Muhamad Saiful Bahri Yusoff

Prevalence and associated factors of stress, anxiety and depression among prospective medical students

Many studies have reported that the prevalence of psychological distress among medical students during medical training was high. However, there are very few studies exploring on the psychological health of prospective medical students. This study aimed to determine the prevalence and associated factors for stress, anxiety and depression symptoms among the prospective medical students. A cross-sectional study was done on two cohorts of applicants to a public medical school. A total of 839 applicants were invited to participate in the study. The 21-item Depression Anxiety Stress Scale was administered to the applicants after they completed interviews. A total of 743 (92.2%) applicants took part in the study. The prevalence of moderate to extremely severe level of stress, anxiety and depression were 3.6%, 54.5% and 1.9%, respectively. Stress was significantly associated with extra-curricular activity (p<0.001) and race (p<0.001). Anxiety was associated with extra-curricular activity (p<0.001), race (p<0.001), mother education level (p=0.002) and CGPA group (p=0.034). Depression was associated with academic performance in class (p<0.001) and race (p=0.004). Prevalence of stress and depression among entering medical students was low; however prevalence of anxiety was high which could be due to worry about the interviews to enter medical course. The associated factors of psychological distress among prospective medical students were related to academic, non-academic, parent education and cultural backgrounds.

The impact of medical education on psychological health of students: a cohort study.

Many studies have shown that the prevalence of psychological distress among medical students during medical training is higher than that in general population. A few studies have shown that the prevalence of psychological distress among medical students before the onset of medical training was similar to general population. This study aimed to investigate psychological health of medical students before and during medical training. A one-year prospective study was done on successful applicants who undergo the first year of medical training for 2010/2011 academic session. The stress, anxiety and depression were measured by the DASS-21 at five intervals; during interview (Time 0), two months (Time 1), four months (Time 2), six months (Time 3) and final examination (Time 4) of the first year medical training. The prevalence of unfavourable stress, anxiety and depression before the onset of medical training was 4.1%, 55.6% and 1.8%, respectively. The prevalence of unfavourable stress during medical training ranged between 11.8% and 19.9%. The prevalence of anxiety during medical training ranged between 41.1% and 56.7%. The prevalence of depression during medical training ranged between 12% and 30%. Mean scores of stress and depression before (Time 0) and during medical training (Time 1–4) were significantly different (p < 0.001). The prevalence and level of unfavourable stress and depression during medical training were significantly higher than before the onset medical training. This study supports views that medical training is not an optimal environment to psychological health of medical students.

A longitudinal study of relationships between previous academic achievement, emotional intelligence and personality traits with psychological health of medical students during stressful periods.

CONTEXT There is considerable evidence that emotional intelligence, previous academic achievement (i.e. cumulative grade point average (GPA)) and personality are associated with success in various occupational settings. This study evaluated the relationships of these variables with psychological health of first year medical students during stressful periods. METHODS A 1-year prospective study was done with students accepted into the School of Medical Sciences, Universiti Sains Malaysia. Information on emotional intelligence, GPA and personality traits were obtained prior to admission. The validated Universiti Sains Malaysia Emotional Quotient Inventory and Universiti Sains Malaysia Personality Inventory were used to measure emotional intelligence and personality traits, respectively. Stress, anxiety and depression were measured by the 21-item Depression Anxiety Stress Scale during the end-of-course (time 1) and final (time 2) examinations. RESULTS At the less stressful period (time 1), stress level was associated with agreeableness and the final GPA, anxiety level was associated with emotional control and emotional conscientiousness and depression level was associated with the final GPA and extraversion. At the more stressful period (time 2), neuroticism associated with stress level, anxiety level was associated with neuroticism and emotional expression, and depression level was associated with neuroticism. CONCLUSIONS This study found that neuroticism was the strongest associated factor of psychological health of medical students during their most stressful testing period. Various personality traits, emotional intelligence and previous academic performance were associated factors of psychological health during a less stressful period. These data suggest that early identification of medical students who are vulnerable to the stressful environment of medical schools might help them maintain psychological well-being during medical training.

Stress Management for Medical Students: A Systematic Review

Tertiary education has always been regarded as highly stressful environment to students (Saipanish, 2003; Sherina et. al, 2003). Medical training further adds to the already stressful environment. Studies have revealed a high prevalence of psychological distress in medical students, ranging from 21.6% to 56% (Aktekin et al., 2001; Chandrasekhar et al., 2007; Dahlin et al., 2005; Firth, 1986; Guthrie et al., 1995; Miller & Surtees, 1991; Johari & Hashim, 2009; Saipanish, 2003; Sherina et al., 2003; Yusoff et al., 2011; Yusoff et al., 2010; Zaid et. al, 2007). Two studies in Malaysian government universities reported that 29.1 % to 41.9% of the medical students surveyed had psychological distress (Sherina et al., 2003; Yusoff et al., 2010) and another study in a Malaysian private medical school reported that 46.2% had psychological distress (Zaid et al, 2007). Apart from that, the stress level is higher in medical students compared to students in other courses. A study in Singapore reported that 57% of medical students had psychological distress compared to 47.3% of law students (Ko et al., 1999). Another study in Turkey reported that 47.9% of medical students had psychological distress compared to 29.2% of economic and physical education students as measured by GHQ (Aktekin et al., 2001). The alarming facts suggested that a sense of growing pressure on medical students.

Associations of Pass-Fail Outcomes with Psychological Health of First-Year Medical Students in a Malaysian Medical School

OBJECTIVES The demanding and intense environment of medical training can create excessive pressures on medical students that eventually lead to unfavorable consequences, either at a personal or professional level. These consequences can include poor academic performance and impaired cognitive ability. This study was designed to explore associations between pass-fail outcome and psychological health parameters (i.e. stress, anxiety, and depression symptoms). METHODS A cross-sectional study was conducted on a cohort of first-year medical students in a Malaysian medical school. The depression anxiety stress scale 21-item assessment (DASS-21) was administered to them right after the final paper of the first-year final examination. Their final examination outcomes (i.e. pass or fail) were traced by using their student identity code (ID) through the Universiti Sains Malaysia academic office. RESULTS A total of 194 (98.0%) of medical students responded to the DASS-21. An independent t-test showed that students who passed had significantly lower stress, anxiety, and depression symptoms than those who failed the first-year final examination (P <0.05). Those who experienced moderate to high stress were at 2.43 times higher risk for failing the examination than those who experienced normal to mild stress. CONCLUSION Medical students who failed in the final examination had higher psychological distress than those who passed the examination. Those who experienced high stress levels were more likely to fail than those who did not. Reducing the psychological distress of medical students prior to examination may help them to perform better in the examination.

Stability of DREEM in a Sample of Medical Students: A Prospective Study

Background. Over the last 15 year, DREEM was applied in various educational settings to appraise educational climate. So far, none of article reported its stability in Malaysian medical students. Objective. To determine stability of the DREEM to measure educational climate at different time and occasions using a sample of medical students. Methodology. A prospective cohort study was done on 196 first year medical students. It was administered to the medical students at four different intervals. The Cronbachs alpha and intraclass correlation analysis were applied to measure internal consistency and agreement level across the intervals. The analysis was done using SPSS 18. Result. A total of 186 (94.9%) medical students responded completely to the DREEM inventory. The overall Cronbachs alpha value of the DREEM at the four measurements ranged between 0.91 and 0.94. The average Cronbachs alpha values of the five subscales ranged between 0.45 and 0.83. The ICC coefficient values for the DREEM total score was 0.67 and its subscales ranged between 0.51 and 0.62. Conclusion. This study supported satisfactory levels of stability and internal consistency of the DREEM to measure educational climate over multiple observations in a sample of Malaysian medical students. Continued research is required to optimise its psychometric credential across educational settings.

The BigSib students' peer group mentoring programme.

SD 0.5). They reported inadequate time to have learners perform EPs, however (mean 2.1, SD 1.3). Inter-rater reliability on the 20 EPs showed substantial agreement for Searching (j = 0.70) and Application of Evidence (j = 0.72); moderate agreement for Overall Competence (j = 0.57) and Evaluation of Evidence (j = 0.44); and fair agreement for Question Formation (j = 0.22). Residents reported that using the EP improved their EBM skills and allowed them to apply previous EBM teaching. Both teaching staff and residents reported lack of time as a barrier to performing EPs in the inpatient setting and recommended online versions of the forms. The EP is feasible to use during inpatient rotations with modest faculty training. Inter-rater reliability was generally good, but requires further assessment. The EP can be a useful method for determining residents’ EBM competence.

Psychometric properties of the Medical Student Well-Being Index among medical students in a Malaysian medical school

This study evaluated the convergent, discriminant, construct, concurrent and discriminative validity of the Medical Student Wellbeing Index (MSWBI) as well as to evaluate its internal consistency and optimal cut-off total scores to detect at least moderate levels of general psychological distress, stress, anxiety and depression symptoms. A cross sectional study was done on 171 medical students. The MSWBI and DASS-21 were administered and returned immediately upon completion. Confirmatory factor analysis, reliability analysis, ROC analysis and Pearson correlation test were applied to assess psychometric properties of the MSWBI. A total of 168 (98.2%) medical students responded. The goodness of fit indices showed the MSWBI had a good construct (χ(2)=6.14, p=0.803, RMSEA<0.001, RMR=0.004, GFI=0.99, AGFI=0.97, CFI=1.00, IFI=1.02, TLI=1.04). The Cronbachs alpha value was 0.69 indicating an acceptable level of internal consistency. Pearson correlation coefficients and ROC analysis suggested each MSWBIs item showed adequate convergent and discriminant validity. Its optimal cut-off scores to detect at least moderate levels of general psychological distress, stress, anxiety, and depression were 1.5, 2.5, 1.5 and 2.5 respectively with sensitivity and specificity ranged from 62 to 80% and the areas under ROC curve ranged from 0.71 to 0.83. This study showed that the MSWBI had good level of psychometric properties. The MSWBI score more than 2 can be considered as having significant psychological distress. The MSWBI is a valid and reliable screening instrument to assess psychological distress of medical students.

Experiences from a medical students' well-being workshop.

medical schools with groups that were heterogeneous for gender and year of medical school in order to obtain data for the development of the questionnaire. Secondly, we designed the first version of the questionnaire, which incorporated 90 items and used a Likert scale-based response format. Thirdly, we administered the questionnaire to 800 medical students in 75 medical schools in Brazil. Fourthly, using these data, we validated the questionnaire and tested internal consistency, discriminant validity, construct validity and factor analysis. Evaluation of results and impact Cronbach’s a for internal consistency of the questionnaire was 0.78. Cronbach’s a was tested for each item and all items with a £ 0.3 (38 items) were eliminated. Two other items were eliminated after semantic analysis, resulting in a questionnaire with 50 items. The results were analysed according to gender and year of medical course. The data showed significant differences between these groups. Total scores from the questionnaire were compared with self-evaluation scores on QoL and showed a significant positive correlation (r = 0.56, Spearman coefficient). Factor analysis (rotated component matrix) showed the presence of 13 domains in the questionnaire, explaining 56.8% of total variation. Grouping domains by similarity of theme resulted in the identification of five main domains: overall QoL; physical QoL; time management; the learning environment, and psychological QoL. The questionnaire analysis showed that 45.4% of the students were not satisfied with their medical courses. Factors that improve the QoL of medical students were good supervision of practical activities, participation in projects of social development, good classes, good teachers and contact with patients. Lack of free time to study, engage in leisure pursuits, maintain relationships and gain enough rest was considered a major factor in decreasing QoL for medical students. Students in Years 3 and 4 showed the lowest QoL scores in relation to the medical course and for the domains of the questionnaire; these values were lower for females. Students in Years 5 and 6 had better relationships with teachers and regarded the medical course as very competitive. We also made a transcultural translation to English. The questionnaire permits analysis of the QoL of medical students and the factors that generate stress in this group. This understanding can help medical schools design appropriate interventions.

Confirmatory Factor Analysis of the Universiti Sains Malaysia Emotional Quotient Inventory Among Medical Students in Malaysia

The Universiti Sains Malaysia Emotional Quotient Inventory (USMEQ-i) is a Malay-language emotional intelligence (EI) inventory that was based on a mixed-model approach of EI. It was specifically developed and validated for use among medical course applicants. However, evidence to support its use among medical students is inadequate. This study aims to provide further construct validity evidence for the USMEQ-i among medical students through confirmatory factor analysis (CFA). A cross-sectional study was carried out on a sample of 479 medical students in Universiti Sains Malaysia (USM). After a preliminary analysis, data from only 317 respondents were found suitable for inclusion in CFA. CFA was performed using the maximum likelihood estimation method with bootstrapping due to the nonnormality of items at the multivariate level. The results of the analysis support the two-factor model of the EI component and the one-factor model of the faking component. However, the USMEQ-i should be administered with caution until further cross-validation studies are conducted among students in other medical schools in Malaysia.