Self-development groups reduce medical school stress: A controlled intervention study

Department of Clinical Medicine, Section for Psychiatry, University of Bergen, N-5020 Bergen, Norway.
BMC Medical Education (Impact Factor: 1.22). 03/2010; 10(1):23. DOI: 10.1186/1472-6920-10-23
Source: PubMed


High stress levels and mental health problems are common among medical students and there is a lack of studies on group interventions that aim to reduce such distress during medical school.
A full class of students (n = 129) participated in group sessions during their third year of medical school in Bergen, Norway. The subsequent third-year class (n = 152) acted as control group, in order to create a quasi-experimental design. Two types of group intervention sessions were offered to the first class. One option was self-development groups led by trained group psychotherapists. Alternatively, students could choose discussion groups that focused on themes of special relevance to doctors, led by experienced general practitioners. The intervention comprised of 12 weekly group sessions each lasting 90 minutes. Data were gathered before the intervention (T1), and three months post intervention (T2). Distress was measured using the Perceived Medical School Stress (PMSS) and Symptom Check List-5 (SCL-5) assessments.
The intervention group showed a significant reduction in PMSS over the observation period. The subsequent year control group stayed on the same PMSS levels over the similar period. The intervention was a significant predictor of PMSS reduction in a multiple regression analysis adjusted for age and sex, beta = -1.93 (-3.47 to -0.38), P = 0.02. When we analysed the effects of self-development and discussion groups with the control group as reference, self-development group was the only significant predictor of PMSS reduction, beta = -2.18 (-4.03 to -0.33), P = 0.02. There was no interaction with gender in our analysis. This implicates no significant difference between men and women concerning the effect of the self-development group. There was no reduction in general mental distress (SCL-5) over this period.
A three-month follow-up showed that the intervention had a positive effect on perceived medical school stress among the students, and further analyses showed this was due to participation in self-development groups.

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    • "There was low inconsistency among studies, with individual effect sizes ranging from −0.665 to 0.060 and I 2 = 35.56%. One study (Holm et al 2010 (SGD) in Figure 2) reported a positive effect size (i.e., outcomes were worse for intervention). The funnel plot was asymmetric to the left of the mean. "
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    ABSTRACT: Introduction Three systemic reviews reported that, although many studies echoed the importance of stress management programs in medical curricula, yet very few high quality studies provided convincing evidence of their effectiveness. So far, none of meta-analysis study was done to appraise their effectiveness on medical students’ psychological health. Objective The author conducted a meta-analysis to quantitatively appraise and summarize all studies of stress management interventions on medical students’ psychological health that include general psychological distress, stress, anxiety and depression symptoms. Method The author planned, conducted and reported this study according to the PRISMA standard of quality for reporting meta-analyses. Result The author yielded 23921 relevant articles based on search terms and eventually, after critical appraisal, only 13 articles were included in the meta-analysis. Stress management interventions were associated with moderate, statistically significant improvement of medical students’ psychological health [-0.335 (95% CI, -0.423, -0.246), P < 0.001] with low inconsistency among the studies (I2 = 30.46%). Subgroup analyses demonstrated there were consistent interactions with the duration of intervention (Q-value (df) = 15.56 (3), p = 0.001) and research design (Q-value (df) = 4.93 (1), p = 0.026). Sensitivity analyses did not change the study conclusions. Conclusion Stress management interventions were associated with moderate effects on medical students’ psychological health compared with no intervention. Brief to medium-duration intervention demonstrated significant larger effects than long-duration intervention. Likewise, RCT studies showed larger effects than non-RCT studies. Future research with RCT design should directly compare different types of stress management interventions based on a sound theoretical basis.
    Full-text · Article · Dec 2013
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    • "It is also relevant for preventing future mental health deterioration. A previous intervention study from the University of Bergen has shown promising results in reducing perceived medical school stress [22], but it is still uncertain whether the intervention has a positive long-term effect on stress levels. Individuals with a personality profile making them especially vulnerable to medical school stressors are likely to profit from such intervention programs, in which they learn to cope with the many challenges they may face, thereby interpreting their environment as less stressful. "
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    ABSTRACT: High levels of stress and deteriorating mental health among medical students are commonly reported. In Bergen, Norway, we explored the impact of personality traits measured early in their curriculum on stress reactions and levels of depression and anxiety symptoms as junior physicians following graduation. Medical students (n = 201) from two classes participated in a study on personality traits and mental health early in the curriculum. A questionnaire measuring personality traits (Basic Character Inventory (BCI)) was used during their third undergraduate year. BCI assesses four personality traits: neuroticism, extroversion, conscientiousness and reality weakness. Questionnaires measuring mental health (Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist 25 (SCL-25)), and stress (Perceived Medical School Stress (PMSS)) were used during their third and sixth undergraduate year. During postgraduate internship, Cooper's Job Stress Questionnaire (CJSQ) was used to measure perceived job stress, while mental health and stress reactions were reassessed using HADS and SCL-25. Extroversion had the highest mean value (5.11) among the total group of participants, while reality weakness had the lowest (1.51). Neuroticism and reality weakness were related to high levels of perceived job stress (neuroticism r = .19, reality weakness r = .17) as well as higher levels of anxiety symptoms (neuroticism r = .23, reality weakness r = .33) and symptoms of depression (neuroticism r = .21, reality weakness r = .36) during internship. Neuroticism indirectly predicted stress reactions and levels of depression and anxiety symptoms. These relations were mediated by perceived job stress, while reality weakness predicted these mental health measures directly. Extroversion, on the other hand, protected against symptoms of depression (r = -.20). Furthermore, females reported higher levels of job stress than males (difference = 7.52). Certain personality traits measured early in the course of medical school relates to mental health status as junior physicians during postgraduate internship training. This relation is mediated by high levels of perceived job stress.
    Full-text · Article · Nov 2013 · BMC Medical Education
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    • "The Norwegian PMSS authors used the same 5-point Likert scale as Vitaliano et al. used in the original PMSS [9], [19], [20] (ranging from „I strongly disagree“ to „I strongly agree“). However, in the original version the scale score encompassed 0-4 points, while Tyssen et al.[9] used a scale from 1-5. "
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    ABSTRACT: Objective: Medical students encounter specific stressors during their studies. As a result, they develop anxiety, depression and burnout symptoms more frequently than their similarly aged, but employed counterparts. In 1984, Vitaliano et al. published a 13-item instrument for the measurement of stress specific to medical school: the “Perceived Medical School Stress Instrument“ (PMSS). Since then, it has been widely applied and validated in English-speaking countries. No German version of the PMSS exists to date. Thus, our aim was to translate the instrument into the German language in order to be able to measure medical school stress in German-speaking countries. Method: The items of the PMSS were translated into German by three separate researchers. The resulting translations were compared and combined with each other to establish a first German version of each item in the PMSS. These items were then translated back into English by two native English speakers to validate the correct primary translation. Based on a revised German version, a cognitive debriefing with 19 German medical students and a theoretical testing on 169 German medical students, the final German translations for each of the 13 items were determined. Results: The PMSS was easily translated into German and there was a high congruency between the primary translations into German and the secondary translations back into English. Incongruities between the translations were solved quickly. The assessment of the German equivalent of the PMSS showed good results regarding its reliability (Cronbach’s Alpha 0.81). Conclusion: A German version of the PMSS is now available for measuring the medical school related stress in German-speaking countries.
    Full-text · Article · May 2013 · GMS Zeitschrift fü medizinische Ausbildung
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