Analysis of stress levels among medical students, residents, and graduate students at four Canadian schools of medicine

Association of Personality Traits With the Efficacy of Stress Management Interventions for Medical Students Taking Objective Structured Clinical Examinations

PURPOSE

Personality traits are associated with psychophysiological stress, but few studies focus on medical students. This study aimed to better understand the association of personality traits with the efficacy of stress management interventions for medical students.

METHOD

A randomized controlled trial was conducted with fourth-year students who took the objective structured clinical examination at Bernard University Lyon 1 in December 2021. Students were randomized in cardiac biofeedback, mindfulness, and control groups. Each intervention was implemented for 6 minutes before the examination. Physiological stress levels were collected during the intervention. Psychological stress levels were rated by students at baseline and after the intervention. Personality traits were assessed via the Big-Five Inventory. Interactions between personality traits and the efficacy of the interventions were analyzed using multivariable linear regression models.

RESULTS

Four hundred eighty-one students participated. Higher baseline psychological stress levels were associated with higher neuroticism and agreeableness ( β = 10.27 [95% confidence interval {CI}, 7.40-13.13; P < .001] and β = 3.42 [95% CI, 0.98-5.85; P = .006], respectively) and lower openness ( β = -4.95; 95% CI, -7.40 to -2.49; P < .001). As compared with the control intervention, both stress management interventions led to lower levels of psychological ( P < .001 for both) and physiological stress levels (biofeedback: P < .001 and mindfulness: P = .009). Biofeedback efficacy varied by extraversion score for psychological ( β = -5.66; 95% CI, -10.83 to -0.50; P = .03) and physiological stress reduction ( β = -0.002; 95% CI, -0.003 to -0.00004; P = .045). Mindfulness efficacy varied by agreeableness score for psychological stress reduction ( β = -7.87; 95% CI, -13.05 to -2.68; P = .003).

CONCLUSIONS

Students with a high score in extraversion may benefit more from biofeedback interventions, while students with high scores in agreeableness may benefit more from mindfulness interventions.

Wellness Activities, Stress, and Academic Performance in Medical Students

INTRODUCTION

Medical student wellness has a range of effects from academic performance to tragic mortality. Many factors correlate with academic performance, including study environments, faculty support, research participation, and student attitude. Its relationship with student stress and wellness demonstrates mixed results. This study hopes to help clarify these results and will also assess the interplay of these factors in relation to the pre-clerkship and clerkship phases of medical school.

METHODS

This retrospective descriptive study was conducted using a de-identified database from 2017 to 2023, provided per an Institutional Review Board (IRB) protocol. The subjects were the students of the classes of 2021-2027 at the Kirk Kerkorian School of Medicine at UNLV. The database included performance data including semester, clinical subject, and USMLE Step 1 and Step 2 exam scores. Other data included variables relating to self-perceived stress and time spent in wellness activities before medical school and at the end of the pre-clerkship and clerkship phases of medical school. The effects of these variables were calculated with bivariate correlations and independent samples T-tests using cut-off points calculated from the class means of those variables. A total of 361 medical students were included in the study.

RESULTS

Students with high wellness time had lower stress levels in both the pre-clerkship and clerkship phases of medical school (5.83 vs. 7.3 p < 0.001* and 5.74 vs. 8.49 p < 0.001*, respectively). Students with low stress levels in the pre-clerkship phase scored 5.81 points higher on the Step 1 exam (p = 0.013*). Clerkship phase stress levels were significantly negatively correlated with all clinical subject exams except for pediatrics. Stress levels in the pre-clerkship and clerkship phases had similar relationships with the second and third semester and Step 2 exams, respectively, although not statistically significant. Wellness activity time did not have a significant relationship with academic performance.

CONCLUSION

Stress levels had significant negative relationships with many medical school exams. Although wellness activity time did not have a direct relationship with academic performance, its relationship with stress levels can allude to an indirect effect on academic performance. This, along with fending off burnout and stress, are reasons why medical student wellness should be a priority for medical schools, faculty, and their students.

Mental health and burnout during medical school: Longitudinal evolution and covariates

BACKGROUND

Medical students' rate of depression, suicidal ideation, anxiety, and burnout have been shown to be higher than those of the same-age general population. However, longitudinal studies spanning the whole course of medical school are scarce and present contradictory findings. This study aims to analyze the longitudinal evolution of mental health and burnout from the first to the last year of medical school using a wide range of indicators. Moreover, biopsychosocial covariates that can influence this evolution are explored.

METHOD

In an open cohort study design, 3066 annual questionnaires were filled in by 1595 different students from the first to the sixth year of the Lausanne Medical School (Switzerland). Depression symptoms, suicidal ideation, anxiety symptoms, stress, and burnout were measured along with biopsychosocial covariates. The longitudinal evolution of mental health and burnout and the impact of covariates were modelled with linear mixed models.

RESULTS

Comparison to a same-aged general population sample shows that medical students reported significantly more depression symptoms and anxiety symptoms. Medical students' mental health improved during the course of the studies in terms of depression symptoms, suicidal ideation, and stress, although suicidal ideation increased again in the last year and anxiety symptoms remained stable. Conversely, the results regarding burnout globally showed a significant worsening from beginning to end of medical school. The covariates most strongly related to better mental health and less burnout were less emotion-focused coping, more social support, and more satisfaction with health.

CONCLUSION

Both improvement of mental health and worsening of burnout were observed during the course of medical school. This underlines that the beginning and the end of medical school bring specific challenges with the first years' stressors negatively impacting mental health and the last year's difficulties negatively impacting burnout.

Factors in turnover intention of cardiothoracic surgery residents

Increasing numbers of cardiothoracic surgery residents are resigning, without completing their training. This study analyzes how their turnover intention is related to the training environment, and individual psychological factors. Responses by 57 Korean cardiothoracic surgery residents were analyzed. Their levels of depression, anxiety, grit, and empathy, working conditions, the effect of someone's presence to discuss their concerns with, burnout, and turnover intention were identified as the research variables. Descriptive statistical analysis, correlation analysis, and structural equation modeling were used for data analysis. Burnout has the most significant relationship with turnover intention. It has a mediating effect on the influence of depression, grit (sustained interest), and working conditions, over turnover intention. Empathy, and the presence of someone to discuss concerns with, also affect turnover intention directly. The study also confirmed that grit and work satisfaction affect turnover intention indirectly, through burnout. The study identified both individual- and systemic-level factors for an effective training environment, to reduce cardiothoracic surgery residents' tendencies of leaving the residency program, and supporting them for greater satisfaction with their career choice. In order to resolve negative emotions such as burnout and depression, and foster empathy, a human resource development program for the residents' psychological support must be prepared. The program director should be adequately educated to take charge of the training program, oversee the residents' education and welfare, and perform the roles of role-model and mentor.

Daily stress, and mental health of professional degree graduate students in Chinese traditional medicine universities: the mediating role of learning career adaptation

BACKGROUND

With the expansion of professional degree graduate students' enrollment in China education, the mental health of these professional degree graduate students in medical-related majors who are under pressure of study, scientific research, clinical practice, and employment should not be ignored. What is the mental health level of these graduate students under the effect of learning career adaptation (internal resources) in the face of daily stress (external factors)? The purpose of this study is to discuss the relationship between these variables, and the mediating role of learning career adaptation of professional degree graduate students in traditional Chinese medicine colleges, and universities, to provide a theoretical basis for improving the learning career adaptation of students, and improving the level of mental health.

METHODS

A cross-sectional survey was conducted among 1593 professional degree graduate students majoring in clinical medicine, traditional Chinese medicine, and nursing in five traditional Chinese medicine universities. Finally, 660 questionnaires were returned, with a recovery rate of 41.43%. The scores of daily stress, learning career adaptation, and mental health were measured by Daily Stressors Scale for graduate students, graduate-students learning career adaptation scale, and General Mental Health Questionnaire (GHQ-20). Descriptive statistics were used to analyze the status quo of daily stress, learning career adaptation, and mental health. Pearson correlation analysis were used to analyze the relationship between them. we undertake analyses using structural equation modeling to construct the latent variable path model of daily stress, learning career adaptation on mental health. The significance level of the mediating effect was tested by the non-parametric percentile bootstrap method.

RESULTS

The scores of mental health, daily stress, and learning career adaptation were 50.56 ± 10.80, 35.12 ± 19.55, and 67.13 ± 7.48 respectively. Daily stress was negatively correlated with the three dimensions of learning career adaptation: career confidence, focus on his career, and career control (P < 0.01). Daily stress was positively correlated with depression and anxiety (P < 0.01). Self-affirmation, depression, and anxiety were negatively correlated with career confidence, focus on his career, and career control (P < 0.05). Learning career adaptation plays a partial mediating role between daily stress, and mental health (p < 0.001), with an intermediate effect value of 0.127, representing 28.54% of the total effect.

CONCLUSIONS

Mental health, learning career adaption of medical-related professional degree graduate students in traditional Chinese medical universities were at a moderate degree, and an upper-middle level respectively, while daily stress is to a lesser extent. Learning career adaptation mediates the relationship between daily stress, and mental health partially. To some extent, it can buffer the impact of daily stress on mental health, especially anxiety. The educational administrator could take various measures to improve the mental health of professional degree graduate students. It can also enhance their learning career adaptation from the perspective of individuals, and organizations to improve their mental health.

Mental health throughout the medical career: A comparison of depression, anxiety, and stress levels among medical students, residents, and physicians

BACKGROUND

Different stages of a physician's career may be associated with different types of mental health impairment.

AIMS

This study aimed to compare symptoms of anxiety, depression, and stress and their associated factors among medical students, medical residents, and physicians.

METHODS

A cross-sectional study was conducted. Data collection included sociodemographic data, religiosity (Duke University Religion Index), and mental health (21-item Depression, Anxiety and Stress Scale - DASS-21) data. The comparison between the groups was performed using ANOVA, and the associated factors were evaluated via linear regression models.

RESULTS

The sample consisted of 1,417 participants: 778 medical students, 190 medical residents, and 468 established physicians. Medical students had significantly higher depression, anxiety, and stress scores as compared to medical residents and established physicians. However, regarding DASS 21 scores, no significant differences were found between established physicians and medical residents. The factors associated with mental health in the different groups showed that being married and male were associated with better mental health among physicians and medical residents, while the factors of male gender, being in later years of the course, and lower religious attendance were associated with better mental health in students.

CONCLUSION

Medical students had worse mental health outcomes when compared to residents and established physicians. Interventions are needed to minimize suffering during medical education and career.

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.

Anxiety, depression, and academic stress among medical students during the COVID-19 pandemic

Background

The social distancing policies implemented by the health authorities during the COVID-19 pandemic in Mexico and elsewhere led to major changes in teaching strategies for college undergraduates. So far, there is limited data regarding the impact of the lockdown on the academic stress and mental health of these students.

Objective

To assess the occurrence of academic difficulties, anxiety, depression, and academic stressors resulting in somatization with subsequent coping strategies linked to the pandemic.

Materials and methods

A cross-sectional study was conducted with 728 medical students (years 1-5). A purposely designed questionnaire to assess academic difficulties associated with the pandemic was administered electronically. The validated Goldberg anxiety and depression scale was also used, as well as the SISCO-II inventory on academic stress.

Results

Screening for anxiety and depression led to a prevalence of 67.9 and 81.3%, respectively. Most relevant stressors, reported always or nearly always, included professors' evaluations (63.9%), and reading overload of academic papers (50.6%). Factorial analyses showed that women were more prone to stress than men (p < 0.001). Somatization symptomatology included drowsiness or increased need of sleep, anxiety, anguish, desperation, chronic fatigue, and sleep disorders. Common coping strategies included practicing a hobby, done always or nearly always by 65% of students with high stress, and 34% of those with low stress (p < 0.001).

Conclusion

There was a relevant impact of the mandatory lockdown during COVID-19 pandemic on the mental health of medical students reflected in the high prevalence rates of anxiety, depression, and stressors in the studied population pointing to the need for designing and implementing preventive strategies to deal with the effects of lockdowns.

The Association between COVID-19 Pandemic and the Quality of Life of Medical Students in Silesian Voivodeship, Poland

(1) Background: Since the COVID-19 pandemic spread rapidly in 2020, medical universities have been affected by a particular crisis. Due to the increased risk of SARS CoV-2 transmission, the authorities of medical faculties all over the world, including Poland, started to minimize direct contact between students. The objective of the paper is to identify and assess determinants of the quality of life among medical students in Poland before and during the COVID-19 pandemic. (2) Methods: We analyzed data obtained in a cross-sectional study performed among three groups of students tested in three consecutive research periods: period before the COVID-19 pandemic, the COVID-19 pandemic lockdown period and the COVID-19 pandemic period following lockdown. (3) Results: The total number of participants was 1098. We identified that the research period before the COVID-19 pandemic was the risk factor for lower quality of life in terms of the somatic and environmental domains. It was also confirmed that determinants such as poor financial situation, low frequency of physical activity and bad self-declared health status harmed the QoL scores in all domains. (4) Conclusions: The obtained results confirmed that better financial situation, higher physical activity and better self-declared health status were statistically significant factors improving the quality of life of first-year medical students in Poland. The findings of our study also showed that the declared somatic and environmental domains of QoL among medical students were better during the COVID-19 pandemic period. Our observations confirmed that the immediate implementation of e-learning could protect against the deterioration of mental health and quality of life in first-year medical students during possible future epidemic crises.

Coping styles to vitiate the risk of psychological morbidities among pre/para-clinical and clinical undergraduate medical students: a comparative cross-sectional study in India

Background

Psychological morbidities are high among undergraduate medical students. They experience the transition between pre/para-clinical and clinical training as a stressful period and cope differently. Research from India in this regard are lacking. The aim of this study is to assess and compare the prevalence of psychological morbidities, associated factors and coping styles between pre/para-clinical and clinical undergraduate medical students. This institution-based cross-sectional observational design study was conducted among pre/para-clinical and clinical group of undergraduate medical students (a total of 382) by using a questionnaire in the period between April and June 2021. Stratified random sampling technique was used to select the study participants. The survey included standard self-administered questionnaires like GHQ-28 and Lin-Chen’s coping inventory to assess psychological morbidities and coping styles, respectively. Associated factors for psychological morbidities, and coping styles between two groups, were compared using chi-square test, independent t-test and binary logistic regression analysis.

Results

Out of the 382 responders, psychological morbidities (GHQ-28 score > 23) were found in 61% participants. Both groups reported high level, a slightly higher preponderance in clinical (61.5%) than pre/para-clinical students (60.6%) and with nonsignificant difference of psychological morbidities. Compared to pre/para-clinical group, clinical group was found to have more substance consumption behavior (p < 0.001), dissatisfaction with academic performance (p < 0.001), sought psychiatric consultation (p < 0.004) and currently on psychiatric treatment (p < 0.04). Overall, coping was found to be average and good among the participants. Active problem coping behavior was more significantly used by pre/para-clinical group, while passive problem coping and passive emotional coping behaviors were positively significantly correlated with psychological morbidities in clinical group.

Conclusions

This study established a significant correlation between psychological morbidities and passive coping styles in clinical group. These students need interventions to encourage the use of more active coping styles during the training to provide advances in future career. A strong correlation with dissatisfied academic performance may be a call for an efficient and more student-friendly curriculum.

Psychological Morbidities and Coping Styles: A Rural Institution-Based Cross-Sectional Comparative Study between Undergraduate Medical Students Undergoing Different Phases of Training

Background Psychological morbidities are high among undergraduate medical students. They experience the transition between pre-/para-clinical and clinical training as a stressful period, and cope differently. Research studies from India in this regard are lacking.

Aims The aim of this study is to assess and compare the prevalence of psychological morbidities and their respective associated factors and coping styles between pre-/para-clinical and clinical undergraduate medical students.

Materials and Methods This institution-based cross-sectional observational design study was conducted among undergraduate medical students (a total of 382) in pre-/para-clinical and clinical years by using a questionnaire in the period between April and June 2019. A stratified random sampling technique was used to select the study participants. The survey included standard self-administered questionnaires like General Health Questionnaire-28 (GHQ-28) and Lin–Chen's coping inventory to assess psychological morbidities and coping styles, respectively. Associated factors for psychological morbidities and coping styles between two groups were compared using the Chi-square test, independent t-test, and binary logistic regression analysis.

Results Out of the 382 responders, psychological morbidities (GHQ-28 score > 23) were found in 61% participants. Both groups reported high levels of psychological morbidities; a slightly higher preponderance in clinical (61.5%) than in pre-/para-clinical students (60.6%) with a nonsignificant difference. Compared with the pre-/para-clinical group, the clinical group was found to have more substance consumption behavior (p < 0.001), dissatisfaction with academic performance (p < 0.001), sought psychiatric consultation (p < 0.004), and at that time on psychiatric treatment (p < 0.04). Active problem coping behavior was more significantly used by the pre-/para-clinical group, while passive problem coping and passive emotional coping behaviors were positively significantly correlated with psychological morbidities in the clinical group.

Conclusion This study suggests a significant correlation between psychological morbidities and passive coping styles in the clinical group. These students need interventions to encourage the use of more active coping styles during training to provide advances in future career. A strong correlation between psychological morbidities and dissatisfied academic performance may be a call for an efficient and more student-friendly curriculum.

A pilot study investigating the efficacy of brief, phone-based, behavioral interventions for burnout in graduate students

OBJECTIVE

This pilot study tested the efficacy of two brief, phone-administered, behavioral interventions derived from behavioral activation in reducing burnout among doctoral students.

METHODS

Sixty-six doctoral students demonstrating current high burnout were randomly assigned to one of three intervention conditions: (1) Reward: increasing pleasant, rewarding behaviors, (2) Approach: approaching important goals that they have been avoiding, or (3) Control: monitoring only.

RESULTS

Results indicated that doctoral students treated with the approach intervention reported significantly lower burnout compared to participants in the control condition immediately after the intervention and at a 1-week follow-up. Results also suggested that students in the approach intervention also reported higher well-being compared to students in the control condition.

CONCLUSION

These findings suggest that this approach intervention is an effective treatment for school burnout for doctoral students that can be delivered remotely through phone and web technology.

Prevalence and changes in depressive symptoms among postgraduate students: A systematic review and meta-analysis from 1980 to 2020

Education actively helps us develop our well-being and health, but postgraduate students are at high risk of depression. The prevalence of depression symptoms varies from 6.2% to 84.7% among them, and its changes throughout the years remains unclear. The present study aimed to estimate the real prevalence of depression symptoms among postgraduate students and the changes from 1980 to 2020. Thirty-seven primary studies with 41 independent reports were included in the meta-analysis (none reports were in high-quality, three were medium-to-high quality, 20 were low-to-medium quality, and 18 were low-quality), involving 27,717 postgraduate students. The pooled prevalence of overall, mild, moderate, and severe depression symptoms was 34% (95% CI: 28-40, I²  = 98.6%), 27% (95% CI: 22-32, I²  = 85.8%), 13% (95% CI: 8-21, I²  = 97.3%), and 8% (95% CI: 6-11, I²  = 81.0%), respectively. Overall, the prevalence of depression symptoms remained relatively constant through the years following 1980 (overall: β = -0.12, 95% CI: [-0.39, 0.15], p = 0.39; mild: β = 0.24, 95% CI: [-0.02, 0.51], p = 0.07; moderate: β = -0.24, 95% CI: [-0.75, 0.26], p = 0.34; severe: β = 0.13, 95% CI: [-0.25, 0.51], p = 0.50). Doctoral students experienced more depressive symptoms than did master's students (43% vs. 27%; Q = 2.23, df = 1, p = 0.13), and studies utilising non-random sampling methods reported a higher prevalence of mild depression and lower moderate depression symptoms than those that used random sampling (overall: 34% vs. 29%; Q = 0.45, df = 1, p = 0.50; mild: 29% vs. 21%; Q = 1.69, df = 1, p = 0.19; moderate: 16% vs. 25%; Q = 1.79, df = 1, p = 0.18; severe: 8% vs. 9%; Q = 0.13, df = 1, p = 0.72) despite these differences was not statistically significant. The prevalence of depression symptoms was moderated by the measurements and the quality of primary studies. More than one-third of postgraduates reported depression symptoms, which indicates the susceptibility to mental health risk among postgraduates. School administrators, teachers, and students should take joint actions to prevent mental disorders of postgraduates from increasing in severity.

Study Engagement and Burnout of the PhD Candidates in Medicine: A Person-Centered Approach

This study focused on exploring individual variations in doctoral candidates' well-being, in terms of experienced research engagement and burnout by using a person-centered approach. In addition, the associations between well-being profiles and gender, country of origin, study status (full-time or part-time), research group status and drop-out intentions were explored. The participants were 692 PhD candidates in the field of medicine. Latent profile analysis was employed to identify the well-being profiles. Four distinct profiles were identified: high engagement-low burnout, high engagement-moderate burnout, moderate engagement-moderate burnout, and moderate engagement-high burnout. Working in a clinical unit or hospital and working in a research group seemed to be related to increased engagement and reduced risk for suffering burnout, while the intentions to quit one's doctoral studies were more frequently reported in profiles with moderate levels of engagement. The findings imply that although a significant number of PhD candidates in medicine had an increased risk for developing burnout, for most of the PhD candidates research education is an engaging experience.

Navigating the Infinite Number of Educational Resources: The Development of a Publicly Available Surgical Educational Digital Resource Library

OBJECTIVE

There has been an explosion of digital resources available for general surgical education and board preparation. This makes it difficult for a new learner, regardless of their training level, to determine which resources best fit their needs. The uncertainty surrounding resource selection due to the large number of options causes stress, anxiety, and inefficiency for surgical learners. Our objective was to develop a digital surgical educational resource library to assist with selection.

DESIGN

A needs assessment via multi-center focus groups encompassing all levels of learners from various subspecialties and training levels (medical students, trainees, junior surgeons, and senior surgeons) was performed to determine what information is desired in a surgical resource library. We conducted follow-up interviews and surveys to learn which resources were most commonly used for studying throughout training.

SETTING

Multi-institutional RESULTS: The initial needs assessment detailed requests for an expansive array of surgical resources characterized by media type and price. We identified 104 resources that met these criteria. There were 33 resources used by medical students, 37 by residents, 16 used specifically for surgical boards preparation, and 25 by attending surgeons. These resources were composed of textbooks, review books, question banks, audio resources, video resources, and review courses. The prices of the resources ranged from free to greater than 400 dollars.

CONCLUSIONS

A digital resource library should be broad and must address needs that change along a learner's career. Changes and improvements are required not only to meet the changing needs of the learners, but also to ensure the library remains current with the ever-growing number of resources. We plan to incorporate reviews of the resources from those surveyed to help visitors of the online library determine which resources may best suit their needs. Development of a digital resource library may assist learners by helping them easily identify what is available and has been peer reviewed allowing them to determine what best meets their educational needs.

Doctoral capital and well-being amongst Australian PhD students: exploring capital and habitus of doctoral students

Purpose

The Higher Degree Research (HDR) journey is known for its difficulties, complexities and challenges (Lees-Deutsch, 2020), with many students experiencing multi-faceted issues and concerns (Skopek et al., 2020). Therefore, the purpose of this research is to investigate the relationships that exist between variables, vulnerability factors and doctorial capital of candidates (n = 532) studying at Australian universities (2019).

Design/methodology/approach

A quantitative cross-sectional correlational research design and Bronfenbrenner's socio – ecological framework (personal, home, university, community) was utilised to collect participants' (n = 532) descriptive statistics. Bourdieu's social reproduction theory was used as a lens to examine how experiences, across the PhD candidature, are influenced by several psychosocial factors and doctoral capital.

Findings

From such a dual methodological approach, the findings from this study suggests that (1) age, (2) gender, (3) nationality, (4) financial/work status, (5) years of PhD and (6) attending postgraduate (PG) student events, go to significantly (p < 0.001) impact (positively and negatively) on students' experiences and correspondingly, impacts on their self-confidence, motivation and mental health and well-being status.

Research limitations/implications

Research limitations are related to the recruitment of more doctoral students across more Australian universities. Further research is required from HDR supervisors, so as to “balance” the experiences of the PhD journey in higher education.

Practical implications

In order to succeed in academia and HDR programs, students need to identify with and develop the “right kind of capital” to successfully navigate fields of social and scholarly play. Investigating how the participants perceive their social and scholarly habitus is seen as crucial in helping students to develop positive dispositions relevant to being a doctoral student.

Social implications

The concept of doctoral capital and well-being, amongst Australian PhD students, is under researched and requires further investigation as a precursor to developing more specific policy designs aimed at providing heightened positive learning environments/HDR programs tailored to support doctoral students.

Originality/value

Whilst reforms to improve PhD experiences are well established across the international literature (Geven et al., 2018; Skopek et al., 2020), evidence for Australia is largely missing. It is envisaged, that findings from this research will further assist in the development of quality policies that would go to provide effective services and support for doctoral students within Australian universities.

Assessment of Student Perspectives on Improving Wellness in Medical School: Qualitative Results from a Cross-Sectional Survey of Medical Students in Florida

PURPOSE

Helping medical students maintain wellbeing has become an important concern, as many medical students report a decline in their mental health during the course of their training. To improve students' wellbeing, some schools have implemented wellness programs into their curricula. While there is growing research about the effectiveness of these programs, little is known about what medical students themselves desire to support their wellbeing. This study aimed to assess medical student perspectives regarding the most effective ways to promote wellness during medical school.

PARTICIPANTS AND METHODS

To address this gap in the literature, a survey was administered to medical students at the nine medical schools in the state of Florida. Participants included 864 medical students, whose anonymous responses were analyzed descriptively as well as qualitatively to determine major themes.

RESULTS

Students provided novel suggestions and recommendations, including ideas for curricular additions and changes, cultural changes within schools, promoting positive behaviors and extracurricular activities, and providing resources for students.

CONCLUSION

Based on the participants' responses, it is evident that wellness is an important issue to medical students and, given the variety of suggestions, schools should strongly consider what wellness changes to implement and whether participation in them should be mandatory. The results of this study will be a resource to medical schools and educators who are considering curricular changes to address medical student wellbeing.

Beyond the curriculum: a cross-sectional study of medical student psychological distress, and health care needs, practices and barriers

INTRODUCTION

Medical students report significant levels of distress, and are reluctant to seek help despite health care needs, often citing factors associated with the medical school environment beyond training, generally termed the 'hidden curriculum'.

OBJECTIVES

The primary objectives of the current study were to establish the level of psychological distress in a sample of medical students enrolled in an Atlantic Canadian medical school, explore factors that predict the psychological distress, examine health care needs, concerns, and practices, and consider potential barriers to care.

METHODS

Instruments assessing distress (i.e., the Kessler Psychological Distress scale), predictors of distress (i.e., the Perceived Medical School Stress scale), and health care needs and practices (i.e., the Medical Student Health Survey) were administered to 180 medical students. Distress was also compared to three age, sex, and frequency matched Canadian Community Health Survey (CCHS) samples representing the general Canadian population, full time university/college students, and those reporting Anxiety Disorder diagnosed by a healthcare provider.

RESULTS

Medical students reported significantly higher levels of psychological distress than each comparison group, which was significantly predicted by training year, and three PMSS subscales, i.e., "Medical school controls my life", "Is more a threat than a challenge", and "Long hours and responsibilities associated with clinical training". Eighty-six percent of students reported health care needs ranging from common complaints to mental illness, with many either seeking services outside their training institution, consulting with peers, or not attaining care, primarily for reasons of confidentiality and/or non-permissive training schedules.

CONCLUSIONS

Medical student psychological distress is significant, and while it may reflect rigors of training, it is also linked with stigma, perceptions that the curriculum is controlling and can often be considerably overwhelming. As a function of this environment, students may not be adequately attending to their own health issues.

Medical Student Psychological Distress and Mental Illness Relative to the General Population: A Canadian Cross-Sectional Survey

PURPOSE

To provide national data on Canadian medical students' mental health and show how their mental health compares with that of similarly aged postsecondary graduates from the general population.

METHOD

In 2015-2016, the authors conducted a survey of medical students in all years of study at all 17 Canadian medical schools. The surveys included validated items and instruments to assess for psychological distress, suicidal ideation, and diagnosed mood and anxiety disorders. Comparative analyses were performed between medical students and similarly aged postsecondary graduates using data from the Canadian Community Health Survey-Mental Health 2012.

RESULTS

The participation rate across all medical students was 40.2% (4,613/11,469). Relative to the general population of postsecondary graduates aged 20-34, medical students aged 20-34 had significantly higher rates of diagnosed mood disorders, diagnosed anxiety disorders, suicidal ideation, and psychological distress. Among medical students, being female was associated with having a mood or anxiety disorder, lifetime suicidal ideation, moderate or severe psychological distress, and higher mean Kessler Psychological Distress Scale 6-item summative scores. Being in clinical training was associated with having suicidal ideation, moderate or severe psychological distress, and mood and anxiety disorders.

CONCLUSIONS

Compared with postsecondary graduates from the general population, medical student respondents had significantly higher rates of psychological distress, suicidal ideation, and mood and anxiety disorders. Further research is needed to understand the factors that are contributing to these higher rates.

Investigating the Relationship Between Resilience, Stress-Coping Strategies, and Learning Approaches to Predict Academic Performance in Undergraduate Medical Students: Protocol for a Proof-of-Concept Study

Background

The evolution of an undergraduate medical student into an adept physician is perpetual, demanding, and stressful. Several studies have indicated medical students have a higher predominance of mental health problems than other student groups of the same age, where medical education acts as a stressor and may lead to unfavorable consequences such as depression, burnout, somatic complaints, decrease in empathy, dismal thoughts about quitting medical school, self harm and suicidal ideation, and poor academic performance. It is imperative to determine the association between important psychoeducational variables and academic performance in the context of medical education to comprehend the response to academic stress.

Objective

The aim of this proof-of-concept study is to determine the relationship between resilience, learning approaches, and stress-coping strategies and how they can collectively predict achievement in undergraduate medical students. The following research questions will be addressed: What is the correlation between the psychoeducational variables resilience, learning approaches, and stress-coping strategies? Can academic performance of undergraduate medical students be predicted through the construction of linear relationships between defined variables employing the principles of empirical modeling?

Methods

Study population will consist of 234 students registered for the MBBS (Bachelor of Medicine, Bachelor of Surgery) at Mohammed Bin Rashid University of Medicine and Health Sciences distributed over 4 cohorts. Newly registered MBBS students will be excluded from the study. Various psychoeducational variables will be assessed using prevalidated questionnaires. For learning approaches assessment, the Approaches and Study Skills Inventory for Students questionnaire will be employed. Resilience and stress-coping strategies will be evaluated using the Wagnild-Young resilience scale and a coping strategies scale derived from Holahan and Moos’s Coping Strategies Scale, respectively. Independent variables (resilience, stress-coping strategies, and learning approaches) will be calculated. Scores will be tested for normality by using the Shapiro-Wilk test. An interitem correlational matrix of the dependent and independent variables to test pairwise correlation will be formed using Pearson bivariate correlation coefficients. Regression models will be used to answer our questions with type II analyses of variance in tests involving multiple predictors. Regression analyses will be checked for homogeneity of variance (Levine test) and normality of residuals and multicollinearity (variance inflation factor). Statistical significance will be set at 5% (alpha=.05). Effect sizes will be estimated with 95% CIs.

Results

Psychoeducational instruments in the form of validated questionnaire have been identified in relation to the objectives. These questionnaires have been formatted for integration into Google forms such that they can be electronically distributed to the consenting participants. We submitted the proposal to MBRU institutional review board (IRB) for which exemption has been awarded (application ID: MBRU-IRB-2019-013). There is no funding in place for this study and no anticipated start date. Total duration of the proposed research is 12 months.

Conclusions

Psychoeducational instruments used in this study will correlate resilience, stress-coping strategies, and learning approaches to academic performance of undergradudate medical students. To the best of our knowledge, no study exploring the multidimensional association of key psychoeducational variables and academic performance in undergraduate medical students has been pursued. Investigated variables, resilience, learning approaches, and stress-coping strategies, are individual traits, however; students’ learning history before they joined MBRU is unknown, so our research will not be able to address this specific aspect.

International Registered Report Identifier (IRRID)

PRR1-10.2196/14677

Depression Among First- and Fifth-Year Medical Students in Riyadh, Saudi Arabia

BACKGROUND

Depression, which is characterized by persistent sadness, is a highly prevalent and serious medical disease that affects more than 300 million individuals worldwide. It is hypothesized that the onset of depressive symptoms in medical students occurs due to prolonged exposure to the stressful environment of medical colleges. Hence, we aimed to determine the presence of depressive symptoms and compare the level of depression between the first-year and fifth-year medical students in Riyadh city, Saudi Arabia.

MATERIALS AND METHODS

This cross-sectional study was performed with convenient sampling from 2 medical colleges in Riyadh in the Kingdom of Saudi Arabia from October to November 2017. The English version of Beck's Depression Inventory questionnaire was used in this study. Statistical analysis was administered using SPSS via chi-square test, and P-value less than 0.05 was considered statistically significant.

RESULTS

The questionnaire was answered by 241 participants. The age variable shows a bimodal distribution. The mean age of first-year and fifth-year students was 19±0.8 years and 23±2.1 years, respectively. Fifth-year students comprised 53.5% of the total sample, and male students accounted for 63.1% of the total sample. After analysis, the results show that male students scored higher than female students on the lower side of the scale in both years. Most of the first-year female students scored a higher level of depression compared with male students (P=0.001), whereas no difference between males and females (P=0.04) was found in the fifth-year students' data.

CONCLUSION

Our study shows a new pattern of reported depressive symptoms among first-and fifth-year medical students. In addition, the study suggests that depression is more common in female medical students as compared with their male counterparts. For future studies, we recommend using randomized sampling in a cohort study including all levels of medical students to further investigate and confirm the findings.

Burnout and Mental Health Problems in Biomedical Doctoral Students

Although burnout and mental health problems may adversely impact quality of scientific research, academic productivity, and attrition in biomedical doctoral training programs, very little research has been done on this topic. Recent studies have used brief survey methods to begin to explore burnout and mental health problems in biomedical doctoral students. In this pilot study, biomedical doctoral students (N = 69; 12% of enrolled biomedical doctoral students at a large research institution's school of medicine in the United States) were administered standardized psychiatric interviews and self-report questionnaires focused on dimensions of burnout, mental health symptoms, and academic outcomes. We discovered high levels of burnout, depression, and anxiety. Additionally, we identified that burnout was significantly associated with thoughts related to dropping out, subjective appraisal of employment opportunities, functional impairment due to a mental health problem, and having at least one current psychiatric disorder. These findings extend prior research indicating the presence of significant emotional health challenges doctoral students in biomedical graduate programs face involving high burnout and difficulties with the training environment. We outline several recommendations and next steps to programmatically understand and address these emerging emotional wellness concerns in biomedical doctoral students.

Genetic counseling students' experiences with mental illness during training: An exploratory study

Mental illness is a substantive issue for graduate students. We investigated experiences of mental illness during training among genetic counseling students, a subgroup of graduate students for which little data exists on this topic. Genetic counseling students and recent graduates (n = 227) completed an online survey, from who 11 were selected to participate in semi-structured telephone interviews. Thematic analysis and member checking were employed to interpret the interviews. An overarching theme of importance to participants' mental health during genetic counseling training was safety, with subthemes of: trust/confidentiality, stigma and fear of labeling, developing a unique professional identity, and ability to engage in self care strategies. Our data could help genetic counseling training programs develop strategies to support students' mental health.

In their own words: stressors facing medical students in the millennial generation

BACKGROUND

Medical student exposure to stressors is associated with depression, burnout, somatic distress, decreases in empathy, serious thoughts about dropping out of medical school, suicidal ideation, and poor academic performance. Despite this, there have been no recent, multicenter, qualitative studies assessing medical students' perceptions of their greatest stressor(s).

OBJECTIVE

The goal of this study was to identify the most significant stressors noted by medical students themselves, in order to inform the development of programs and policies to reduce medical student distress.

DESIGN

Medical students from the nine schools in the state of Florida were invited to complete an anonymous online questionnaire assessing wellness and distress. Students were notified that all responses were voluntary and that individual responses would not be linked to themselves or their program. This paper focuses on students' responses to fixed-response items regarding their experience of stress and open-ended responses to the following question: 'What do you consider to be the greatest stressor(s) facing medical students?' Qualitative data were analyzed using the Grounded Theory method of data analysis.

RESULTS

Results confirmed the impact of several stressors highlighted in previous studies (e.g., excessive workload, difficulties with studying and time management, conflicts in work-life balance and relationships, medical school peer relations, health concerns, and financial stressors). However, students also reported unique system-level concerns that have not consistently been highlighted in past research (e.g., medical school administrative failures, concerns about lack of assistance with career planning, and assessment-related performance pressure.

CONCLUSIONS

Though individually focused interventions have demonstrated some success, medical students self-report stressors that may be better addressed through system-level changes.

Prevalence of Psychological Distress Among Undergraduate Students at Jazan University: A Cross-Sectional Study

Background:

Undergraduate learning is a sensitive and challenging period for students and has been reported to result in high rates of psychological distress in them.

Objectives:

To determine the prevalence of psychological distress among undergraduate students at Jazan University, Kingdom of Saudi Arabia.

Materials and Methods:

A cross-sectional study was conducted among a stratified sample of 500 undergraduate students from five faculties at Jazan University. All participants completed an anonymous, self-administered questionnaire, which included questions about their sociodemographic details and a measuring scale of general psychological distress, the Brief Symptom Inventory-18 (BSI-18).

Results:

A total of 450 students satisfactorily completed the questionnaire. Of these, 139 (30.9%) were screened positive for psychological distress based on the BSI-18 scale. Females scored significantly higher than males on the somatization (P = 0.002) and anxiety subscales (P = 0.006) as well as on the total symptom scale (the General Severity Index; P = 0.005). However, there was no significant difference between males and females regarding the depression subscale (P = 0.149). Twenty-eight students (6.2%) reported moderate to extreme levels of distress due to suicidal thoughts in the past 1 week before inclusion in this study.

Conclusions:

This study found that ~31% of undergraduate students at Jazan University are psychologically distressed. This finding necessitates the need for rigorous efforts to develop proper screening and intervention programs targeting this population.

Differential determination of perceived stress in medical students and high-school graduates due to private and training-related stressors

OBJECTIVE

Numerous studies from diverse contexts have confirmed high stress levels and stress-associated health impairment in medical students. This study aimed to explore the differential association of perceived stress with private and training-related stressors in medical students according to their stage of medical education.

METHODS

Participants were high-school graduates who plan to study medicine and students in their first, third, sixth, or ninth semester of medical school or in practical medical training. The self-administered questionnaire included items addressing demographic information, the Perceived Stress Questionnaire, and items addressing potential private and training-related stressors.

RESULTS

Results confirmed a substantial burden of perceived stress in students at different stages of their medical education. In particular, 10-28% of students in their third or ninth semesters of medical school showed the highest values for perceived stress. Training-related stressors were most strongly associated with perceived stress, although specific stressors that determined perceived stress varied across different stages of students' medical education. High-school graduates highly interested in pursuing medical education showed specific stressors similar to those of medical students in their third, sixth, or ninth semesters of medical school, as well as stress structures with heights of general stress rates similar to those of medical students at the beginning of practical medical training.

CONCLUSIONS

High-school graduates offer new, interesting information about students' fears and needs before they begin medical school. Medical students and high-school graduates need open, comprehensive information about possible stressors at the outset of and during medical education. Programmes geared toward improving resilience behaviour and teaching new, functional coping strategies are recommended.

A comparison of stress levels, coping styles and psychological morbidity between graduate-entry and traditional undergraduate medical students during the first 2 years at a UK medical school

BACKGROUND

Stress levels and psychological morbidity are high among undergraduate medical students (UGs), but there is a lack of research into the psychological health of UK graduate-entry medical students (GEs). GEs are likely to experience different (perhaps more severe) stressors and to cope with stress differently. We compared stress levels, psychological morbidity and coping styles in GE versus UG medical students studying at the same UK medical school in the same academic year. A cross-sectional self-rated questionnaire study of all first- and second-year GE and UG medical students was conducted. Perceived stress, psychological morbidity, recent adverse life events, stress-related personality traits and coping styles were assessed using standard questionnaires.

RESULTS

75% GEs and 46% UGs responded to the questionnaire. Both groups reported equally high levels, and similar profiles of, perceived stress and psychological morbidity. Levels of recent adverse life events and stress-related personality traits were similar in both groups. Compared to UGs, GEs were more likely to use active coping (p = 0.02) and positive reframing (p = 0.03), but were also more likely to use substances (alcohol and other drugs; p < 0.001) to help them cope. Unlike UGs, second-year GEs showed less perceived stress (p = 0.007) and psychological morbidity (p = 0.006) than first-year GEs although levels of both were still high.

CONCLUSION

Our results show that both GE students and their younger UG counterparts on a traditional medical course have similar profiles of stress symptoms. They do, however, cope with stress differently. GEs are more likely to use active problem-focused coping strategies, and they are also more likely to cope by using substances (alcohol or other drugs). GE students need interventions to prevent maladaptive coping styles and encourage adaptive coping that are tailored to their needs. Such interventions should be targeted at first-year students. It is vital that these students develop positive coping skills to benefit them during training and in a future career that is inherently stressful.

Mental Well-Being in First Year Medical Students: A Comparison by Race and Gender: A Report from the Medical Student CHANGE Study

PURPOSE

In this study, authors sought to characterize race and gender disparities in mental health in a national sample of first year medical students early in their medical school experience.

METHOD

This study used cross-sectional baseline data of Medical Student CHANGES, a large national longitudinal study of a cohort of medical students surveyed in the winter of 2010. Authors ascertained respondents via the American Association of Medical Colleges questionnaire, a third-party vendor-compiled list, and referral sampling.

RESULTS

A total of 4732 first year medical students completed the baseline survey; of these, 301 were African American and 2890 were White. Compared to White students and after adjusting for relevant covariates, African American students had a greater risk of being classified as having depressive (relative risk (RR)=1.59 [95 % confidence interval, 1.37-2.40]) and anxiety symptoms (RR=1.66 [1.08-2.71]). Women also had a greater risk of being classified as having depressive (RR=1.36 [1.07-1.63]) and anxiety symptoms (RR-1.95 [1.39-2.84]).

CONCLUSIONS

At the start of their first year of medical school, African American and female medical students were at a higher risk for depressive symptoms and anxiety than their White and male counterparts, respectively. The findings of this study have practical implications as poor mental and overall health inhibit learning and success in medical school, and physician distress negatively affects quality of clinical care.

Mental health issues amongst medical students in Asia: a systematic review [2000-2015]

BACKGROUND

Studies have shown that the stress experienced by medical students is far greater than that experienced by other university students. In this study, we aim to understand the consequent mental health issues that are experienced by medical students, particularly in Asia, via a systematic review of the current literature.

METHODS

Initial searches on MEDLINE, Embase and SpringerLink came up with a total of 1,033 unique articles. Studies not focusing on medical students alone, not mentioning mental health issues or not containing prevalence values were excluded.

RESULTS

We included 14 articles in our analysis. ADs had a prevalence of 7.04% (100/1,420). Depression was prevalent in 11.0% (1,115/10,147) of students. A total of 12.9% (54/420) and 12.9% (41/319) of male and female medical students respectively were screened for depression. Preclinical students were also 1.63 times more likely to be depressed compared to clinical students, with 98.0% (48/49) pre-clinical students having screened for depression, compared to 60% (27/45) clinical students. Home staying medical students are 1.33 times more likely to be depressed compared to hostel-stayers, with 12.1% (29/239) of home stayers being depressed compared to 9.2% (37/402) of hostel stayers.

CONCLUSIONS

We found that mental health issues affect a significant proportion of medical students and they are more prevalent in certain subpopulations of medical students. Our data revealed that preclinical and home staying students can be more susceptible to depression. More research should be done regarding this issue. With such information, it is hoped that appropriate interventions can be designed to improve the mental health of medical students.

Experiences of Psychological Distress and Sources of Stress and Support During Medical Training: a Survey of Medical Students

OBJECTIVE

The authors examine the prevalence of psychological distress, the stressors experienced, and the supports used by medical students and residents during their medical training at a Canadian university.

METHOD

This study used an online survey that included a standardized instrument to evaluate psychological distress (Kessler-10) and Likert-based survey items that examined stress levels related to family relationships, living accommodations, commuting, finances, and program requirements. Depressive symptoms, substance use, and suicidal ideation were also measured, as were supports accessed (e.g., counseling) and students' perceptions of the overall supportiveness of the university. Non-parametric descriptive statistics were used to examine the prevalence of psychological distress, sources of stress, and supports accessed.

RESULTS

Surveys were received from 381 students (37% response). Most students (60%) reported normal levels of psychological distress on the K10 (M = 19.5, SD = 6.25), and a subgroup reported high to very high levels of psychological distress. A small number also reported substance use, symptoms of depression, and/or suicidal ideation.

CONCLUSION

These results indicate that students experience psychological distress from a number of stressors and suggest that medical schools should act as key partners in supporting student well-being by promoting self-care, educating students on the risks of burnout, and developing programs to support at-risk students.

The Adverse Effect of Weight Stigma on the Well-Being of Medical Students with Overweight or Obesity: Findings from a National Survey

BACKGROUND

The stigma of obesity is a common and overt social bias. Negative attitudes and derogatory humor about overweight/obese individuals are commonplace among health care providers and medical students. As such, medical school may be particularly threatening for students who are overweight or obese.

OBJECTIVE

The purpose of our study was to assess the frequency that obese/overweight students report being stigmatized, the degree to which stigma is internalized, and the impact of these factors on their well-being.

DESIGN

We performed cross-sectional analysis of data from the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES) survey.

PARTICIPANTS

A total of 4,687 first-year medical students (1,146 overweight/obese) from a stratified random sample of 49 medical schools participated in the study.

MAIN MEASURES

Implicit and explicit self-stigma were measured with the Implicit Association Test and Anti-Fat Attitudes Questionnaire. Overall health, anxiety, depression, fatigue, self-esteem, sense of mastery, social support, loneliness, and use of alcohol/drugs to cope with stress were measured using previously validated scales.

KEY RESULTS

Among obese and overweight students, perceived stigma was associated with each measured component of well-being, including anxiety (beta coefficient [b] = 0.18; standard error [SE] = 0.03; p < 0.001) and depression (b = 0.20; SE = 0.03; p < 0.001). Among the subscales of the explicit self-stigma measure, dislike of obese people was associated with several factors, including depression (b = 0.07; SE =  .01; p < 0.001), a lower sense of mastery (b = -0.10; SE = 0.02; p < 0.001), and greater likelihood of using drugs or alcohol to cope with stress (b =  .05; SE = 0.01; p < 0.001). Fear of becoming fat was associated with each measured component of well-being, including lower body esteem (b = -0.25; SE = 0.01; p < 0.001) and less social support (b = -0.06; SE = 0.01; p < 0.001). Implicit self-stigma was not consistently associated with well-being factors. Compared to normal-weight/underweight peers, overweight/obese medical students had worse overall health (b = -0.33; SE = 0.03; p < 0.001) and body esteem (b = -0.70; SE = 0.02; p < 0.001), and overweight/obese female students reported less social support (b = -0.12; SE = 0.03; p < 0.001) and more loneliness (b = 0.22; SE = 0.04; p < 0.001).

CONCLUSIONS

Perceived and internalized weight stigma may contribute to worse well-being among overweight/obese medical students.

Psychological Distress and its Correlates among University Students: A Cross-Sectional Study

STUDY OBJECTIVE

Mental health disorders are common among university students. In addition to the normal stressors of everyday life, students must deal with stresses related to their education. Our aim was to identify the mental health status of university students and its correlation with socio-demographic, academic performance, and menstrual features.

DESIGN

A cross sectional study was conducted among undergraduate health students using the Symptoms Checklist-90- Revised (SCL-90-R). The Global Severity Index (GSI), raw scores of SCL-90-R subscales, and correlated factors were reported and analyzed.

RESULTS

A total of 171 health students completed the survey. Psychopathological symptoms were found in 23% of the student. Depression was the most prevalent mental reported symptom (100%). There was no significant association between the symptoms and variables such as age, gender, living in university dormitories, marital status, field of study, academic performance, and the day of menstrual cycle while filling the form. GSI scores were significantly related to regular menses. The odds of being identified as a mentally unhealthy individual was 0.37 times lower for those who experienced regular menstrual cycles.

CONCLUSION

Psychological distress is prevalent among health students and tends to be reported more by female students with irregular periods and during luteal phase of menstrual cycle. Preventive and treatment programs need to be developed. It is also recommended that SCL-90-R be administered at least 7 days after the end of menstrual bleeding.

Stress in romanian first year nursing students

Objective: This study aims to analyze the stress of the students from the nursing department within the Medical Midwife and Nurse School from our University. Subjects and methods: For this purpose a questionnaire, comprising the factors the students consider important for their academic preparation during the first year, was elaborated and applied to 100 students. Results: The result analysis revealed no significant differences as far as the genders of the subjects were concerned. In the same way, the prior academic background or the student experience did not influence the level of stress. The social and economic factors seem to be involved in choosing a career and thus influence the academic stress. For this purpose, a questionnaire comprising the factors the students consider important for their academic preparation during the first year, was elaborated and applied to 100 students. We used the Students t-test to determine differences between groups and considered p<0.05 as significant. Conclusions: The stress equally affects the nursing department students, regardless of their gender or prior studies. Social and economic factors play a role in adapting to a new academic environment, having higher expectations and requirements.

Needs, expectations, and concerns of medical students regarding end-of-life issues before the introduction of a mandatory undergraduate palliative care curriculum

BACKGROUND

In the past, implementation of effective palliative care curricula has emerged as a priority in medical education. In order to gain insight into medical students' needs and expectations, we conducted a survey before mandatory palliative care education was introduced in our faculty.

METHODS

Seven hundred nine students answered a questionnaire mainly consisting of numeric rating scales (0-10).

RESULTS

Participants attributed a high importance to palliative care for their future professional life (mean, 7.51 ± 2.2). For most students, symptom control was crucial (7.72 ± 2.2). However, even higher importance was assigned to ethical and legal issues (8.16 ± 1.9). "Self-reflection regarding their own role as a physician caring for the terminally ill along with psychological support" was also regarded as highly important (7.25 ± 2.4). Most students were moderately concerned at the prospect of being confronted with suffering and death (5.13 ± 2.4). This emotional distress was rated significantly higher by female students (5.4 ± 2.4 versus 4.6 ± 2.4; p < 0.001). Seventeen percent of all students rated their distress as being 7 of 10 or higher, which indicates a considerable psychological strain in terms of dealing with end-of-life issues in the future. Professional or personal experience with terminally ill persons lowered these anxieties significantly (4.99 ± 2.34 versus 5.47 ± 2.5, p < 0.05).

CONCLUSIONS

Medical students stated a remarkably high interest in learning palliative care competencies. Responding to their specific concerns and needs-especially with regard to the acquisition of emotional coping skills-may be key for the development of successful palliative care curricula.

Physician, heal thyself: a qualitative study of physician health behaviors

OBJECTIVE

The authors explore how physicians perceive their own health and barriers to healthcare, as well as what might motivate their behavior.

METHODS

This qualitative study uses semi-structured interviews of a purposive sampling of physicians, both staff and housestaff, from Walter Reed Army Medical Center and the Medical College of Wisconsin. Transcripts of interviews that probed attitudes and behaviors towards self-care were coded independently by two reviewers using grounded theory qualitative methods.

RESULTS

The authors conducted 28 interviews until no new themes emerged. Common barriers to healthcare included inadequate time, fear of consequences, and concern about confidentiality, particularly for stigmatizing diseases identified as mental health problems, chronic pain, substance abuse, and sexual dysfunction. Common behaviors included neglecting one's health, minimizing symptoms, self-diagnosing, and a strong desire not to burden colleagues. Participants were split into those who felt it was fine to self-medicate and others who avoided it. Participants proposed solutions for identified problems, including building time into schedules for self-care, monitoring electronic medical record access to make providers accountable, obtaining care at other institutions, and working to change the culture around healthcare for physicians.

CONCLUSIONS

All participants in this study perceived significant unresolved issues pertaining to self-care. Physicians commonly neglect their own care and experience barriers to care, some self-generated and some systems based. The results and suggested interventions provide fodder for future research.

Gender differences in worry during medical school

OBJECTIVES

This research examined worry in medical students at various stages of training with reference to worries related to academic and clinical training, finances and relationships with peers. The study focused on gender differences in worries, testing the notion that being married or being in a long-term or cohabitating relationship with a partner would be linked to increased worry among women, but decreased worry among men. Additional goals included examining the relationship between worry and the seeking of counselling, and investigating the disadvantage for medical students associated with living with parents.

METHODS

Data collected serially on class cohorts at one western US medical school yielded 868 responses from medical students, which were analysed using general linear models, generalised linear models and generalised estimation equations.

RESULTS

Among four types of worry, academic and financial worries were similarly dominant (p < 0.001); financial worries were found to increase over the course of medical training (p < 0.001). Men reported more worry than women (p < 0.001). Gender differences were qualified by marital status (p = 0.007). Being married was linked to higher levels of academic and financial worry among women, whereas for men marriage was linked to lower academic, but higher financial worry (p < 0.001). Living with parents was always associated with a higher level of worry (p < 0.0001). Married male students were more likely to seek counselling than unmarried male students, whereas this pattern was reversed for female students (p = 0.002).

CONCLUSIONS

This study confirms that both academic and financial stress represent the greatest sources of worry in medical students. It also represents the first research to demonstrate higher levels of worry in male than female medical students, which may be evidence of women's increased representation in the medical school population. These data also support the persistence of traditional gender roles in the marriages of medical students; marriage is related to an increased psychological burden in women in comparison with men.

A cross-sectional study of body shape and eating attitude among Indian female healthcare students

OBJECTIVE

The current study aimed at assessing eating attitude and body shape concerns among Indian female healthcare students who had received some teaching/training in Psychiatry.

METHOD

The study was conducted at government medical and nursing college. All the undergraduate healthcare students enrolled with institute at the time of study constituted the sampling frame for the study. Survey-based methodology was used for data collection. Study scales included semi-structured proforma, Eating Attitudes Test-26 (EAT-26) (including the three sub-scales), and Body Shape Questionnaire (BSQ). Data were analyzed using Pearson's and Spearman's correlation statistics and ANOVA with post hoc analysis.

RESULTS

A total of 498 students returned the completed study questionnaire. There was significant correlation between Body Mass Index (BMI) and EAT-26 scores) including the sub-scales score of EAT-26). Similarly, BMI and BSQ scores were also significantly correlated.

DISCUSSION

The findings from current study help understand the body shape and eating attitudes of Indian female healthcare students who had received some teaching/training in Psychiatry.

Challenges of Becoming a Scholar: A Study of Doctoral Students' Problems and Well-Being

Successful studying in Ph. D. education is a complex matter. Although Ph. D. students are a highly select group, some never finish. This paper explores the problems that doctoral candidates face during their doctoral studies as well as students' well-being in relation to their studying engagement. The study is part of a larger research project on doctoral education. Altogether 669 doctoral students from the Faculties of Arts, Medicine, and Behavioural Sciences responded to the survey. Doctoral students' perceptions of the problems they encountered during their studies varied. The problems reported were related to general working processes, domain-specific expertise, supervision, the scholarly community, and resources. Doctoral students' well-being and study engagement showed a clear relationship. More effective means are needed to foster students' ability to overcome problems encountered during their Ph. D. studies.

Correlations between psychological symptoms and social relationships among medical undergraduates in Anhui Province of China

OBJECTIVES

To assess the prevalence of psychological symptoms (depression, anxiety) among Chinese medical students and to find the possible relationships between psychological symptoms and social relationships.

METHODS

A sample of 10,140 medical students was investigated with a structured questionnaire, that included the Beck Depression Inventory, Beck Anxiety Inventory, Social Support Rating Scale, and Family APGAR Index (adaptability, partnership, growth, affection, resolve).

RESULTS

The present study revealed that 16.8% of the medical students suffered from depressive symptoms and 14.1% from anxiety symptoms. Female students were more likely to have anxiety, the second-year students had higher levels of psychological symptoms than the first-year students. Likewise, significant differences were found among college, satisfaction of specialty, and economic condition of the family in anxiety and depression symptoms. Social support, family function, and all dimensions were significantly negatively associated with depression and anxiety symptoms. Multivariable ordinal logistic regression showed that less social support, poor family function, the second-year students, and unsatisfactory specialty were associated with more psychological symptoms, after adjusting the effects of sex, age, and college.

CONCLUSIONS

Medical students have a relatively high level of depression and anxiety symptoms. These findings support the hypothesis that if medical students are better supported and cared for, negative psychosocial consequences might be prevented or at least reduced.

Changing the learning environment: the medical student voice

BACKGROUND

Students' perceptions of their learning environment influence both how they learn and the quality of their learning outcomes. The clinical component of undergraduate medical courses takes place in an environment designed for clinical service and not teaching. Tension results when these two activities compete for resources. An impending increase in medical student numbers led us to assess the learning environment with a view to planning for the future.

METHODS

An open ended question 'If you could change three things about medical school, what would they be?' was added to the Dundee Ready Educational Environment Measure (DREEM). This was used to assess the learning environment of students in years 4 and 5. Allowing students to actively voice their views about changes in the curriculum was considered a useful extension to the DREEM questionnaire.

RESULTS

The findings indicated commonalities over the two years of clinical teaching. The areas of commonality included the need for: more clinical exposure early in the curriculum; fewer lectures; greater consistency in terms of assessment; and more constructive relationships. Fourth-year students tended to voice more concerns around resourcing, and sought more clarification about roles and learning outcomes.

DISCUSSION

There is a need to address concerns raised by students in the areas of curricula, assessments and access to earlier clinical training. Concerns that can be addressed are increasing resource access, implementation of clearer objectives, consistency of teaching and assessments across sites, more formative assessments, and engaging feedback. Students would also benefit from substantive mentoring and role-modelling.

Common mental disorders among medical students at Universidade Federal de Sergipe: a cross-sectional study

OBJECTIVE

Estimate the prevalence of common mental disorder and its associated factors among medical students of the Universidade Federal de Sergipe.

METHOD

A cross-sectional study was carried out, applying Self Reporting Questionnaire-20 to 473 students from the 512 medical students enrolled in 2006 and compared with compared with a structured questionnaire by the authors containing information on the socio-demographic characteristics, the teaching-learning process and the psycho-emotional experiences of the students. Freshmen were excluded after initial comparison with the students already exposed to the medical course. Statistical analysis by multiple logistic regression after calculating simple and adjusted odds ratio (OR).

RESULTS

The general prevalence of common mental disorder was 40% (n = 473); after exclusion of the freshmen it increased to 42.5% among students from the 2nd to the 12th semester. It was higher among those who did not have faith in their acquisition of the skills needed to become a good doctor (OR = 2.82), who felt less comfortable about course activities (OR = 3.75), who considered themselves emotionally stressed (OR = 2.14), among those who did not consider themselves happy (OR = 2.85), who believed that the course did not match their expectations (OR = 1.64) and those who had a prior diagnosis of mental disorder by a psychiatrist (OR = 3.78).

CONCLUSION

The results suggest the necessity of changes to the teaching-learning process and the establishment of a preventive mental health program for medical students.

Alternating skills training and clerkships to ease the transition from preclinical to clinical training

BACKGROUND

The transition from preclinical to clinical training is perceived as stressful with a high workload being the main difficulty. To ease this transition, we implemented a dual learning year, where just-in-time skills training and clerkships alternated.

AIMS

To examine the effect of the dual learning year on students' stress and perceptions of workload and skills level, and to compare these data with a baseline measurement from a curriculum in which skills training was provided in advance of clerkships.

METHOD

During the first Master year, students completed four rotations in which 5 weeks of skills training and 5-week clerkships alternated. In the second clerkship week of each rotation, students (n = 476) completed questionnaires measuring their experienced workload, perceived skills level and stress. Analysis of variance was used for trend analysis and to determine differences with the baseline measurement (n = 83).

RESULTS

During the dual learning year, 'experienced workload' decreased (F(1,471) = 9.408, p < 0.01), 'perceived skills level' increased (F(1,471) = 94.202, p < 0.001) and stress decreased (F(1,471) = 3.309, p < 0.10). 'Experienced workload' was lower (F(5,553) = 7.599, p < 0.001) and 'perceived skills level' was comparable to the baseline measurement.

CONCLUSIONS

Compared to the baseline measurement and the results of earlier studies on transition difficulties, alternating just-in-time skills training and clerkships seem to ease the transition from preclinical to clinical training.