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      Perceived Stress, Sources and Severity of Stress among medical undergraduates in a Pakistani Medical School

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          Abstract

          Background

          Recently there is a growing concern about stress during undergraduate medical training. However, studies about the same are lacking from Pakistani medical schools. The objectives of our study were to assess perceived stress, sources of stress and their severity and to assess the determinants of stressed cases.

          Methods

          A cross-sectional, questionnaire-based survey was carried out among undergraduate medical students of CMH Lahore Medical College, Pakistan during January to March 2009. Perceived stress was assessed using the perceived stress scale. A 33-item questionnaire was used to assess sources of stress and their severity.

          Results

          The overall response rate was 80.5% (161 out of 200 students). The overall mean perceived stress was 30.84 (SD = 7.01) and was significantly higher among female students. By logistic regression analysis, stressed cases were associated with occurrence of psychosocial (OR 5.01, 95% CI 2.44-10.29) and academic related stressors (OR 3.17 95% CI 1.52-6.68). The most common sources of stress were related to academic and psychosocial concerns. 'High parental expectations', 'frequency of examinations', 'vastness of academic curriculum', 'sleeping difficulties', 'worrying about the future', 'loneliness', 'becoming a doctor', 'performance in periodic examinations' were the most frequently and severely occurring sources of stress. There was a negative but insignificant correlation between perceived stress and academic performance (r = -0.099, p > 0.05).

          Conclusion

          A higher level of perceived stress was reported by the students. The main stressors were related to academic and psychosocial domains. Further studies are required to test the association between stressed cases and gender, academic stressors and psychosocial stressors.

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          Most cited references34

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          Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors.

          Despite an increased risk of suicide among physicians we lack studies on prevalence and predictors of suicidal ideation among medical students and young doctors. A prospective study of Norwegian medical students (n=522) re-examined after the first postgraduate year, comprising suicidal thoughts and attempts, perceived study stress, job stress, and personality. The previous year prevalence of suicidal thoughts was 14% at both points of time. The lifetime prevalence was 43%, while 8% had planned suicide, and 1.4% had attempted suicide. Suicidal ideation in medical school was predicted by lack of control, personality trait, single marital status, negative life events and mental distress (anxiety and depression). In the first postgraduate year, mental distress was the most important predictor, but before controlling for this variable, job stress, vulnerability (neuroticism), single status, and less working hours were independent predictors. Prospectively, suicidal thoughts and vulnerability as student predicted postgraduate suicidal ideation. The level of suicidal thoughts was high, but the level of attempts was low. Preventive efforts should be directed both at the students' abilities to cope with stress and at mental health services for young doctors. LIMITATIONS OF STUDY: The lower response rate at follow-up (57%) may reduce external validity.
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            Embarking upon a medical career: psychological morbidity in first year medical students.

            This study was undertaken to measure the prevalence of psychological morbidity, and the nature and source of stress, in first year medical students. Two hundred and four first year medical students at a university in the north of England were sent a postal, self-report questionnaire. They were asked to complete the General Health Questionnaire (GHQ), the Stress Incident Record and to give details of their alcohol consumption. A total of 172 students (84.3%) replied. Thirty-six per cent of the students scored above the threshold of the GHQ, indicating probable psychological disturbance. There was no difference between men and women. Approximately half of the students described a stressful incident, the majority of which were related to medical training rather than to personal problems. Male students reported drinking significantly more alcohol than female students, but there was no relationship between levels of alcohol consumption and either psychological disturbance or reporting of stress. The findings suggest that even at the preliminary stages of medical training, many students find aspects of the medical course very stressful. The psychological well-being of medical students needs to be more carefully addressed, and closer attention paid to the styles of medical teaching that may provoke avoidable distress.
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              A prospective analysis of stress and academic performance in the first two years of medical school.

              This study provides prospective, longitudinal data on the relationship between stress-related measures and academic performance during the first two years of medical school. First year medical students (n = 121) were surveyed prior to beginning classes (wave 1), and again 8 months later (wave 2). Personality variables predisposing to distress (optimism and trait anxiety), stress response (depression and state anxiety), and stress management strategies were assessed at wave 1 and wave 2. Pre-medical academic scores, and grades at the end of five assessment periods over the course of the first 2 years of medical school were also obtained. As expected, pre-medical-school academic performance strongly predicted performance in medical school. Academic performance before and during medical school was negatively related to reported stress levels. On bivariate correlations, there were numerous significant relationships between stress reported at waves 1 and 2, and medical school academic performance assessed after these measures. In addition there were modest negative correlations between self-reported coping strategies of 'humour' and 'wishful thinking', and consequent academic performance. However, the predictive value of stress and its management on prospective academic performance was much decreased once pre-medical-school performance was statistically controlled.
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                Author and article information

                Journal
                BMC Med Educ
                BMC Medical Education
                BioMed Central
                1472-6920
                2010
                15 January 2010
                : 10
                : 2
                Affiliations
                [1 ]3rd year Undergraduate Medical Student, CMH Lahore Medical College, University of Health Sciences, Abdur Rahman Road, Lahore Cantt, Pakistan
                [2 ]Department of Physiology, CMH Lahore Medical College, University of Health Sciences, Abdur Rahman Road, Lahore Cantt, Pakistan
                [3 ]Department of Community Medicine, Melaka Manipal Medical College, Malaysia
                Article
                1472-6920-10-2
                10.1186/1472-6920-10-2
                2820489
                20078853
                a15aa68f-aba7-464a-a533-98f4ecbc376c
                Copyright ©2010 Shah et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 2 April 2009
                : 15 January 2010
                Categories
                Research Article

                Education
                Education

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