More on medical student stress
2001; Wiley; Volume: 35; Issue: 7 Linguagem: Inglês
10.1046/j.1365-2923.2001.00996.x
ISSN1365-2923
Autores Tópico(s)Medical Education and Admissions
ResumoMedical EducationVolume 35, Issue 7 p. 617-618 Free Access More on medical student stress J Morrison, J MorrisonSearch for more papers by this authorK Moffat, K MoffatSearch for more papers by this author J Morrison, J MorrisonSearch for more papers by this authorK Moffat, K MoffatSearch for more papers by this author First published: 20 December 2001 https://doi.org/10.1046/j.1365-2923.2001.00996.xCitations: 35 Dr Jill Morrison, Department of General Practice, University of Glasgow, 4 Lancaster Crescent, Glasgow G12 8QQ, UK AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Being a student can be stressful.1 Living away from home, making the transition from child to adult, and coping with a course of study can be difficult for young people. Medical school may be particularly stressful as students come into close contact with serious illness and death, in addition to meeting the demands of the curriculum.2 Studies which have tried to identify the sources of stress among medical students generally point to three main areas: academic pressures; social issues; and financial problems.3 The majority of stressful incidents in traditional curricula are related to medical training rather than to personal problems.4,5 Workload and feeling overwhelmed by the amount of information to be mastered are major sources of stress. Fears of failing or falling behind are particular preoccupations. Other significant academic sources of stress include disillusionment with medicine and the realities of medical school,5 perception of 'hurdle jumping',4 relationships with teachers,5,6 and dealing with death and suffering.6 Social issues which can cause stress include the effects of being a medical student on personal life, in particular managing leisure activities and social relationships.6,7 The factors causing stress vary with the stage of the course. Concern about workload, performance and personal competence seem particularly marked in first year.5,7 In studies of medical students in later years, factors inherent in medical training such as dealing with patients, disease and death, relationships with consultants and effects on personal life, are important.6 This Journal has recently published a number of research papers investigating medical student stress. At the beginning of this year, Jenny Firth-Cozens commented on the findings of a study published in the Journal which compared stress in Turkish medical students before and after entry to medical school and with two other groups of students.8 The important message, she wrote, is that young first year students are similar to their peers at entry and there is something about the experience of being a student and perhaps also the particular experience of being a medical student, which causes a sharp increase in the symptoms of stress.9 Does medical student stress matter? It could be argued that a certain amount of stress is necessary for students to perform well. An over relaxed attitude could lead to complacency and a failure to do sufficient work. Stress, however, can lead to psychological ill health in medical students. Several studies have examined the relationship between causes of stress and psychological morbidity. Depression and anxiety are associated with concerns about mastering knowledge, personal endurance and ability, and lack of time for other activities.3,7 Anxiety is also associated with feelings of anonymity, peer competition, long hours and loss of social time.3,7 What should be done about medical student stress? In the UK, the General Medical Council recommends that 'Medical Schools should have mechanisms in place to identify symptoms of stress that might be early signs of mental illness'.2 Medical schools in the USA and Canada tackle the problem at an earlier stage by undertaking prevention in the form of health promotion programs. These have been shown to reduce the effects of stress on medical students' health and academic performance.10 In this edition of the Journal, Lee and Graham report on a study designed to examine the feelings and perceptions about stress and coping of students during the first and second years of medical school, to understand the students' perspective regarding a 'Wellness' or stress prevention elective and to provide information to improve the design of wellness curricula.11 The study was based in Case Western Reserve University School of Medicine in Cleveland, Ohio, which runs a Wellness Elective. This comprises a series of 6-weekly, one hour lectures by medical and allied health professionals who provide information about wellness, stress reduction and coping strategies. Wellness issues are presented by physicians who offer examples of how they balance the multiple demands of a medical career. At the end of the course, students write a two page essay critiquing the elective, describing the stresses they have encountered in medical school, discussing their present coping behaviour and how they plan to incorporate what they have learned from the elective. Students reported being stressed by the overwhelming amount of information they are expected to learn during their first and second years and they identified techniques for coping with stress, particularly talking with their peers. They were generally very positive about the wellness elective and they considered it to be an essential part of the medical curriculum. The elective seemed to meet an important student need. It gave the students validation that they were entitled to have time for personal wellbeing without feeling guilty. More female students participated in this elective, although the authors point out that conclusions about this cannot be drawn from the study results. The issue of whether female students experience more stress or are more interested in wellness merits further exploration. One of the limitations of this study is that the course was an elective and the students who undertook it were self-selected. It is not clear if the findings can be generalised to students who did not undertake the elective. The causes of stress and preferred coping strategies, however, are similar to those reported in other studies and it is likely that similar programs would benefit at least some students in other curricula. It could be argued that stress prevention programs should be core components of the curriculum for all medical students. Some students may not acknowledge they have a problem with stress. Others may not feel under stress at this stage but could still benefit from advice on stress prevention as it is very difficult to accurately predict which students will develop stress at a later stage of their professional career.12 Firth-Cozens concluded her commentary by stating that this topic will continue to be of interest because of the important link between stress levels among medical professionals and the quality of care they give.9 We therefore make no apology for revisiting this important issue. References 1 Wolf TM. Stress, coping and health: enhancing well-being during medical school. Med Educ 1994; 28: 8– 17. 2 http://www. gmc-uk.org/n_hance/med_ ed/student.htm. 3 Vitaliano PP, Russo J, Carr JE, Heerwagen JH. Medical school pressures and their relationship to anxiety. J Nervous Mental Dis 1984; 172: 730– 6. 4 Coles C. Medicine and stress. Med Educ 1994; 28: 3– 4. 5 Guthrie EA, Black D, Shaw CM, Hamilton J, Creed FH, Tomenson B. Embarking upon a medical career: psychological morbidity in first year medical students. Med Educ 1995; 29: 337– 41. 6 Firth J. Levels and sources of stress in medical students. BMJ 1986; 292: 1177– 80. 7 Stewart SM, Betson C, Lam TH, Marshall IB, Lee PWH, Wong CM. Predicting stress in first year medical students: a longitudinal study. Med Educ 1997; 31: 163– 8. 8 Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety, depression and stressful life events among medical students: a prospective study in Antalya, Turkey. Med Educ 2001; 35: 12– 7.DOI: 10.1046/j.1365-2923.2001.00726.x 9 Firth-Cozens J. Medical student stress. Med Educ 2001; 35: 6– 7.DOI: 10.1046/j.1365-2923.2001.00832.x 10 Wolf TM, Randall HM, Faucett JM. A survey of health promotion programs in U.S. & Canadian medical schools. Am J Health Promotion 1988; 3: 33– 6. 11 Lee J & Graham A. Students' perception of medical school stress and their evaluation of a wellness elective. Medical Educ 2001; 35: 652– 659. 12 Tyssen R, Vaglun P, Gr∅nvold NT, Ekeberg ∅. Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study. Med Educ 2001; 35: 110– 20.DOI: 10.1046/j.1365-2923.2001.00770.x Citing Literature Volume35, Issue7July 2001Pages 617-618 ReferencesRelatedInformation
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