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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 102-107

Level of stress among postgraduate junior residents during their postgraduation in medical colleges of Coastal Karnataka – A cross-sectional study


1 Department of Psychiatry, Yenepoya Medical College, Mangalore, Karnataka, India
2 Adult Mental Health Team, Dorothy Pattison Hospital, Black Country Partnership NHS foundation Trust, Walsall, UK

Date of Submission20-Feb-2021
Date of Acceptance28-May-2021
Date of Web Publication30-Dec-2021

Correspondence Address:
Dilshana Nafisa
Black Country Healthcare NHS Foundation Trust, Dorothy Pattison Hospital, Walsall, WS2 9XH
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_9_21

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  Abstract 


Background: Stress has been an unavoidable reality of resident's life. Postgraduates face numerous stressors in their medical training. Stress may indirectly lead to medical errors which negatively impact the quality of patient care. However, the severity varies among individuals. Here, we present a study where we looked into the levels of stress among postgraduate junior residents of Coastal Karnataka and its association with various sociodemographic and clinical variables.
Materials and Methods: This cross-sectional study conducted among postgraduate residents of various departments of seven medical colleges of Coastal Karnataka involved 236 participants. Ethical clearance was obtained from the institutional ethical committee. The sociodemographic and clinical variables of participants were collected using an online questionnaire. Assessment of stress level was done using Perceived Stress Scale.
Results: The study indicated statistically significant increase in stress level among females compared to males (P = 0.009). The year of postgraduation, number of years taken to join postgraduation, and subject of postgraduation did not make any significant difference in the level of stress. However, most of the postgraduates had moderate stress scale scores.
Conclusion: Postgraduation is indeed a time of incredible stress to all the residents. Our study was also able to indicate the same. There is a need to provide psychological support during their training.

Keywords: Postgraduation, resident, stress, training


How to cite this article:
Bhat M, Nafisa D, Kakunje A, Mithur R, Karkal R. Level of stress among postgraduate junior residents during their postgraduation in medical colleges of Coastal Karnataka – A cross-sectional study. J Curr Res Sci Med 2021;7:102-7

How to cite this URL:
Bhat M, Nafisa D, Kakunje A, Mithur R, Karkal R. Level of stress among postgraduate junior residents during their postgraduation in medical colleges of Coastal Karnataka – A cross-sectional study. J Curr Res Sci Med [serial online] 2021 [cited 2022 Jan 17];7:102-7. Available from: https://www.jcrsmed.org/text.asp?2021/7/2/102/334468




  Introduction Top


Postgraduates face numerous stressors in their medical training. Residency is a stressful period as residents need to work for long hours and they have high responsibility toward the lives of patients. Stress impairs decision-making, learning abilities, and skills. Stress leads to medical errors which may negatively impact the quality of patient care. Hence, it not only affects health-care providers but also affects patients.[1] Several studies have shown that burnout, anxiety, depression, fatigue, and distress are highest among doctors.[2]

Junior residents face high levels of job-related pressure as they have to perform the roles of student, medical professional, and teacher simultaneously. This can lead to high rates of burnout and physical complaints in them.[3] Stress affects every individual in a physiological and psychological way.[4] The psychological dysfunction due to stress often goes unnoticed and is neglected. Most of them fail to recognize mental strain completely and rely on denial and avoidance as coping strategies which are ineffective measures.[5] The workload and long working hours imposes a significant challenge to balance both professional and personal life.[6]

Stress management is very important during the period of postgraduation training. Social support by consultants and colleagues is necessary to reduce the work-related stress.[3] This study explores the level of stress in postgraduate junior residents during their postgraduation and the association between sociodemographic, clinical variable, and the stress level.


  Materials and Methods Top


This study was conducted at a University Campus in Southern India. This was a cross-sectional study using a convenient sampling method. The sample size was calculated using the formula: N = (Z21−α/2 p q)/d2

At 5% level of significance and 40% of anticipated proportion with a 7% of margin of error, the total sample size needed was 188. However, we included a total of 236 participants in our study. Ethical clearance was obtained from the institutional ethical committee (Protocol No: YEC2/441). The study was conducted over a period of 9 months from January 2020 to September 2020.

Postgraduate residents from various departments of seven medical colleges of Coastal Karnataka were included in the study. Data were collected using an online questionnaire after obtaining the consent. Postgraduate junior residents who were not willing to participate in the study and those with known psychiatric illness were excluded from the study. It was done to prevent the past psychiatric illness from causing increased stress levels in the study subjects which can lead to bias.

The sociodemographic and clinical variables of subjects were recorded in a semi-structured pro forma prepared for the clinical study using an online questionnaire. Perceived Stress Scale (PSS) by Sheldon Cohen was used for measuring the level of stress among the participants.[7] It is a 10-item self-administered questionnaire that measures the degree to which situations in one's life are appraised as stressful. Scores ranging from 0 to 13 were considered as low stress, 14–26 as moderate stress, and 27–40 as high perceived stress. A total of 15 min is needed to complete the questionnaires.

Statistical analysis was done using Statistical Package for the Social Sciences 22 (IBM Corporation, New York, USA) program running on windows operating system. Appropriate statistical tests such as Chi-square test, one-way ANOVA, and independent t-test were used.


  Results Top


A total of 236 participants were enrolled in the study out of which nine participants were excluded as they were diagnosed with psychiatric illness. Hence, a total of 227 participants were included in the study [Figure 1].
Figure 1: Flowchart of the study participants

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[Table 1] shows the sociodemographic details. Among the total participants, 120 (52.9%) were females and 107 (47.1%) were males. In the study population, 159 (70%) were between the age of 26 to30 years, 42 (18.5%) between 21 and 25 years, and 26 (11.5%) were more than 31 years of age. One hundred and fifty-eight (69.6%) participants were single and 66 (29.1%) of them were married. Among those who were married, 28 (12.4%) of them had children. Two hundred and three (89.4%) participants were from a clinical departments, followed by 22 (9.7%) from paraclinical departments and 2 (0.9%) from preclinical departments [Figure 2] and [Figure 3].
Table 1: Sociodemographic details

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Figure 2: Distribution of pre- and paraclinical departments

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Figure 3: Distribution of clinical departments

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One hundred and two (44.9%) postgraduates were studying their 1st year of postgraduation, 47 (20.7%) were in 2nd year, and 78 (34.4%) were doing their final year of their postgraduation. Majority of the postgraduates were staying in hostel (65.6%), followed by 49 (21.6%) of them were staying at home. One hundred and fifteen (50.7%) participants had joined postgraduation within 1 year of finishing their graduation degree, whereas 103 (45.4%) of them joined after 2–5 years and 9 (4%) participants joined postgraduation after 5 years of completing MBBS. Two-seven (11.9%) participants suffered from a chronic medical illness including bronchial asthma, chronic obstructive pulmonary disease, and hypertension. Use of substances such as alcohol, nicotine, and cannabis was reported by 43 (18.8%) subjects. Overall, 200 (88.1%) subjects had moderate level of PSS scores, 18 (7.9%) had mild, and 9 (4%) had high level of PSS scores [Figure 4] and [Table 2].
Figure 4: Distribution of Perceived Stress Scale scores

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Table 2: Prevalence of stress in each subgroup

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In our study, we compared the stress levels of postgraduates of various age groups. Most of the subjects of all age groups had moderate stress scale scores. However, the difference in stress levels between the age groups was not found to be significant (F = 1.54, P = 0.217). We found that stress levels were higher in females which is statistically significant (t = 2.65, P = 0.009) and majority of them had moderate stress scale scores (53.5%). We compared the stress level between married and unmarried postgraduates. However, there was no statistically significant difference (F = 0.18, P = 0.835). When we compared the stress levels of postgraduates studying in different years of postgraduation, we found no significant difference in their stress levels. However, majority of them among all the three years of postgraduation had moderate stress scale scores.

The place of stay during the postgraduation of various postgraduates may be different. Postgraduates may stay in home or hostel or in various other locations. When we compared their effect on stress, we found no significant difference (F = 0.60, P = 0.545). It is believed that years taken to join postgraduation may play a role in the level of stress. However, we could not find any statistically significant difference (F = 0.154, P = 0.858). The subject of postgraduation did not make any difference in causing stress which was proved by statistically insignificant result (P = 0.178). Similarly, chronic illness (P = 0.297) and substance use (P = 0.724) in postgraduates did not produce any significant difference on stress. However, most of the post graduates had moderate stress scale scores in our study sample.


  Discussion Top


This is a unique study performed on postgraduates of various departments of different medical colleges. Our study found that female residents have higher perceived stress. This finding is in line with various other studies by Boerjan et al., Hameed et al., and Ebrahimi and Kargar;[3],[8],[9],[10],[11],[12],[13] This could be due to excess family responsibilities and household activities performed by females.[10] The gender differences between males and females in terms of stress response may also play a role in this finding.[14] According to the study done by Boerjan et al., women residents had more health complaints.[3]

A study done by Ebrahimi and Kargar showed that stress increases with increasing age.[10] In contrast to this, our study found no significant difference in stress levels between the various age groups. Marriage is known to be an important stressful event in life. According to our study, marital status of the postgraduates did not have any significant effect on stress levels. The presence or absence of children also did not make any difference. This finding is in line with a study done by Ebrahimi and Kargar and Guruprakash et al. Their study reported no difference in stress levels between married and unmarried residents.[10],[13] The study done by Hameed et al. showed that married status was significantly associated with a higher prevalence of burnout. It was also attributed to increased responsibilities in married residents.[8] However, a study done by Tian et al. indicated that stress was less common among those who were married and those without children.[9]

A study done by Chew et al. on psychiatry residents showed that junior postgraduates have higher stress scores compared to the senior postgraduates.[15] Burnout is another significant problem affecting postgraduates. Bari et al; displayed burnout was high among post graduate residents as compared to junior consultants.[16] In contrast to the finding of the above studies, we found that year of postgraduation did not make any significant difference in stress levels.

The place of stay may play a role in determining the level of stress. However, we observed no difference in stress levels among postgraduates staying at home or hostel or in other location. The years taken to join postgraduation after completion of graduation may have an impact on stress levels. The study indicated no significant difference in the level of stress when the number of years taken to join postgraduation was assessed. This has been a unique finding which has not been studied previously.

Various studies have been done which looked into stress levels within different clinical departments. A study conducted by Ebrahimi and Kargar; reported that the highest stress score was observed among gynecology residents, whereas residents of dermatology had lowest stress scores.[10] Gandhi et al. compared stress levels between surgical branch residents and anesthesia residents and reported that residents of surgical branches had higher PSS scores compared to residents of anesthesia.[17] However, no studies could be found comparing stress levels between preclinical, paraclinical, and clinical departments. When we compared the stress levels among postgraduates studying in various departments, we found that the subject of postgraduation did not make any difference in causing stress.

Chronic stress can precipitate chronic medical illnesses and vice versa.[12] A study done by Fernando and Samaranayake; and Ebrahimi and Kargar; found higher stress levels among postgraduates who had a chronic illness.[10],[12] In contrast to the above finding, our study revealed no difference in the perceived stress among postgraduates who had a chronic illness.

Almost 88% of the postgraduates had moderate level of PSS scores. This finding is supported by the studies done by Guruprakash et al. and Papaefstathiou et al.[13],[18] On the contrary, a handful of studies reported that majority of the residents had severe or high level of stress or burnout.[1],[19],[20] Multiple factors such as long working hours can lead to increased stress levels and may cause higher chances of developing depressive symptoms. The other factors which contribute to stress might be an emotional load which involved dealing with frequent death of patients, anxiety about their future position, or the quality of their medical training, the workloads.[20] Postgraduates usually have fear of making mistakes, time pressures and difficulty to meet deadlines, difficulty working with uncooperative and incompetent colleagues, lack of adequate comfortable restrooms and other facilities for doctors, and lack of incentives.[19]

The strengths of the study are that it includes a large sample size of 236 and postgraduates from various clinical and nonclinical departments of seven medical colleges. However, limitations are that it is a cross-sectional study and was conducted through an online questionnaire. The information on the presence of substance use was taken in the study. However, further details on the pattern of use and dependence were not explored.


  Conclusion Top


Postgraduation is indeed a time of incredible stress to all the residents with most demonstrating moderate stress levels. Our study was also able to indicate the same. With a bit of planned work hours, social support, mindfulness, and application of proper stress management techniques, the stress during postgraduation can be effectively controlled. There is a need to provide psychological support during their training.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Msaouel P, Keramaris NC, Tasoulis A, Kolokythas D, Syrmos N, Pararas N, et al. Burnout and training satisfaction of medical residents in Greece: Will the European Work Time Directive make a difference? Hum Resour Health 2010;8:16.  Back to cited text no. 1
    
2.
Soares DS, Chan L. Stress and wellbeing of junior doctors in Australia: A comparison with American doctors and population norms. BMC Med Educ 2016;16:183.  Back to cited text no. 2
    
3.
Boerjan M, Bluyssen SJ, Bleichrodt RP, van Weel-Baumgarten EM, van Goor H. Work-related health complaints in surgical residents and the influence of social support and job-related autonomy. Med Educ 2010;44:835-44.  Back to cited text no. 3
    
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Joseph B, Parvaneh S, Swartz T, Haider AA, Hassan A, Kulvatunyou N, et al. Stress among surgical attending physicians and trainees: A quantitative assessment during trauma activation and emergency surgeries. J Trauma Acute Care Surg 2016;81:723-8.  Back to cited text no. 4
    
5.
Tendulkar AP, Victorino GP, Chong TJ, Bullard MK, Liu TH, Harken AH. Quantification of surgical resident stress “on call”. J Am Coll Surg 2005;201:560-4.  Back to cited text no. 5
    
6.
Zubair MH, Hussain LR, Williams KN, Grannan KJ. Work-related quality of life of US general surgery residents: Is it really so bad? J Surg Educ 2017;74:e138-46.  Back to cited text no. 6
    
7.
Cohen S, Kamarck T, Mermelstein R. Global measure of perceived stress. Health Soc Behav 1983;24:385-96.  Back to cited text no. 7
    
8.
Hameed TK, Masuadi E, Al Asmary NA, Al-Anzi FG, Al Dubayee MS. Study of resident duty hours and burnout in a sample of Saudi residents. BMC Med Educ 2018;18:180.  Back to cited text no. 8
    
9.
Tian L, Pu J, Liu Y, Zhong X, Gui S, Song X, et al. Relationship between burnout and career choice regret among Chinese neurology postgraduates. BMC Med Educ 2019;19:162.  Back to cited text no. 9
    
10.
Ebrahimi S, Kargar Z. Occupational stress among medical residents in educational hospitals. Ann Occup Environ Med 2018;30:51.  Back to cited text no. 10
    
11.
Kim K, Lee S, Choi YH. Relationship between occupational stress and depressive mood among interns and residents in a tertiary hospital, Seoul, Korea. Clin Exp Emerg Med 2015;2:117-22.  Back to cited text no. 11
    
12.
Fernando BM, Samaranayake DL. Burnout among postgraduate doctors in Colombo: Prevalence, associated factors and association with self-reported patient care. BMC Med Educ 2019;19:373.  Back to cited text no. 12
    
13.
Guruprakash KV, Mehta SG, Atul B, Prakash J, Divinakumar KJ, Khan SA, et al. A study of relationship between perceived stress, coping pattern, burnout, and general psychopathology among the postgraduate medical students. Ind Psychiatry J 2018;27:141.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Verma R, Balhara YP, Gupta CS. Gender differences in stress response: Role of developmental and biological determinants. Ind Psychiatry J 2011;20:4-10.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Chew QH, Holmboe E, Sim K. Learning environment, stress and coping in psychiatry residents within a national training program: A longitudinal study. Perspect Med Educ 2019;8:160-6.  Back to cited text no. 15
    
16.
Bari A, Kamran R, Haroon F, Bano I. Burnout among pediatric residents and junior consultants working at a tertiary care hospital. Pak J Med Sci 2019;35:45-9.  Back to cited text no. 16
    
17.
Gandhi K, Sahni N, Padhy S, Mathew P. Comparison of stress and burnout among anesthesia and surgical residents in a tertiary care teaching hospital in North India. Postgrad Med 2018;64:145-9.  Back to cited text no. 17
    
18.
Papaefstathiou E, Tsounis A, Papaefstathiou E, Malliarou M, Sergentanis T, Sarafis P. Impact of hospital educational environment and occupational stress on burnout among Greek medical residents. BMC Res Notes 2019;12:281.  Back to cited text no. 18
    
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Al-Dubai SA, Ganasegeran K, Perianayagam W, Rampal KG. Emotional burnout, perceived sources of job stress, professional fulfillment, and engagement among medical residents in Malaysia. ScientificWorldJournal 2013;2013:1-9.  Back to cited text no. 19
    
20.
Blanchard P, Truchot D, Albiges-Sauvin L, Dewas S, Pointreau Y, Rodrigues M, et al. Prevalence and causes of burnout amongst oncology residents: A comprehensive nationwide cross-sectional study. Eur J Cancer 2010;46:2708-15.  Back to cited text no. 20
    


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