Objective To assess the exposure to different stressors and the prevalence of depression among medical students at different levels of education, taking gender differences into account.

Design  Students were asked to complete a new stress inventory called the Higher Education Stress Inventory (HESI), the Major Depression Inventory (MDI), slightly modified, and questions on suicidal ideation developed by Meehan.

Setting  The study was carried out at the Karolinska Institute Medical University, Stockholm, Sweden. Matched controls from the general population were used.

Participants  All registered students in Years 1, 3 and 6 were enrolled in the study (n = 342). The response rate was 90.4%.

Results  Year 1 students gave high ratings to the workload and lack of feedback stressors. Year 3 students gave high ratings to ‘Worries about future endurance/competence’ and ‘Pedagogical shortcomings’. In Year 6, both the latter factors were rated highly, but Year 6 students also gave higher ratings than the 2 other groups to ‘Non-supportive climate’. In all 3 cohorts students complained of lack of feedback. Female students gave higher ratings than males to 4 out of 7 factors. Several stress factors were identified as being associated with depression. The prevalence of depressive symptoms among students was 12.9%, significantly higher than in the general population, and was 16.1% among female students versus 8.1% among males. A total of 2.7% of students had made suicide attempts, but none during the previous year.

Conclusion  Year 1 students indicated experiencing the highest degree of pressure from studies. A gender difference regarding stress levels was also seen, where women reported higher levels of stress than men. Medical students had higher depression rates than the general population, and women students had higher rates than men.

Stress and depression among medical students: a cross-sectional study

OBJECTIVE To develop a model linking the processes and outcomes of workplace learning. METHODS We synthesised a model from grounded theory analysis of group discussions before and after experimental strengthening of medical students' workplace learning. The research was conducted within a problem-based clinical curriculum with little early workplace experience, involving 24 junior and 12 senior medical students. RESULTS To reach their ultimate goal of helping patients, medical students must develop 2 qualities. One is practical competence; the other is a state of mind that includes confidence, motivation and a sense of professional identity. These 2 qualities reinforce one another. The core process of clinical workplace learning involves 'participation in practice', which evolves along a spectrum from passive observation to performance. Practitioners help students participate by being both supportive and challenging. The presentation of clear learning objectives and continuous periods of attachment that are as personal to the student(s) and practitioner(s) as possible promote workplace learning. CONCLUSIONS The core condition for clinical workplace learning is 'supported participation', the various outcomes of which are mutually reinforcing and also reinforce students' ability to participate in further practice. This synthesis has 2 important implications for contemporary medical education: any reduction in medical students' participation in clinical practice that results from the patient safety agenda and expanded numbers of medical students is likely to have an adverse effect on learning, and the construct of 'self-directed learning', which our respondents too often found synonymous with 'lack of support', should be applied with very great caution to medical students' learning in clinical workplaces.

Experience‐based learning: a model linking the processes and outcomes of medical students' workplace learning

The available research indicates that the prevalence of stress is increasing among students studying in higher education. Issues such as student retention and student progression are becoming increasingly important for all universities. There are a significant number of studies that have examined stress and this paper critically reviews that research and identifies several issues that as yet have not been explored. The paper also highlights a number of key weaknesses in the current literature base. In previous studies there has been a focus on a quantitative approach, and research studies have been restricted to using as subjects individuals from a narrow range of disciplines. It is also suggested that there is a need to undertake longitudinal research to investigate individuals' stress experiences during the period they study at university.

Stress and the higher education student: a critical review of the literature

Objective Consumers are living longer, creating more pressure on the health system and increasing their requirement for self-care of chronic conditions. Despite rapidly-increasing numbers of mobile health applications (‘apps’) for consumers’ self-care, there is a paucity of research into consumer engagement with electronic self-monitoring. This paper presents a qualitative exploration of how health consumers use apps for health monitoring, their perceived benefits from use of health apps, and suggestions for improvement of health apps. Materials and Methods ‘Health app’ was defined as any commercially-available health or fitness app with capacity for self-monitoring. English-speaking consumers aged 18 years and older using any health app for self-monitoring were recruited for interview from the metropolitan area of Perth, Australia. The semi-structured interview guide comprised questions based on the Technology Acceptance Model, Health Information Technology Acceptance Model, and the Mobile Application Rating Scale, and is the only study to do so. These models also facilitated deductive thematic analysis of interview transcripts. Implicit and explicit responses not aligned to these models were analyzed inductively. Results Twenty-two consumers (15 female, seven male) participated, 13 of whom were aged 26–35 years. Eighteen participants reported on apps used on iPhones. Apps were used to monitor diabetes, asthma, depression, celiac disease, blood pressure, chronic migraine, pain management, menstrual cycle irregularity, and fitness. Most were used approximately weekly for several minutes per session, and prior to meeting initial milestones, with significantly decreased usage thereafter. Deductive and inductive thematic analysis reduced the data to four dominant themes: engagement in use of the app; technical functionality of the app; ease of use and design features; and management of consumers’ data. Conclusions The semi-structured interviews provided insight into usage, benefits and challenges of health monitoring using apps. Understanding the range of consumer experiences and expectations can inform design of health apps to encourage persistence in self-monitoring.

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Mobile Health Apps to Facilitate Self-Care: A Qualitative Study of User Experiences.

The present study was conducted to provide future researchers and dental educators with an overview of stress amongst undergraduate dental students reported in the literature. This overview is needed for the development of a new questionnaire measuring the level of stressors including students, staff and process of dental education. In addition, the review can be used to modify dental curricula to decrease such stress and produce better dentists. Our study consisted of a systematic review of 49 peer-reviewed articles published between 1966 till October 2008 in English, discussing different aspects of stress amongst undergraduate dental students. These aspects are demographic variables of stress, sources of stress, impact of stress, indicators of stress, instruments measuring stress level and management of stress. Major sources of reported stress were related to examinations, clinical requirements and dental supervisors. Studies suggest using signs and symptoms for early detection of stress and proper intervention.

Stress amongst dental students: a systematic review

Introduction Medical education is long and emotionally taxing. It can involve levels of stress that lead to disruptions in both physical and mental health. This qualitative study explores the views of Year 5 medical students on the causes of stress throughout their undergraduate medical training.

Method  Semi-structured interviews were conducted with 21 final year medical students at the University of Birmingham between January and May 2001.

Results  Pressure of work, especially in terms of preparing for examinations and acquiring professional knowledge, skills and attitudes were reported as the most stressful aspects of medical training. Transition periods, particularly between school and medical school, preclinical and clinical training, and clinical training to approaching qualification were highlighted as particularly stressful. A perceived lack of support from the medical school authorities also appeared to add to student stress levels.

Discussion  Student stress may be alleviated by greater guidance and support from the medical school during crucial transition periods. Aspects of professional socialisation may also need to be addressed to reduce the levels of stress associated with undergraduate training for future generations of medical students.

Christina Radcliffe

Papers

Perceived stress during undergraduate medical training: A qualitative study