Stress In Medical Education Research Articles

Perceived Stress in Medical Education: Relationship with Empathy and Stigmatisation

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.

IJCM_358A: A Study of Adversity Quotient, Emotional Quotient and Spiritual Quotient among Medical Undergraduates in Nanded District of Maharashtra

Background: Medical Education deals with vast curriculum, human interactions and huge amount of stress. The changing scenario in medical education with introduction of CBME pattern, just having high Cognitive Intelligence is not enough to achieve academic success. With increasing stress in medical education and uncertainties like Covid-19, it is high time we think beyond Intelligence quotient for professional success. Adversity Quotient (AQ) is a measure of a person’s ability to cope with and overcome adversity. Emotional Quotient (EQ) measures person’s ability to identify and manage their own emotions as well as emotions of others. Spiritual Quotient (SQ) correlates to a person’s awareness and consciousness. Objectives: This study aims to assess AQ, EQ and SQ among Medical Undergraduate students and correlation between them. Methodology: A cross sectional study was conducted from November 2022 to October 2023 on 466 Medical Undergraduate students in Dr Shankarrao Chavan Government Medical college, Nanded, Maharashtra. Data was collected using predesigned, pretested, semi structured e-questionnaire. Data was compiled in MS Excel and analyzed using SPSS. Results: The participants included 262 males and 204 females. The mean AQ, EQ and SQ were 144.28, 329.81 and 57.14 respectively. The study showed high positive correlation between AQ and SQ (r=0.807; p= 0.000), AQ and EQ (r= 0.760; p= 0.000) and EQ and SQ (r= 0.871; p= 0.000) and correlation was significant at 0.01 level (2 tailed). Conclusion: This study concludes high positive correlation between AQ and SQ, AQ and EQ, EQ and SQ. Exploring these quotients helps students become more resilient and better prepared to cope up with the curriculum.

RELIABILITY, VALIDITY, AND FACTOR STRUCTURE OF THE 12-ITEM GENERAL HEALTH QUESTIONNAIRE (GHQ-12) AMONG STUDENTS AT CAN THO UNIVERSITY OF MEDICINE AND PHARMACY

Background: Stress in medical education has been inevitable among medical students. The prevalence of mental health problems among medical students is increasing, requiring a reliable tool for accessing assessments. The General Health Questionnaire (GHQ-12), designed to screen for mental disorders and psychological stress, is a promising tool. Although the factor structure of GHQ-12 has been studied internationally, it is still unclear in Vietnam. Objectives: To evaluate the reliability, validity, and factor structure of the Vietnamese version of the GHQ-12 questionnaire. Materials and method: An analytic cross-sectional study of the online Microsoft survey on 1763 students majoring in medicine, traditional medicine, and preventive medicine at Can Tho University of Medicine and Pharmacy from May 2022 to May 2023. Results: Samples in the study comprised 1763 respondents, out of whom male respondents were 42.8%, and female respondents were 57.2%. The average age was 22.62 with the highest proportion being the age group 18-29 years old (95.7%). Our research subjects were mainly studying medicine (86.5%), and the remaining disciplines included Traditional Medicine (8.1%) and Preventive Medicine (5.4%). The average GHQ-12 score was 16.22 points with the mean score obtained on item 5 (1.74) being the highest, indicating that most students were under strain. Cronbach's alpha coefficient of 0.893 showed an appropriate level of confidence. A two-factor structure with nine categories of “negative items” (2, 5, 6, 9, 10) and “positive items” (1, 3, 4, 8) had a cumulative variance of 60.175% drawn from the study. Conclusions: The Vietnamese version of GHQ-12 has enough reliability and validity to assess the mental health of medical students. The results indicated that students had higher-than-average scores, meaning poorer mental health. Furthermore, the study revealed a two-factor structure with nine categories including “negative items” and “positive items” with a cumulative variance of 60.175%. The two-factor structure suggests that GHQ-12 can be a multidimensional measure.

Assessment of Depression, Anxiety and Stress among the Undergraduate Physiotherapy Students

Background: Today, psychological morbidities such as depression, anxiety and stress are most common psychiatrichealth issues worldwide. Stress in medical education especially among the undergraduate students has become aglobal phenomenon nowadays. According to WHO, depression is the most common mental disorder, characterisedby sadness, loss of interest or pleasure, feelings of guilt or low self-worth, low energy and poor concentration anddisturbance in sleep or appetite, Anxiety disorders are characterised by excessive fear and worry and relatedbehavioural disturbances and stress is defined as a state of worry or mental tension caused by a difficult situation.This study is important to identify the risk factors of depression, anxiety and stress among the undergraduatephysiotherapy students, as it affects their health as well as their academic achievements. The aim and objective ofthis study is to assess depression, anxiety and stress among the undergraduate physiotherapy students by usingDASS-21 scale.Methods: This is an observational study was conducted in a Physiotherapy College in Maharashtra. The totalduration of this study was 6 months from October 2022 to March 2023. Data was collected from 43 undergraduatephysiotherapy students from first year to fourth year by using a DASS-21 questionnaire.Conclusion: Psychological illness in the form of depression, anxiety and stress have been reported in substantialproportion of undergraduate. Depression has been reported in 76.74% of students, while anxiety and stresswere found in 86.05% and 83.72% respectively. Organized interventions should be initiated to prevent excessivepsychological illness among undergraduate physiotherapy students.

A Cross-Sectional Study on Empathy and its Association With Stress in Medical Students

Introduction: Empathy is the cornerstone of the doctor-patient relationship and a crucial quality associated with better patient compliance and clinical outcomes. This study aims to assess the level of empathy and its association with the level of stress in 3rd and 4th year medical students Methods: This cross-sectional study was conducted in Kathmandu Medical College after taking ethical approval from the Institutional Review Committee and informed written consent from all the participants. The respondents completed a structured questionnaire including demographic profile, Jefferson Scale of Empathy-Student Version, and Perceived Stress Scale. Data were entered and analyzed in Statistical Package for the Social Sciences version 20. Results: A total of 255 questionnaires were obtained with a response rate of 85.2%. The mean empathy score was 101.79 (SD = 11.26) and the mean perceived stress score was 18.55(SD = 5.56). There was a statistically significant negative correlation between empathy and stress (p-value <0.01) and similar negative correlations were seen in sub-group analysis. Female students had higher empathy scores compared to their male counterparts (p-value <0.01). Fourth-year students reported lower empathy scores than third-year students (p-value <0.05). Conclusion: Stress was found to be a significant determinant of empathy among medical students. Medical educators must be aware of this and should try to incorporate means to alleviate stress in medical education. Furthermore, effective stress management techniques to preserve empathy in medical students with a view to improve clinical competency and achieve optimum patient care needs to be studied.

Inventory of Sources of Stress During Medical Education - Further Validation

IntroductionThe Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA.ObjectivesTo further validate the ISSME using Confirmatory Factor Analysis and to analyze the psychometric properties of a new version including additional sources of stress.MethodsParticipants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS).ResultsConfirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274; RMSEA=.0581, p<.001; CFI=.917; TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ2/df=3.513; RMSEA=.061, p<.001; CFI=.88.; TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students.ConclusionsThis further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.DisclosureNo significant relationships.

Inventory of Sources of Stress During Medical Education - Further Validation

Introduction The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA.ObjectivesTo further validate the ISSME using Confirmatory Factor Analysis and to analyze[ATP1] the psychometric properties of a new version including additional sources of stress.MethodsParticipants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS).ResultsConfirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274; RMSEA=.0581, p<.001; CFI=.917; TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ2/df=3.513; RMSEA=.061, p<.001; CFI=.88.; TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students.Conclusions This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.DisclosureNo significant relationships.

Emotional Intelligence and Perceived Stress in Medical Education: A Questionnaire Based Survey among Medical studens

Aim: To investigate the levels of EI and perceived stress (PS) among two groups of healthcare students (medical and dental) and examined their relationship. Methods: A cross-sectional questionnaire survey was conducted among medical and dental undergraduates and interns at CMH Lahore Medical College and Institute of Dentistry to assess their levels of EI and PS. Participants were assessed on self-administered Sterrett’s EI questionnaire and Perceived Stress Scale (PSS). The data col-lected from 627 participants was analyzed using SPSS version 24. Results: Correlational analysis showed an inverse relationship between EI and PS among medical and dental un-dergraduates. Significant association was observed between level of EI and year of study for both the disciplines. Majority of the participants reported moderate levels of EI and PS. Conclusion: EI can positively affect the students’ ability to perform well under stressful situations in healthcare education. Undergraduate curriculum should be designed to focus on EI based education in order to enable healthcare students to cope well with the stress related to their clinical training. Keywords: Emotional Intelligence, stress, medical education, medicine, dentistry

STRESS, STRESSORS, AND COPING STRATEGIES BETWEEN PRE-CLINICAL AND CLINICAL MEDICAL STUDENTS AT UNIVERSITI TUNKU ABDUL RAHMAN

Stress in medical education has been inevitable among medical students. However, the prevalence of stress among pre-clinical and clinical medical students differed by year of study. There were several stressors reported to affect medical students. Therefore, effective coping strategies were applied to manage the stress faced by medical students. The aim of this study was to determine the prevalence of stress, stressors and coping strategies comparing pre-clinical and clinical Universiti Tunku Abdul Rahman (UTAR) medical students, and the associated stressors and stress among them. This was a cross-sectional study with a study population of 223 medical students. Universal sampling was used. A self-administered questionnaire which included socio-demographic characteristics, the General Health Questionnaire (GHQ-12), the Medical Students Stressor Questionnaire (MSSQ) and the Brief COPE Inventory were used in this study. The overall prevalence of stress among medical students was 48.15%. Clinical students had a higher prevalence of stress (53.73%) compared to pre-clinical students (39.02%). Year 3 students had the highest prevalence of stress (64.58%) compared to other years of study. Nearly 1 out of 2 medical students were stressed (48.15%). Academic Related Stressor ranked the highest and Acceptance was the most practiced coping strategy. The only associated stressor with stress was Academic Related Stressor.

Reducing stress among medical students: A qualitative study of students' perspectives.

Background:Qualitative studies on students' perspectives about stress in medical education are sparse but nonetheless potentially relevant.Aim:The aim of the study was to assess the proportion of students who considered medical education to be excessively stressful and to elicit students' perspectives about ways to reduce stress in medical education.Materials and Methods:All medical undergraduate students of the college were asked about various aspects of stress in medical training using a self-rated questionnaire. Qualitative answers about the ways of reducing stress were also obtained using the questionnaire.Results:Medical education was considered to be excessively stressful by 265 (55.1%) students. The most common themes expressed for reducing the stress of medical education included those of “less frequent exams,” “more spare time,” and “slowing the pace of study or reducing syllabuses.”Conclusion:Majority of students considered medical training to be stressful and curricular overload is an important reason for the same.

Effects of Stress and Stress Hormones on Heart Rate Variability Parameters in 1st Year Medical Students

Stress in present world is inevitable where each individual in pursuit of achieving the maximum undergoes through this event. stress in medical education has resulted in decreasing the confidence of students and cause of various abnormal psychological conditions. Anxiety induced stress is common and this exaggerates during the time of examinations. This altered state of mind results in variation of heart rate variability indices and biochemical parameters which needs to be examined. The present study attempts to correlate stress with biochemical and HRV parameters. The present study inducted first year medical graduate course students after obtaining informed consent. 30 students participated in the study among them 18 were male and 12 female students with mean age of 17.9±0.55 years The students were subjected for 5minute recording of ECG under standard conditions for heart rate variability parameters. The recording of these parameters was done once when the students joined the course and the second recording was obtained after 6 months when the 2ndInternal examination Viva-voce were conducted similarly for evaluation of the biochemical physiological stressors was evaluated by collecting 5ml of venous blood and subjected to serum cortisol and uric acid levels analysis immediately using Fully automated Bidirectionally Interfaced Chemi Luminescent Immuno Assay for cortisol and Photometry for uric acid levels twice when the recording of heart rate variability (HRV) was done. Results were subjected to statistical analysis using statistical software sPss 20.0. students ”t” test and Pearson's tests were done. A p value of <0.05 was considered to be statistically significant. Our results showed correlation of uric acid levels with time domain parameters of heart rate variability and LF/HF ratio of frequency domain. The cortisol levels could not directly link with heart rate variability parameters. Serum cortisol and uric acid levels are good indicators for determination of stress as demonstrated in our study of academic environment. Though we could establish uric acid levels correlating with decrease in short term recording of heart rate variability parameters. We would suggest further studies with larger sample size and recordings during university examinations which would predict its usefulness. We suggest academic stress can lead to chronic illness and thus detoriate the quality of life lead by health professionals. Hence we suggest early intervention and change curriculum as well as evaluation process which can reduce the stress perceived by students.

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students

BackgroundMedical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI).MethodsThe reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical students. The K-HESI, Beck Depression Inventory (BDI) and questions regarding quality of life (QOL) and self-rated physical health (SPH) were administered.ResultsExploratory factor analysis of the K-HESI identified seven factors: Low commitment; financial concerns; teacher-student relationship; worries about future profession; non-supportive climate; workload; and dissatisfaction with education. A subsequent confirmatory factor analysis supported the 7-factor model. Internal consistency of the K-HESI was satisfactory (Cronbach’s α = .78). Convergent validity was demonstrated by its positive association with the BDI. Known group validity was supported by the K-HESI’s ability to detect significant differences on the overall and subscale scores of K-HESI according to different levels of QOL and SPH.ConclusionsThe K-HESI is a psychometrically valid tool that comprehensively assesses various relevant stressors related to medical education. Evidence-based stress management in medical education empirically guided by the regular assessment of stress using reliable and valid measure is warranted.

Perceived stress among medical students: To identify its sources and coping strategies

Context: Stress in medical education is common and process-oriented. It often exerts a negative effect on their academic performance, physical health, and psychological well being. Aims: This study aims at identification of such susceptible students in the early stage i.e. first year of medical education, and to provide them essential support in the form of an intervention program to lessen the negative consequences of stress. Materials and Methods: A cross-sectional survey was carried out among the First MBBS students of NKP Salve Institute of Medical Sciences and Research Center, Nagpur, India. A 41-item questionnaire was designed to assess the sources of stress and their severity. Likert's 5-point scale was used to quantify the extent of severity on each item. Coping strategies adopted by students were assessed by using a 22-item stress inventory, and a questionnaire based on 19 institutional stress-reducing factors was used to identify its role. Results: The survey resulted into an overall response rate of 87% (131 out of 150 students). Median stress level based on 41 items was evaluated for each student. About 29% (40 students) had median stress level greater than 3. Female students were more stressed (17.19%) than male students (14.93%). The study revealed that students generally adopt active coping strategies rather than avoidant strategies like alcohol and drug abuse. The study indicated that emotional support system is a major stress-relieving factor for students. Conclusion: Prevalence of perceived stress is high among medical students. It seems that academic-related problems are greater perceived stressors. Review of academics, exam schedules and patterns, better interaction with the faculty and proper guidance, intervention programs and counseling could certainly help a lot to reduce stress in medical students.

A qualitative study of how doctors use impression management when they talk about stress in the UK

Objectives - To examine how junior doctors talk about experiences and perceptions of stress in order to better understand the socio-cultural influences of stress in medical education. Methods - In depth semi-structured interviews were conducted with 10 doctors who were at the end of the first year of the UK Foundation Programme (FY1, equivalent to the intern year). A discourse analysis approach was used to analyse the findings. Results - Participants were found to typically normalise, deflect or trivialise their own experiences of stress. Consistent patterns of talking about stress; 'busyness', 'patient responsibility' and being the 'good doctor' were identified. These patterns formed interpretive repertoires that can be viewed as functioning as a form of impression management. The repertoires allow doctors to talk about their views and experiences of stress as a wider professional issue, without risk of being judged on how an inability to cope with stress might reflect on their own performance as a doctor. Conclusions - Consistent patterns of talking about stress exist in medical education and shape individual and organisational responses. Doctors who are not coping with stress may risk increased harm by not seeking help as a consequence of prolonging attempts to maintain the impression of coping. Greater sensitivity is required where stress is simply constructed as an environmental factor or where those who admit to not coping become marginalised. Medical educators require greater awareness of the dominant stress repertoires employed within their organisation.

Stress in Medical Education: a global issue or Much Ado About Nothing specific?

The South-East Asian Journal of Medical Education (SEAJME) is the culmination of the SEARAME's vision to bring together medical educationists in the region to promote collaborative efforts toward uplifting the standards of medical education in the region and beyond through dissemination of knowledge. This journal will be the ideal platform to disseminate research findings and stimulate discussion among experts in the field. Open access policy of the journal will facilitate this ideal.From November 2019, The South-East Asian Journal of Medical Education (SEAJME) is indexed in EuroPub

Inventário de Fontes de Estresse Acadêmico no Curso de Medicina (IFSAM)

O Inventário de Fontes de Estresse Acadêmico no Curso de Medicina (IFSAM) foi desenvolvido para caracterizar as principais fontes de estresse acadêmico dos estudantes da Faculdade de Medicina da Universidade do Porto (FMUP) e a intensidade com que são experienciadas. O inventário (31 itens) foi construído por meio de entrevistas semiestruturadas a estudantes (n = 80) dos seis anos da licenciatura. Suas propriedades psicométricas foram testadas num estudo com 251 estudantes dos seis anos do curso (160 do sexo feminino e 91 do sexo masculino). A validade de constructo foi avaliada mediante análise fatorial que resultou numa solução de cinco fatores ("exigências do curso", "exigências humanas", "estilos de vida", "competição" e "adaptação") com 54,8% da variância explicada e boa representatividade do constructo. O IFSAM total evidencia ainda uma boa fidelidade, com um coeficiente de consistência interna de.88. Os resultados revelam que o IFSAM apresenta boas características psicométricas na amostra, podendo constituir um instrumento útil na avaliação das fontes e intensidade de estresse acadêmico do curso de Medicina noutras instituições.

Perception of faculties regarding the stress in medical education – a qualitative study.

BackgroundAs compared to other professional courses students of medical course are more prone to get depressed and commit suicide. Stress in medical education is responsible for it. AimTo understand the perception of faculties regarding the reasons of stress in medical education.Setting and DesignQualitative study done by focused group discussion.Materials and Methodsfour focused group discussions were performed. Each group discussion was attended by eight faculties. Open ended questions related to reasons for stress in medical education related to course and curriculum, environmental issue and students issue were asked and discussed. ResultsWe observed that long duration of medical course, comparison with other profession and language problem are the most important stress inducing factors related to course and curriculum. Regarding the environmental issues homesickness, financial mismanagement and cultural shock were important reasons for stress and burden of study, pre PG exams and lack of extracurricular activities were important stress inducing factors related to student’s issue.Conclusionfaculties are well aware of students problems and stress can be reduced profoundly by addressing the problems raised by them in study.

A relação entre o stress e os estilos de vida nos estudantes de medicina da Faculdade de Medicina do Porto.

Different studies have demonstrated that there are significant changes in the health and habits/life-style of university students, and it seems that Medical students also reveal a significant vulnerability to the adoption of health risk behaviours. The present study aims to (1) characterize the main sources of academic stress of the Medical School students of the University of Porto as well as the intensity with which they are experienced, (2) investigate the variations in academic stress and psychosocial variables, due to gender, year of course and displacement from home and (3) contribute, for the first time, to the understanding of stress and life-style of medical students in Portugal. The empirical study included a sample of 251 students from all 6 years of the course (160 females and 91 males), evaluated by the following instruments: (1) The Inventory of Sources of Academic Stress in Medical Education (ISASME), and the Portuguese versions of (2) the Brief Personal Survey (BPS), (3) the General Health Questionnaire 12 (GHQ-12), and (4) the Interpersonal Behaviour Survey-Brief (ICIBrief). In terms of overall levels of stress (GHQ-12), a prevalence of 58.2% of clinically significant stress symptoms was found, with the students from the basic cycle and those who are living away from home, presenting higher levels of stress. In terms of life-style, 47% of the students revealed health risk behaviours, with eating habits, physical exercise, alcohol and drug consumption, and body image being the main problem areas. Gender and year of course seem to have a significant influence on the variables studied, being the female students those who present higher levels of academic stress, stress responses (pressure/overload, physical distress, anxiety, anger/frustration, inefficiency, depression and loss of control), and low levels of coping confidence; the students of the basic cycle reveal higher levels of stress in managing their life-style (academic stress), general stress symptoms and stress responses. This study calls attention for the need of preventive intervention with medical students in order to prevent negative consequences of stress and improve their life-style by promoting individual and social resources.

Coping with entitlement in medical education.

Medical educators had hoped that increased elective time, decreased night call, ethics courses, and other efforts to address nontechnical issues and reduce stress in medical education would provide student physicians more time and encouragement for personal development and self-scrutiny and would promote the development of more healthy, humanistic, and self-motivated physicians.1 2 3 4 5 6 7 However, despite what many would agree is a richer educational atmosphere, there is little evidence that these and other innovations have had any enduring influence on the character of the physician who is produced by the improved system.7 If anything, many experts are voicing increasing concern about such problems . . .

Impairment Prevention in the Training Years

The new Mental Health Program for Physicians in Training, at UCLA, offers free psychiatric evaluation and short-term psychotherapy to UCLA medical students and house officers, utilizing a large group of physician volunteers from the clinical and regular faculties. The program features complete confidentiality and an off-campus setting and provides help in a number of specialized areas. It also conducts research on stress in medical education. A basic aim is to promote a sense of community in the medical profession by demonstrating the concern of mature practitioners for their young colleagues. It also seeks to foster greater sensitivity among young physicians by educating them about the importance of their own psychological needs. The UCLA program provides a model for mental health services that are low in cost, both to medical trainees and to the training institution, at a time of severe budget shrinkage.