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      Resilience, stress, and coping among Canadian medical students

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          Abstract

          Background

          Numerous studies have established that medical school is a stressful place but coping styles and resilience have not been adequately addressed as protective factors.

          Method

          Using a cross-sectional design, 155 students were surveyed using the Connor-Davidson Resilience Scale, Perceived Stress Scale, and the Canadian Community Health Survey Coping Scale. Mean scores were compared by gender and between our sample and normative scores using t-tests. Multivariate linear regression was performed to examine whether stress levels were related to coping and resilience.

          Results

          Medical students had higher perceived stress, negative coping, and lower resilience than age and gender-matched peers in the general population. Male medical students had higher positive coping scores than general population peers and higher resilience, and lower perceived stress than female medical students. Coping scores did not vary by gender in our sample. The multivariate model showed that resilience and negative, but not positive coping, predicted stress.

          Conclusions

          Medical students are neither more resilient nor better equipped with coping skills than peers in the population. Greater emphasis on self-care among medical trainees is recommended. Emphasizing the importance of self-care during medical training, whether by formal incorporation into the curriculum or informal mentorship, deserves further study.

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          Most cited references31

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          Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

          Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.
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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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              A methodological review of resilience measurement scales

              Background The evaluation of interventions and policies designed to promote resilience, and research to understand the determinants and associations, require reliable and valid measures to ensure data quality. This paper systematically reviews the psychometric rigour of resilience measurement scales developed for use in general and clinical populations. Methods Eight electronic abstract databases and the internet were searched and reference lists of all identified papers were hand searched. The focus was to identify peer reviewed journal articles where resilience was a key focus and/or is assessed. Two authors independently extracted data and performed a quality assessment of the scale psychometric properties. Results Nineteen resilience measures were reviewed; four of these were refinements of the original measure. All the measures had some missing information regarding the psychometric properties. Overall, the Connor-Davidson Resilience Scale, the Resilience Scale for Adults and the Brief Resilience Scale received the best psychometric ratings. The conceptual and theoretical adequacy of a number of the scales was questionable. Conclusion We found no current 'gold standard' amongst 15 measures of resilience. A number of the scales are in the early stages of development, and all require further validation work. Given increasing interest in resilience from major international funders, key policy makers and practice, researchers are urged to report relevant validation statistics when using the measures.
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                Author and article information

                Journal
                Can Med Educ J
                Can Med Educ J
                Canadian Medical Education Journal
                University of Saskatchewan
                1923-1202
                2014
                17 December 2014
                : 5
                : 1
                : e5-e12
                Affiliations
                [1 ]Department of Internal Medicine, University of Alberta
                [2 ]Department of Psychiatry, University of Saskatchewan
                Author notes
                Correspondence: Marilyn Baetz, MD, FRCPC, Room 117 Ellis Hall, Royal University Hospital, Saskatoon, SK, Canada, S7N 0W8; Telephone: 306-844-1310; Facsimile: 306-844-1533; Email: M.Baetz@ 123456usask.ca
                Article
                cmej0505
                10.36834/cmej.36689
                4563614
                26451221
                bc30e4fd-f1d8-4501-8696-dd955083b66b
                © 2014 Rahimi, Baetz, Bowen, Balbuena; licensee Synergies Partners

                This is an Open Journal Systems article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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