors associated with depression in medical students.

RESULTS

The response rate was 65.7%, with 14.7% students reporting a previous depression diagnosis. Most students indicated that, if depressed, they would feel embarrassed if classmates knew. Many believed that revealing depression could negatively affect professional advancement. Factor analyses revealed three underlying stigma constructs: personal weakness, public devaluation, and social/professional discrimination. Students associating personal weakness with depression perceived medication as less efficacious and the academic environment as more competitive. Those endorsing public stigma viewed medication and counseling as less efficacious and associated depression with an inability to cope. Race, gender, and diagnosis of past/current depression also related to beliefs about stigma. Depression measures most strongly predicted stigma associated with personal weakness and social/professional discrimination.

CONCLUSIONS

Recommendations for decreasing stigma among physicians-in-training include consideration of workplace perceptions, depression etiology, treatment efficacy, and personal attributes in the design of stigma reduction programs that could facilitate help-seeking behavior among physicians throughout their career.

'We are a tight community': social groups and social identity in medical undergraduates

CONTEXT

Medical students often form close communities during their studies. These communities play a role in the development of professional identity, collaborative learning and the development of interpersonal skills. The existing literature describes both positive and negative implications of student social groups and social identity. The subjective student experience of this community forming is not fully described.

METHODS

This was a qualitative study researching students' experiences of communities and social bonding. A sample of 32 final-year medical students from two major teaching hospitals participated in semi-structured interviews, which were analysed according to constructivist grounded theory principles.

RESULTS

Four major themes emerged during research. The first is enforced isolation, and describes the geographical and institutional separation of medics from other undergraduates. The second is self-isolation and refers to the tendency of medical students to form exclusive social groups to maximise opportunities to 'decompress', obtain social constancy and facilitate horizontal learning. The third concerns the supportive network, wherein the medical community serves to provide its members with mutual support. The final theme refers to judging self and others, and describes the both respectful and critical ways in which students perceive themselves and their peers. These themes influence one another in an ongoing dynamic fashion, and grant insight into the establishment and maintenance of a cohesive medical community.

CONCLUSIONS

This study presents a conceptual construct for elucidating the roles and significance of communities in medical undergraduates. By better understanding the inter- and intra-personal dynamics inherent in this construct, we are better placed to support the welfare of our students and comprehend their social experiences and motivations.

Sources of Stress and Coping Strategies among Undergraduate Medical Students Enrolled in a Problem-Based Learning Curriculum

Background. Medical education is rated as one of the most difficult trainings to endure. Throughout their undergraduate years, medical students face numerous stressors. Coping with these stressors requires access to a variety of resources, varying from personal strengths to social support. We aimed to explore the perceived stress, stressors, and coping strategies employed by medical students studying in a problem-based learning curriculum. Methodology. This is a cross-sectional study of randomly selected medical students that explored demographics, perceived stress scale, sources of stress, and coping strategies. Results. Of the 378 medical students that participated in the study, males were 59.3% and females 40.7%. Nearly 53% of the students often felt stressed, and a third felt that they could not cope with stress. Over 82% found studying stressful and 64.3% were not sleeping well. Half of the students reported low self-esteem. Perceived stress scores were statistically significantly high for specific stressors of studying in general, worrying about future, interpersonal conflict, and having low self-esteem. Coping strategies that were statistically significantly applied more often were blaming oneself and being self-critical, seeking advice and help from others, and finding comfort in religion. Female students were more stressed than males but they employ more coping strategies as well. Conclusions. Stress is very common among medical students. Most of the stressors are from coursework and interpersonal relationships. Low self-esteem coupled with self-blame and self-criticism is quite common.

Prevalence of stress among medical students: a comparative study between public and private medical schools in Bangladesh

Background

Throughout the world all health professionals face stress because of time-pressures, workload, multiple roles and emotional issues. Stress does not only exist among the health professionals but also in medical students. Bangladesh has currently 77 medical colleges 54 of which are private. This study was designed to collect baseline data of stress-level among Bangladeshi students, which we believe will form the basis for further in depth studies.

Methods

A cross-sectional study was conducted on medical students from 2 public and 6 private medical-schools in Bangladesh. All medical schools have common curriculum formulated by the Government of Bangladesh. The study population was 1,363 medical students of Year-III and IV of academic session 2013/2014. Universal sampling technique was used. The period of study was February to June 2014. Data was collected using a validated instrument, compiled and analysed using SPSS version-20.

Results

A total of 990 (73%) out 1,363 medical students participated in the study, of which 36% were male and 64% were female. The overall prevalence of stress of the study population was 54%. 53% of male and 55% of female were reported suffering from stress. 54% of Year-III students and 55% of Year-IV were noted suffering from stress. There was statistically significant (p = 0.005) differences in the level of stress between public (2.84 ± 0.59) and private (2.73 ± 0.57) medical schools student.

Conclusions

More than half of Bangladeshi medical students are suffering from measureable academic stress. It would be pertinent if the relevant authorities could address the issue so as to provide a conducive medical learning environment.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-015-1295-5) contains supplementary material, which is available to authorized users.

Relationship among Medical Student Resilience, Educational Environment and Quality of Life

CONTEXT

Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students.

METHODS

We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young's resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire - short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI).

RESULTS

Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (β=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (β=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (β=-6.48; 95%CI=-10.01 to -2.95), psychological (β=-22.89; 95%CI=-25.70 to -20.07), social relationships (β=-14.28; 95%CI=-19.07 to -9.49), and physical health (β=-10.74; 95%CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (β=-31.42; 95%CI=-37.86 to -24.98), learning (β=-7.32; 95%CI=-9.23 to -5.41), teachers (β=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (β=-7.33; 95%CI=-8.53 to -6.12), atmosphere (β=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (β=-3.12; 95%CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements.

CONCLUSIONS

Medical students with higher resilience levels had a better quality of life and a better perception of educational environment. Developing resilience may become an important strategy to minimize emotional distress and enhance medical training.

The Impact of the Australian and New Zealand College of Anaesthetists’ Specialist Examinations on Trainee Learning and Wellbeing: A Qualitative Study

Assessment is an essential component of any medical specialist training program and should motivate trainees to acquire and retain the knowledge and skills essential for specialist practice, and to develop effective approaches to learning, essential for continuous professional development. Ideally, this should be achieved without creating an unreasonable burden of assessment. In this qualitative study we sought to investigate the underlying processes involved in trainees’ preparation for Australian and New Zealand College of Anaesthetists’ examinations, focusing on how the examinations helped trainees to learn the Australian and New Zealand College of Anaesthetists’ curriculum, and to identify any potential areas for improvement. We also explored the effect the examinations had on trainees’ lives, to identify if the examinations were a potential threat to their wellbeing. Using a phenomenological approach and purposive sampling, we conducted semi-structured interviews with post-fellowship trainees (n=20) selected from three different regions, with sampling continuing to achieve data saturation. We undertook a thematic analysis of the transcribed interview data utilising a general inductive approach. Our preliminary data suggest that, while the examinations are an important extrinsic motivator to learn and important for professional development, interviewees described many test-driven learning strategies, including rote learning and memorising past examination questions. A strong theme was the considerable impact on participants’ relationships and social activities for prolonged periods. Our findings support further research in this area and, in particular, into alternative testing strategies that might increase the proportion of time spent in useful study while decreasing less useful study time.

Prevalence and correlates of depression among college nursing students in China

This study aims to assess the prevalence of depression and examine potential risk factors correlated to depression among nursing college students in China. Between September and November 2012, a total of 763 college nursing students were randomly selected to participate in a survey, which included the Center for Epidemiologic Studies Depression Scale (CES-D). The result showed that 22.9% (95% CI: 20.0%-25.9%) of participants reported high score on the CES-D (16 or above). Risk factors significantly associated with depression in the univariate analysis were academic performance, academic stress, interest in majors, occupational future, interpersonal relationship, frequency of exercise, self-reported health status, social support, educational level of father, relationship with parents and making decisions without interference by parents. Backward multivariate logistic regression analysis revealed that lower academic stress, and better occupational future were strongly related to lower risk of depression, followed by active use of social support, full making decision power, better relationship with father and higher self-reported health status. The findings suggested that in order to prevent depression among college nursing students, school- and family-based strategies should be developed and implemented.

Empathy among medical students: is there a relation with quality of life and burnout?

Background

We aimed to assess medical students' empathy and its associations with gender, stage of medical school, quality of life and burnout.

Method

A cross-sectional, multi-centric (22 medical schools) study that employed online, validated, self-reported questionnaires on empathy (Interpersonal Reactivity Index), quality of life (The World Health Organization Quality of Life Assessment) and burnout (the Maslach Burnout Inventory) in a random sample of medical students.

Results

Out of a total of 1,650 randomly selected students, 1,350 (81.8%) completed all of the questionnaires. Female students exhibited higher dispositional empathic concern and experienced more personal distress than their male counterparts (p<0.05; d≥0.5). There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25). Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5). Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5). Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Gender (β = 0.27; p<0.001) and perspective taking (β = 0.30; p<0.001) were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (β = −0.18) and perspective taking (β = −0.14) (p<0.001). Personal accomplishment was associated with higher perspective taking (β = 0.21; p<0.001) and lower personal distress (β = −0.26; p<0.001) scores.

Conclusions

Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important association with decreasing personal distress and was also a predicting variable for perspective taking.

Psychological distress and its correlates among dental students: a survey of 17 Colombian dental schools

BACKGROUND

Links between the demanding nature of studies in the health sciences, students' personality traits and psychological distress have been well-established. While considerable amount of work has been done in medicine, evidence from the dental education arena is sparse and data from Latin America are lacking. The authors conducted a large-scale investigation of psychological distress among dental students in Colombia and sought to determine its curriculum and student-level correlates.

METHODS

The Spanish version of the Derogatis' Symptoms Checklist Revised (SCL-90-R) was administered to all students officially registered and attending classes or clinics in 17 dental schools in 4 geographic districts of Colombia between January and April 2012. Additional information was collected on participants' socio-demographic information and first career choice, as well as school's characteristics such as class size. The Global Severity Index (GSI) score, a measure of overall psychological distress, served as the primary analytical endpoint. Analyses relied on multilevel mixed-effects linear and log-binomial regression, accounting for study design and sample characteristics.

RESULTS

A total of 5700 dental students completed the survey, a response rate of 67%. Pronounced gradients were noted in the association between socio-economic status and psychological distress, with students in higher strata reporting fewer problems. After adjustment for all important covariates, there was an evident pattern of increasing psychological distress corresponding to the transition from the didactic, to the preclinical and clinical phases of training, with few differences between male and female students. Independent of other factors, reliance on own funds for education and having dentistry as the first career choice were associated with lower psychological distress.

CONCLUSIONS

Levels of psychological distress correlated with students' socio-economic and study-level characteristics. Above and beyond the influence of person-level factors, variations in levels of distress paralleled specific transitional stages of the 5-year dental curriculum, providing opportunities for targeted interventions.

Prevalence and associated factors of stress, anxiety and depression among prospective medical students

Many studies have reported that the prevalence of psychological distress among medical students during medical training was high. However, there are very few studies exploring on the psychological health of prospective medical students. This study aimed to determine the prevalence and associated factors for stress, anxiety and depression symptoms among the prospective medical students. A cross-sectional study was done on two cohorts of applicants to a public medical school. A total of 839 applicants were invited to participate in the study. The 21-item Depression Anxiety Stress Scale was administered to the applicants after they completed interviews. A total of 743 (92.2%) applicants took part in the study. The prevalence of moderate to extremely severe level of stress, anxiety and depression were 3.6%, 54.5% and 1.9%, respectively. Stress was significantly associated with extra-curricular activity (p<0.001) and race (p<0.001). Anxiety was associated with extra-curricular activity (p<0.001), race (p<0.001), mother education level (p=0.002) and CGPA group (p=0.034). Depression was associated with academic performance in class (p<0.001) and race (p=0.004). Prevalence of stress and depression among entering medical students was low; however prevalence of anxiety was high which could be due to worry about the interviews to enter medical course. The associated factors of psychological distress among prospective medical students were related to academic, non-academic, parent education and cultural backgrounds.

Perceived sources of stress amongst Chilean and Argentinean dental students

INTRODUCTION

The prevalence of high levels of stress as well as its multilevel consequences is well documented amongst students in the health sciences, and particularly in dentistry. However, investigations of perceived stress amongst Spanish-speaking student groups are sparse. This study aimed to (i) describe the translation, adaptation and psychometric properties of a Spanish version of the Dental Environment Stressors questionnaire and (ii) to examine the perceived sources of stress and their associations with the students' study year and gender in two dental schools in Latin America.

MATERIALS AND METHODS

All students officially registered in the dental schools of the University of San Sebastian (USS) in Chile and the Catholic University of Cordoba (CUC) in Argentina were invited to participate in the study. The DES30 questionnaire was adapted in Spanish using translation/back-translation, an expert bilingual committee, and consensus building. Cronbach's alpha was used to measure the instrument's internal consistency, and iterated principal factor analysis with promax rotation was employed to explore its underlying factor structure. Descriptive, bivariate and multivariate methods were used to examine the patterns of association between individual stressors, factor scores and students' characteristics.

RESULTS

Three hundred and four students comprised the study's analytical sample, with two-thirds of those being female. The DES30-Sp demonstrated good internal consistency (Cronbach's α = 0.89). A four-factor solution emerged and included 'academic workload', 'clinical training', 'time constraints' and 'self-efficacy beliefs' factors. 'Fear of failing a course or a year', 'examinations and grades' and 'lack of time for relaxation' were amongst the top individual-item stressors reported by students in both schools. Amongst this group of undergraduate dental students, those in Argentina, in higher study year, and females reported higher perceived stress.

CONCLUSIONS

Increased workload, time constraints and some aspects of clinical training were the top stressors of approximately 300 Chilean and Argentinean dental undergraduates. Some variations between schools, males and females and study years were noted. The Spanish version of the DES30 questionnaire performed well, but future studies should evaluate the instrument's properties in larger and more diverse dental student populations.