|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2016 | Volume
: 16
| Issue : 1 | Page : 41-46 |
|
To study impact of stress on education and health profile of newly admitted medical students in a medical college of Eastern India
Arunima Chaudhuri1, Ayan Goswami1, Manjushree Ray2, Samir Kumar Hazra3
1 Department of Physiology, Burdwan Medical College and Hospital, Burdwan, India
2 Department of Anaesthesiology, National Medical College Kolkata, Kolkata, West Bengal, India
3 Department of Gynaecology and Obstetrics, Burdwan Medical College, Burdwan, India
| Date of Web Publication | 7-Jan-2016 |
Correspondence Address:
Arunima Chaudhuri
Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1319-6308.167752
Background: Medical education is inherently stressful and emotionally demanding training. Objectives: The objective was to assess the stress levels, its causes, and impact on health and education on first MBBS students. Materials and Methods: This cross-sectional pilot project was conducted in a Medical College in Eastern India during a time span of 2 months, after receiving approval from the Institutional Ethics Committee and informed consent from the subjects. One hundred and fifty MBBS students in the age group of 18–20 years under stress were chosen for the study. Stress level was assessed according to the Presumptive Life Event Stress Scale (PSLES) and categorized into two groups: 41–200: less/moderate stress; more than 200: severe stress. The Perceived Stress Scale (PSS) of Sheldon Cohen was also used. Scores around 13 were considered as average. Scores of 20 or higher were considered high stress. Baseline anthropometric measurements were done; body mass index and waist to hip ratio (WHR) were calculated. Resting pulse rate and blood pressure were measured. The results of internal assessment examinations conducted in this time period were recorded. The computer software Statistical Package for the Social Sciences version 16 was used for analysis of the data. Results: A total of 30 subjects had moderate PSLES scores (167.25 ± 26.67); 120 had high scores (373.86 ± 149.21; P < 0.000). We found statistically significant higher heart rate, diastolic blood pressure, WHR, and PSS scores (22.05 ± 5.02 vs. 19.25 ± 4.21; P 0.003) in subjects having high PSLES scores. No significant effect of stress scores were observed on systolic blood pressure. Examination results were significantly worse in the highly stressed group (64.3 ± 10.8 vs. 69.1 ± 9.6; P 0.019) as compared to subjects having moderate stress. Conclusions: These results indicated a negative impact of stress on health and education among MBBS students. أثير التوتر على التحصيل العلمي والوضع الصحي لطلبة الطب المقبولين حديثا في كلية الطب في شرقي الهند
خلفية البحث: يعد ّالتعليم الطبي بطبيعته مجهدا وتدريبا يتطلب المزيد من العاطفة .
الأهداف: كان الهدف تقييم مستويات التوتر وأسبابه، وآثاره على الصحة فى طلاب المستوى الأول في يرنامج بكالوريوس الطب والجراحة
المواد و منهج الدراسة: أجريت هذه الدراسة في كلية الطب في شرقي الهند خلال فترة قدرا ثلا أشهر، وبعد تلقي موافقة لجنة الأخلاقيات المؤسسية و موافقة أفراد عينة الدراسة .
وقد تم اختيار مائة وخمسين طالب بكالوريوس طب وجراحة في الفئة العمرية من 18-20 سنة مصابون بالتوتر. وقد تم تقييم مستوى التوتر وفقا لمقياس افتراض و أحداث الحياة (PSLES) Presumptive Life Event Stress Scaleحيث تم التصنيفا على مجموعتين: 41-200: التوتر الاقل او المعتدل. أكثر من 200: االتوتر الشديد. وقد استخدم أيضا مقياس شيلدون كوهين للتوتر (PSS). واعتبر حوالي 13
كمتوسط. واعتبر 20 أعلى ارتفاع للتوتر. ا و قد أخذت قياسات كتلة الجسم و ونسبة الخصر إلى الورك وتم قياس معدل النبض وضغط الدم. ونتائج امتحانات التقييم الداخلي التي أجريت في هذه الفترة الزمنية تم تسجيلها. و قد تم استخدام برامج الكمبيوتر الحزمة الإحصائية العلوم الاجتماعية النسخة 16 لتحليل البيانات.
النتائج: لوحظ ان مجموعه 30 مشاركا كانت معدلات التوتر لديهم معتدلة (167.25 ± 26.67)؛ بينما 120 كان نسبتهم عالية (373.86 ± 149.21؛ P <0.000). وجدت أعلى نسبة ذات دلالة إحصائية في سرعة ضربات القلب، ضغط الدم الانبساطي، WHR، PSS (22.05 ± 5.02 مقابل 19.25 ± 4.21؛ 0.003 P) في أفراد عيتة الدراسة ليس له تأثير كبير وقد لوحظ أثر التوتر على ضغط الدم الانقباضي. وكانت نتائج الفحص بشكل كبير أسوأ في هذه المجموعة (64.3 ± 10.8 مقابل 69.1 ± 9.6؛ 0.019- P) بالمقارنة مع الأفراد ذوى المعددل المعتدل.
الاستنتاجات: هذه النتائج تدل على وجود تأثير سلبي للتوتر على الصحة والتعليم بين المستوي الأول لبرنامج الطب و الجراحة. Keywords: Health hazards, medical education, stress
How to cite this article:
Chaudhuri A, Goswami A, Ray M, Hazra SK. To study impact of stress on education and health profile of newly admitted medical students in a medical college of Eastern India. Saudi J Sports Med 2016;16:41-6 |
How to cite this URL:
Chaudhuri A, Goswami A, Ray M, Hazra SK. To study impact of stress on education and health profile of newly admitted medical students in a medical college of Eastern India. Saudi J Sports Med [serial online] 2016 [cited 2023 Feb 8];16:41-6. Available from: https://www.sjosm.org/text.asp?2016/16/1/41/167752 |
| Introduction | |  |
Medical education is inherently stressful and emotionally demanding training. Increasing population, fast paced industrialization, increased competitiveness, unanticipated problems in workplace have increased the stress among the medical students in recent times.[1],[2],[3] Chronic exposure of this busy demanding schedule leads to stress which influences learning and memory capabilities, which disrupts their flexible thinking and ultimately leads to improper decision and patient care. Stress experiences often lead to various chronic health conditions such as hypertension, coronary heart disease.[1],[2],[3],[4] Stress at work is an important risk factor for the emergence of metabolic syndrome. Plausible pathophysiology involves direct neuroendocrine effects and autonomic imbalance.[3],[4],[5]
Perceived stress has been found to be higher for students in various healthcare courses. A national survey of physicians in Canada showed that both male and female doctors experienced high levels of occupational stress.[1] Another study in a teaching hospital in Pakistan showed 68% of the doctors were not satisfied with their jobs and workload.[3] Female doctors had significantly lower satisfaction with their workload. The magnitude of the problem was further emphasized in the report of the American Foundation for Suicide Prevention which claimed that on the average, death by suicide is about 70% more likely among male physicians than among other professionals and 250–400% higher among female doctors. Higher levels of stress are also seen in majority of the nurses.[5]
Hence, this pilot project was conducted among first MBBS students to assess the stress levels, its causes and impact on health and education, so that stress management programs may be implemented for improvement in positive coping skills.[6]
| Materials and Methods | | |
This cross-sectional pilot project was conducted in a tertiary care hospital in Eastern India in a time span of 2 months, after receiving approval from the Institutional Ethics Committee. Informed consent was taken from the subjects.
Inclusion criteria
MBBS students of the first professional batch of Burdwan Medical College.
Exclusion criteria
All students of MBBS first professional batch not willing to participate in the study, or are absent during the study period due to some personal problems were excluded.
Methods
One fifty medical students of first MBBS admitted in Burdwan Medical College were included in the study.
On the first appointment, history of the subjects was carefully recorded. Subjects were asked to tally a list of 43 life events based on a relative score. Stress level in the subjects was assessed according to the Presumptive Life Event Stress Scale (PSLES).[7] Accordingly, they were categorized into two groups: less/moderate stress and severe stress. Score stress 41–200 less/moderate stress; more than 200 severe stress.
The Perceived Stress Scale (PSS) of Sheldon Cohen, the most widely used psychological instrument for measuring the perception of stress, was used. It is a measure of the degree to which situations in one's life are appraised to be stressful. Items were designed to find how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale also includes a number of direct queries about current levels of experienced stress. The questions in the PSS ask about feelings and thoughts during the last month. It comprises of 10 items, four of which are reverse-scored, measured on a 5-point scale from 0 to 4. PSS scores are obtained by reversing responses (e.g. 0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) to the four positively stated items (items 4, 5, 7, and 8) and then summing across all scale items. Total score ranges from 0 to 40.[8] Scores around 13 are considered average. High stress groups usually have a stress score of around 20-point. Scores of 20 or higher are considered high stress, and persons in this range, might consider learning new stress reduction techniques as well as joining exercise programs to at least 3 times a week. High psychological stress is associated with high blood pressure, higher body mass index (BMI), larger waist to hip ratio (WHR), shorter telomere length, higher cortisol levels, suppressed immune function, decreased sleep, and increased alcohol consumption. These are all important risk factors for cardiovascular disease.
On the day of the test, no cigarette, nicotine, coffee, or drugs was permitted.
Baseline anthropometric measurements were done.
Anthropometry
Body weight
A digital weighing scale was used to measure body weight with an accuracy of + 100 g. Subjects were weighed without their shoes.
Height
Standing body height was measured without shoes to the nearest 0.5 cm with the use of height stand with shoulders in relaxed position and arms hanging freely.
Body mass index
BMI was calculated as body weight in kilograms divided by square of body height in meters. Those subjects with BMI >25 were categorized as obese and those with BMI <25 as nonobese.[9]
Waist to hip ratio
WHR of the subjects was measured. Waist circumference was measured at the level of umbilicus and hip circumference at the fullest point around buttocks. Waist circumference was divided by hip circumference in order to calculate the WHR.
Subjects were asked to take rest for 15 min. Resting pulse rate and blood pressure were measured. Heart rate was recorded in the supine position by conventional method during normal quiet breathing for a period of 1 min followed by recording of blood pressure.
The results of internal assessment examinations conducted in this time period were recorded. The exams were conducted in the Department of Physiology and consisted of multiple choice questions, short answer type questions and assessment of all examinations were be done by same set of examiners who were blind to the study.
Statistical analysis
The computer software Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0., SPSS Inc., Chicago, IL, USA) was used for analysis of data. Values were recorded as mean and standard deviation. Unpaired t-test was used to determine statistically significant differences during an intragroup analysis of subjects done according to PSLES. Spearman rank order correlation coefficient was calculated between the independent variable (PSS) and the dependent variables (anthropometric measurements, pulse, blood pressure, and performance in examinations) to understand the effect of stress on health and education. For all analysis, P < 0.05* was considered statistically significant and P < 0.01** as highly significant.[10]
| Results | | |
Among 150 students, 92 were male and 58 were females. 30 subjects had moderate PSLES scores (167.25 ± 26.67); 120 had high scores (373.86 ± 149.21; P < 0.000). Mean age was 18.25 ± 0.84 vs. 18.23 ± 0.83, and there was no significant difference in age between the two groups (P = 0.9). We found statistically significant higher heart rate (80.63 ± 4.4 vs. 76.5 ± 9.2; P 0.019*), diastolic blood pressure (80.49 ± 9.03 vs. 77.6 ± 5.41; P 0.03*), WHR and PSS scores (22.05 ± 5.02 vs. 19.25 ± 4.21; P 0.003) in subjects having high PSLES scores. Females had significantly higher stress scores as compared to males. No significant effect of stress scores were observed on systolic blood pressure (121.1 ± 13.89 vs. 120.87 ± 11.11; P 0.92). Examination results were significantly worse in the highly stressed group (64.3 ± 10.8 vs. 69.1 ± 9.6; P 0.019*) as compared to subjects having moderate stress [Table 1]. PSS was negatively correlated to exam results with r value of –0.04, positively correlated with pulse rate and diastolic blood pressure with r value of 0.2 and 0.03, respectively [Table 2]. | Table 1: Mean and SD values of different parameters studied in MBBS students
Click here to view |
 | Table 2: Correlation between the independent variable (PSS) and the dependent variables (anthropometric measurements, pulse, BP, and performance in examinations)
Click here to view |
| Discussion | | |
This study was conducted to study the impact of stress on health and education among first MBBS students. Due to sudden exposure to the vast and stressful course of MBBS these young medical students experience lots of stress. Further due to inadequate rest and leisure time they cannot adequately prepare properly for exams and they fail to coordinate their learning with teaching. The medical students of today will be doctors of tomorrow and if more attention is paid to decrease their stress in early days in medical schools this will improve the quality of their life and most important patient care in future. The results of the present study indicated a negative impact of stress on health and education among MBBS students.
Females perceived more stress as compared to males in the present study. Autonomic imbalance is associated with stress. Vagal inhibitory influence decreases and sympathetic activity increases.[11],[12],[13] Estrogen is a sympathoinhibitor and vagotonic hormone. A metabolite of progesterone exerts sympathoinhibitory effect and attenuates sympathetic baroreflex responses via a central mechanism.[11] Women were thought to be protected from cardiovascular diseases before menopause due to the effect of female reproductive hormones. However, stress in modern day life is one of the important factors negatively influencing the cardiovascular profile of young females.[12],[13]
Salam et al. in 2015[14] conducted a study to identify the stress-prevalence and coping strategies among University Kebangsaan Malaysia (UKM) medical students. Standardized questionnaire on stress and coping strategies was used. Forty-eight coping items under task, emotion, and avoidance strategies were measured using 5-point Likert-scale. Overall stress-prevalence was 49%. Female and Malay respondents were more stressed. Significant differences of stress-level were observed between Malays and non-Malays in first year (P = 0.04) and in third year (P = 0.01). Most common strategies used to cope with stress were task-oriented while emotion-oriented was least. Stress-prevalence and stress-level in UKM medical students were high. Most of the respondents coped stress using task-oriented strategies. Stressor and its effective management must be ensured. Educational institutions should act as a creative designer of the learning environment to get relieve from educational stressor.
Medical students are exposed to regular pressure with overwork of academic burden and examination. Coping is a way that a person reacts or responds toward stressors. Failing to cope with stress effectively causes deterioration of academic and professional performances and increases the psychological distress.[14],[15],[16],[17]
A study by El-Gilany et al.[18] sought to determine whether there was a difference in perceived stress levels of male medical students at Mansoura University, Egypt, compared with male medical students at King Faisal University, Saudi Arabia. The self-reported questionnaire covered four categories, including 15 items, on sources of stress (stressors). The PSS and hospital anxiety and depression scale were used to measure stress, anxiety, and depression. There was no significant difference between the two groups in number of stressors. Anxiety and depression were significantly higher among Egyptian than Saudi students. Stress, anxiety, and depression are frequent among medical students. Counseling and preventive mental health services should be an integral part of the routine clinical facilities caring for medical students.
Samara et al. in 2015[19] conducted a study to explore the different parameters related to physical activity, including self-efficacy, as well as the perceived barriers to and benefits of physical activity in young Saudi females. Ninety-four first year female Saudi university students in Riyadh, Kingdom of Saudi Arabia, participated. The students were from eight bachelor's programs in health and well-being, and each completed a questionnaire with questions divided into five parts as follows: (1) Socioeconomic status, (2) physical activity, (3) self-efficacy, (4) social factors, and (5) barriers and facilitators related to physical activity. The students exercised at home and alone, and there was low self-efficacy for physical activity. Among social factors, attending university was the only factor that hindered physical activity. The most important barrier was the lack of designated areas available for physical activity.
Abdulghani et al.[20] study conducted a study to determine the prevalence of stress among medical students and to observe an association between the levels of stress and their academic performance. The prevalence of stress was measured and compared with the five study variables, such as gender, academic year, academic grades, regularity to course attendance, and perceived physical problems. The total prevalence of stress was 63%, and the prevalence of severe stress was 25%. The prevalence of stress was higher (P < 0.5) among females (75.7%) than among males (57%). The stress significantly decreased as the year of study increased, except for the final year. Students' grade point average (academic score) or regularity to attend classes was not significantly associated with the stress level. The prevalence of stress was higher during the initial 3 years of study and among the female students. We also observed high stress levels among first MBBS students.
Among the thirty subjects who were having less PSS scores twenty-two were participating in outdoor games irregularly, six were singers. 98% of subjects with higher PSS scores had sedentary lifestyles. Banerjee et al. in 2015[21] conducted a study to demonstrate effects of physical exercise on cardiovascular profile in young undergraduate males in health sector. They concluded that early lifestyle modification by regular exercises may improve not only the quality of life in general but patient care in particular in students of health care services. Similar results were also noticed in studies by Gupta et al. in 2014.[22] In the present study, we found that perceived stress was less in subjects participating in sports even irregularly and their cardiovascular profile was better.
Previously we had conducted two studies to see impact of progressive muscle relaxation on cardiovascular profile of health care professionals and found increasing stress among health care professionals is a cause for concern and there is need to adopt early lifestyle modification by practicing relaxation exercises to ameliorate stress and to improve not only their quality of life in general but patient care in particular.[12],[13]
Sources of student stress can be academic pressures, social or personal issues, and medical students have to face the challenge of rigorous curriculum and also have to learn how to deal with emotionally difficult experiences. A survey study design was conducted among medical students at Faculty of Medicine, King Faisal University by Abdel Rahman et al. in 2013.[23] 244 medical students were participated in the study. All participants were provided a self-administered questionnaire. A Likert scale with 3-point for responses was used. Questionnaires were given to participants 2 month before end-semester examinations, to minimize the extra stress symptoms a score of stress was calculated. Prevalence of stress was 53% among Saudi students. Medical students reported high levels of stress. In our study, 80% students were highly stressed.
Limitations and future scope
This study was conducted in only one medical college of West Bengal. In future, we have planned to conduct a study in all medical colleges of West Bengal to study the effect of stress on medical students in our population.
| Conclusions | | |
The results of the present study indicated a negative impact of stress on health and education among first MBBS students. Perceived stress was negatively correlated to health and education and coping skills like sports, yoga needs to be implemented to ameliorate stress.
Acknowledgement
We here by acknowledge the West Bengal university of health sciences for encouraging us to conduct the study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Al-Lamki L. Stress in the Medical Profession and its roots in Medical School. Sultan Qaboos Univ Med J 2010;10:156-9.  |
| 2. | Mannapur B, Dorle AS, Hiremath LD, Ghattargi CH, Ramadurg U, Kulkarni KR. A study of psycological stress in undergraduate medical students at S. N. Medical College, Bagalkot, Karnataka. J Clin Diagn Res 2010;4:2869-74. |
| 3. | Khuwaja AK, Qureshi R, Andrades M, Fatmi Z, Khuwaja NK. Comparison of job satisfaction and stress among male and female doctors in teaching hospitals of Karachi. J Ayub Med Coll Abbottabad 2004;16:23-7. |
| 4. | Sharma VK, Trakroo M, Subramaniam V, Rajajeyakumar M, Bhavanani AB, Sahai A. Effect of fast and slow pranayama on perceived stress and cardiovascular parameters in young health-care students. Int J Yoga 2013;6:104-10. [ PUBMED]  |
| 5. | Kane PP. Stress causing psychosomatic illness among nurses. Indian J Occup Environ Med 2009;13:28-32. [ PUBMED] |
| 6. | Varvogli L, Darviri C. Stress management techniques: Evidence-based procedures that reduce stress and promote health. Health Sci J 2011;5:74-89. |
| 7. | Singh G, Kaur D, Kaur H. Presumptive stressful life events scale (psles) – A new stressful life events scale for use in India. Indian J Psychiatry 1984;26:107-14. [ PUBMED] |
| 8. | Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96. [ PUBMED] |
| 9. | WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne: Health Communications Australia; 2000. |
| 10. | Park K. Health information and basic medical statistics. In: Park's Textbook of Preventive and Social Medicine. 20 th ed. Jabalpur, India: Bhanot; 2009. p. 742-56. |
| 11. | Chaudhuri A, Borade NG, Saha S. Relationship of gender and lipid profile with cardiac parasympathetic reactivity. J Basic Clin Reprod Sci 2012;1:30-3. |
| 12. | Chaudhuri A, Ray M, Saldanha D, Bandopadhyay AK. Cardio-respiratory response of young adult Indian male subjects to stress: Effects of progressive muscle relaxation. Med J DY Patil Univ 2014;7:304-8. |
| 13. | Chaudhuri A, Ray M, Saldanha D, Bandopadhyay A. Effect of progressive muscle relaxation in female health care professionals. Ann Med Health Sci Res 2014;4:791-5. [ PUBMED] |
| 14. | Salam A, Mahadevan R, Abdul Rahman A, Abdullah N, Abd Harith AA, Shan CP. Stress among first and third year medical students at University Kebangsaan Malaysia. Pak J Med Sci 2015;31:169-73. |
| 15. | Salam A, Rabeya Y, Muhammad AB, Mainul H. Stress among medical students in Malaysia: A systematic review of literatures. Int Med J 2013;20:649-55. |
| 16. | Habeeb KA. Prevalence of stressors among female medical students Taibah University. J Taibah Univ Med Sci 2010;5:110-9. |
| 17. | Johari AB, Hassim IN. Stress and coping strategies among medical students in National University of Malaysia, Malaysia University of Sabah and University Kuala Lumpur Royal College of Medicine Perak. J Community Health 2009;15:106-15. |
| 18. | El-Gilany AH, Amr M, Hammad S. Perceived stress among male medical students in Egypt and Saudi Arabia: effect of sociodemographic factors. Ann Saudi Med 2008;28:442-8. [ PUBMED] |
| 19. | Samara A, Nistrup A, Al-Rammah TY, Aro AR. Lack of facilities rather than sociocultural factors as the primary barrier to physical activity among female Saudi university students. Int J Womens Health 2015;7:279-86. |
| 20. | Abdulghani HM, AlKanhal AA, Mahmoud ES, Ponnamperuma GG, Alfaris EA. Stress and its effects on medical students: a cross-sectional study at a college of medicine in Saudi Arabia. J Health Popul Nutr 2011;29:516-22. |
| 21. | Banerjee S, Chaudhuri A, Roy PS, Sarkar SK. Effect of exercise on undergraduate health care students. Saudi J Sports Med 2015;15:51-5. |
| 22. | Gupta R, Chaudhuri A, Bansod N. A study of physical fitness of trained individuals of an urban population in Pune. Saudi J Sports Med 2014;14:103-8. |
| 23. | Abdel Rahman AG, Al Hashim BN, Al Hiji NK, Al-Abbad Z. Stress among medical Saudi students at College of Medicine, King Faisal University. J Prev Med Hyg 2013;54:195-9. [ PUBMED] |
[Table 1], [Table 2]
|
Search Pubmed for