Resilience in the Third Year of Medical School: A Prospective Study of the Associations Between Stressful Events Occurring During Clinical Rotations and Student Well-Being

Mount Sinai School of Medicine, New York, NY 10029, USA.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 03/2009; 84(2):258-68. DOI: 10.1097/ACM.0b013e31819381b1
Source: PubMed


In the third year of medical school students are exposed to many stressful and potentially traumatic events, including witnessing patient suffering or death, personal mistreatment, and poor role modeling by physicians. These experiences may explain increases in anxiety and depression during medical school. However, to date this has not been studied.
The present study prospectively measured stressful clerkship events occurring during the 2006-2007 academic year in third-year medical students of the Mount Sinai School of Medicine (n = 125), using surveys completed monthly. Students labeled stressful events traumatic if they met the trauma criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. The authors measured anxiety, depression, and posttraumatic stress symptoms at the beginning and end of the year and twice during the year. At year's end they also measured students' personal growth.
Class participation varied from 106 (85%) at baseline to 82 (66%) at endpoint. Most students (101; 81%) completed at least one monthly survey. Many students reported exposure to trauma as well as personal mistreatment and poor role modeling by superiors. Trauma exposure was positively associated with personal growth at year's end. In contrast, exposure to other stressful events was positively associated with endpoint levels of depression and other stress symptoms.
Trauma exposure was common but not associated with poor outcomes by year's end, which suggests that students were resilient. Nonetheless, unprofessional behavior by resident and attending physicians might have adverse effects on the well-being of students.

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    • "The literature is clear about the importance of having high levels of resilience in stressful, harsh or uncertain environments – all of which are common in medical practice (Howe, Smajdor & Stockl, 2005; Haglund et al., 2009; Drybye & Shanafelt, 2012). The strong significant associations between resilience and certain personality traits are in agreement with literature on their association with well being (Schmutte & Ryff, 1997; Ryan & Deci, 2000; Cloninger, 2004; Cloninger & Zohar, 2011) which is primarily related to high Self-directedness, Cooperativeness and Persistence. "
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    • "Some degree of stress is found in any profession, and a certain amount of stress can be motivating for some individuals, but physicians exhibit greater burnout from stressors than the general population (Shanafelt et al., 2012). The stressors include, among other things, workload, exposure to patient death/suffering, ethical conflicts, the hidden curriculum and poor role models (e.g., Hafferty and Franks, 1994; Figley, 2002; Dyrbye et al., 2005; Haglund et al., 2009). These stressors, if not managed adequately by the medical student or physician can lead to substance abuse, suicide, increased cynicism, medical errors, impaired competency, burnout, depression, a sense of lack of accomplishment, as well as influencing specialty choice (Dyrbye et al., 2005, 2006; West et al., 2006; Pejušković et al., 2011). "
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    • "Adverse interactions with preceptors have variously been characterized as an issue of style [20] or educator professionalism [21] and as involving disrespectful interactions, belittlement, humiliation, bullying, harassment and abuse [22-27]. Our findings add to a fairly limited literature describing the consequences of such adverse interactions [22-24,28] and, further, provide an explanation of why students responded in the way that they did in our setting. "
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