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      In their own words: stressors facing medical students in the millennial generation

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          ABSTRACT

          Background: Medical student exposure to stressors is associated with depression, burnout, somatic distress, decreases in empathy, serious thoughts about dropping out of medical school, suicidal ideation, and poor academic performance. Despite this, there have been no recent, multicenter, qualitative studies assessing medical students’ perceptions of their greatest stressor(s). Objective: The goal of this study was to identify the most significant stressors noted by medical students themselves, in order to inform the development of programs and policies to reduce medical student distress. Design: Medical students from the nine schools in the state of Florida were invited to complete an anonymous online questionnaire assessing wellness and distress. Students were notified that all responses were voluntary and that individual responses would not be linked to themselves or their program. This paper focuses on students’ responses to fixed-response items regarding their experience of stress and open-ended responses to the following question: ‘What do you consider to be the greatest stressor(s) facing medical students?’ Qualitative data were analyzed using the Grounded Theory method of data analysis. Results: Results confirmed the impact of several stressors highlighted in previous studies (e.g., excessive workload, difficulties with studying and time management, conflicts in work–life balance and relationships, medical school peer relations, health concerns, and financial stressors). However, students also reported unique system-level concerns that have not consistently been highlighted in past research (e.g., medical school administrative failures, concerns about lack of assistance with career planning, and assessment-related performance pressure. Conclusions: Though individually focused interventions have demonstrated some success, medical students self-report stressors that may be better addressed through system-level changes.

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          Most cited references30

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          Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

          To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Medline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Searches used combinations of the Medical Subject Heading terms medical student and depression, depressive disorder major, depressive disorder, professional burnout, mental health, depersonalization, distress, anxiety, or emotional exhaustion. Reference lists of retrieved articles were inspected to identify relevant additional articles. Demographic information, instruments used, prevalence data on student distress, and statistically significant associations were abstracted. The search identified 40 articles on medical student psychological distress (i.e., depression, anxiety, burnout, and related mental health problems) that met the authors' criteria. No studies of burnout among medical students were identified. The studies suggest a high prevalence of depression and anxiety among medical students, with levels of overall psychological distress consistently higher than in the general population and age-matched peers by the later years of training. Overall, the studies suggest psychological distress may be higher among female students. Limited data were available regarding the causes of student distress and its impact on academic performance, dropout rates, and professional development. Medical school is a time of significant psychological distress for physicians-in-training. Currently available information is insufficient to draw firm conclusions on the causes and consequences of student distress. Large, prospective, multicenter studies are needed to identify personal and training-related features that influence depression, anxiety, and burnout among students and explore relationships between distress and competency.
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            Personal life events and medical student burnout: a multicenter study.

            Burnout, a marker of professional distress prevalent among residents and physicians, has been speculated to originate in medical school. Little is known about burnout in medical students. The authors sought to identify the prevalence of burnout, variation of its prevalence during medical school, and the impact of personal life events on burnout and other types of student distress. All medical students (n = 1,098) attending the three medical schools in Minnesota were surveyed in spring 2004 using validated instruments to assess burnout, quality of life, depression, and alcohol use. Students were also asked about the prevalence of positive and negative personal life events in the previous 12 months. A total of 545 medical students (response rate 50%) completed the survey. Burnout was present in 239 (45%) of medical students. While the frequency of a positive depression screen and at-risk alcohol use decreased among more senior students, the frequency of burnout increased (all p < .03). The number of negative personal life events in the last 12 months also correlated with the risk of burnout (p = .0160). Personal life events demonstrated a stronger relationship to burnout than did year in training on multivariate analysis. Burnout appears common among U.S. medical students and may increase by year of schooling. Despite the notion that burnout is primarily linked to work-related stress, personal life events also demonstrated a strong relationship to professional burnout. The authors' findings suggest both personal and curricular factors are related to burnout among medical students. Efforts to decrease burnout must address both of these elements.
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              Medical Student Mental Health 3.0: Improving Student Wellness Through Curricular Changes

              Medical education can have significant negative effects on the well-being of medical students. To date, efforts to improve student mental health have focused largely on improving access to mental health providers, reducing the stigma and other barriers to mental health treatment, and implementing ancillary wellness programs. Still, new and innovative models that build on these efforts by directly addressing the root causes of stress that lie within the curriculum itself are needed to properly promote student wellness. In this article, the authors present a new paradigm for improving medical student mental health, by describing an integrated, multifaceted, preclinical curricular change program implemented through the Office of Curricular Affairs at the Saint Louis University School of Medicine starting in the 2009–2010 academic year. The authors found that significant but efficient changes to course content, contact hours, scheduling, grading, electives, learning communities, and required resilience/mindfulness experiences were associated with significantly lower levels of depression symptoms, anxiety symptoms, and stress, and significantly higher levels of community cohesion, in medical students who participated in the expanded wellness program compared with those who preceded its implementation. The authors discuss the utility and relevance of such curricular changes as an overlooked component of change models for improving medical student mental health.
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                Author and article information

                Journal
                Med Educ Online
                Med Educ Online
                ZMEO
                zmeo20
                Medical Education Online
                Taylor & Francis
                1087-2981
                2018
                05 October 2018
                : 23
                : 1
                : 1530558
                Affiliations
                Department of Psychiatry, University of Florida College of Medicine , Gainesville, FL, USA
                Author notes
                CONTACT Lisa J. Merlo lmerlo@ 123456ufl.edu McKnight Brain Institute ,Gainesville, FL 32610

                Supplemental material for this article can be accesed here .

                Article
                1530558
                10.1080/10872981.2018.1530558
                6179084
                30286698
                41a0b4b2-080f-4f07-88fb-4177667f5a73
                © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 January 2018
                : 05 September 2018
                : 21 September 2018
                Page count
                Tables: 3, References: 41, Pages: 11
                Funding
                Funded by: Professionals Resource Network
                This work was supported by the Professionals Resource Network, Inc., an integral arm of the Florida Medical Association.
                Categories
                Research Article

                Education
                medical education,wellness,stressors,medical school,qualitative research
                Education
                medical education, wellness, stressors, medical school, qualitative research

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