Keywords
wellbeing
distress
University of the Witwatersrand
How to Cite
Abstract
Background. Globally, medical students experience a low level of well-being, high levels of distress and burnout.
Objective. To evaluate the well-being of fourth year students in the Bachelor of Medicine and Surgery (MB BCh) degree at the University of the Witwatersrand (WITS).
Methods. A cross-sectional study was conducted among 333 fourth year MB BCh students at WITS in 2023. The minimum sample size was 179 (95% CI, p<0.05). The students completed an online questionnaire using the Medical Students Well-being Index (MSWBI). Multivariable logistic regression was used to identify predictors of severe distress.
Results. The response rate was 53.75%. Most participants were distressed (97.06%) and many (74.71%) severely distressed. Several factors were associated with distress, including sex, age, funding, underutilisation of mental health resources, lack of faculty support, preferred time off and perception of the academic content. Predictors of severe distress were age, school leavers, perceived distress, exercise and feelings about grades. Discussion. We found higher levels of distress than reported in other developing countries. More than half (53.57%) of the participants were depressed, which is notably higher than the 36.4% previously reported in another South African study. Participants who self-identified as distressed were more than five times more likely to be severely distressed, however, mental health resources are still severely underutilised.
Conclusion. This study provided insight into the distress levels among fourth year MB BCh students at WITS and the contributing factors. Early intervention during the students’ pre-clinical years of training is crucial and would benefit both the students and the future patients under their care.
This study was able to provide insight into the level of distress in South African medical students, as well as the factors contributing to their distress. Further research can be aimed to assess the wellbeing of students in the clinical phase of medical training.
References
Oxford University Press. Oxford English Dictionary. Version 11.7.712, 2020. https://www.oed.com/ (accessed 20 November 2023).
Jafari N, Loghmani A, Montazeri A. Mental health of medical students in different levels of training. Int J Prev Med 2012;3(Supplementary 1):S107.
Rahimi B, Baetz M, Bowen R, Balbuena L. Resilience, stress, and coping among Canadian medical students. Can Med Educ J 2014;5 (1):e5–e12. https://doi.org/10.36834%2Fcmej.36689
Lawrence D, Wu F, Ireland M, Hafekost K. National mental health survey of doctors and medical students. Beyond Blue; 2013.
Dyrbye LN, West CP, Satele D, et al. Burnout among US medical students, residents, and early career physicians relative to the general US population. Acad Med 2014;89(3):443-451. https://doi. org/10.1097%2Facm.0000000000000134
Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA 2016;316(21):2214-2236. https://doi.org/10.1001%2Fjama.2016.17324
Van Niekerk L, Scribante L, Raubenheimer PJ. Suicidal ideation and attempt among South African medical students. S Afr Med J 2012;102(6):372-373. https://doi.org/10.7196%2Fsamj.5503
Fares J, Al Tabosh H, Saadeddin Z, El Mouhayyar C, Aridi H. Stress, burnout and coping strategies in preclinical medical students. N Am J Med 2016;8(2):75. https://doi.org/10.4103%2F1947-2714.177299
Farrell SM, Kadhum M, Lewis T, Singh G, Penzenstadler L, Molodynski A. Wellbeing and burnout amongst medical students in England. Int Rev Psychiatry 2019;31(7-8):579-583. https://doi.org/10.1080% 2F09540261.2019.1675960
Langness S, Rajapuram N, Marshall M, Rahman AS, Sammann A. Risk factors associated with student distress in medical school: associations with faculty support and availability of wellbeing resources. PLos One 2022;17(4):e0265869. https://doi.org/10.1371/journal.pone.0265869
Lu CM, Lien YJ, Chao HJ, Lin HS, Tsai IC. A structural equation modeling of mental health literacy in healthcare students. Int J Environ Res 2021;18(24):13264. https://doi.org/10.3390%2Fijerph182413264
Dyrbye LN, Szydlo DW, Downing SM, Sloan JA, Shanafelt TD. Development and preliminary psychometric
properties of a well-being index for medical students. BMC Med Educ 2010;10:1-9. https://doi.
org/10.1186%2F1472-6920-10-8
Van der Walt S, Mabaso WS, Davids EL, De Vries PJ. The burden of depression and anxiety among medical students in South Africa: A cross-sectional survey at the University of Cape Town. S Afr Med J 2020;110(1):69-79. https://doi.org/10.7196%2Fsamj.2019.v110i1.14151
Western M, Tomaszewski W. Subjective wellbeing, objective wellbeing and inequality in Australia. PLos One 2016 Oct 3;11(10):e0163345.
Jafari N, Loghmani A, Montazeri A. Mental health of medical students in different levels of training. Int J Prev Med 2012;3(Suppl1):S107. https://doi.org/10.1371/journal.pone.0163345
Schwartz CE, Stucky BD, Stark RB. Expanding the purview of wellness indicators: validating a new measure that includes attitudes, behaviors, and perspectives. Health Psychol Behav 2021;9(1):1031-1052. https://doi. org/10.1080%2F21642850.2021.2008940
Dyrbye LN, Schwartz A, Downing SM, Szydlo DW, Sloan JA, Shanafelt TD. Efficacy of a brief screening tool to identify medical students in distress. Acad Med 2011;86(7):907-914. https://doi. org/10.1097%2Facm.0b013e31821da615
PAHarris,RTaylor,RThielke,JPayne,NGonzalez,JG.Conde,Researchelectronicdatacapture(REDCap)– A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform. 2009 Apr; 42(2): 377-81.
PA Harris, R Taylor, BL Minor, V Elliott, M Fernandez, L O’Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda, REDCap Consortium, The REDCap consortium: Building an international community of software partners, J Biomed Inform. 2019 May 9. https://doi.org/10.1016/j.jbi.2019.103208
Raosoft Inc. Sample size calculator. Raosoft Inc, 2004. http://www.raosoft.com/samplesize.html (accessed 14 June 2022).
HaykalKA,PereiraL,PowerA,FournierK.Medicalstudentwellnessassessmentbeyondanxietyanddepression: A scoping review. PLos One 2022;17(10):e0276894. https://doi.org/10.1371%2Fjournal.pone.0276894
StataCorp L. Stata statistical software: Release 15 (2017). College Station, TX: StataCorp LP. 2017.
Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ 2016 Jan;50(1):132-49. https://doi.org/10.1111/medu.12927
Mian A, Kim D, Chen D, Ward WL. Medical student and resident burnout: a review of causes, effects, and prevention. J Fam Med Dis Prev 2018 Dec 31;4(4):1-8.
Olson KD. Physician burnout—a leading indicator of health system performance? Mayo Clin Proc 2017 Nov 1 (Vol. 92, No. 11, pp. 1608-1611). Elsevier. https://doi.org/10.1016/j.mayocp.2017.09.008
Brazeau CM, Schroeder R, Rovi S, Boyd L. Relationships between medical student burnout, empathy, and professionalism climate. Academic medicine. 2010 Oct 1;85(10):S33-6.
Rajapuram N, Langness S, Marshall MR, Sammann A. Medical students in distress: The impact of gender, race, debt, and disability. PLos One 2020;15(12):e0243250. https://doi.org/10.1371%2Fjournal.pone.0243250 28. Otten D, Tibubos AN, Schomerus G, et al. Similarities and differences of mental health in women and men: a systematic review of findings in three large German cohorts. Frontiers in Public Health. 2021 Feb 5;9:553071.Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc 2005;80(12):1613-1622. https://doi.org/10.4065%2F80.12.1613
Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed
solutions. Mayo Clin Proc 2005;80(12):1613-1622. https://doi.org/10.4065%2F80.12.1613
Enns MW, Cox BJ, Sareen J, Freeman P. Adaptive and maladaptive perfectionism in medical students: a longitudinal investigation. Med Educ 2001;35(11):1034-1042. https://doi.org/10.1111%2Fj.1365-
2001.01044.x
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2023 G Dove, M Botes, K Colborne, P Lestoalo, P Mashiane, S Moodley, E Naidoo, L Nyoka, P Sodo, A Dreyer