41Journal of Medical Education Winter Spring 2008 Vol.11, No.1 2 [614146]

41Journal of Medical Education Winter & Spring 2008 Vol.11, No.1 & 2
Corresponding author: Dr Ameneh Barikani is an
assistant professor of social medicine in Qazvin university
of medical sciences and Health services.
Phone :+ 989124251600 – 02813336001E-mail: [anonimizat] in Medical Students
Barikani A, MD, MPH
Assistant professor of social medicine Department of Qazvin university
Introduction
Beginning a university program involves many
changes in a high school student’s life whichcan be stressful
(1). Living away from home,
making the transition to a more independent lesssupported condition, and copying with the studydemands of the program can be difficult foryoung people. Medical school may be particularlystressful as students come into close contactstressful as students come into close contact with
serious illnesses and deaths (2).Studies which have tried to identify the sourcesof stress among medical students generallypointed to three main areas: academic pressures,social issues and financial problems (2).The majority of stressful incidents in traditionalcurricula are related to medical training ratherthan to personal problems (3,4). Workload andfeeling overwhelmed by the information load thatshould be mastered are major sources of stress.Fears of failing or falling behind are particularpreoccupations. Other significant academicsources of stress include disillusionment withBackground and purpose: Beginning medicine for the first time as a academic program is a very
stressful for medical students. This study is an attempt to determine stress in medical students ofQazvin University of Medical Sciences and Health Services.Methods: A survey of randomly selected medical students of all years in Quazvin medical university
were conducted based on a questionnaire including demographic data and items examining possiblesources of anxiety based on our experience with medical students and a scale to measure the anxietyexperienced by the students as well as an item asking students how satisfied they are with studyingmedicine were given to all subjects. On the questionnaire space were provided for respondent toexpress their comments on each factor they identify as source of stress. To measure the anxiety thestudents were asked to mark the level of anxiety they experienced on a six point scale. Analyses ofdata was conducted with SPSS version 12. Relation between variables was assessed with chi-squaretest with a significance level of <0.05.Results: Of the 200 students who received questionnaires 155 completed and returned them ( response
rate = 77.7%). Of all respondent , 123 (79.4%) were female, 140 (90.3%) were unmarried. Nearlyhalf the students (45%) experienced intermediate or higher levels of stress. More frequently expressedfactors leading to stress were “ initial adaptation to the program” (84.5%) ,apprehension of exam(41.3%) and economic issues(32.4%).Conclusion: Our findings suggests that many stressors are present in the path to become a doctor. A
more detailed investigation of these factor throughout universities of medicine and based on thatintroducing procedures centrally and university-based will undoubtedly help tackle many of theseproblems.Key words: S
TRESS FACTORS , M EDICAL STUDENT: [anonimizat] 2007; 11 (1,2): 41-44

42medicine and realities of medical school (4).
Perception of hurdle jumping (3), relationshipswith teachers (5,6)and dealing with death andsuffering (5). Social issues which can causestress include the effects of being a medicalstudent on personal life in particular managingleisure activities and social relationships (5,6).The factors causing stress vary with the timespent in medical training, concern aboutworkload, performance and perceived personalcompetence which seems particularlypronounced in the first year (4,6). In studies ofmedical students in later years factors inherentin medical training such as dealing with patients,disease and death, relationships with consultantsand effects on personal life are important (5).Several studies investigated causes of stressand psychological morbidity in medical students.Depression and anxiety are associated withconcerns about mastering knowledge, personalendurance and ability and lack of time for otheractivities (2,3).Anxiety is also associated withfeeling of loneliness , peer competition, long hoursand loss of social time (2,6).
In the UK, the General Medical Council
recommends that medical schools should havemechanisms in place to identify symptoms ofstress that might be early signs of mental illness(2). Medical schools in the USA and Canadatackle the problem at an earlier stage byundertaking prevention in the form of healthpromotion programs. These have been shownto reduce the effects of stress on medicalstudents health and academic performance (7).Given the importance of stress on medicalstudents we undertook this study as an attemptto determine stress in medical students of QazvinUniversity of Medical Sciences and HealthServices; if any problem exists we will use theresult of this study as a first step to develop asolution.
MethodsIn this survey 200 medical students of all years
in Quazvin medical university were randomlyselected. A questionnaire including demographicdata and items examining possible sources ofanxiety based on our experience with medical
students and a scale to measure the anxietyexperienced by the students as well as an itemasking students how satisfied they are withstudying medicine were given to all subjects. Onthe questionnaire space were provided forrespondent to express their comments on eachfactor they identify as source of stress. Thesewere codified and categorized. To measure theanxiety the students were asked to mark the levelof anxiety they experienced on a six point scaleranging from without any stress to very severestress.Analyses of data was conducted with SPSSversion 12. Relation between variables wasassessed with chi-square test with a significancelevel of <0.05.
ResultsOf the 200 students who received questionnaires
155 completed and returned them ( responserate = 77.7%). Of all respondent , 123 (79.4%)were female, 140 (90.3%) were unmarried.Table1 shows the frequency distribution offactors leading to stress for medical studentsaccording to sex.Table 2 . shows the frequency distribution of
self-expressed stress experienced by medicalstudents by sex. Interestingly self-expressedstress of 11(7.1) of medical students was verysevere and 11(7.1) of them haven’t any stress(table2).Of all respondent 64(41.3%) were not satisfiedwith educational facilities, 28(18.1%) wereunsatisfied with the accommodation services and14(9%) had to work for living and studyexpenses.A majority of students didn’t participate in anyregular sport (34.8%) or exercise less than onehour (34.2%) per week . Of all students, only2(1.2%) were satisfied from behavior of patientsan others had low satisfaction (40.6%) or nosatisfaction (27.2%). Of all respondents only4.5% found the interaction with hospital staffsatisfactory.The majority of students (86.3%) felt that facultymembers did not treat their responsibility to
Stress in Medical Students / Barikani a

43Journal of Medical Education Winter & Spring 2008 Vol.11, No.1 & 2
teaching and students education as
expected.Of all students, 80% were expresseddiscomfort with night shifts and 55% of themsaid that the questions of exams were verydifficult.
DiscussionThis study showed a relatively high prevalence
of stress experienced by both male and femalemedical students. In another study (5) prevalenceof emotional disturbance was 31.2% which wassimilar to that reported from medical students inUnited States.There was no difference inprevalence or in mean scores of stress between
Table1. The frequency distribution of factors leading to stress for medical
students by sex
Table 2. Frequency distribution of self-expressed stress experienced by medical students by sex male and female students similar to that reported
from medical students in United Kingdom (2).Compared with 144(92.9%), only 11 (7.1%)students were completely free of symptoms. Aconsiderable proportion of stressed students hadstress levels that were likely to result indeveloping symptom and psychiatric problemwhich is similar to findings of UK study . Initialadaptation to the program were more stressfulthan other stages of traning. But in Supe studystress was found to be significantly more insecond and third yearlevels (8).Living away fromhome and coping with a new program of studycan be thought as roots of stress in the first yearof program. Later in the program work related
Factors leading to stress Men
(%) Women
(%) Total
(%)
Initial adaptation to the program 30(93.8) 101(82.1) 131(84.5)
Economic issues 10(31.3) 40(32.5) 50(32.3)
Patient's behavior 1(3.1) 12(9.8) 13(8.4)
interaction with ward staff 1(3.1) 12(9.8) 13(8.4)
Hospital Student Services 1(3.1) 13(10.6) 14(9.1)
University teachers 1(3.1) 18(14.6) 19(12.3)
Apprehension of exam 12(37.5) 52(42.3) 64(41.3)
Family problem 8(25) 8(6.5) 16(10.3)
Future career 4(12.5) 29(23.6) 33(21.3)
Stress levels Women
(%) Men
(%) Total
(%)
Without stress 7(5.7) 4(12.5) 11(7.1)
Incident stress 27(22) 7(21.9) 34(21.9)
Minimal stress 32(26) 8(25) 40(25.8)
Intermediate stress 31(25.2) 4(12.5) 35(22.6)
Severe stress 17(13.8) 7(21.9) 24(15.5)
Very severe stress 9(7.3) 2(6.3) 11(7.1)
Total 123(100) 32(100) 155(100)

44 stress are more pronounced in hospital such as
interaction with patient and staff.There are undoubtedly many difficult,unchangeable aspects of medical training butmore emphasis on what students like for exampletalking to patients might mediates. Thesedifficulties talking to patients would be simpleway to reduce feeling of frustration andpowerlessness. Other methods suggested forreducing student stress are the use of smallgroups of teaching and support and counselingservice (9).In medical education this has beenparty achieved by the introduction of staff-student committees that can examine for changethe rules governing difficult aspects of jobs (10).Our findings suggests that many stressors arepresent in the path to become a doctor. A moredetailed investigation of these factor throughoutuniversities of medicine and based on thatintroducing procedures centrally and university-based will undoubtedly help tackle many of theseproblems.
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