Beyond prevalence to process: the role of self and identity in medical student well-being.

CONTEXT: Problematic stress levels among medical students have been well established. This stress can lead to depression, suicidal ideation, substance abuse, burnout and cynicism, having a negative effect on students and their patients. METHODS: We propose to move towards examining the processes underlying well-being in some medical students and vulnerability in others. We draw upon social psychological literature to propose that self-complexity, medical student identity and associated norms all have the capacity to influence medical students' well-being in both positive and negative ways. RESULTS: We identify two key dilemmas facing medical students with regard to the social psychological factors investigated. First, a diverse set of interests and a high level of self-complexity is thought to buffer against the effects of stress and might also be beneficial for medical practitioners, but the intensive nature of medical education makes it difficult for students to pursue outside interests, leading to a strongly focused identity. Second, a strong group identity is associated with high levels of social support and improved well-being, but unhealthy group norms may have a greater influence on individuals who have a strong group identity, encouraging them to engage in behaviours that place their well-being at risk. A model is proposed outlining how these potentially contradictory social psychological processes may combine to impact upon medical students' well-being. CONCLUSIONS: There is great scope for investigating the role of self-complexity, identity and norms in the medical education context, with room to investigate each of these factors alone and in combination. We highlight how our proposed model can inform medical educators as to the students who may be most vulnerable to the effects of stress and the potential interventions from which they may benefit. We conclude that social psychological factors make a valuable contribution to understanding the complex issue of well-being in medical education.

Looking beyond personal stressors: an examination of how academic stressors contribute to depression in Australian graduate medical students.

BACKGROUND: Medical school is a challenging environment that requires students to deal effectively with stress borne out of the medical education environment, as well as their personal lives. Previous research has not systemically distinguished between academic and personal sources of stress, and in particular has not explored the independent contribution that academic stressors make to medical student depression. PURPOSES: This study aimed to investigate whether academic stressors make a unique contribution to the level of depressive symptoms in medical students, over and above the contribution made by personal stressors alone. METHODS: Sixty-seven medical students completed an online questionnaire designed to measure the total number of recent life events (personal and academic), and their perceived impact, using a modified version of the Psychiatric Epidemiology Research Interview Life Events Scale. Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale. RESULTS: Both the total number of personal stressors, r(67) = .363, p = .003, and their perceived impact, r(67) = .412, p = .001, were found to be positively related to depressive symptoms. A positive relationship was also observed between depressive symptoms and the total number of academic stressors, r(67) = .321, p = .008, and their perceived impact, r(67) = .489, p < .001. In addition, it was found that the perceived impact of academic stressors was able to explain higher levels of depressive symptoms in medical students over and above the effect afforded by personal stressors alone. CONCLUSION: The findings of this study suggest that stress borne out of the medical school environment contributes to depressive symptoms in medical students over and above the contribution made by personal stressors alone. This indicates that although it is important to help students cope with stress borne out of their personal lives, interventions by medical schools aimed at reducing the impact of academic stressors on medical student depression may also be of great importance.

Identity and norms: the role of group membership in medical student wellbeing.

Medical students experience high levels of mental health problems, which can lead to poor academic performance, substance abuse and burnout. The current paper draws on social psychology to explore the factors underpinning wellbeing in medical students. From the literature it is evident that there is a strong association between group membership and wellbeing. There is also evidence, however, that when the norms of a group prescribe unhealthy behaviours, group members who identify strongly with the group are likely to engage in those behaviours. It was hypothesized that (a) there would be a positive relationship between identification and wellbeing in medical students, (b) perceptions of norms would be positively related to unhealthy behaviour which would be negatively related to wellbeing and (c) identification would be positively related to levels of norm-related unhealthy behaviour. Ninety-two Australian medical students completed measures of identification, endorsement of norms, own behaviour in relation to norms and three indicators of wellbeing. The results supported the first hypothesis and showed only partial support for the second, suggesting a primarily positive role of group processes in medical student wellbeing. The implications for interventions to improve wellbeing in medical schools and directions for future research are discussed.