Abstract
Introduction: Physicians and physicians-in-training experience sustained stress, leading to increased rates of burnout, anxiety, depression, and suicide. This study explored stress patterns in third year students during clerkships at a U.S. medical school. Methods: Students completed an anonymous modified mental health professional stress survey during three successive clerkships and rated six stress factors on a Likert-type scale, from o to 3. Statistical analysis included descriptive statistics and linear mixed-effects regression models. Results: Twenty nine survey responses were collected. Overall, stress due to workload, professional self-doubt, and home-work conflicts was significantly higher than stress associated with patient-related difficulties, organizational structure, and difficulties with other healthcare workers (all p values < 0.05). On Internal Medicine and Surgery, more than 75% of students worked over 60 hours/week and reported the highest level of home-work conflicts. Women had significantly lower work-related interpersonal stress scores than men (p = 0.04). Conclusion: Medical students encounter complex Stressors during clerkships. Potential strategies to help improve the learning climate are discussed, such as duty hour limits, reduced workload, teaching time management skills, fostering emotional intelligence qualities, and team-building exercises involving all learners.
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Dahlin, M., Joneborg, N., and Runeson, B. Stress and depression among medical students: a cross-sectional study. Medical Education. 2005; 39:594–604.
Dyrbye, L.N., Thomas, M.R., and Shanafelt, T.D. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Academic Medicine. 2006; 81:354–373.
Dyrbye, L.N., Thomas, M., Massie, F.S., Power, D.V., Eacker, A., Harper, W., Durning, S., Moutier, C, Szydlo, D.W., Novotny, P.J., Sloan, J.A., and Shanafelt, T.D. Burnout and suicidal ideation among U.S. medical students. Annals of Internal Medicine. 2008; 149:334–341.
Radcliffe, C, and Lester, H. Perceived stress during undergraduate medical training: a qualitative study. Medical Education. 2003; 37:32–38.
Schmitter, M., Liedl, M., Beck, J., and Rammeisberg, P. Chronic stress in medical and dental education. Medical Teacher. 2008; 30:97–99.
Murphy, R.J., Gray, S.A., Sterling, G., Reeves, K., and DuCette, J. A comparative study of professional student stress. Journal of Dental Education. 2009; 73:328–337.
Garg, A., Chren, M.M., Sands, L.P., Matsui, M.S., Marenus, K.D., Feingold, K.R., and Elias, P.M. Psychological stress perturbs epidermal permeability barrier homeostasis. Archives of Dermatology. 2001; 137:53–59.
Yang, Y., Koh, D., Ng, V., Lee, F.C., Chan, G., Dong, F., and Chia, S.E. Salivary cortisol levels and work-related stress among emergency department nurses. Journal of Occupational and Environmental Medicine. 2001; 43:1011–1018.
Al-Ayadhi LY. Neurohormonal changes in medical students during academic stress. Annals of Saudi Medicine. 2005; 25:36–40.
Bergman, B., Ahmad, F., and Stewart, D.E. Work family balance, stress, and salivary cortisol in men and women academic physicians. International Journal of Behavioral Medicine. 2008; 15:54–61.
Brant, H., Wetherell, M.A., Lightman, S., Crown, A., and Vedhara, K. An exploration into physiological and self-report measures of stress in pre-registration doctors at the beginning and end of a clinical rotation. Stress. 2010; 13:155–162.
Tseng, T., Iosif, A.M., and Seritan, A.L. Stress effects: A study of salivary cortisol levels in third year medical students. Stress and Health. 2011; Jan 12 [Epub ahead of print].
Yang, Y., Koh, D., Ng, V., Lee, C.Y., Chan, G., Dong, F., Goh, S.H., Anantharaman, V., and Chia, S.E. Self perceived work related stress and the relation with salivary IgA and lysozyme among emergency department nurses. Occupational and Environmental Medicine. 2002; 59:836–841.
Ng, V., Koh, D., Mok, B., Lim, L.P., Yang, Y., and Chia, S.E. Stressful life events of dental students and salivary immunoglobulin A. International Journal of Immunopathology and Pharmacology. 2004; 17:49–56.
Cushway, D., Tyler, P.A., and Nolan P. Development of a stress scale for mental health professionals. British Journal of Clinical Psychology. 1996; 35:279–295.
Laird, N.M., and Ware, J.H. Random-effects models for longitudinal data. Biometrics. 1982; 38:963–74.
Accreditation Council for Graduate Medical Education. Approved Standards. Available at http://acgme-2010standards.org/approved-standards.html. Accessed March 24, 2011.
Friedman, E., Karani, R., and Fallar, R. Regulation of medical student work hours: A national survey of deans. Academic Medicine. 2011; 86:30–33.
Seritan, A.L., Hunt, J., Shy, A., Rea, M., and Worley, L. The state of medical student Wellness: A call for culture change. Academic Psychiatry (in press).
Listyowardojo, T.A., Nap, R.E., and Johnson, A. Demographic differences between health care workers who did or did not respond to a safety culture survey. BioMedCentral Research Notes. 2011; 4:328 [Epub ahead of print].
Lefevre, J.H., Roupret, M., Kerneis, S., and Karila, L. Career choices of medical students: a national survey of 1780 students. Medical Education. 2010; 44:603–612.
Hojat, M., Gonnella, J.S., Mangione, S., Nasca, T.J., Veloski, J.J., Erdmann, J.B., Callahan, CA., and Magee, M. Empathy in medical students as related to academic performance, clinical competence and gender. Medical Education. 2002; 36:522–527.
Karlson, B., Eek, F., Hansen, A.M., Garde, A.H., and Ørbæk, P. Cortisol variability and self-reports in the measurement of work-related stress. Stress and Health. 2011; 27:e11–24.
Eek, F., Karlson, B., Garde, A.H., Hansen, A.M., and Ørbæk, P. Cortisol, sleep, and recovery — Some gender differences but no straight associations. Psychoneuroendocrinology 2011; Jun 2 [Epub ahead of print].
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Tseng, T., Iosif, AM. & Seritan, A.L. The Cost of Education: Medical Student Stress during Clerkships. Med.Sci.Educ. 21, 360–366 (2011). https://doi.org/10.1007/BF03341737
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DOI: https://doi.org/10.1007/BF03341737