|Year : 2018 | Volume
| Issue : 1 | Page : 42-45
Psychological perturbs among undergraduate medical students of public and private sector universities in Pakistan
Muhammad Mustafa Qamar, Abeer Bhatti, Maida Naseem, Ayesha Farooq, Sumbal Shahzadi, Sitara Batool, Akhtar Rasul, Ayesha Basharat
Department of Physical Therapy, Sargodha Medical College, University of Sargodha, Sargodha, Pakistan
|Date of Web Publication||15-Feb-2018|
Muhammad Mustafa Qamar
Department of Physical Therapy, Sargodha Medical College, University of Sargodha, Sargodha
Background: Most stressing curricula in the world at present is medical science; excess stress among students lead to a decrease in their performance due to physical as well psychological decline. The study under consideration was done for determination of the psychological stress that is perceived by the undergraduate medical students, to identify the stressors causing stress, domains in which it is more prevalent in students of various medical disciplines in Pakistan.
Materials and Methods: A comparative cross-sectional study using Medical Students Stressor Questionnaire was carried on a sample of 300 students of various medical disciplines of public and private universities chosen by convenience sampling.
Results: Across the various disciplines of medical education, more stress was found in the DPT students and least in the AHS students. The results reported the prevalence of stress 28.5% in DPT students, 24.2% in MBBS students, 23.7% in DHND students, and 23.6% in AHS students. Among the sectors, more stress level was found in public sector university students (77.6%) than private sector students (22.4%). The stressors causing more stress among the undergraduate medical students were identified to be the group activity-related stressor and social activity- related stressor.
Conclusion: The study showed that the high prevalence of stress was found to be in the DPT students followed by the MBBS, DHND, and AHS. Stress was more prevalent in public sector medical students as compared to the private sector.
الخلفية: معظم المناهج الدراسية مبعثا للضغط النفسي في العالم في الوقت الحاضر هي العلوم الطبية؛ يؤدي التوتر الزائد بين الطلاب إلى انخفاض في أدائهم بسبب الانخفاض الاداء الجسدي وكذلك النفسي. وأجريت هذه الدراسة لتحديد الضغوط النفسية التي يعاني منها طلاب الطب، لتحديد الضغوطات التي تسبب الإجهاد، والمجالات التي هو أكثر انتشارا في الطلاب من مختلف التخصصات الطبية في باكستان.
المواد والطرق: تم إجراء دراسة مقطعية باستخدام استبانة "التوتر النفسي لطلبة الطب" على عينة مكونة من 300 طالبا من مختلف التخصصات الطبية في الجامعات الحكومية والخاصة التي تم اختيارها من خلال أخذ العينات الملائمة.
النتائج: عبر التخصصات المختلفة للتعليم الطبي، تم العثور على مزيد من التوتر في الطلاب دبت (دكتوراه العلاج الطبيعي) وأقل في طلاب أهس (طلاب العلوم الطبية). انتشار الإجهاد 28.5٪ في الطلاب دبت، 24.2٪ في الطلاب مبس (طلاب بكالوريوس الطب)، 23.7٪ في طلاب دند (دكتوراه التغذية)، و 23.6٪ في الطلاب أهس. ومن بين القطاعات، تم العثور على مزيد من التوتر في طلاب الجامعات في القطاع العام (77.6٪) من طلاب القطاع الخاص (22.4٪). تم تحديد الضغوطات المسببة لمزيد من التوتر بين طلاب الطب الجامعي ليكون النشاط المرتبط بالضغط النفسي والضغط النفسي المرتبط بالنشاط الاجتماعي.
الخلاصة: أظهرت الدراسة أن ارتفاع معدل انتشار الإجهاد وجد في طلاب دبت (دكتوراه العلاج الطبيعي)
Keywords: Medical students, psychological perturb, public and private sector universities, stressors
|How to cite this article:|
Qamar MM, Bhatti A, Naseem M, Farooq A, Shahzadi S, Batool S, Rasul A, Basharat A. Psychological perturbs among undergraduate medical students of public and private sector universities in Pakistan. Saudi J Sports Med 2018;18:42-5
|How to cite this URL:|
Qamar MM, Bhatti A, Naseem M, Farooq A, Shahzadi S, Batool S, Rasul A, Basharat A. Psychological perturbs among undergraduate medical students of public and private sector universities in Pakistan. Saudi J Sports Med [serial online] 2018 [cited 2019 Aug 24];18:42-5. Available from: http://www.sjosm.org/text.asp?2018/18/1/42/225292
| Introduction|| |
Psychological perturb means stress or anxiety at a cognitive level, which exists in thinking patterns which arise after the initiative, as a response to environmental demands placed on the body. Hans S. who first time used word “Stress.” He described it as the sum of physical, psychological tensions on a person, which arises due to wear and tear. Webster's new world dictionary defines stress as “state or a condition which have predominant characteristics as the symptoms of mental and physical stress that can originate from a situation in which person feels extremely pressurized.” Stress shows the failure of a human to face challenges of the environment which are either real or conceived. Selye presented a model which divides stress into two types such as eustress and distress. This model states that when stress increases the performance due to demands placed on individual, it may be considered eustress or favorable and positive stress while a little stress can help to keep alert and focused but extreme stress occurring suddenly or chronic stress over time not relieved by any strategy considered distress, unfavorable stress, lead to tension, worries, altered behavioral pattern  which can wreak damage both psychologically and physically. Stress is not altogether a negative thing whose presence is being feared but on the contrary is needed for learning as narrated by Linn and Zeppa.
The optimal level of stress enhances learning and performance, but the excess of it have a negative influence on doing physical chores and mental performance, disturbing person's personal, social, academic, and professional life. The highly stressful environment of medical colleges creates a sense of competition rather than cooperation, long hours of lectures, large amount of syllabus with poor time management creates less chance for students to lighten up; hence, less they participate in extracurricular activities leading to declining in their physical strength along with mental problems leading to decrease in attention span, interest to study, ability to focus, ability to make timely and effective decisions, and reduced ability to effectively communicate and interact with patients. This could lead to feelings of insufficiency and frustration with clinical practice and on a long run decreases interest in clinical work in the future and possibility of affecting patient's lives and health of the community and as a wholly negative impact on patient care.
Stress level and the impact it has on medical students depend highly on the personality type of individual that either they take every stressful event mildly, cultural background, coping strategies, time management, demands placed on them, and support of those around them.
| Materials and Methods|| |
The study under consideration is a comparative cross-sectional. We had done a qualitative research using Medical Students Stressor Questionnaire (MSSQ). A survey using questionnaire was done in the different Universities of Punjab, Pakistan. Three Hundred undergraduate medical students of DPT, MBBS, AHS, and DHND were asked to fill a questionnaire that helped us to understand their stress level and to know possible sources and domain, which were the cause of stress. There were no right or wrong answers. A verbal or written consent according to the Helsinki Declaration was taken from the participating students.
The survey form consisted of ten questions from five domains having statements of situation that are previously reported by the students as the main causes of stress, to be ticked marked by participants according to their own perception and opinion that either they think about that particular situation as the possible cause of stress in their personality, either it did not cause them any stress or mild one, moderate or severe one, and rate it accordingly. The score is from 0 to 4 depending on the level of stress they faced, for example, 0-no stress and 4-severe. The data obtained was analyzed to assess the stress level and the domain in which it is more prevalent.
All the data were collected, arranged, and demonstrated as mean and in the form of percentages, then analyzed by SPSS version 16 (Released 2007. SPSS for Windows, SPSS Inc., Chicago) and Excel expressed in the form of charts and graphs.
| Results|| |
Response rate in our study was 94%. The mean age of participants under study was found to be 21 years, all of them falling within the range of 17–25 years. Most of them were females. Across the various disciplines of medical education, more stress was found in the DPT students and least in the AHS students [Figure 1]. The stress level in various domains in medical students illustrated in [Figure 2].
The domains causing more stress among the undergraduate medical students were identified to be the group activity related in DPT and DHND and social activity related in DPT students.
The stress level experienced by the medical students depends on many factors such as degree program in which they are enrolled and syllabus in which they have to cover and examination system. Hence, the studies done in different countries come up with the different conclusions., The study was done in Pakistan in Aga Khan University, findings of this study showed that while moving through the academic years in medical education, more than 90% of students suffer from stress. Almost, similar findings were shown by results of Indian study as 73% and study of spain using the Thai stress test reported the level as 61.4%.
Due to large content to be learned, DPT students reported the highest amount of stress followed by MBBS, DHND students followed by AHS students, respectively.
Lack of guidance by teachers reported a higher stress level among AHS students following, DPT, DHND, and MBBS, respectively.
| Discussion|| |
This is the prime study to explore the stress level in the different medical discipline. It insights the difficulties and problems that the students were facing in academic, clinical, personal, and social part of life.
Response rate in our study was 94%. Participants mean age was found out to be 21 years. Almost, all participants reported having faced a certain level of stress as moving through the medical years. Across genders, the stress level in female students was found to be more than male, being 84.8% in females and 15.2% in male students, which is similar to the findings of the cross- sectional survey that included students from four Jordanian medical faculties in the academic year of 2013–2014. For measuring stress levels, we used MSSQ and come up with a conclusion that stress level was found to be more in females as compared to males. However, it contradicted the results reported by the study done to find out the link between the stress experienced and gender and causes stress in 1st year students in HIHT University using the same questionnaire as our-MSSQ. This study showed that the stress levels were found out to be more in males (82.2) than females (61.8%).
Across the various disciplines of medical education, more stress was found in the DPT students and least in the AHS students. The prevalence of stress was found to be 28.5% in DPT students, 24.2% in MBBS students, 23.7% in DHND students, and 23.6% of AHS students. Any study to find out the level of stress in students of different medical disciplines has not been reported in Pakistan before.
The domains causing more stress among the undergraduate medical students were identified to be the group activity related in DPT and DHND students, including stressor, for example, participation in class discussion, need to do well because of external pressure by parents and teachers, and feeling of incompetence, and the social activity related causes more stress in DPT and MBBS students, including stressor for example, not able to answer questions asked by patients, facing illness and death of patients, and interruptions by others, which is in contrast with the previous studies done for example, a study done in HIHT university using the same questionnaire reported that the most prevalent stressors in MBBS students are academic, group-related, and teaching-related.
Among different sectors, more stress level was found in public sector university students (77.6%) than private sector students (22.4%). The current prevalence of stress is higher in the 1st year (21.5%) and in the final year (27.4%) followed by the 3rd year (18.1%), 2nd year (17.3%), and 4th year (15.6%). In contrast to CMH, Lahore medical college that is 78% in the 1st year and 83% in the 2nd year. In 1st year, change of environment along with a large amount of content and fear of new atmosphere brings stress. As second and third year proceed, these students become busy with preclinical courses which are highly demanding in nature. In a final year, there is a transition from preclinical to clinical training and a feeling that the knowledge that a student has not enough and fewer skills to and students naturally assume that they have more responsibility for patient care as they are to start it in the near future. Life of health-care providers is extremely stressful and demanding; hence, high level of stress and even suffering from exhaustion have been reported among medical students from other countries as well.,
The maximum level of stress was reported to be in students at the end of 1st year.
Psychological perturb which are prevalent among medical student's cause considerable personal discomfort, dissatisfaction, and impaired quality of life and affecting their interpersonal skills and self-esteem.
This study characteristically focuses on the domains of the stressors to find out in which domain the level of stress is more significant and to find out that to which stressor, the medical students are prone to and either the discipline in which their study can have a significant impact on the stress level or not or either to study in private or public university has something to do with the stress level perceived.
| Conclusion|| |
The study showed that the high prevalence of stress was found to be in the DPT students followed by the MBBS, DHND, and AHS. Stress was more prevalent in public sector medical students as compared to the private sector. Different stress coping strategies should be a part of curriculum to manage stress.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Breznitz S, Goldberg L. Handbook of stress: theoretical and clinical aspects. New York, The Free Press, 1993.
Soanes C. New Pocket Oxford Dictionary. 9th
ed. New Delhi: Oxford University Press; 2001. p. 901.
Everly Jr GS, Rosenfeld R. The nature and treatment of the stress response: A practical guide for clinicians. Springer Science & Business Media. 2012.
Selye H. Confusion and controversy in the stress field. J Human Stress 1975;1:37-44.
Linn BS, Zeppa R. Stress in junior medical students: Relationship to personality and performance. J Med Educ 1984;59:7-12.
Hoe DC, Wah CK, Rian CA, Eliza Au E, Goud BK, Kamath U. Stress manifestations of medical students and its relation with gender and life style changes. Int Med J Stud Res 2012;2:37-45.
Shapiro SL, Shapiro DE, Schwartz GE. Stress management in medical education: A review of the literature. Acad Med 2000;75:748-59.
Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ 2005;39:594-604.
Malathi A, Damodaran A. Stress due to exams in medical students – Role of yoga. Indian J Physiol Pharmacol 1999;43:218-24.
Shaikh BT, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, et al.
Students, stress and coping strategies: A case of pakistani medical school. Educ Health (Abingdon) 2004;17:346-53.
Supe AN. A study of stress in medical students at Seth G.S. Medical college. J Postgrad Med 1998;44:1-6.
Saipanish R. Stress among medical students in a thai medical school. Med Teach 2003;25:502-6.
Munir AH, Husam A, Muhammad AS, Mohammad H, Fadi A, Zouhair A, et al
. Sources and predictors of stress among medical students in Jordan. Bull Environ Pharmacol Life Sci 2015;4:113-21.
Saxena Y, Shrivastava A, Singhi P. Gender correlation of stress levels and sources of stress among first year students in a medical college. Indian J Physiol Pharmacol 2014;58:147-51.
Shah M, Hasan S, Malik S, Sreeramareddy CT. Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC Med Educ 2010;10:2.
Tchen G, Carter A, Gibbons P, McLaughlin P. What is the relationship between indicators of stress and academic performance in first year university students? A prospective study. J Inst Retr 2001;40:463-73.
Ortmeier BG, Wolfgang AP, Martin BC. Career commitment, career plans, and perceived stress: A survey of pharmacy students. Am J Pharm Educ 1991;55:138-42.
Wolfgang AP. The health professions stress inventory. Psychol Rep 1988;62:220-2.
Qamar MM, Basharat A, Rasul A, Basharat S, Ijaz MJ, Islam A. Perception of physical therapy students and professionals about the importance of professional ethics. Int J Med Appl Health 2014;2:57-61.
[Figure 1], [Figure 2]