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Background

In recent years there has been a growing appreciation of the issues of quality of life and stresses involved medical training as this may affect their learning and academic performance. However, such studies are lacking in medical schools of Nepal. Therefore, we carried out this study to assess the prevalence of psychological morbidity, sources and severity of stress and coping strategies among medical students in our integrated problem-stimulated undergraduate medical curriculum.

Methods

A cross-sectional, questionnaire-based survey was carried out among the undergraduate medical students of Manipal College of Medical Sciences, Pokhara, Nepal during the time period August, 2005 to December, 2006. The psychological morbidity was assessed using General Health Questionnaire. A 24-item questionnaire was used to assess sources of stress and their severity. Coping strategies adopted was assessed using brief COPE inventory.

Results

The overall response rate was 75.8% (407 out of 525 students). The overall prevalence of psychological morbidity was 20.9% and was higher among students of basic sciences, Indian nationality and whose parents were medical doctors. By logistic regression analysis, GHQ-caseness was associated with occurrence of academic and health-related stressors. The most common sources of stress were related to academic and psychosocial concerns. The most important and severe sources of stress were staying in hostel, high parental expectations, vastness of syllabus, tests/exams, lack of time and facilities for entertainment. The students generally used active coping strategies and alcohol/drug was a least used coping strategy. The coping strategies commonly used by students in our institution were positive reframing, planning, acceptance, active coping, self-distraction and emotional support. The coping strategies showed variation by GHQ-caseness, year of study, gender and parents' occupation.

Conclusion

The higher level of psychological morbidity warrants need for interventions like social and psychological support to improve the quality of life for these medical students. Student advisors and counselors may train students about stress management. There is also need to bring about academic changes in quality of teaching and evaluation system. A prospective study is necessary to study the association of psychological morbidity with demographic variables, sources of stress and coping strategies.

Background

College students are prone to stress due to the transitional nature of college life. High levels of stress are believed to affect students' health and academic functions. If the stress is not dealt with effectively, feelings of loneliness, nervousness, sleeplessness and worrying may result. Effective coping strategies facilitate the return to a balanced state, reducing the negative effects of stress.

Methods

This descriptive cross-sectional study was performed to determine sources of stress and coping strategies in nursing students studying at the Iran Faculty of Nursing & Midwifery. All undergraduate nursing students enrolled in years 1-4 during academic year 2004-2005 were included in this study, with a total of 366 questionnaires fully completed by the students. The Student Stress Survey and the Adolescent Coping Orientation for Problem Experiences Inventory (ACOPE) were used for data collection.

Results

Most students reported "finding new friends" (76.2%), "working with people they did not know" (63.4%) as interpersonal sources of stress, "new responsibilities" (72.1%), "started college" (65.8%) as intrapersonal sources of stress more than others. The most frequent academic source of stress was "increased class workload" (66.9%) and the most frequent environmental sources of stress were being "placed in unfamiliar situations" (64.2%) and "waiting in long lines" (60.4%). Interpersonal and environmental sources of stress were reported more frequently than intrapersonal and academic sources. Mean interpersonal (P=0.04) and environmental (P=0.04) sources of stress were significantly greater in first year than in fourth year students. Among coping strategies in 12 areas, the family problem solving strategies, "trying to reason with parents and compromise" (73%) and "going along with family rules" (68%) were used "often or always" by most students. To cope with engaging in demanding activity, students often or always used "trying to figure out how to deal with problems" (66.4%) and "trying to improve themselves" (64.5%). The self-reliance strategy, "trying to make their own decisions" (62%); the social support strategies, "apologizing to people" (59.6%), "trying to help other people solve their problems" (56.3%), and "trying to keep up friendships or make new friends" (54.4%); the spiritual strategy, "praying" (65.8%); the seeking diversions strategy, "listening to music" (57.7%), the relaxing strategy "day dreaming" (52.5%), and the effort to "be close with someone cares about you" (50.5%) were each used "often or always" by a majority of students. Most students reported that the avoiding strategies "smoking" (93.7%) and "drinking beer or wine" (92.9%), the ventilating strategies "saying mean things to people" and "swearing" (85.8%), the professional support strategies "getting professional counseling" (74.6%) and "talking to a teacher or counselor" (67.2%) and the humorous strategy "joking and keeping a sense of humor" (51.9%) were used "seldom or never".

Conclusion

First year nursing students are exposed to a variety of stressors. Establishing a student support system during the first year and improving it throughout nursing school is necessary to equip nursing students with effective coping skills. Efforts should include counseling helpers and their teachers, strategies that can be called upon in these students' future nursing careers.

Background: Previous studies found that stress, depression, burnout, anxiety, and depersonalisation play a significant role amongst dental and medical students. We wanted to examine if students of the University of Erlangen-Nuremberg also would report elevated values as can been found in similar publications. Furthermore, particularly coping strategies were investigated.

Methods: The data collection took place in April 2008 including 182 dental and medical students of the 4th and 5th academic year at the University of Erlangen-Nuremberg. Demographic data and the following screening instruments were used: Maslach Burnout Inventory (MBI), Cambridge Depersonalisation Scale (CDS-9), Hospital Anxiety and Depression Scale (HADS), Brief COPE.

Results: Descriptive statistics showed higher pathological values in dental students than in medical students. The difference was especially pronounced on the depersonalisation scale (CDS-9), with 20.4% of the dental students, but only 5.5% of the medical students showing scores above a cut-off of 19. The scores decreased in the course of 3 semesters of dentistry. The students with elevated values showed a higher degree of dysfunctional coping.

Conclusion: Our results obtained with the screening instruments are in line with the results of previous investigations of other authors and point out the importance of this issue. It might be useful to develop programs teaching dental students more adaptive coping strategies before their first patient contact.

Background

Since the stress and coping are the most reported problems by adolescents, this study aims to apprise the stressors, coping strategies and influential factors among male adolescents.

Methods

The effect of stressors, coping strategies and some demographics variables were studied in 402 male adolescents in Tehran, Iran. A self-administered questionnaire was used to collect the data. A multiple regression was performed to assess factors related to perceived stress.

Results

The mean age of adolescents was 15.44 (SD=0.68) years. The mean value of perceived stress for the whole sample was 17.99 (SD=6.02). Cognitive/emotional coping was the most frequent coping style. The findings revealed that there was a significant correlation between perceived and accumulative stress. In multiple regression analysis, the accumulative stress, social resources, parent`s education and grade point average were found to be significant predictors of perceived stress.

Conclusion

The findings suggest that increased level of perceived stress is associated with accumulative stress, social resources and parent`s education that are modifiable factors. Stress management education might be a solution to overcome increased perceived stress.

Background

Mental health problems in young people are an important public health issue. Students leaving their hometown and family at a young age to pursue better educational opportunities overseas are confronted with life adjustment stress, which in turn affects their mental health and academic performance. This study aimed to examine the relationships among stress, coping strategies, and depressive symptoms using the stress coping framework in overseas Chinese university preparatory students in Taiwan.

Methods

A cross-sectional study was conducted at an overseas Chinese university preparatory institute in Taiwan. Of enrolled overseas Chinese university preparatory students at 2009, 756 completed a structured questionnaire measuring stress, strategies for coping with it, and the Center for Epidemiologic Studies Depression Scale.

Results

High levels of stress significantly predicted the adoption of active, problem-focused coping strategies (R2 = 0.13, p < .01) and passive, emotion-focused coping strategies (R2 = 0.24, p < .01). Acceptable CFI, SRMR, and RMSEA values from the structural equation modeling analysis demonstrated that the model satisfactorily fits the stress coping framework, after active coping strategies were eliminated from the model. Results from the Sobel test revealed that passive coping strategies mediated the relation between stress and depressive symptoms (z = 8.06, p < .001).

Conclusion

Our study results suggested that stress is associated with coping strategies and depressive symptoms and passive strategies mediate the relation between stress and depressive symptoms in overseas Chinese university preparatory students.

Background

The current study explored the prevalence of depressed mood among Chinese undergraduate students and examined the coping patterns and degree of flexibility of flexibility of such patterns associated with such mood.

Methods

A set of questionnaire assessing coping patterns, coping flexibility, and depressive symptoms were administered to 428 students (234 men and 194 women).

Results

A total of 266 participants both completed the entire set of questionnaires and reported a frequency of two or more stressful life events (the criterion needed to calculate variance in perceived controllability). Findings showed that higher levels of depressive symptoms were significantly associated with higher levels of both event frequency (r = .368, p < .001) and event impact (r = .245, p < .001) and lower levels of perceived controllability (r = -.261, p < .001), coping effectiveness (r = -.375, p < .001), and ratio of strategy to situation fit (r = -.108, p < .05). Depressive symptoms were not significantly associated with cognitive flexibility (variance of perceived controllability; r = .031, p = .527), Gender was not a significant moderator of any of the reported associations.

Conclusions

Findings indicate that Chinese university students with depressive symptoms reported experiencing a greater number of negative events than did non-depressed university students. In addition, undergraduates with depressive symptoms were more likely than other undergraduates to utilize maladaptive coping methods. Such findings highlight the potential importance of interventions aimed at helping undergraduate students with a lower coping flexibility develop skills to cope with stressful life events.

Background & objectives:

Psychosocial stressors leading to allostatic load need to be explored further as these have great scope for early intervention. Stress studies done in India are mostly based on sources of stress and objective measures of stress. Therefore, the objective of the present study was to assess stress appraisal among students (16-17 yr) and to identify institution-specific differences (Private vs. Government) in stress appraisal and coping.

Methods:

The study was carried out among 16-17 yr old apparently normal students. Eighty students were recruited from six schools ensuring equal representation from gender/category of schools (Government/ Private). Validated and culturally adaptable behavioural scales for perceived stress (PSS), stressful life events (LES) and coping were administered. Psychological morbidity was assessed using GHQ-12. Data on 75 students were available for statistical analysis.

Results:

The students of both Government and Private schools showed similar stress perception, though the former tend to have a higher mean score. The scores were significantly higher on avoidance coping (P<0.05). The stepwise regression model showed coping as the independent predictor of perceived stress (R2= 10%).

Interpretation & conclusions:

Students from Government schools had significantly higher scores on avoidance coping and therefore, suitable for a systematic study on chronic stress for early intervention.

Background

Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK.

Method

A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups.

Results

A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p < 0.0001); and that there was a lack of opportunity to explore academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008).

Conclusion

There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors.

The current study examined how specific coping strategies mediate the relationship between Conscientiousness (C) and positive affect (PA) in a large, multiethnic sample. Using an internet-based daily diary approach, 366 participants (37.6% Caucasian, 30.6% Asian American, 20.7% Hispanic, 9.1% African American) completed measures that assessed daily stressors, coping strategies used to deal with those stressors, and PA over the course of five days. In addition, participants completed a measure of the Five-Factor Model of Personality. Problem-Focused coping partially mediated the relationship between C and PA. Individuals higher in C used more problem-focused coping, which, in turn, was associated with higher PA. The findings of the current study suggest C serves as a protective factor from stress through its influence on coping strategy selection. Other possible mediators in the C-PA relationship are discussed.

The purpose of this qualitative study was to examine the nature of work-related stress and coping experienced by African-American family physicians. Ten African-American family physicians across the state of Ohio were interviewed using a standardized open-ended format. Interview data were analyzed through an "editing" technique and QSR Nud*ist, a qualitative software program. Patterns and themes common to the interviews were identified. Stressors presented by research participants included experiences with racism in medicine, doubt, and a strong desire to prove oneself in the medical environment. Distinctive coping strategies involved spirituality, kinship, and the development of strength and perseverance in the face of adversity. Responses to general questions on stress and coping indicated difficulties with the shift toward managed care and use of "time for self, away from medicine" types of coping strategies. Results underscored the importance of culture and race in stress and coping processes, and suggested that programs and policies addressing the specific pressures faced by African-American physicians in training and practice need to be developed.

College students at university have to face several stress factors. Although sports practice has been considered as having beneficial effects upon stress and general health, few studies have documented its influence on this specific population. The aim of this comparative study was to determine whether the intensity of the college students’ sports practice (categorized into three groups: rare, regular, or intensive) would influence their levels of stress and self-efficacy, their coping strategies, and their academic success/failure. Three self-completion questionnaires were administered to 1071 French freshmen during their compulsory medical visit at the preventive medicine service of the university. Results indicated that students with intensive sport practice reported lower scores of general stress, academic stress, and emotion-focused coping strategies, and higher scores of self-efficacy than those with rare practice. However, the proportion of successful students did not differ significantly between the three groups of sports practice.

Objective

To test the hypothesis that pain patients differ from well children in their appraisal and coping with daily stressors and to test a model of the relation of stress appraisal and coping to symptoms and disability.

Methods

Pediatric patients with chronic abdominal pain (n = 143) and well children (n = 104) completed a 5-day diary study regarding their appraisal and coping with daily stressors. Somatic symptoms, depressive symptoms, and functional disability were assessed 2 months later.

Results

Compared to well children, pain patients were less confident of their ability either to change or to adapt to stress and were less likely to use accommodative coping strategies. Different patterns of stress appraisal were associated with active, passive, and accommodative coping. Both appraisals and coping were significantly related to symptoms and disability.

Conclusions

The relation between stress and symptoms in pediatric pain patients may be explained in part by their appraisal and coping with stressors. The relation between appraisal and coping was consistent with Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer.

This study aimed to determine which coping strategies are associated with better quality of life (QOL) in adolescents with asthma. Furthermore, because coping can mediate the effects of health stressors on QOL, this study also examined the indirect effect of asthma severity on QOL via coping. Between January and May 2003, 553 Dutch adolescents with asthma (aged 12–6 years) completed questionnaires assessing coping strategies, symptom severity, overall QOL and positive QOL domain (positive effects of asthma domain). The relations between symptom severity, coping strategies and QOL were tested with structural equation modelling (SEM). Symptom severity affected overall and positive QOL, both directly and indirectly via coping. The coping strategies restricted lifestyle and worrying about asthma were associated with poorer overall QOL. The use of the coping strategies restricted lifestyle, positive reappraisal, and information seeking was related to increased scores on the positive QOL domain, whereas hiding asthma was related to lower scores on the positive QOL domain.

The findings of this study suggest that coping mediates the effect of symptoms of asthma on QOL among adolescents with asthma. Several suggestions for interventions to improve asthma-specific QOL are discussed.

Background

Research on intraoperative stressors has focused on external factors without considering individual differences in the ability to cope with stress. One individual difference that is implicated in adverse effects of stress on performance is “reinvestment,” the propensity for conscious monitoring and control of movements. The aim of this study was to examine the impact of reinvestment on laparoscopic performance under time pressure.

Methods

Thirty-one medical students (surgery rotation) were divided into high- and low-reinvestment groups. Participants were first trained to proficiency on a peg transfer task and then tested on the same task in a control and time pressure condition. Outcome measures included generic performance and process measures. Stress levels were assessed using heart rate and the State Trait Anxiety Inventory (STAI).

Results

High and low reinvestors demonstrated increased anxiety levels from control to time pressure conditions as indicated by their STAI scores, although no differences in heart rate were found. Low reinvestors performed significantly faster when under time pressure, whereas high reinvestors showed no change in performance times. Low reinvestors tended to display greater performance efficiency (shorter path lengths, fewer hand movements) than high reinvestors.

Conclusion

Trained medical students with a high individual propensity to consciously monitor and control their movements (high reinvestors) displayed less capability (than low reinvestors) to meet the demands imposed by time pressure during a laparoscopic task. The finding implies that the propensity for reinvestment may have a moderating effect on laparoscopic performance under time pressure.

Background:

This is an experimental study and it discusses the effectiveness of social support in managing academic stress among students.

Aim:

The purpose of this study is to understand the importance of social support in managing stress.

Materials and Methods:

Simple random sampling was assigned to a number of 120 students, equally divided into an experimental and a control group. Classes on social support as coping mechanisms were given to the experimental group only. The accumulated data were then analyzed, descriptive statistics were used to interpret and evaluate the prevalence of academic stress, and social support. Correlation analysis was employed in the examination of the relationship between stress and social support.

Results:

The findings of this study indicate that there are significant differences between the experimental group and the control group in relation to stress and social support. Eventually, the experimental group proved to cope with academic stress better than the control group, and they were satisfied with their academic performance during the experimentation.

Conclusion:

Hence, it is highly advisable to encourage the students to use social support as coping mechanisms.

BACKGROUND:

Stress has been defined as a barrier to concentration, problem solving, decision making, and other necessary abilities for students’ learning; it also has some symptoms and illnesses in the students such as depression and anxiety. In reviewing stress and its consequences, the methods of coping with stress in the method of response to it would be more important than the nature of stress itself. Therefore, this study aimed to determine the effectiveness of stress management training program on depression, anxiety and stress rate of the nursing students.

METHODS:

This parallel group randomized quasi-experimental trial, was done on 68 Bs nursing students of Nursing and Midwifery School in Isfahan University of Medical Sciences from 2010 to 2011. The questionnaires of this study consisted of individual characteristics and Depression, Anxiety and Stress Scale (DASS-42). In a random fashion, The intervention group was trained with stress management training program in 8 two hours sessions, twice a week. The questionnaires were completed by both groups before, after and one month after the study.

RESULTS:

The results of the study indicated that there was no significant difference before the intervention in depression, anxiety and stress mean scores in the two groups. After the intervention, the mean scores of anxiety and stress in the intervention group was 5.09 (4.87) and 8.93 (6.01) and in the control group was 10 (6.45) and 13.17 (7.20), that reduction in depression mean score was significantly greater in the intervention group in the control group (p = 0.040). Furthermore, the mean scores of anxiety and stress showed a significant difference between the two groups (Anxiety p = 0.001; Stress p = 0.011); this reduction also had been remained after a month.

CONCLUSIONS:

According to the results of the present study, holding stress management training program workshops in different courses of the mental health department can improve mental health of the students.

Aim

To retrospectively analyze the rate of multi-type abuse in childhood and the effects of childhood abuse and type of coping strategies on the psychological adaptation of young adults in a sample form the student population of the University of Mostar.

Methods

The study was conducted on a convenience sample of 233 students from the University of Mostar (196 female and 37 male), with a median age of 20 (interquartile range, 2). Exposure to abuse was determined using the Child Maltreatment Scales for Adults, which assesses emotional, physical, and sexual abuse, neglect, and witnessing family violence. Psychological adaptation was explored by the Trauma Symptom Checklist, which assesses anxiety/depression, sexual problems, trauma symptoms, and somatic symptoms. Strategies of coping with stress were explored by the Coping Inventory for Stressful Situations.

Results

Multi-type abuse in childhood was experienced by 172 participants (74%) and all types of abuse by 11 (5%) participants. Emotional and physical maltreatment were the most frequent types of abuse and mostly occurred together with other types of abuse. Significant association was found between all types of abuse (r = 0.436-0.778, P < 0.050). Exposure to sexual abuse in childhood and coping strategies were significant predictors of anxiety/depression (R2 = 0.3553), traumatic symptoms (R2 = 0.2299), somatic symptoms (R2 = 0.2173), and sexual problems (R2 = 0.1550, P < 0.001).

Conclusion

Exposure to multi-type abuse in childhood is a traumatic experience with long-term negative effects. Problem-oriented coping strategies ensure a better psychosocial adaptation than emotion-oriented strategies.

Background

Surgical residency has the reputation of being arduous and stressful. We sought to determine the stress levels of surgical residents, the major causes of stress and the coping mechanisms used.

Methods

We developed and distributed a survey among surgical residents across Canada.

Results

A total of 169 participants responded: 97 (57%) male and 72 (43%) female graduates of Canadian (83%) or foreign (17%) medical schools. In all, 87% reported most of the past year of residency as somewhat stressful to extremely stressful, with time pressure (90%) being the most important stressor, followed by number of working hours (83%), residency program (73%), working conditions (70%), caring for patients (63%) and financial situation (55%). Insufficient sleep and frequent call was the component of residency programs that was most commonly rated as highly stressful (31%). Common coping mechanisms included staying optimistic (86%), engaging in enjoyable activities (83%), consulting others (75%) and exercising (69%). Mental or emotional problems during residency were reported more often by women (p = 0.006), who were also more likely than men to seek help (p = 0.026), but men reported greater financial stress (p = 0.036). Foreign graduates reported greater stress related to working conditions (p < 0.001), residency program (p = 0.002), caring for family members (p = 0.006), discrimination (p < 0.001) and personal and family safety (p < 0.001) than Canadian graduates.

Conclusion

Time pressure and working hours were the most common stressors overall, and lack of sleep and call frequency were the most stressful components of the residency program. Female sex and graduating from a non-Canadian medical school increased the likelihood of reporting stress in certain areas of residency.

Background

This study examined the relationship between life satisfaction among medical students and a basic model of personality, stress and coping. Previous studies have shown relatively high levels of distress, such as symptoms of depression and suicidal thoughts in medical undergraduates. However despite the increased focus on positive psychological health and well-being during the past decades, only a few studies have focused on life satisfaction and coping in medical students. This is the first longitudinal study which has identified predictors of sustained high levels of life satisfaction among medical students.

Methods

This longitudinal, nationwide questionnaire study examined the course of life satisfaction during medical school, compared the level of satisfaction of medical students with that of other university students, and identified resilience factors. T-tests were used to compare means of life satisfaction between and within the population groups. K-means cluster analyses were applied to identify subgroups among the medical students. Analysis of Variance (ANOVA) and logistic regression analyses were used to compare the subgroups.

Results

Life satisfaction decreased during medical school. Medical students were as satisfied as other students in the first year of study, but reported less satisfaction in their graduation year. Medical students who sustained high levels of life satisfaction perceived medical school as interfering less with their social and personal life, and were less likely to use emotion focused coping, such as wishful thinking, than their peers.

Conclusion

Medical schools should encourage students to spend adequate time on their social and personal lives and emphasise the importance of health-promoting coping strategies.

Background:

Being in medical school has always been regarded as highly stressful. Excessive stress causes physical and mental health problems. Persistent stress can impair students’ academic achievement and personal or professional development. The aim of this study is to explore the nature of stress among medical students by determining the prevalence, sources and pattern of stress and the factors affecting it.

Methods:

We chose a cross-sectional study design utilizing validated questionnaires, the 12 items General Health Questionnaire (GHQ-12) and Medical Student Stressor Questionnaire (MSSQ), to evaluate stress levels and stressors. School and ethical committee clearance were obtained prior to the study. Data were analysed using SPSS version 12.

Results:

Of the medical students who were administered the questionnaire, 761 (72%) respondents participated in this study. The prevalence of stress among the medical students was 29.6%. The top 10 stressors were academic-related. Prevalence of stress for the first, second, third, fourth and fifth year students was 26.3%, 36.5 %, 31.4%, 35.3% and 21.9%, respectively. Year of study was the only significant factor affecting stress among medical students (P-value < 0.05).

Conclusions:

The prevalence of stress among medical students in USM is high. Academic-related problems were the major stressor among medical students. Year of study was the factor most significantly associated with medical students’ stress. There was a bimodal pattern of the stress level throughout the year of study.

Background

Few studies have addressed the challenges that international medical students face and there is a dearth of information on the behavioural strategies these students adopt to successfully progress through their academic program in the face of substantial difficulties of language barrier, curriculum overload, financial constraints and assessment tasks that require high proficiency in communication skills.

Methods

This study was designed primarily with the aim of enhancing understanding of the coping strategies, skill perceptions and knowledge of assessment expectations of international students as they progress through the third and fourth years of their medical degree at the School of Medicine, University of Tasmania, Australia.

Results

Survey, focus group discussion and individual interviews revealed that language barriers, communication skills, cultural differences, financial burdens, heavy workloads and discriminatory bottlenecks were key factors that hindered their adaptation to the Australian culture. Quantitative analyses of their examination results showed that there were highly significant (p < 0.001) variations between student performances in multiple choice questions, short answer questions and objective structured clinical examinations (70.3%, 49.7% & 61.7% respectively), indicating existence of communication issues.

Conclusions

Despite the challenges, these students have adopted commendable coping strategies and progressed through the course largely due to their high sense of responsibility towards their family, their focus on the goal of graduating as medical doctors and their support networks. It was concluded that faculty needs to provide both academic and moral support to their international medical students at three major intervention points, namely point of entry, mid way through the course and at the end of the course to enhance their coping skills and academic progression. Finally, appropriate recommendations were made.

There is increasing interest in integrating population health and informatics topics into the undergraduate medical curriculum, yet little consensus exists on the most effective approach to accomplish this. We introduced the use of an academic data warehouse of encrypted patient information into an existing 2nd year medical school course. Exercises were developed requiring students to retrieve and interpret information regarding local disease prevalence, practice patterns, and patient characteristics. These exercises were integrated into existing weekly problem sets in a multiple-choice format. Faculty and student perceptions were assessed with surveys, and augmented with interviews of student volunteers, and database usage statistics. Our results indicate widespread agreement among both students and faculty that population-based medicine warrants inclusion in undergraduate medical education. The majority of the students felt the exercises complemented the clinical cases around which they were structured. There was less agreement, however, that the exercises were valuable, with several students suggesting a more open-ended, discussion-oriented approach. It was clear that faculty perceptions had a significant impact on student reactions.

Objective

To investigate psychological well-being and substance abuse among medical students in Pakistan.

Methods

A cross-sectional questionnaire-based survey was conducted in six medical colleges across Pakistan. Final-year medical students were interviewed by either a postgraduate trainee in psychiatry or a consultant psychiatrist.

Results

A total of 540 medical students were approached; 342 participated and the response rate was 64.5%. Mean age was 23.73 years (SD 2.45 years); 52.5% were male and 90% single. Two out of every five respondents reported that work/study at medical school affected their personal health and well-being. A considerable proportion of students were aware of alcohol and smoking as coping strategies for stress in medical students. The main factors causing stress were heavy workload (47.4%), relationship with colleagues (13.5%) and staff (11.9%). A total of 30% reported a history of depression and 15% among them had used an antidepressant. More than half were aware of depression in colleagues. The majority of respondents said that teaching provided on substance misuse in the areas of alcohol and illegal drugs, management/treatment of addiction, and models of addiction was poor. There was significant association (p = 0.044) between stress and awareness about alcohol as a coping strategy for stress among medical students. A significant negative association was also found between medical colleges in public sector (p = 0.052), female gender (p = 0.003) and well-being.

Conclusion

The majority of the medical students reported a negative impact of heavy workload on their psychological well-being. Significant numbers of medical students think that substance misuse is a coping strategy for stress. Teaching on addiction/addictive substances is poor at undergraduate level in Pakistani medical colleges.

The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being.

Objectives

To examine health related quality of life (HRQOL), perceived stress, and coping skills in the 3 preclinical years of a doctor of pharmacy (PharmD) curriculum.

Methods

Health-related quality of life, perceived stress, and coping strategies were measured using the Short Form-36, Perceived Stress Scale, and Brief COPE. Average annual scores were compared across curriculum years.

Results

Two hundred thirteen students enrolled in the study. Entering students had physical and mental HRQOL scores that were similar to age-adjusted US norms. Mental HRQOL scores were significantly lower and stress significantly higher during the second year of the PharmD curriculum compared to the first year (p < 0.05). Lower mental HRQOL scores were associated with increased stress and use of maladaptive coping skills in all years of the curriculum.

Conclusion

Increased stress and reduced mental HRQOL were observed across the first 3 years of a PharmD curriculum. Methods to reduce stress and/or use of maladaptive coping skills are needed to improve students' HRQOL throughout the pharmacy curriculum.