The Medical Student Stress Scale - CENTILE … OF SCHOLARLY CONCENTRATION The Medical Student Stress...
Transcript of The Medical Student Stress Scale - CENTILE … OF SCHOLARLY CONCENTRATION The Medical Student Stress...
A R E A O F S C H O L A R L Y C O N C E N T R A T I O N
The Medical Student Stress Scale: Development of a New Measure of Medical Student Stress
Using Modern Measurement Theory Applications O c t o b e r 2 0 t h , 2 0 1 5
Matthew J Mosquera, MS Melinda Ring, MD; Gaurava Agarwal, MD; Karon Cook, PhD
David Victorson, PhD
N O R T H W E S T E R N U N I V E R S I T Y F E I N B E R G S C H O O L O F M E D I C I N E
The “Why” -Background-
Inspiration
Medical Student Stress
Unique
Poten3ally Harmful Widespread
Conceptual Framework for Medical Student Stress
Conceptual Framework References: • Dyrbye, Liselotte N., Matthew R. Thomas,
and Tait D. Shanafelt. "Medical student distress: causes, consequences, and proposed solutions." Mayo Clinic Proceedings. Vol. 80. No. 12. Elsevier, 2005.
• Hillhouse, J. J., C. M. Adler, and D. N. Walters. "A simple model of stress, burnout and symptomatology in medical residents: a longitudinal study."Psychology, Health & Medicine 5.1 (2000): 63-73.
• Maslach, C. (2003) ‘Job Burnout: New Directions in Research and Intervention’, Current Directions in Psychological Science 12(5): 189–92.
• Maslach, C., W.B. Shaufeli and M.P. Leiter (2001) ‘Job Burnout’, Annual Review of Psychology 52(1): 397–422.
• Dahlin, Marie E., and Bo Runeson. "Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study." BMC Medical Education 7.1 (2007): 6.
• Dunn, Laura B., Alana Iglewicz, and Christine Moutier. "A conceptual model of medical student well-being: promoting resilience and preventing burnout."Academic Psychiatry 32.1 (2008): 44-53.
• Vitaliano, Peter P., et al. "A biopsychosocial model of medical student distress." Journal of behavioral medicine 11.4 (1988): 311-331.
Among 4th year medical students
burnout rates are as high as 49% across
all chosen special3es1
Medical School
75% of 1st year internal medicine
residents went from burnout free to some level of burnout a?er their first year of
residency2
Residency
400 physician suicides each
year3 MDs
1.) Dyrbye, L.N. et al. Medical Teacher. 2011, 2.) Ripp, J. et al. Academic Medicine. 2011, 3.) Andrew, LB. et al. Medscape. 2014
A Dangerous Reality
Not Cutting it
Numerous scales exist to help
quan3fy medical student stress
Vague Lengthy Outdated
Critical Unmet Need
: There is currently no validated scale for effec?vely measuring stress levels among American medical students in the 21st century.
“The How” -Methods-
Development of the Medical Student Stress Scale (MSSS) Item Pool
1.) Literature review 2.) Conceptual framework
3.) Crea3on of ini3al item pool 4.)Expert Revisions
5.) Individual cogni3ve interviews 6.) Final round of expert revision
7.) Final 35-‐item pool for tes3ng
Sample of Item Revision
35-Item Pool for Testing
1.) I no3ce fluctua3ons in my
appe3te
2.) I have difficulty asking for help
3.) I have trouble falling and/or staying
asleep
4.) I receive less sa3sfac3on from learning new material
5.) I am unable to relax
6.) I feel anxious
7.) I am unable to enjoy ac3vi3es
outside of classes/rota3ons
8.) I feel pressure to take on
extracurricular ac3vi3es (student groups, research ,
etc.)
9.) I no3ce that I drink alcohol in
excess
10.) I use drugs in excess (prescrip3on and/or non-‐Rx)
11.) I feel hopeless that I’ll ever get my
degree
12.) I feel depressed
Since starting medical school….
35-Item Pool for Testing Cont.
13.)I’m stressed about finances
14.) I have a hard 3me mo3va3ng myself to study
15.) I feel emo3onally exhausted
16.) I feel bothered by the amount of exposure I have to death and human
suffering
17.) I am fearful of failing
18.) I exercise less
19.) I feel unsupported by my
peers 20.) I feel compe33on
from my peers
21.) I feel unsupported by
faculty
22.) I feel taken advantage of by
faculty
23.) It it challenging to maintain
rela3onships with others outside of
school
24.) I feel pressure from others to get
good grades
Since starting medical school….
35-Item Pool for Testing Cont.
25.) I feel unmo3vated to acend class
26.) I feel pressure from myself to get
good grades
27.) I am overly self-‐cri3cal
28.) I feel the need to be perfect
29.) I am unsure of my abili3es as a
student
30.) I hardly have enough 3me to get things done
31.) I feel overwhelmed by everything there
is to do
32.) I struggle maintaining a
healthy school-‐life balance
33.) It is challenging to
start or maintain roman3c
rela3onships
34.) I think about dropping out of
school
35.) I ques3on my decision to enter medical school
Since starting medical school….
Validity Measures
Perceived Stress Scale 4 (PSS-‐4)
PROMIS Anxiety 4 item
Burnout Measure Short Version
Current Stress Visual Analog Scale
Utrecht Work Engagement Scale (UWES-‐15)
Average hours sleep per night
Exercise Frequency
Data Source
Online Survey via RedCap
~15 minutes to complete
Goal of n=300 (M1-‐M4 at Feinberg SOM)
Sample of REDCap Survey
Development of the Medical Student Stress Scale (MSSS) Item Pool cont.
8.) Survey administra3on
9.) Data Analysis (EFA)
10.) Revised 10-‐item scale
The “Payoff” -Results-
Demographics
• 347 Total records (goal n=300)
Demographics cont.
Exploratory Factor Analysis (EFA)
The 10 items came from an EFA 1 factor
solu3on Eigenvalue = 5, which accounts for 50% of the
variance
Preliminary MSSS-10 Item # Context Stem
1 Since star3ng medical school, I am unable to relax
2 Since star3ng medical school, I feel anxious
3 Since star3ng medical school, I am unable to enjoy ac3vi3es outside of classes/rota3ons
4 Since star3ng medical school,
I feel hopeless that I’ll ever get my degree
5 Since star3ng medical school,
I feel depressed
6 Since star3ng medical school,
I feel emo3onally exhausted
7 Since star3ng medical school,
I am fearful of failing
8 Since star3ng medical school,
I am overly self-‐cri3cal
9 Since star3ng medical school,
I feel overwhelmed by everything there is to do
10 Since star3ng medical school,
I struggle maintaining a healthy school-‐life balance
Breakdown of Totals
1 1 0
1 1 2
3 3 2
8
13
17
7
11 12
22
14
20
23
15
22
19
14 14 15
20
17
8 9
5
11
5 6
2
0 0 0
2 1 1 1
0
5
10
15
20
25
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
Freq
uenc
y
MSSS 10-item total (min 10, max 50)
Distribution of MSSS-10 Totals
Internal Consistency (Reliability)
Cronbach’s alpha = 0.89
All item total correla3ons were between 0.55 and 0.68
Factorial Validity
àFactor coefficients for the 10 items ranged between 0.63 and 0.76
Concurrent and Convergent Validity Associa3on between MSSS-‐10 & Validity Measures
MSSS-‐10 Type of Validity Evidence Burnout Measure .767**
Convergent Validity (Construct) PROMIS Anxiety .683**
Convergent Validity (Construct) Perceived Stress .750**
Convergent Validity (Construct) Visual Analog Scale (current stress) .657**
Convergent Validity (Construct) Regularity of Exercise -‐.223**
Concurrent Validity (Criterion) Hours of Sleep on Average
-‐.209** Concurrent Validity (Criterion)
**. Correla3on is significant at the 0.01 level (2-‐tailed).
Known Groups Validity
The “Ok, so what now??”
-Discussion-
Strengths and limitations
Strengths: -High power -Created by students (with expert advice) for students
Limitations: -Timing of survey administration (in relation to exams, really no perfect time)
-Participation Rate (potential for those with most stress, declining survey, especially M3 and M4; also M1/M2 vs M3/M4 rates disparate)
Looking ahead
Invaluable measurement
tool
Medical Student
preference
Takes 2 minutes to complete
Accurate
Adapted to the 21st century medical student
Acknowledgements Special thanks to:
Dr.David Victorson Dr.Melinda Ring Dr.Karon Cook and
Dr.Gaurava Agarwal For all of your help, support, and guidance!!!
N O R T H W E S T E R N U N I V E R S I T Y F E I N B E R G S C H O O L O F M E D I C I N E
thank you!