Perceived Stress on Labor and Delivery (L&D) During OB/GYN Clerkship From Students, Residents, and Faculty's Perspectives

Abstract

BACKGROUND: Appropriate stress levels can stimulate medical trainees to think and react quickly. However, little is known about the effects of stress on medical students' learning on L&D which is characterized by a complex, dynamic and unpredictable teamwork environment. Likewise the specific factors contributing to students' stress on L&D have not been reported. METHODS: Individual interviews were conducted with 3 consecutive cohorts of students at the end of their OB/GYN clerkships and a group of OB/GYN residents and faculty through convenience sampling in 2015. Participants were asked to identify the most stressful clinical setting during the clerkship and factors contributing to the stress in this environment. Thematic analysis and manual coding were applied to code and synthesize the data to identify the perceived stressful factors among students, residents, and faculty. RESULTS: L&D was the most stressful learning environment during the OB/GYN clerkship as reported by 14/19 students (73.7%). A total of 11 stressful factors from 4 categories were identified: 2 (terminology, interacting with residents) classified as Interpersonal Communication; 4 (pace, logistics, intrinsic sensitive nature of L&D, non-routine schedule) considered as Context; 3 (crisis, emergency, patient refusal of student involvement) fell into Clinical Scenario; 2 (student role and assignment, the amount of new knowledge and skills required) identified as Learning Tasks. Most residents and faculty (75%) reported that factors from Context would contribute to students' stress on L&D, and all students (100%) agreed. The majority of residents and faculty believed factors from Learning Tasks were stressful for students; but only 26.3% of students shared the same perception. DISCUSSION: Context factors contributing to stress were perceived by students, residents and faculty alike as contributing to stress and considered non-controllable, whereas OB/GYN residents and faculty differed in the perception of the effects of Learning Tasks on stress from students' perception. Clerkship programs are encouraged to integrate preparation of Context into curriculum through educational interventions to optimize students' stress level without increasing residents' and faculty's teaching pressure.