Tool for Predicting Medical Student Burnout From Sustained Stress Levels: Factor Analysis of the Medical Education Hassles Scale-R.

CONTEXT: Acute stress during medical school affects the health of students and is associated with burnout. The Medical Education Hassles Scale-R (MEHS-R) is designed to measure acute stress among medical students. Researchers using the MEHS-R primarily report overall hassles scores, which are unable to discriminate between different categories of hassles encountered. OBJECTIVE: The present study examined the factor structure of the MEHS-R to identify subscales that would be useful to categorize hassles for research and assessment purposes. DESIGN: Longitudinal, observational study. SETTING: Two osteopathic medical schools. PARTICIPANTS: Five hundred six first-year medical students. MAIN OUTCOME MEASURE: The MEHS-R was administered at orientation and 9 to 10 times throughout the first year, classified into examination, vacation, and routine medical school activity periods. Students rated the 101 items on a 4-point scale (0=none to 3=a great deal) to indicate how much of a hassle each item had been during the previous week. Demographic subgroups were males, females, married students, single students, whites, and ethnic minorities. RESULTS: Exploratory factor analysis was conducted on data collected at the first school during orientation. Seven subscales were identified: Academic and Time Pressures, Financial, Social, External Influences, Day-to-Day Functioning, Relationships With Immediate Family, and Health. Cronbach α were ≥0.75. Stability of these subscales was examined using confirmatory factor analysis. Both of the fit indices used indicated the 7-subscale model for the MEHS-R adequately fit the data obtained during examination and routine medical school activity periods, one fit index indicated adequate fit for the vacation period, and neither indicated adequate fit for the data from the second school. Of the 7 subscales, 5 had a strong correspondence with categories identified by the scale developers. Fit indices also indicated the 7-subscale model was adequately generalizable to the demographic subgroups with the exception of the ethnic minorities subgroup. CONCLUSIONS: Exploratory factor analysis performed on the MEHS-R supported formation of subscales similar to categories identified during MEHS-R development. Results of the current study supported the use of the MEHS-R for the investigation of acute stress in medical students. In future research, targeted wellness interventions for medical students may be developed based on student responses to this instrument.

Depression, anxiety, and perceived hassles among entering medical students.

This study investigated depression and anxiety among students who were entering medical school prior to the onset of their medical curriculum. Entering students reported financial, day-to-day, academic, and time hassles as concerns. Interestingly, the population characteristics of gender, marital status, and ethnicity impacted the type of self-reported hassles indicated by the students. Measurements of depression and anxiety indicated that entering medical school students' emotional status resembles that of the general population. The results suggest that it is the rigors of the medical curriculum that may play an important role in the increased prevalence of depression and anxiety for students during their medical education. Further, students who are entering medical field already have concerns about medical school and are in the process of anticipating the necessary adjustment to the challenges ahead of them. Preventative programming efforts should begin early in medical education and address a wide variety of concerns from academic, to interpersonal relationships and financial worries.

Correlation between prior exercise and present health and fitness status of entering medical students.

Four hundred forty-one students were tested for strength, agility, flexibility, and endurance as well as for body fat, heart rate, and blood pressure. Questionnaires estimated prior exercise, sleep, diet, and leisure habits. Students were more fit than published norms. Their reported prior exercise habits correlated positively with estimated VO2max. Positive results of endurance tests correlated with better eating habits and lower blood pressure. Strong correlation existed between reported exercise and lower body fat, heart rate, and diastolic blood pressure. Blood pressure was in the hypertensive range in 57 individuals, and high blood pressure correlated with higher body weight, percent body fat, and resting heart rate. The authors concluded that most incoming medical students are fit and physically active. Positive correlations exist between prior exercise habits, performance on fitness tests, and indicators of reduced health risks. There was high correlation between risk factors for heart disease and measured blood pressure.

A modified YMCA bench press test as a predictor of 1 repetition maximum bench press strength.

This study evaluated the influence of cadence on the Young Men's Christian Association (YMCA) bench press test for predicting 1 repetition maximum (1RM) bench press test performance. Fifty-eight medical students (37 men, 21 women) were evaluated for anthropometric variables (age, height, weight, fat-free mass, and percent fat), 1RM bench press, and 2 cadence tests of muscular endurance performed at cadences of 30 and 60 repetitions per minute (reps.min(-1)). Each test was performed on a separate day, with 5 days rest in between. There was no significant difference among the number of repetitions performed at each cadence by men, whereas women performed significantly more repetitions at the slower cadence. Repetitions at either cadence were good predictors of 1RM bench press in both genders (men: 30 reps.min(-1), r(2) = 0.757, standard error of the estimate [SEE] = 8.0 kg; 60 reps.min(-1), r(2) = 0.884, SEE = 8.2 kg; women: 30 reps.min(-1), r(2) = 0.754, SEE = 3.1 kg; 60 reps.min(-1), r(2) = 0.816, SEE = 2.7 kg). The addition of anthropometric dimensions to the regression equations did not improve predictive accuracy. Using both fast and slow cadences, the YMCA bench press test can provide a valid estimation of 1RM performance in untrained young men and women.