Perceived Stress in Medical Education: Relationship with Empathy and Stigmatisation

Yıl 2024, Cilt: 31 Sayı: 3, 261 - 270, 29.09.2024

Gözde Bacık Yaman , Berna Nar , Gökçe İşcan

https://doi.org/10.17343/sdutfd.1496746

Öz

Objective: Medical students have been shown to report high levels of perceived stress. Perceived stress leads to a loss of empathy and negatively affects attitudes and behaviours towards patients. This study aimed to investigate the perceived stress levels and empathy skills of medical students and their relationship with their attitudes to mental illness.
Material and Method: A cross-sectional study was conducted in Türkiye between March 2024 and April 2024 using an online survey. A total of 544 medical students attending university in the academic year 2023-2024 completed the questionnaire, which included the sociodemographic data form, the perceived medical school stress scale, the empathy scale, and the beliefs towards mental illness scale. Participants were asked whether they had received psychiatry training, whether they had been diagnosed with a mental illness, and whether they would disclose if they were diagnosed with a mental illness.
Results: By gender, the mean Perceived Medical School Stress Scale score of females was statistically significantly higher than that of males (p=0.035). Perceived Medical School Stress Scale scores did not differ by training year, whereas Beliefs Towards Mental Illness Scale Weak Social and Interpersonal Skills sub-dimension scores did (p=0.643; and p=0.027, respectively). The Empathy Scale score of students who received psychiatry training was statistically significantly higher than that of students who did not receive a placement (p=0.003). A low significant negative correlation was found between the Perceived Medical School Stress and Empathy Scale scores (rho=-0.098; p=0.005).
Conclusion: In our study, the perceived stress of medical students during their training differs according to gender, and its relationship with empathy skills is demonstrated. Individualised interventions to prevent and alleviate stress should be developed for students who need support coping with difficulties during their training.

Anahtar Kelimeler

Empathy, Medical students, Stigma, Stress

Kaynakça

• . Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc 2005;80:1613-22. https://doi.org/10.4065/80.12.1613
• 2. Dyrbye LN, Thomas MR, Shanafelt TD. A systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med 2006;81(4):354-73. https://doi.org/10.1097/00001888-200604000-00009.
• 3. Hunt J, Eisenberg D. Mental health problems and help-seeking behaviour among college students. J Adolesc Health 2010;46(1):3-10. https://doi.org/10.1016/j.jadohealth.2009.08.008.
• 4. Cihan FG, Kutlu R, Medine MK. Occupational future concerns and stress management conditions of intern doctors. JAREM 2017;7(3): 122. https://doi.org/10.5152/jarem.2017.1321.
• 5. Arslan MA, Dönmez L. Effect of Stress and Coping with Stress Capability on Burnout among Medical Students. Akd Tıp D 2017;3(3):149-157. https://doi.org/10.17954/amj.2017.87.
• 6. Tyssen R, Vaglum P, Grønvold NT, et al. Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study. Med Educ 2000;35(2):110-20. https://doi.org/10.1046/j.1365-2923.2001.00770.x
• 7. Rosal MC, Ockene IS, Ockene JK, et al. A longitudinal study of students' depression at one medical school. Acad Med 1997;72(6):542-6. https://sid.ir/paper/629843/en.
• 8. Akdemir M, Aktekin MR, Şenol YY, et al. Depression and psychological distress in medical students, a prospective study. Noro Psikiyatr Ars 2022;59(2):116. https://doi.org/10.29399/npa.27799.
• 9. Kötter T, Voltmer E. Measurement of specific medical school stress: translation of the “Perceived Medical School Stress Instrument” to the German language. GMS Z Med Ausbild 2013;30(2). https://doi.org/10.3205/zma000865.
• 10. Dyrbye LN, Harper W, Durning SJ, et al. Patterns of distress in US medical students. Med Teach 2011;33(10):834-9. https://doi.org/10.3109/0142159X.2010.531158.
• 11. Mihailescu M, Neiterman E. A scoping review of the literature on the current mental health status of physicians and physicians-in-training in North America. BMC Public Health 2019;19:1-8. https://doi.org/10.1186/s12889-019-7661-9.
• 12. Thomas MR, Dyrbye LN, Huntington JL, et al. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med 2007;22:177-83. https://doi.org/10.1007/s11606-006-0039-6.
• 13. Eren HK, Gürhan N. Determination of the relationship between the beliefs of nursing students toward mental illnesses and their empathic tendency levels. Perspect Psychiatr Care 2021;57:1034-40. https://doi.org/10.1111/ppc.12654.
• 14. Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract 2002;52:9-12.
• 15. Coulehan JL, Platt FW, Egener B, et al. “Let me see if I have this right…”: words that help build empathy. Ann Intern Med. 2001;135:221-7.
• 16. Hojat M, Louis DZ, Markham FW, et al. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med 2011;86(3):359-64. https://doi.org/10.1097/ACM.0b013e3182086fe1.
• 17. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. The Lancet 2009;374(9702):1714-21. https://doi.org/10.1016/S0140-6736(09)61424-0.
• 18. Webb M, Peterson J, Willis SC, et al. The role of empathy and adult attachment in predicting stigma toward severe and persistent mental illness and other psychosocial or health conditions. J Ment Health Couns 2016;38(1):62-78. https://doi.org/10.17744/mehc.38.1.05.
• 19. Granados-Gámez G, Lopez Rodriguez MDM, Corral Granados A, et al. Attitudes and Beliefs of Nursing Students toward Mental Disorder: The Significance of Direct Experience with Patients. Perspect Psychiatr Care 2017;53:135-143. https://doi.org/10.1111/ppc.12147.
• 20. Poreddi V, Thimmaiah R, Math SB. Attitudes toward people with mental illness among medical students. J Neurosci Rural Pract 2015;6:349–354. https://doi.org/10.4103/0976-3147.154564.
• 21. Patten SB, Remillard A, Phillips L, et al. Effectiveness of contact-based education for reducing mental illness-related stigma in pharmacy students. BMC Med Educ 2012;12:120. https://doi.org/10.1186/1472-6920-12-120 .
• 22. Fletcher I, Castle M, Scarpa A, et al. An exploration of medical student attitudes towards disclosure of mental illness. Med Educ Online 2020;25(1):1727713. https://doi.org/10.1080/10872981.2020.1727713.
• 23. Wrigley S, Jackson H, Judd F, Komiti A. Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. Aust N Z J Psychiatry 2005;39:514–21. https://doi.org/10.1080/j.1440-1614.2005.01612.x
• 24. Lyons Z, Janca A. Impact of a psychiatry clerkship on stigma, attitudes towards psychiatry, and psychiatry as a career choice. BMC Med Educ 2015;15:34. https://doi.org/10.1186/s12909-015-0307-4
• 25. Wang P-W, Ko C-H, Chen C-S, et al. Changes of explicit and implicit stigma in medical students during psychiatric clerkship. Acad Psychiatry 2016;40:224–8. https://doi.org/10.1007/s40596-015-0432-8
• 26. Zare-Bidaki M, Ehteshampour A, Reisaliakbarighomi M, et al. Evaluating the effects of experiencing virtual reality simulation of psychosis on mental illness stigma, empathy, and knowledge in medical students. Front Psychiatry 2022;13:880331. https://doi.org/10.3389/fpsyt.2022.880331.
• 27. Vitaliano PP, Maiuro RD, Mitchell E, et al. Perceived stress in medical school: resistors, persistors, adaptors and maladaptors. Soc Sci Med 1989;28(12):1321-9. https://doi.org/10.1016/0277-9536(89)90351-1.
• 28. Çınar Tanrıverdi E, Yılmaz S, Çayır Y. Evaluation of the validity and reliability of the perceived medical school stress scale in Turkish medical students. PloS one 2023;18(8):e0288769. https://doi.org/10.1371/journal.pone.0288769.
• 29. Hirai M, Clum GA. Development, Reliability, and Validity of The Beliefs Toward Mental İllness Scale. J Psychopathol Behav Assess 2000;22(3):221-36. https://doi.org/10.1023/A:1007548432472.
• 30. Bilge A, Çam O. Ruhsal The validity and reliability of beliefs towards mental illness scale. Anadolu Psikiyatri Derg 2008;9(2):91-4.
• 31. Baron-Cohen S, Wheelwright S. The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. J Autism Dev Disord 2004;34:163-175. https://doi.org/10.1023/B:JADD.0000022607.19833.00.
• 32. Bora E, Baysan L. Psychometric features of the Turkish version of the empathy quotient in university students. Klinik Psikofarmakol Bülteni 2009;19(1):39-47.
• 33. Wakabayashi A, Baron-Cohen S, Wheelwright S, et al. Development of short forms of the Empathy Quotient (EQ-Short) and the Systemizing Quotient (SQ-Short). Pers Individ Dif 2006;41(5):929-40. https://doi.org/10.1016/j.paid.2006.03.017.
• 34. Voltmer E, Kötter T, Spahn C. Perceived medical school stress and the development of behaviour and experience patterns in German medical students. Medl Teach 2012;34(10):840-7. https://doi.org/10.3109/0142159X.2012.706339 .
• 35. Marchewka W, Loster Z, Marchewka J, et al. Stress associated with undergraduate medical courses: A translation and validation of the Perceived Medical School Stress Instrument into Polish and its adaptation to the Polish environment. Folia Med Cracov 2020;60(2). https://doi.org/10.24425/fmc.2020.135013.
• 36. Bartlett J, Fowler K. Beyond the curriculum: a cross-sectional study of medical student psychological distress, and health care needs, practices and barriers. Social psychiatry and psychiatric epidemiology, 55, 1215-1221. Soc Psychiatry Psychiatr Epidemiol 2020;55:1215-21. https://doi.org/10.1007/s00127-019-01771-1.
• 37. Tyssen R, Dolatowski FC, Røvik JO, et al. Personality traits and types predict medical school stress: a six‐year longitudinal and nationwide study. Med Educ 2007;41(8):781-7. https://doi.org/10.1111/j.1365-2923.2007.02802.x.
• 38. McKenna SP, Doward LC. The translation and cultural adaptation of patient-reported outcome measures. Value Health 2005;8(2):89-91. https://doi.org/10.1111/j.1524-4733.2005.08203.x.
• 39.Tjia J, Givens JL, Shea JA. Factors associated with undertreatment of medical student depression. J Am Coll Health 2005;53(5):219-24. https://doi.org/10.3200/JACH.53.5.219-224.
• 40. Givens JL, Tjia J. Depressed medical students' use of mental health services and barriers to use. Acad Med 2002;77(9):918-21. https://doi.org/10.1097/00001888-200209000-00024.
• 41. Casas RS, Xuan Z, Jackson AH, et al. Associations of medical student empathy with clinical competence. Patient Educ Couns 2017;100(4):742-7. https://doi.org/10.1016/j.pec.2016.11.006.
• 42. Andersen FA, Johansen ASB, Søndergaard J, et al. Revisiting the trajectory of medical students’ empathy, and impact of gender, speciality preferences and nationality: a systematic review. BMC Medl Educ 2020;20:1-18. https://doi.org/10.1186/s12909-020-1964-5.
• 43. Li W, Reavley N. Recognition and beliefs about treatment for mental disorders in mainland China: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2020;55:129-49. https://doi.org/10.1007/s00127-019-01799-3.
• 44. Spagnolo AB, Murphy AA, Librera LA. Reducing stigma by meeting and learning from people with mental illness. Psychiatr Rehabil J 2008;31(3):186. https://doi.org/10.2975/31.3.2008.186.193.
• 45. Lyons Z, Janca A. Impact of a psychiatry clerkship on stigma, attitudes towards psychiatry, and psychiatry as a career choice. BMC Med Educ 2015;15:1-10. https://doi.org/10.1186/s12909-015-0307-4.
• 46. Wang PW, Ko CH, Chen CS, et al. Changes of explicit and implicit stigma in medical students during psychiatric clerkship. Acad Psychiatry 2016;40:224-8. https://doi.org/10.1007/s40596-015-0432-8.
• 47. Sahin G, Amancalı M, Sayın SA, et al. Undergraduate nursing students' attitudes towards patients with mental disorders and related factors. Acıbadem University Health Sciences Journal 2019;10(2):218-24. https://doi.org/10.31067/0.2019.144.
• 48. Yadav T, Arya K, Kataria D, et al. Impact of psychiatric education and training on the attitude of medical students towards mentally ill: A comparative analysis. Ind Psychiatry J 2012;21(1):22. https://doi.org/10.4103/0972-6748.110944.
• 49. Telles-Correia D, Marques JG, Gramaça J, et al. Stigma and attitudes towards psychiatric patients in Portuguese medical students. Acta Med Port 2015;28(6):715-9. https://doi.org/10.20344/amp.6231.
• 50. Birdoğan SY, Berksun EO. Attitudes towards psychiatrıc patients in 1st and 6th-year medical students. Kriz Dergisi 2002;10(2):1-7. https://doi.org/10.1501/Kriz_0000000184.
• 51. Lampe L, Coulston C, Walter G, et al. Familiarity breeds respect: attitudes of medical students towards psychiatry following a clinical attachment. Australas Psychiatry 2010;18(4):348-53. https://doi.org/10.3109/10398561003739612.
• 52. Tan SM, Azmi MT, Reddy JP, et al Does clinical exposure to patients in medical school affect trainee doctors’ attitudes towards mental disorders and patients? A pilot study. Med J Malaysia 2005;60:328-37.
• 53. Bacık Yaman G, Kumbul H, Köyüstü B, Hüseynov İ, Özdamar Ünal G. University students' attitudes towards mental illness and its relationship with empathy. Med J SDU 2023;30(4):662-71. https://doi.org/10.17343/sdutfd.1357125
• 54. Oliveira AM, Machado D, Fonseca JB, et al. Stigmatizing attitudes toward patients with psychiatric disorders among medical students and professionals. Front Psychiatry 2020;11:326. https://doi.org/10.3389/fpsyt.2020.00326.
• 55. Dovidio JF, Gaertner SL, Kawakami K. Intergroup contact: The past, present, and the future. Group Process Intergroup Relat 2003;6(1):5-21. https://doi.org/10.1177/1368430203006001009.
• 56. Yang CPP, Hargreaves WA, Bostrom A. Association of empathy of nursing staff with reduction of seclusion and restraint in psychiatric inpatient care. Psychiatr Serv 2014;65(2):251-4. https://doi.org/10.1176/appi.ps.201200531.
• 57. Hepdeniz ÖK, Temel UB, Uğurlu M. The evaluation of empathy levels of undergraduate students of a faculty of dentistry. Med J SDU 2023;30(2):235-44. https://doi.org/10.17343/sdutfd.1287519.
• 58. Arslantaş H, Abacıgil F, Adana F, et al. Beliefs of Nursing Students about Mental Illnesses and Social Distance: The Effects of Theoretical and Practical Psychiatric Nursing Education. In Yeni Symposium 2019;57(1). https://doi.org/10.5455/NYS.20190214084140.
• 59. Oban G, Kucuk L. The Effect of the Education Aiming at Informing About Schizophrenia to Social Distance and Attitudes Among High School Students. J Educ Res Nurs 2012; 9(2): 35-41.
• 60. Antoniadis D, Gouti A, Kaloudi E, et al. Greek students' attitudes towards mental disorders. Psychiatry 2016;27(2):98-105. https://doi.org/10.22365/jpsych.2016.272.98.