Level of stress in Final year MBBS students at Rural Medical College: A Cross-sectional Study.
- Shelke Umesh S1, Kunkulol Rahul R2, Narwane Sandeep P3
Introduction: Stress, defined as an imbalance between environmental conditions necessary for survival and the ability of individuals to adapt to those conditions, has a high prevalence in MBBS students. A variety of stressors play a significant role in developing stress. Objective: To study the level of stress and stressors responsible in Final MBBS students of Rural Medical College, Loni. Methods: A descriptive cross sectional study was carried out in 100 students (50 of either sex) willing to participate in the study. They were subjected to fill the Medical Student Stressor Questionnaire, which consists of 40 questions for evaluating the stressors and severity of stress perceived by the subjects. Results: 71% subjects’ perceived moderate stress, while 13% and 16% perceived high and mild stress respectively. Academic stressor counted for moderate stress in 63% and high stress in 24 % of subjects, which was higher than other stressors. Conclusion: Academic stressors being the major stressor perceived,Strategies are required to decrease the burden of academic stress in the students.
Stress is defined as an imbalance between environmental conditions necessary for survival and the ability of individuals to adapt to those conditions1.Studies have revealed a high prevalence of stress in medical students, ranging from 30% to 50%2-7. Learning a lot of new information in relatively short time, with pressure of exams,cause development of stress in medical students 8. A stressor is defined as a personal or environmental event that causes stress9, 10.
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Stressors of medical students can be grouped into academic related, intrapersonal and interpersonal related, teaching and learning-related, social related, drive and desire related and group activities related stressors3. One or more of such stressors might act at the same time and contribute in development of stress among students.
Excessive amount of stress in medical training predisposes students to have difficulties in solving interpersonal conflicts,sleeping disorder, decreased attention, reduced concentration, temptation to cheat on exams, depression, loss of objectivity, increased incidence of errors, and improper behavior, such as negligence. Stress may also manifest in the form of headaches, gastrointestinal disorders, coronary heart disease, impaired judgments, absenteeism, self-medication, suicidal ideation, depression and the consumption of drugs and alcohol11,12.
A few studies in India have studied the prevalence of stress and stressors responsible in medical students. The present study (references from folder Indian references) was planned to study of stress in last year medical students at Rural Medical College.
A descriptive cross sectional study was conducted with a study population of 100 medical students (50 of either sex) in III MBBS from Rural Medical College, Loni, Ahmednagar. Duration of the study conducted form 1stFebruary 2014 to 1st March 2014.
IEC approval was taken before the commencement of study.
Students who were ready to give consent were enrolled in the study and inclusion and exclusion criteria were applied. III MBBS students of either sex consenting to participate were included in the study. Students not ready to participate or of other year were excluded from the study.
The participants were subjected toMedical Student Stressor Questionnaire (MSSQ)3
The MSSQ consists of 40 items representing the six stressor domains.Each item were answered in the form of score as
The 40 items were divide into sections A(20 items) and B(20 items) respectively. Total score of A and B of each domain were divided by following value and results were interpreted.
1. Academic related stressors (ARS) =13
2. Intrapersonal and interpersonal related stressors (IRS) =7
3. Teaching and learning-related stressors (TLRS) =7
4. Social related stressors (SRS) =6
5. Drive and desire related stressors (DRS) =3
6. Group activities related stressors (GARS) =4
0.00-1.00 causes mild stress
1.01-2-00 causes moderate stress
2.01-3.00 causes high stress.
3.01-4.00 causes Severe stress.
The mild type of stress means it does not cause any or mild stress. The moderate type indicated that it caused reasonable but manageable stress. The high type of stress indicated lot of stress and causes emotional disturbances and mildly compromises daily activities. The severe stress indicates severe emotional disturbances and compromise of daily activities.
Statistical Analysis: Data were analyzed by Chi- square test.
Moderate type of stress due to academic related stressors was commonly seen in final year MBBS students in both genders. 33% females and 30% malesshowed Moderate type of stress. 15% femalesshowed high type of stress as compared to 9% in males.Severe type of stress was seen in one male. 80% of males and 96% of females suffered from moderate, high or severe type of stress due to academic related stressors. (Table 1)
Table: 1Distribution between Academic related stressors (ARS) and Gender
|Sr. No.||Type of Stress Caused due to ARS||Males||Females||Total|
Value of χ² =7.976, d.f. = 3, significant, p<0.05
By applying g Chi-square test there is a significant association between ARS and gender (p<0.05)
Table: 2 Distribution between Intrapersonal and interpersonal related stressors (IRS)
|Sr. No.||Type of Stress Caused due to IRS||Number of Males
|Number Of Females||Total|
Table 2 showsfrequency of stress due to IRS. Moderate type of stress due to intrapersonal and interpersonal related stressors in final year MBBS students was high in both gender. 29% females and 25% males showed moderate type of stress. 10% malesand 8% femalesshowedhigh type of stress due to intrapersonal and interpersonal related stressors. 70% of males and 74% of females suffered from moderate to high type of stress in this category.
Table: 3 Distribution between Teaching and learning-related stressors (TLRS) and Gender.
|Sr. No.||Type of Stress Caused due to TLRS||Number of Males||Number Of Females||Total|
Value of χ² =3.226, d.f.=2, significant, p<0.05
By applying g Chi-square test there is a significant association between Teaching and learning-related stressors (TLRS) and sex (p<0.05)
Table 3 showed more number of moderate type of stress due to teaching and learning-related stressors (TLRS) in final year MBBS students in both gender. 30% females and 29% malesshowed moderate type of stress. 17% males showed mild type of stress and 9% femalesshowed high type of stress due to teaching and learning-related stressors (TLRS). 66% of males and 78% of females suffered from moderate to high type of stress.
Table: 4 Distribution between Social related stressors (SRS) and Gender
|Sr. No.||Type of Stress Caused due to SRS||Number of Males||Number Of Females||Total|
Table 4 displays more moderate type of stress due to social related stressors (SRS) in final year MBBS students in both genders. 28% females and 26% males showed moderate type of stress. 20% malesshowed mild type of stress and 8% femalesshowed high type of stress due to social related stressors (SRS). 60% of males and 80% of females showed moderate to high type of stress.
Table: 5Association between Drive and desire related stressors (DRS) and Gender
|Sr. No.||Type of Stress Caused due to DRS||Number of Males||Number Of Females||Total|
Value of χ² =3.648, d.f.=3, significant, p<0.05
By applying g Chi-square test there is a significant association between Drive and desire related stressors (DRS) and sex (p<0.05)
Table 5 shows more subjects showing mild type of stress due to drive and desire related stressors (DRS) in final year MBBS students in both genders. 31 % males and 24% femalesshowed moderate type of stress. 19% femalesshowed mild type of stress, 5% femalesshowed high type of stress and 2% femalesshowedsevere type of stress due to drive and desire related stressors (DRS). 38% of males and 52% of females showed moderate to severe type of stress.
Table: 6Association between Group activities related stressors (GARS) and Gender
|Sr. No.||Type of Stress Caused due to GARS||Number of Males||Number Of Females||Total|
Table 6 showed more moderate type of stress due to group activities related stressors (GARS) in final year MBBS students in both gender. 22 % males and 23% femalesshowed moderate type of stress. 21% malesshowed mild type of stress, 8% femalesshowed high type of stress and 1% males&femalesshowedSevere type of stress due to group activities related stressors (GARS).
Table 7 Stressors according to rank of mean degree of stress perceived by medical students. Test and examinations was the only item that caused moderate to high stress among students. All other items fell under the category of mild to moderate stress except working with computers and talking to patients about personal problems.
Table 7. Stressors according to rank of mean degree of stress perceived by medical students (by MSSQ)
|S. No.||Item||Mean||Standard deviation|
|Causing moderate to high stress|
|Causing mild to moderate stress|
|Getting poor marks||1.96||1.26|
|Large amount of content to be learnt||1.9||1.13|
|Not enough medical skill practice||1.88||1.16|
|Facing illness or death of the patients||1.88||1.30|
|Need to do well (self-expectation)||1.85||1.18|
|Lack of time to review what have been learnt||1.84||1.08|
|Unjustified grading process||1.81||1.18|
|Quota system in examinations||1.78||1.29|
|Need to do well (imposed by others)||1.71||1.17|
|Uncertainty of what is expected of me||1.69||1.19|
|Frequent interruption of my work by others||1.68||1.09|
|Conflict with teacher(s)||1.66||1.04|
|Lack of recognition for work done||1.64||0.99|
|Verbal or physical abuse by teacher(s)||1.63||1.20|
|Unable to answer questions from patients||1.59||1.17|
|Conflict with personnel(s)||1.57||1.24|
|Learning context – full of competition||1.48||1.11|
|Verbal or physical abuse by personnel(s)||1.47||1.18|
|Teacher – lack of teaching skills||1.46||1.29|
|Poor motivation to leam||1.43||1.16|
|Verbal or physical abuse by other student(s)||1.41||1.23|
|Not enough feedback from teacher (s)||1.41||0.96|
|Lack of time for family and friends||1.4||1.01|
|Participation in class presentation||1.39||1.18|
|Unable to answer the questions from the teachers||1.36||0.97|
|Having difficulty understanding the content||1.33||0.92|
|Feeling of incompetence||1.33||1.08|
|Falling behind ill reading schedule||1.31||1.10|
|Conflicts with other students||1.25||0.99|
|Participation in class discussion||1.16||1.14|
|Lack of guidance from teacher (s)||1.14||1.05|
|Not enough study material||1.13||1.12|
|Unwillingness to study medicine||1.02||1.04|
|Parental wish for you to study medicine||1.01||1.22|
|Causing nil to mild stress|
|Working with computers||0.94||1.07|
|Talking to patients about personal problems’||0.71||0.94|
Degree of stress classification: 0 – 1.00 is ‘causing nil to mild stress’, 1.01 – 2.00 is ‘causing mild to moderate
stress’, 2.01 – 3.00 is ‘causing moderate to high stress’ and 3.01 – 4.00 is ‘causing high to severe stress’
MSSQ having a high score in a particular stressor group generally indicates that the subjects perceive events, conditions or situations from that particular group as causing the subjects stress. The scores, however, do require frank and honest response in order for it to be of any use. The scores are also affected by factors which can falsely increase or lower the scores, but generally the validity and reliability studies have indicated that the scores from the questionnaire are highly trustworthy.8
Personal and environmental events that cause stress are known as stressors9,10. Stressors of medical students are grouped into six categories.
Academic related stressors refer to any event related to the academics of the students.Interpersonal and intrapersonal related stressors refer to any form of relationships between and within individuals that cause stress. Teaching and learning related stressors refer to any events related to teaching or learning that causes stress. Social related stressors refer to any form of community and societal relationships that cause stress. Drive and desire related stressors refer to any form of internal or external forces that influence one’s attitude, emotion, thought and behavior which subsequently cause stress.Group activities related stressors refer to any group events and interactions that cause stress13.
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In present study moderate type of stress caused due all the 6 stressors was commonly seen in both genders of final year MBBS students. Statistically significant difference was seen in males and females with respect to academic related, teaching related and drive and desire related stressors. This difference was also noted in a study by Waghachavare et.al.14
Our study showed 58% of males and 64% of females perceiving moderate to high type of stress. This was high as compared to studies conducted in Malaysia which were 29.1 % to 41.9% in government institutes2,5,6 and 46.2% in a private school6, as measured by GHQ-12.In a study on medical student conducted in GS medical college, it was observed that 73% of students perceived stress15. Zung’sself rating scale for depression was used for the study. In the study by Waghachavareet.al.14,which used DASS-21 and GAD scales, stress was perceived by 34 % of medical students. There was a significant difference between males and females perceiving stress.
The academic related stressor had 63% of population in the moderate type of stress, while it became 88% when moderate to severe type of stress added together. Academic related stressor was followed by intra and interpersonal related, teaching and learning related, social related, group related and drive and desire related stressors. The academic factor was higher stressor as compared to physical, emotional and social factors in the study conducted in GS medical college.
Studies have revealed that the stressors affecting medical students’ well-being seem to be related to the medical training, especially academic matters3, 6, 14-19.
On ranking the items depending upon the mean level of stress that the students perceived, it was found that the stress related to the academics was highest (Table 7). This finding supports the findings of the study done by Yusoff et al.2
To conclude, the study showed high prevalence of stress among students with respect to different stressors. Academic stressors have significant association with stress among students. Females show more stress as compared to males. Strategies are required to decrease the burden of academic stress in the students.
Final MBBS students (Batch 2011 and 2012) and Mr. Hemant Pawar (Statistician), Department of Pharmacology &Research cell, Rural Medical College (PIMS- DU), Loni.
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