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Understanding Medical Students’ Experience with Stress and Its Related Constructs: A Focus Group Study from Singapore

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Abstract

Objective

In order to protect medical students from burnout and its untoward psychiatric effects, it is imperative to understand their stress, burnout, coping, and resilience experiences. This study aimed to derive collective definitions from the medical student perspective, to identify common themes of students’ experiences, and to distinguish pre-clinical and clinical year students’ experiences relating to these four constructs.

Methods

The authors conducted focus groups of medical students in Singapore across 4 years using a semi-structured question guide. Participants shared their understanding, experiences, and the relationships between stress, burnout, coping, and resilience. Coders independently evaluated construct definitions and derived common themes through an iterative process, and compared transcripts of pre-clinical and clinical year students to determine differences in experience over time.

Results

Nine focus groups (54 students, 28 females, mean age 24.3) were conducted. Students identified common definitions for each construct. Nine themes emerged within three domains: (1) relating constructs to personal experience, (2) interrelating stress, burnout, coping, and resilience, and (3) understanding the necessity of stress. Compared to clinical students, pre-clinical students reported theory-based rather than reality-based experiences and exam-induced stress, defined constructs using present rather than future situations, and described constructs as independent rather than interrelated.

Conclusions

This sample of medical students in Singapore shares a common understanding of stress, burnout, coping, and resilience, but experiences these uniquely. They perceive a positive role for stress. These findings build upon prior literature, suggesting an interrelationship between stress and its related constructs and adding the novel perspective of students from an Asian country.

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Acknowledgements

We would like to thank Dianne Bautista for her assistance with the quantitative data of our study, Prassanna Raman for her assistance in planning and moderating our focus groups, Sharon Sung and David Irby for critical review of the manuscript, and Mara McAdams and the Duke-NUS/SingHealth Academic Medicine Education Institute for assistance in study design and project funding.

Author information

Authors and Affiliations

  1. Duke University School of Medicine, Durham, NC, USA

    Julia Farquhar

  2. Duke-NUS Medical School, Singapore City, Singapore

    Desiree Lie, Angelique Chan & Mandy Ow

  3. National University Health System, Singapore City, Singapore

    Arpana Vidyarthi

Authors
  1. Julia Farquhar
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  2. Desiree Lie
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  3. Angelique Chan
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  4. Mandy Ow
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  5. Arpana Vidyarthi
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Corresponding author

Correspondence to Julia Farquhar.

Ethics declarations

This research was approved by the National University of Singapore Institutional Review Board. Focus group data was anonymized with no linking identifiers.

Disclosure

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Funding Source

The Duke-NUS/SingHealth Academic Medicine Education Institute Medical Education Innovation Grant funded this research.

Appendix: Probe list for focus groups

Appendix: Probe list for focus groups

  1. 1)

    To establish a baseline, we’re going to go around and see how everyone here defines each term we’re studying. How do you define stress? Burnout? Coping? Resilience?

  2. 2)

    We want to know how students relate all these terms.

    1. a.

      Let’s start with the relationship between stress and burnout. Do you think these are related, and how?

    2. b.

      How does coping relate to stress and burnout?

    3. c.

      How does resilience relate to coping? How does it relate to stress and burnout?

  3. 3)

    Is there value in fostering resilience?

    1. a.

      If yes, what do you think can be done to foster resilience?

    2. b.

      How can resilience be fostered early on in medical school?

    3. c.

      How can resilience be fostered that will continue into medical practice?

  4. 4)

    Is there anything you would like to add?

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Farquhar, J., Lie, D., Chan, A. et al. Understanding Medical Students’ Experience with Stress and Its Related Constructs: A Focus Group Study from Singapore. Acad Psychiatry 42, 48–57 (2018). https://doi.org/10.1007/s40596-017-0703-7

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  • DOI: https://doi.org/10.1007/s40596-017-0703-7

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