Stress and coping strategies among Arab medical students: towards a research agenda.

BACKGROUND: Research conducted in the past ten years in the area of stress and coping among Arab medical students has identified some important issues, but other significant aspects have not yet been explored. OBJECTIVES: To provide a systematic review of studies reporting on stress, anxiety and coping among Arab medical students and to identify implications for future research. METHODS: PubMed was searched to identify peer-reviewed English-language studies published between January 1998 and October 2009 reporting on stress and coping among undergraduate Arab medical students. Search strategy used combinations of the terms: Arab medical student, stress, PBL, psychological distress, depression, anxiety and coping strategies. Demographic information on respondents, instruments used, prevalence data and statistically significant associations were abstracted. RESULTS: The search identified 8 articles that met the specified inclusion criteria. Within the limited range of Arab medical students studied, studies suggest these students have a high prevalence of perceived stress, depression and anxiety, with levels of perceived psychological stress as high as those reported in the international literature for medical students of other regions of the world. Limited data were available regarding coping strategies, the impact of stress on academic performance and attrition among Arab students. No data were available regarding the impact of problem-based learning on stress and coping. CONCLUSIONS: The existing literature confirms that stress, depression and anxiety are common among Arab medical students, as for students elsewhere. Little is known about the contribution of different curricula approaches to perceived stress and what coping strategies institutions and students apply to help alleviate stress. Large, prospective, multicentre, multi-method studies are needed to identify personal and curricula features that influence stress, depression, anxiety and coping strategies among Arab students.

Identifying characteristics that students, interns and residents look for in their role models.

OBJECTIVE: To identify characteristics which students, interns and residents look for in their role models. METHODS: A 45-item self-administered questionnaire was sent to a sample (n=96, response rate 80%) consisting of three groups: (1) students in years 3-6 of the medical curriculum (n=66); (2) interns (n=17) and (3) residents (n=13). The questionnaire contained characteristics that participants might use to describe excellent role models, grouped under five general headings: personality, clinical, research and teaching skills, and community service. Other characteristics mentioned by study subjects were qualitatively analysed using content analysis. RESULTS: Personality and teaching and clinical skills were ranked as the top three factors, and research skills and community service as the least important factors by 79 (82%) respondents. Qualitative analysis of characteristics described by respondents for their role models yielded 21 characteristics. These were clustered into three main themes: role models as teacher, physician and person. The most frequently mentioned characteristics were personal characteristics such as positive, respectful attitudes toward patients and their families, and staff and colleagues; honesty; politeness; enthusiasm; competence, and knowledge. Females rated nine personal characteristics significantly higher than males (P < 0.05). Interns and residents valued teaching enthusiasm and competence significantly more than students (P=0.01). Role models had a strong influence on the specialty choice of 53 (55%) respondents. CONCLUSION: Knowing the characteristics of excellent role models should help medical educators to formulate strategies to recruit, retain and develop them. Increasing exposure of a variety of excellent role models to aspiring medical practitioners should be encouraged.

Assessing confidence and competence of senior medical students in an obstetrics and gynaecology clerkship using an OSCE.

CONTEXT: Assessment of clinical confidence and competence of senior medical students during an obstetrics and gynaecology clerkship using an objective structured clinical examination (OSCE). METHOD: A questionnaire was distributed to senior medical students (n=47)to assess pre- and post-OSCE self-perceived confidence and competence in five clinical skills: history taking, performing pelvic examination, interacting and communicating with patients, clinical reasoning and dealing with difficult patient situations. Pre- and post-performance confidence levels were compared and correlated with OSCE scores. RESULTS: The five clinical skills were significantly interrelated (p=0.001). There was no significant difference in OSCE performances between male (n=16) and female (n=31) students. Pre- and post-OSCE confidence in performing pelvic examination was significantly higher in female than male students (p=0.01). Post-OSCE confidence in clinical reasoning and dealing with difficult patient situations only were significantly increased in both groups (p=0.01 and p=0.02, respectively). Pre- and post-performance confidence levels were not significantly correlated to OSCE scores. CONCLUSION: Of five clinical skills rated, self-confidence in clinical reasoning skills and dealing with challenging or complex patient problems only were significantly increased after an OSCE assessing competence. The content of some of our OSCE stations thus enhance confidence in these skills but psychometric and other characteristics of the OSCE such as duration and performance feedback mechanisms need further investigation.