Predicting stress in first year medical students: a longitudinal study

Abstract

While there is ample documentation that medical training is stressful, less is known about predictive variables that might identify students who have the most difficulty in managing stress during medical training. Depression and anxiety in first year medical students were investigated in a longitudinal design. One-hundred and twenty-one medical students (81% of the class) were surveyed. The first survey took place immediately prior to the beginning of medical training (wave 1); the second survey was approximately 8 months after the beginning of classes (wave 2). Medical students who began their first year with relatively low 'A' level grades, high ratings of state anxiety and depression, high trait anxiety and low dispositional optimism, and reliance on avoidant coping strategies were found to be at higher risk for developing depression and anxiety symptoms at wave 2. Students reported increased concern about curriculum and environment, personal competence and endurance, and time to have a life outside medical school at wave 2, compared to their reports at wave 1. Increase in concerns correlated with an increase in depression and anxiety. At both surveys, use of avoidant coping strategies resulted in increased depression and anxiety; at wave 2, active coping and positive reinterpretation resulted in decreased depression and anxiety. These findings suggest characteristics of vulnerable students who might be identified early in their first year and provided with additional support. Educating students to expect an increase in concerns about environment and personal ability to manage the academic load might make these concerns less overwhelming. In addition, information about effective coping strategies (i.e. active coping efforts) and ineffective means of dealing with stress (avoidant coping efforts) might be helpful in preventing distress.

Identity change and the human dissection experience over the first year of medical training

“…However, most of our participants were still very aware of their novice status at the end of their first year and tentative about the level of professional competence they had achieved. A similar finding is reported by Stewart et al (1997) at an equivalent point in medical training so, arguably, our participants had made a realistic evaluation of their position. However, we may also speculate that, as Gaensbauer and Mizner (1980) found, stiff competition at medical school may have had a negative effect on their sense of competence.…”

Promoting self-awareness and reflection through an experiential Mind-Body Skills course for first year medical students

“…The central themes of self discovery and stress relief supported findings of previous studies of medical student stressors (Pitts et al 1961;Linn & Zeppa 1984;Firth 1986;Wolf 1989;Mosley et al 1994;Stewart 1997) showing that medical students do experience physical and psychological stress. Our findings also highlighted that the MBS program allowed for opportunities for making connections and learning which also related to stress reduction.…”

“…The learning objectives of self-awareness and reflection are often challenging to integrate into a medical school curriculum and equally difficult to assess (Boenink et al 2004). There have been a variety of interventions employed to help students alleviate stress, promote well-being and self-reflection, this paper describes the results of an experiential intervention focusing on MBS techniques to achieve these outcomes.Medical students have been surveyed about the physical and psychological challenges of medical school since the early 1970s (Pitts et al 1961;Linn & Zeppa 1984;Firth 1986;Wolf 1989;Mosley et al 1994;Stewart et al 1997). Findings of increased stress levels have motivated a variety of interventions designed to provide sensitivity training (Dashef et al 1974;Hilberman et al 1975), self-awareness (Cadden et al 1969), self-reflection (Killion & Todnem 1991;Maudsley & Fryer-Edwards 2003;Boenink et al 2004), sharing of feelings and well-being (Dashef et al 1974;Coombs & Virshup 1994) discussion of roles as a physician improvement in health habits (Ball & Bax, 2002) and emotional competence (Flowers 2005) as mechanisms for reducing stress and improving coping skills.…”

The relationship between levels of resilience and coping styles in chiropractic students and perceived levels of stress and well-being

“…21 These can involve problem, emotion or avoidance-based strategies to reduce stressful situations. 22 Problem-or task-focused coping involves facing the challenges and seeking solutions to the stressful situation. 23 Emotion-focused strategies are emotionally centered and driven, while avoidance coping strategies are those that seek distraction or removal from the stressproducing situation.…”