Skip to main content
Scheduled maintenance on Monday, June 3rd, with potential service disruption. Find out more.
Intended for healthcare professionals

Abstract

Medical students experience more stress than the general population, which over time can cause mental and physical disease, including burnout. Identifying factors impacting stress during early medical training could inform strategies to minimize its impacts throughout training and in clinical practice. This study surveyed 238 first-year osteopathic medical students to assess stress (Perceived Stress Scale; PSS), grit, sleep quality (Pittsburgh Sleep Quality Index; PSQI), physical activity (Godin-Shephard Leisure-Time Physical Activity Score; LTPA), and nutrition habits (Rapid Eating Assessment for Participants; REAP) within the first 2 weeks of starting medical school and again 10 weeks later. Incomplete responses were removed, leaving 204 study participants. We observed statistically significant decreases in grittiness (∆grit = −2.230%, P = .002) and physical activity (∆LTPA = −22.147%, P < .0001), while perceived stress (∆PSS = 34.548%, P < .0001) and poor sleep quality (∆PSQI% = 19.853, P < .0001) increased. Correlation analyses identified the strongest relationships were between ∆PSS vs ∆PSQI (r = .47, P < .0001) and ∆PSS vs ∆LTPA (r = −.20, P < .01). Multivariable linear regression analysis isolated ∆PSQI (P < .0001) and ∆LTPA (P = .012) as statistically significant predictors of ∆PSS. These results suggest early, repeated curricular interventions focused on physical activity and sleep hygiene may help students better manage stress during medical education.

Get full access to this article

View all access and purchase options for this article.

References

1. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. Medical students, residents, and early career physicians relative to the general U.S. Population. Acad Med. 2014;89(3):443-451.
2. Heinen I, Bullinger M, Kocalevent RD. Perceived stress in first year medical students - associations with personal resources and emotional distress. BMC Med Educ. 2017;17(1):4.
3. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ. 2005;39(6):594-604.
4. Mazurkiewicz R, Korenstein D, Fallar R, Ripp J. The prevalence and correlations of medical student burnout in the pre-clinical years: A cross-sectional study. Psychol Health Med. 2012;17(2):188-195.
5. Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians: A systematic review. JAMA. 2018;320(11):1131-1150.
6. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: Contributors, consequences and solutions. J Intern Med. 2018;283(6):516-529.
7. Duckworth AL, Peterson C, Matthews MD, Kelly DR. Grit: Perseverance and passion for long-term goals. J Pers Soc Psychol. 2007;92(6):1087-1101.
8. Jumat MR, Chow PKH, Allen JC, et al. Grit protects medical students from burnout: A longitudinal study. BMC Med Educ. 2020;20(1):266.
9. Burkhart RA, Tholey RM, Guinto D, Yeo CJ, Chojnacki KA. Grit: A marker of residents at risk for attrition? Surgery. 2014;155(6):1014-1022.
10. Ayala EE, Winseman JS, Johnsen RD, Mason HRC. U.S. medical students who engage in self-care report less stress and higher quality of life. BMC Med Educ. 2018;18(1):189.
11. Almojali AI, Almalki SA, Alothman AS, Masuadi EM, Alaqeel MK. The prevalence and association of stress with sleep quality among medical students. J Epidemiol Glob Health. 2017;7(3):169-174.
12. Azad MC, Fraser K, Rumana N, et al. Sleep disturbances among medical students: A global perspective. J Clin Sleep Med. 2015;11(01):69-74.
13. Ayala EE, Berry R, Winseman JS, Mason HR. A cross-sectional snapshot of sleep quality and quantity among US medical students. Acad Psychiatr. 2017;41(5):664-668.
14. Ahmed N, Sadat M, Cukor D. Sleep knowledge and behaviors in medical students: Results of a single center survey. Acad Psychiatr. 2017;41(5):674-678.
15. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-396.
16. Gans KM, Risica PM, Wylie-Rosett J, et al. Development and evaluation of the nutrition component of the Rapid Eating and Activity Assessment for Patients (REAP): A new tool for primary care providers. J Nutr Educ Behav. 2006;38(5):286-292.
17. Blake H, Stanulewicz N, Mcgill F. Predictors of physical activity and barriers to exercise in nursing and medical students. J Adv Nurs. 2017;73(4):917-929.
18. Yau YHC, Potenza MN. Stress and eating behaviors. Minerva Endocrinol. 2013;38(3):255-267.
19. AlJaber MI, Alwehaibi AI, Algaeed HA, Arafah AM, Binsebayel OA. Effect of academic stressors on eating habits among medical students in Riyadh, Saudi Arabia. J Fam Med Prim Care. 2019;8(2):390-400.
20. Frank E, Tong E, Lobelo F, Carrera J, Duperly J. Physical activity levels and counseling practices of U.S. medical students. Med Sci Sports Exerc. 2008;40(3):413-421.
21. 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;4:094.
22. Godin G. The godin-shephard leisure-time physical activity questionnaire. Health Fit J Can. 2011;4(1):18-22.
23. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatr Res. 1989;28(2):193-213.
24. Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res. 2012;6(4):121-127.
25. Miller-Matero LR, Martinez S, MacLean L, Yaremchuk K, Ko AB. Grit: A predictor of medical student performance. Educ Health Abingdon Engl. 2018;31(2):109-113.
26. Rao WW, Li W, Qi H, et al. Sleep quality in medical students: A comprehensive meta-analysis of observational studies. Sleep Breath. 2020;24(3):1151-1165.
27. Dietch JR, Taylor DJ, Sethi K, Kelly K, Bramoweth AD, Roane BM. Psychometric evaluation of the PSQI in U.S. College students. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 2016;12(8):1121-1129.
28. Amireault S, Godin G. The Godin-Shephard leisure-time physical activity questionnaire: Validity evidence supporting its use for classifying healthy adults into active and insufficiently active categories. Percept Mot Skills. 2015;120(2):604-622.
29. Shim JS, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiol Health. 2014;36:e2014009.
30. Segal-Isaacson CJ, Wylie-Rosett J, Gans KM. Validation of a short dietary assessment questionnaire: The Rapid Eating and Activity Assessment for Participants short version (REAP-S). Diabetes Educat. 2004;30(5):774. 776, 778 passim.
31. Micha R, Peñalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 2017;317(9):912.
32. Kant AK, Graubard BI. Eating out in America, 1987-2000: Trends and nutritional correlates. Prev Med. 2004;38(2):243-249.
33. Lachat C, Nago E, Verstraeten R, Roberfroid D, Van Camp J, Kolsteren P. Eating out of home and its association with dietary intake: A systematic review of the evidence. Obes Rev Off J Int Assoc Study Obes. 2012;13(4):329-346.
34. American Association of Colleges of Osteopathic Medicine. AACOMAS Applicant and Matriculant Profile Summary Report: 2018 Entering Class. Bethesda, MD: American Association of Colleges of Osteopathic Medicine; 2019:34.
35. American Association of Colleges of Osteopathic Medicine. 2019 AACOMAS Profile: Applicant and Matriculant Report. Bethesda, MD: American Association of Colleges of Osteopathic Medicine; 2021:32.
36. Sockrider MM, Maguire GP, Haponik E, Davis A, Boehlecke B. Attitudes of respiratory care practitioners and students regarding pulmonary prevention. Chest. 1998;114(4):1193-1198.
37. Frank E, Carrera JS, Elon L, Hertzberg VS. Predictors of US medical students’ prevention counseling practices. Prev Med. 2007;44(1):76-81.
38. Kelly AM, Townsend KW, Davis S, Nouryan L, Bostrom MP, Felix KJ. Comparative assessment of grit, conscientiousness, and self-control in applicants interviewing for residency positions and current orthopaedic surgery residents. J Surg Educ. 2018;75(3):557-563.
39. Vargas EJ, Zelis R. Integrating nutrition education into the cardiovascular curriculum changes eating habits of second-year medical students. J Clin Lipidol. 2014;8(2):199-205.
40. Boni RADS, Paiva CE, de Oliveira MA, Lucchetti G, Fregnani JHTG, Paiva BSR. Burnout among medical students during the first years of undergraduate school: Prevalence and associated factors. PLoS One. 2018;13(3):e0191746.
41. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: Causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613-1622.
42. Ball S, Bax A. Self-care in medical education: Effectiveness of health-habits interventions for first-year medical students. Acad Med. 2002;77(9):911-917.
43. Fisher JJ, Kaitelidou D, Samoutis G. Happiness and physical activity levels of first year medical students studying in Cyprus: A cross-sectional survey. BMC Med Educ. 2019;19(1):475.
44. Li J, Loerbroks A, Angerer P. Physical activity and risk of cardiovascular disease: What does the new epidemiological evidence show? Curr Opin Cardiol. 2013;28(5):575-583.
45. Vankim NA, Nelson TF. Vigorous physical activity, mental health, perceived stress, and socializing among college students. Am J Health Promot AJHP. 2013;28(1):7-15.
46. Dyrbye L, Harper W, Durning S, et al. Patterns of distress in US medical students. Med Teach. 2011;33:834-839.

Cite article

Cite article

Cite article

OR

Download to reference manager

If you have citation software installed, you can download article citation data to the citation manager of your choice

Share options

Share

Share this article

Share with email
EMAIL ARTICLE LINK
Share on social media

Share access to this article

Sharing links are not relevant where the article is open access and not available if you do not have a subscription.

For more information view the Sage Journals article sharing page.

Information, rights and permissions

Information

Published In

Article first published online: September 5, 2022
Issue published: November/December 2023

Keywords

  1. grit
  2. self-care
  3. medical students
  4. stress
  5. sleep
  6. nutrition
  7. physical activity

Rights and permissions

Copyright © 2022 The Author(s).
Request permissions for this article.

Authors

Affiliations

Alan Boyd, OMSIV
College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA (AB, KM, KBE, EO)
Kyle Mealand, OMS2
College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA (AB, KM, KBE, EO)
Kathaleen Briggs Early, PhD, RDN, CDCES
College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA (AB, KM, KBE, EO)
Emily Oestreich, PhD
College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA (AB, KM, KBE, EO)

Notes

Emily Oestreich, PhD, College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, 200 University Pkwy, Yakima, WA 98901, USA; e-mail: [email protected]

Metrics and citations

Metrics

Journals metrics

This article was published in American Journal of Lifestyle Medicine.

VIEW ALL JOURNAL METRICS

Article usage*

Total views and downloads: 314

*Article usage tracking started in December 2016


Articles citing this one

Receive email alerts when this article is cited

Web of Science: 1 view articles Opens in new tab

Crossref: 0

There are no citing articles to show.

Figures and tables

Figures & Media

Tables

View Options

Get access

Access options

If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:

ACLM members can access this journal content after logging in to their ACLM profile using their membership credentials and clicking the 'View American Journal of Lifestyle Medicine' button.

ACLM members can access this journal content after logging in to their ACLM profile using their membership credentials and clicking the 'View American Journal of Lifestyle Medicine' button.


Alternatively, view purchase options below:

Purchase 24 hour online access to view and download content.

Access journal content via a DeepDyve subscription or find out more about this option.

View options

PDF/ePub

View PDF/ePub

Full Text

View Full Text