Introduction The overall environment of the medical school is often considered very stressful. It projects negative effects not only on the academic performances of medical students but also deteriorate their physical health and psychosocial wellbeing. The aim of this study was to determine the frequency of depression, stress, and anxiety among final year medical students. Methods This observational study was conducted in public and private medical colleges in February 2019. The instrument utilized in this study was Depression, Anxiety, and Stress Scale (DASS-21). Factors predisposing to depression, stress, and anxiety were also recorded. Data were entered and analyzed using SPSS v. 21. Results The mean scores of depression, anxiety, and stress were 18.00 ± 11.5, 19.15 ± 11.2, and 20.92 ± 11.2, respectively. The mean score of anxiety and stress was higher in private college students, while that of depression was higher in public college students. Overall, 57.6% of the students suffered from moderate to extremely severe depression, 74% of the students suffered from moderate to extremely severe anxiety, and 57.7% students had moderate to extremely severe stress. The common reasons to high stress and anxiety included the pressure of passing exams, the pressure of living up to family’s expectations, fear of stepping into the real world of medicine, and dissatisfaction with the administration. Conclusion The incidence of psychological illnesses including anxiety, stress, and depression is high among the medical students of Pakistan. Reasons predisposing the students to these illnesses must be efficiently tackled.

Introduction Diabetes mellitus (DM) is a chronic, progressive metabolic illness which is commonly complicated by coexistence of depression and anxiety. This study aimed to assess the prevalence of anxiety and depression among diabetic patients and the factors predicting this coexistence. Methods It was a cross-sectional, observational study which included patients of type 2 DM admitted in the hospital due to diabetes-related condition - diabetic foot infections/ulcers, hyperosmotic hyperglycaemic state (HHS), and hypoglycaemic coma/seizure. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Data was entered and analysed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Results Mean anxiety score of the participants was 10.88 ± 4.075 and mean depression score was 11.82 ± 4.049. There were 72 (50.7%) patients who had anxiety and 70 (49.2%) patients who had depression. Higher scores of anxiety and depression were statistically significant in female gender, older participants, individuals with longer duration of diabetes, those taking non-insulin treatment, and individuals with painful neuropathy, nephropathy, and foot ulcers. Conclusion The incidence of depression and anxiety among hospitalized patients of diabetes mellitus is high. The coexistence of these two chronic debilitating illnesses is worsening the overall quality of life. It is very important to diagnose and manage anxiety and depression in patients with type 2 DM to ensure higher quality of life and life expectancy.

Background Occupational burnout is an unwanted outcome of chronic workplace stressors which may be emotional or interpersonal. Chronic exposure to human suffering and long working hours have contributed to greater job stress and early burnout among healthcare providers. This study utilized the abbreviated Maslach Burnout Inventory (aMBI) to gauge the extent of overall burnout and on three subscales – perspective taking, compassionate care, and walking in patients' shoes – among interns, postgraduate trainees, and physicians of internal medicine. Materials and methods In this cross-sectional study, 71 internal medicine doctors – 40 interns, 22 postgraduate trainees, and nine physicians – completed aMBI with informed consent. It is a nine-item scale with three subscales – emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Each subscale has three items that are marked on a seven-point Likert scale. Higher scores of EE and DP indicate higher burnout, and a higher score of PA indicates lower burnout. Overall burnout was taken as the sum of EE and DP. Data were entered and analyzed using SPSS v. 22. Results There were 23 (32.4%) male and 48 (67.5%) female doctors with a mean age of 24.25 ± 13.17 years. The mean score of overall burnout was 22.51 ± 6.07 (range: 0–36) and PA was 15.35 ± 1.82 (range: 0–18). Overall moderate to high burnout was seen in 33.8% of doctors. On an individual subscale, 47.8% had high EE, 24% had high DP, and 25.4% reported high burnout on PA. Overall burnout had a statistically significant correlation with the marital status of the doctors, their working hours per week, their average on-call days per week, and their level of expertise. Conclusion There is a high degree of burnout among internal medicine physicians. Working hours and the number of on-call days per week were significant predicting factors. Interns reported the highest frequency of burnout.

Introduction Clinical empathy is the ability to comprehend the perspectives, feelings, and situation of the patients. Clinical empathy instills a sense of satisfaction in the patient. It also facilitates the healthcare provider (HCPs) in taking more sincere and logical clinical decisions. Although there have been numerous studied conducted to explore the pattern of clinical empathy among medical students, the results are mixed and not consistent. Methods This is a cross-sectional, observational study conducted among medical students of Ghulam Muhammad Mahar Medical College in August 2018. Two hundred and seven out of 500 students of all five years completed the study after informed consent. All students completed the 20-item Jefferson Scale of Empathy-Student Version (JSE-S). Data were entered and analyzed using SPSS version 22 (SPSS Inc, Chicago, IL, USA). The internal consistency of JSE-S was 0.71. Frequencies and percentages were calculated for students’ ages and genders. Mean and standard deviation (SD) were calculated for continuous variables. Group comparisons of the empathy scores were conducted using t-test and one-way analysis of variance (ANOVA). p<0.05 was considered as the significant level. Results There were 93 (44.9%) male and 114 (55.1%) female students. Their mean ± SD age was 20.85 ± 2.27 years (range: 17 to 26 years). The mean ± SD empathy score of all students was 98.11 ± 12.31 (range: 20-140). The mean empathy score was categorized according to gender, year of education, and career preference. Females showed a significantly higher empathy score. The lowest empathy was seen for the final year and the highest for the first year. On all three subscales of (JSE-S) - perspective taking, compassionate care, and walking in patients’ shoes - students with “people-oriented” career preference scored higher. Conclusion JSE-S is a self-administered and self-perceived inventory, which reports declining empathy in medical students with ascending years of education. Qualitative studies that can assess the empathy levels from the patients’ perspective are the need of the hour to decide whether or not empathy is a real phenomenon.

Introduction Academic pressure and its associated stress are responsible for disturbances in the circadian cycle of the students. Adequate sleep has crucial role in enhancing cognitive skills especially memory retention. Poor night time sleep quality and consequent daytime sleepiness affects physical and cognitive health of the students. In this study, sleep quality among medical students is evaluated. Methods It was an observational, cross-sectional study conducted with undergraduate medical students. Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. The data was analyzed using Statistical Package for the Social Sciences (SPSS) 22.0 (IBM Corp., Armonk, NY, USA). Results Of 281 students, 155 (55.16%) were pre-clinical students and 126 (44.83%) were clinical students; 207 (73.66%) were female students and 74 (26.33%) were male. The overall frequency of poor sleepers was 172 (61.2%); 95 (55.2%) of these were clinical sciences and 77 (44.8%) were basic sciences students. Sleep latency, duration, and efficiency were more impaired in clinical students (p-value ≤ 0.05). Use of sleep medications and daytime dysfunction was more common in clinical students (p-value ≤ 0.05). Conclusion Medical students are continuously under high academic stress and pressure. Adequate sleep is essential for them to refresh them every day and help in learning and memory processing. Medical students in advance years of education have worse sleep quality than those in early years. Efforts should be taken to improve their sleep quality in order to protect the psychological and emotional health of future doctors.