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      Perceived Stress Among Chinese Medical Students Engaging in Online Learning in Light of COVID-19

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          Abstract

          Purpose

          After a year of the COVID-19 pandemic, countries have repeatedly imposed strict quarantine regimes as the virus mutates and becomes more contagious. Medical undergraduate education has been disrupted and transformed into prolonged home isolation and online learning. Although studies have reported that the COVID-19 pandemic tends to increase perceived stress (PS) and affect the mental health of medical students, the influencing factors are unclear. Therefore, based on the stress process model, this study will comprehensively evaluate the distribution of stressors of medical students and explore the personal and environmental predictors of PS during the epidemic.

          Participants and Methods

          An online survey was conducted among medical students (n=369) from three medical universities in western China who engaged in online learning. A stress process conceptual framework was formed to explore the influencing factors of PS. The survey items contained four sections: (a) the potential stressors derived from academic, psychosocial and health-related demands; coping resources such as (b) online learning environment support and (c) personal resilience, including online learning behavior and individual characteristics; and (d) PS, perception of imbalanced demands and coping resources.

          Results

          The mean PS score was 17.39 (SD=4.58), and over four-fifths (82.3%) of the students had moderate to high levels of stress. The average item scores of academic, psychosocial and health-related stressors were 2.72 (SD=0.55), 2.31 (SD=0.55) and 2.07 (SD=0.50), respectively. Gender, grade, psychosocial stressors, health-related stressors, specific online learning behavior (persistence, attitude and flexibility), and the online learning environment (teaching, social and cognitive presence) were predictors of PS.

          Conclusion

          Our results specify that a reduction in psychological and health-related stressor stimulation, specific online learning behavior promotion, and well-established online learning environment support could be considered essential for alleviating the negative impacts of COVID-19 on the psychosocial health of medical undergraduates.

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          Most cited references67

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          A Global Measure of Perceived Stress

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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.
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              Barriers and solutions to online learning in medical education – an integrative review

              Background The aim of this study is to review the literature on known barriers and solutions that face educators when developing and implementing online learning programs for medical students and postgraduate trainees. Methods An integrative review was conducted over a three-month period by an inter-institutional research team. The search included ScienceDirect, Scopus, BioMedical, PubMed, Medline (EBSCO & Ovid), ERIC, LISA, EBSCO, Google Scholar, ProQuest A&I, ProQuest UK & Ireland, UL Institutional Repository (IR), UCDIR and the All Aboard Report. Search terms included online learning, medical educators, development, barriers, solutions and digital literacy. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed with inclusion/exclusion criteria. A consensus was drawn on which articles were included. Data appraisal was performed using the Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist and NHMRC Appraisal Evidence Matrix. Data extraction was completed using the Cochrane Data Extraction Form and a modified extraction tool. Results Of the 3101 abstracts identified from the search, ten full-text papers met the inclusion criteria. Data extraction was completed on seven papers of high methodological quality and on three lower quality papers. Findings suggest that the key barriers which affect the development and implementation of online learning in medical education include time constraints, poor technical skills, inadequate infrastructure, absence of institutional strategies and support and negative attitudes of all involved. Solutions to these include improved educator skills, incentives and reward for the time involved with development and delivery of online content, improved institutional strategies and support and positive attitude amongst all those involved in the development and delivery of online content. Conclusion This review has identified barriers and solutions amongst medical educators to the implementation of online learning in medical education. Results can be used to inform institutional and educator practice in the development of further online learning. Electronic supplementary material The online version of this article (10.1186/s12909-018-1240-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Psychol Res Behav Manag
                Psychol Res Behav Manag
                prbm
                prbm
                Psychology Research and Behavior Management
                Dove
                1179-1578
                14 May 2021
                2021
                : 14
                : 549-562
                Affiliations
                [1 ]Department of Nursing, The First Affiliated Hospital of Chongqing Medical University , Chongqing, People’s Republic of China
                [2 ]Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University , Chongqing, People’s Republic of China
                [3 ]School of Nursing, Chongqing Medical University , Chongqing, People’s Republic of China
                [4 ]Department of Nursing, Stomatological Hospital of Chongqing Medical University , Chongqing, China
                Author notes
                Correspondence: Bing Yang Department of Nursing, Stomatological Hospital of Chongqing Medical University , 462 Songshi North Road, Yubei District, Chongqing, People’s Republic of ChinaTel +86-13228649430Fax +86-23-89012766 Email yangb@hospital.cqmu.edu.cn
                [*]

                These authors contributed equally to this work

                Author information
                http://orcid.org/0000-0002-7518-7135
                http://orcid.org/0000-0001-5535-2327
                Article
                308497
                10.2147/PRBM.S308497
                8131094
                34017205
                e3d1005b-7026-4029-beb1-c1799f5b56ca
                © 2021 Wang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 02 March 2021
                : 14 April 2021
                Page count
                Figures: 3, Tables: 4, References: 69, Pages: 14
                Funding
                Funded by: the Chongqing Education Science Planning Project;
                Funded by: the Education Research Project of Chongqing Medical University;
                This study was funded by the Chongqing Education Science Planning Project(2016-GX-036) and the Education Research Project of Chongqing Medical University (JY180328).
                Categories
                Original Research

                Clinical Psychology & Psychiatry
                perceived stress,stressor,learning behavior,learning environment,covid-19

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