Person and environmental factors associated with well-being in medical students
Highlights
► We assess well-being in medical students. ► This is associated with having higher professional and lifestyle expectations. ► Worrying about debt and high academic workload linked to poorer well-being. ► Being outgoing, conscientious, and stable related to better well-being.
Introduction
During medical school, medical students are exposed to demanding and heavy workloads. Several studies have shown that these students are under considerable psychological strain (Biro et al., 2010, Dahlin et al., 2005, Radcliffe and Lester, 2003) and that their mental health declines during the course of their training (Guthrie et al., 1998), although their well-being and well-being trajectory may not be different from students in other courses (Carson et al., 2000, Singh et al., 2004).
Well-being can be defined in terms of happiness and overall life satisfaction. People experience high levels of well-being when they feel pleasant emotions, engage in interesting activities, and when they are satisfied with their life (Diener, 1984). Some individuals will experience a high level of well-being despite adverse environmental conditions, while others will experience low levels despite favourable conditions (Seligman & Csikszentmihalyi, 2000). Well-being theorists suggest that personality, cognitions, goals, and coping efforts all play a role in influencing well-being (Diener, Suh, Lucas, & Smith, 1999).
Understanding factors that contribute to the well-being of medical students is important as this might allow appropriate support systems to be implemented. Despite a strong body of evidence from the international literature investigating medical students’ levels of stress, anxiety, depression, and burnout (e.g., Dahlin et al., 2005, Dyrbye et al., 2005, Dyrbye et al., 2006, Shariati et al., 2007, Tyssen et al., 2007), we know little about the factors that influence their positive state; that is, what keeps medical students feeling well.
Personality is regarded as one of the strongest predictors of well-being. Emotional stability and extraversion are typically associated with happiness, well-being, and positive affect, and neuroticism is associated with distress, poor well-being, and negative affect (Diener et al., 1999). The relationship between neuroticism and vulnerability to stress has been widely studied; however, the majority of studies specifically focus on medical post-graduate samples (e.g., Firth-Cozens, 2003, McManus et al., 2004) rather than medical students. Tyssen et al. (2007) examined the relationship between extraversion, neuroticism, and conscientiousness and stress in medical students and found that those high on extraversion and low on neuroticism and conscientiousness were more protected against stress.
There is an increased focus on specialty career choice by the medical education community due to medical students’ career goals changing in response to the changing health system, labour market (Australian Health Ministers’ Conference, 2004), and lifestyle needs (Dorsey, Jarjoura, & Rutecki, 2005). These changes have significant long-term implications for career development, lifestyle and quality of life; however, it is only in recent years that researchers have begun to study well-being in relation to career goals (Lent and Brown, 2008, Uthayakumar et al., 2010). We aimed to advance this line of inquiry by examining the relationship between career expectations and well-being, and between career barriers and well-being.
The outcomes of performing particular behaviours are dependent on the importance placed on the outcome by the individual (Lent, Brown, & Hackett, 1994). For example, if an individual believes they are able to attain their goal of working in a particular medical specialty, they might have positive expectations regarding achieving a certain amount of professional success and/or leisure time to pursue personal activities. Thus, expectations serve as a source of satisfaction, personal fulfilment, and happiness, which are principal elements of well-being (Diener, 1984).
Whilst beneficial conditions, such as a supportive environment, are assumed to increase the likelihood of enacting goals, perceived environmental barriers are likely to have a negative effect on setting and pursuing goals, and limit a person from achieving their potential. Consequently, perceived barriers restrict career options and impair an individual’s capacity to make optimal career decisions (Lent et al., 1994). Thus, when goals are thwarted, well-being is affected negatively (Lord, Diefendorff, Schmidt, & Hall, 2010).
Stress associated with the academic learning environment has been linked to depression, poor health, and poor academic performance. A heavy workload, examinations, and clinical performance were found to be the most significant causes of stress among medical students (Saipanish, 2003, Stewart et al., 1999). Saipanish (2003) reported that medical students worry about their examinations, falling behind in their learning, and receiving lower than expected marks. In addition to these concerns, Vitaliano, Russo, Carr, and Heerwagen (1984) found that peer competition, mastering the vast amount of knowledge, and the long hours of study were also causes of anxiety.
Debt has been found to produce stress and anxiety in medical students and to affect their well-being and career choices (Morra et al., 2008, Shariati et al., 2007). Students experience increased levels of stress and poor academic performance as a result of financial debt (Dyrbye et al., 2005), and students who worry about debt are more at risk of stress and poor performance (Ross, Cleland, & Macleod, 2006).
Studies investigating gender differences in the mental health of medical students have produced mixed results (see Dyrbye et al., 2006, for a review of US and Canadian literature), with some researchers finding that psychological distress is higher among female medical students (Dahlin et al., 2005, Shariati et al., 2007, Tyssen et al., 2007), while others have found no gender differences (Hojat et al., 1999, Richman and Flaherty, 1990). The vast majority of studies have focused on symptoms of anxiety and depression in male and female medical students, although few studies have tested potentially important person and environmental correlates (Dyrbye et al., 2006).
The aim of the present study was to identify person and environmental factors that were associated with optimal psychological functioning of medical students. Based on previous theory and research, it was hypothesised that well-being would be positively related to extraversion, conscientiousness, agreeableness, professional expectations, lifestyle expectations, and gender (being male), and negatively associated with neuroticism, career barriers, debt, and academic stress. Further research aims were to determine whether there were relationships between well-being and openness to experience, age, and year level.
Section snippets
Participants
Medical students in years 2–6 from 11 Australian medical schools across all States/Territories participated in the study. These were drawn from approximately 1000 students who were recruited between 2007 and 2009 as part of a wider project tracking the career choices of medical students and junior doctors.
Psychological well-being
This was assessed using the 5-item World Health Organisation (WHO-5) Well-Being Index (World Health Organization., 1998). The scale measures positive mood, vitality, and general interest over
Results
Participants were 755 medical students aged between 18 and 57 years (M = 24.6, SD = 5.5). There were 119 in year 2, 251 in year 3, 281 in year 4, 73 in year 5 and 31 in year 6. The sample was predominantly Caucasian, and 66% were women. Based on participation in the larger cohort study, the response rate in 2010 was 87%.
Discussion
Identifying the person and environmental factors associated with well-being in medical students represents an important step in raising awareness of health issues, and creates the opportunity for providing support to students during medical school. Our findings supported the hypothesised relationships between well-being and the person variables of extraversion, conscientiousness, neuroticism, professional expectations, and lifestyle expectations, and between well-being and the appraised
Acknowledgement
This study was funded by an Australian Research Council (ARC) Discovery Grant.
References (43)
- et al.
Medical student distress: Causes, consequences, and proposed solutions
Mayo Clinic Proceedings
(2005) - et al.
Big 5 correlates of three measures of subjective well-being
Personality and Individual Differences
(2003) - et al.
Toward a unifying social cognitive theory of career and academic interest, choice, and performance
Journal of Vocational Behavior
(1994) - et al.
Measuring personality in one minute or less: A 10-item short version of the Big Five Inventory in English and German
Journal of Research in Personality
(2007) - et al.
Gender differences in medical student distress: Contributions of prior socialization and current role-related stress
Social Science and Medicine
(1990) - et al.
Career decidedness as a predictor of subjective well-being
Journal of Vocational Behavior
(2010) - et al.
Measuring well-being rather than the absence of distress symptoms: A comparison of the SF-36 Mental Health Subscale and the WHO-Five Well-Being Scale
International Journal of Methods in Psychiatric Research
(2003) - et al.
Determinants of mental well-being in medical students
Social Psychiatry and Psychiatric Epidemiology
(2010) - et al.
Swiss residents’ speciality choices – Impact of gender, personality traits, career motivation and life goals
BMC Health Services Research
(2006) What is coefficient alpha? An examination of theory and applications
Journal of Applied Psychology
(1993)