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The relationship between medical students’ identity and stress: A longitudinal questionnaire study

Lookup NU author(s): Dr Bryan Burford, Dr Gill Vance, Dr David Kennedy


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Background: Medical school is a stressful time for students. Among factors influencing stress and wellbeing is students’ identity – theextent to which they consider themselves as being members of a group. High identification as a medical student potentially has a protective effect against adoption of adverse norms, and so against stress [1]. The literature has also shown that medical students identify as doctors early in medical school [2], and may in fact identify more as doctors than as students [3]. This paper will consider the extent to which these identities are associated with a measure of stress [4]. Additionally, the role of family background associated with possible familiarity with the medical school context was considered. Methodology: Data were collected through a longitudinal cohort questionnaire completed by medical students between 2014 and 2017. This encompassed the first two university-based years, and the third hospital-based year of a five year programme following an integrated curriculum. Questionnaires were completed by medical students at the beginning and end of their first year, and at the end of second and third years. Questionnaires contained a number of scales including the Perceived Stress Scale [4], and measures oft he ingroup ties, centrality and affect [5] associated with identification as a doctor and as a medical student. Linear mixed effects modelling in R was used to consider effects on stress. Perceived stress was included as an outcome variable. Fixed factors were questionnaire time point, the 6 identity scales, participant age and gender, and whether the participant had a close family member (parent/sibling) who was a doctor. Participant was included as a random factor. Criterion-based model selection was used to find an optimal explanatory model from the selected factors. Results: Perceived stress is measured on a summed scale of 10 items on a 5 point scale, giving a range of 0-40. Headline figures show an increase in perceived stress over the course of the study from 14.4 (sd=5.88) at the beginning of first year to18.3 (sd=7.20) at the end of third year. Model selection found that having a family member in medicine did not significantly contribute to the regression model, and nor did measures of identification as a doctor. These predictors were removed from the final model. Significant effects were found for all medical student identification scales, for questionnaire time point, for gender and age. The direction of effects is indicated by coefficients. Higher stress is associated with later questionnaires (beta=0.75), being female (beta=1.73), and higher centrality or importance of medical student identity (beta=1.20). Lower stress was associated with being older (beta=-0.40), having stronger ties to the medical student group (akin to a sense of belonging) (beta=-1.83) and higher ingroup affect (the positive feelings associated with group membership) (beta=-2.40). Discussion: Results suggest that overall, stress increases through the first two years of study. Stress also varies with demographics, with older students seemingly less prone to stress, and women more prone than men. Age may be associated with greater experience of dealing with stress in the past, but while the gender effect may indicate differences in experience, it is possible that there is differential reporting between women and men. The extent and type of identification as a medical student also affects stress. Feeling part of the group, and experiencing positive affect from that membership appear to have a protective effect, but feeling group membership is a central part of one’s identity may be a risk for stress. This makes intuitive sense, as the centrality of group membership may increase concerns that membership will be lost, whereas the other dimensions are indicative of supportive functions of group membership. This remains a work in progress, and future analysis will explore more complex models including other measures including resilience and burnout. References: [1] McNeill KG, Kerr A, Mavor KL. Identity and norms: the role of group membership in medical student wellbeing. Perspect Med Educ, 2014; 3: 101-112 [2] Coster S, Norman I, Murrells T, Kitchen S, Meerabeau E, Sooboodoo E, d’Avray L. Interprofessional attitudes amongst undergraduate students in the health professions: A longitudinal questionnaire survey. Int J Nurs Stud, 2008; 45: 1667-1681 [3] Burford B, Rosenthal-Stott HES. First and second year medical students identify and self-stereotype more as doctors than as students: a questionnaire study. BMC Med Educ, 2017; 17: 209. [4] Cohen S, Kamarck T, Mermelstein. A Global Measure of Perceived Stress. J Health Soc Behav 1983; 24: 385-396 [5] Cameron JE. A three-factor model of social identity. Self and Identity 2004; 3: 239-262

Publication metadata

Author(s): Burford B, Vance G, Kennedy DJ

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Association for the Study of Medical Education Annual Scientific Meeting

Year of Conference: 2018

Pages: 176-176

Online publication date: 11/07/2018

Acceptance date: 02/04/2018

Publisher: Association for the Study of Medical Education