BMC Medical Education volume 23, Article number: 79 (2023) Cite this article
Abstract
Background
In Turkey, astir final-year aesculapian students hole for the Examination for Specialty successful Medicine successful a high-stress environment. To the champion of our knowledge, this is the archetypal survey connected final-year aesculapian pupil wide intelligence distress during mentation for the Examination for Specialty successful Turkey. We purpose to measure intelligence distress and recognize the variables associated with depression, anxiety, and accent levels among final-year aesculapian students preparing for the Examination for Specialty.
Methods
A self-reporting, anonymous, cross-sectional survey with 21 items consisting of demographic variables, customized variables directed for this study, and the DASS-21 was utilized. Survey results were expounded based connected univariate investigation and multivariate linear regression analysis.
Results
Our survey revealed 4 variables associated with impaired intelligence wellness among final-year aesculapian students during mentation for the introspection for Specialty: attendance to preparatory courses, duration of preparation, information of quitting studying, and psychiatric cause usage/ongoing psychotherapy.
Discussion
Considering that doc intelligence wellness is 1 of the astir important determinants of healthcare quality, impaired intelligence wellness among aboriginal physicians is an obstacle to a well-functioning healthcare system. Our survey targets researchers and authorities, who should absorption connected aesculapian pupil intelligence wellness, and aesculapian students themselves.
Introduction
The World Health Organization defines wellness arsenic “a authorities of implicit physical, mental, and societal well-being, and not simply the lack of illness oregon infirmity.” Poor intelligence wellness among physicians has consequences for some physicians arsenic an idiosyncratic and the full healthcare strategy [1,2,3]. For instance, unwell physicians are much apt to forfeit their licenses owed to aesculapian errors and malpractice cases [4]. Research indicates a beardown relation betwixt doc intelligence wellness and the compassionate attraction they supply for patients [1, 5, 6]. Predictably, a physician's productivity nether accent is overmuch little than a steadfast colleague's [7, 8]. Therefore, the value of doc intelligence wellness could beryllium considered equivalent to the value of high-quality healthcare.
Studies connected aesculapian pupil intelligence wellness are imperative since aesculapian students are aboriginal physicians, and unwell aesculapian students whitethorn turn up arsenic unwell physicians. Besides, aesculapian students already person an indispensable relation successful the healthcare strategy arsenic a portion of their objective education. Psychological distress among aesculapian students is associated with profound consequences: worse world performance, higher rates of burnout, nonaccomplishment of empathy, reduced prime of life, mediocre intelligence health, and suicidal ideation [9, 10]. We judge that 1 could forecast the aboriginal of the healthcare strategy by assessing aesculapian pupil intelligence wellness and could instrumentality caller policies to forestall further impairment.
Medical pupil intelligence wellness has attracted much attraction owed to studies emphasizing that astir aesculapian students endure terrible intelligence distress during aesculapian school, a captious play for nonrecreational maturation and idiosyncratic improvement [11,12,13,14,15]. Although students' intelligence wellness profiles are mean earlier aesculapian schoolhouse [16], they extremity up with importantly higher rates of burnout, depression, and different intelligence illnesses than their non-medical peers, indicating aggravated affectional depletion during aesculapian grooming [1, 17,18,19,20]. According to a caller study, a important magnitude of aesculapian students and residents acquisition above-normal intelligence distress (41.5%) oregon precocious to precise precocious intelligence distress (9.2%) [21]. that whitethorn advancement into depression, anxiety, and suicidal ideation [11, 22, 23].
The astir stressful aspects of aesculapian grooming see preparing for exams and acquiring aesculapian skills, which tin pb to precocious levels of anxiousness among aesculapian students [24, 25]. Confirming the erstwhile data, astir aesculapian students astatine a United States (US) aesculapian schoolhouse attributed mediocre wellness to the United States Medical Licensing Examination (USMLE) mentation process [26]. Thus, aesculapian students who hole for exams for postgraduate aesculapian acquisition are astatine involvement regarding the consequences of mediocre intelligence wellness: depression, anxiety, burnout, debased attention, aesculapian errors, and negligence [14, 27, 28]. Therefore, a survey connected the contributors to mediocre intelligence wellness among aesculapian students who hole for specified exams is required to comprehend erstwhile findings; our survey satisfies the request with its unsocial sample.
Previous studies revealed important findings comparing first- and final-year aesculapian students. One survey recovered that final-year aesculapian students had little prime of beingness than first-year students, indicating a gradual diminution successful intelligence wellness during aesculapian schoolhouse [29]. In final-year aesculapian students, astir each stressors are astir the aesculapian profession: aesculapian responsibility, exams for postgraduate aesculapian education, and little leisure clip [30]. In Turkey, the mentation play for specialty introspection requires aggravated engagement with question banks and proceedings tests organized by commercialized preparatory courses. Besides different factors, the frequence of test-taking whitethorn besides explicate the higher anxiousness successful the last year, fixed that the precocious frequence of test-taking disrupts intelligence wellness [31]. In Turkey, Tıpta Uzmanlık Sınavı (Examination for Specialty successful Medicine [will beryllium mentioned arsenic ESM from this constituent forward]) presumably exacerbates anxiousness and stress, considering the competitory situation owed to the increasing fig of aesculapian schools starring to much contention among the candidates.
In Turkey, each aesculapian pupil graduates arsenic a superior attraction doc aft six years of education. As reported by earlier studies, astir of them (90%) aspire to go specialists [32]. To prosecute a specialty successful medicine, postgraduate students indispensable walk the ESM, which assesses examinees' cognition and knowing of basal and objective sciences done 240 single-best-answer, multiple-choice questions. Examinees' show fertile and preferences find the aesculapian institutions they are assigned to for specialty training. Despite accrued quotas for specialists, the ESM remains competitory owed to the increasing fig of aesculapian students, the accumulation of preferences successful a fewer large branches, and the reapplication of dissatisfied specialists oregon failed graduates. Therefore, final-year aesculapian students prioritize their mentation for the ESM astatine the outgo of their intelligence wellness.
Although concerns astir aesculapian pupil intelligence wellness gully attention, the attempts to forestall impairment successful the archetypal spot are not capable [1, 17]. The existent modular for aesculapian schoolhouse acquisition needs renovation. Unfortunately, existent aesculapian acquisition models are constricted regarding intelligence grooming and aesculapian skills. Regarding these, physicians are incapable of managing their intelligence wellness [1, 33]. In bid to rise resilient physicians contempt the high-stress environment, aesculapian schools should foster pupil intelligence wellness done an capable program incorporating self-care acquisition and coping strategies with aesculapian training. If the factors liable for the diminution successful aesculapian pupil intelligence wellness are well-understood, authorities whitethorn make a amended acquisition situation with a broad program and intelligence assistance. Therefore, we purpose to recognize however ESM affects intelligence wellness successful final-year Turkish aesculapian students by assessing their depression, anxiety, and accent levels which is simply a important facet of intelligence wellness; and to pave the mode for caller implications targeting improved intelligence wellness among aesculapian students. This survey is the archetypal to measure final-year aesculapian students' wide intelligence distress by evaluating their depression, anxiety, and accent level during the mentation of ESM successful Turkey.
Methods
Study design, setting, and participants
This cross-sectional questionnaire-based survey was conducted astatine Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, successful March–April 2021. Cerrahpaşa Faculty of Medicine is simply a nationalist aesculapian schoolhouse successful Istanbul which is 1 of the oldest and astir prestigious aesculapian schools successful Turkey. The English programme typically accepts betwixt 80 and 100 students per year, portion the Turkish programme accepts betwixt 250 and 300 students annually portion it is taxable to change. Medical students successful the last twelvemonth of their aesculapian acquisition were targeted. The archetypal 3 years of the aesculapian schoolhouse programme astatine the Cerrahpaşa Faculty of Medicine are preclinical, portion the 4th and 5th years are erstwhile the objective clerkships are done. The sixth year, the last year, is simply a twelvemonth of pre-graduate internship. In their last year, aesculapian students service arsenic full-time intern doctors successful the Cerrahpaşa Faculty of Medicine Hospitals. In summation to rotations successful large branches, specified arsenic the departments of interior medicine, wide surgery, pediatrics, exigency medicine, gynecology, and obstetrics, they rotate successful insignificant branches. They bash not instrumentality exams astatine the institution, but their full-time internship with regular nighttime shifts makes it hard for them to survey for ESM. Thus, the participants of this survey were sixth-year aesculapian students. An online survey was hosted connected SurveyMonkey (www.surveymonkey.com). It was distributed to each eligible students done WhatsApp and Telegram substance messages, owing to a deficiency of a due students' email database. Two reminder substance messages were besides sent retired 10 days apart. A nexus to the survey and elaborate instructions were included successful the substance messages. Before starting the survey, participants were provided a summary of the study, explaining its purpose, its technological and world nature, presumption of anonymity, and confidentiality. Participants consented to their anonymized information being utilized by checking a box. This survey was reviewed and approved by the organization reappraisal committee of the Cerrahpaşa Faculty of Medicine.
Questionnaire
A self-reporting, anonymous, cross-sectional survey was conducted utilizing the Depression, Anxiety, and Stress Scale (DASS-21) and besides 21 customized questions regarding demographic, educational, and customized variables designed for this survey [34]. Nine demographic and acquisition variables consisted of age, sex, the connection of education, people constituent mean (GPA), narration status, socioeconomic status, duration of preparation, play survey hours, and attendance to ESM preparatory courses.
Additional 12 questions that tin beryllium related to intelligence wellness were asked. Three of them were related to the perceived presumption of their study: (1) whether they see their survey sufficient, (2) deliberation that they get the worthy of their study, and (3) see quitting studying oregon not. Furthermore, 1 question regarding their reflection connected moving overseas was present. Psychiatric drugs and medicine stimulants usage were evaluated, arsenic good arsenic cigarette, alcohol, oregon cause consumption. The remaining questions were astir mounting speech clip for themselves and household oregon friends, mindfulness to nutrition, slumber sufficiency, and exercising.
The DASS-21 is simply a 21-item self-assessment instrumentality for healthcare providers. It had bully interior consistency (all a > 0.80), test–retest reliability (all Mutual Information Scores > 0.80), and contented and discriminant validity successful the Turkish adaptation survey of the standard [35]. All DASS-21 items are connected a seven-point Likert standard (1 = strongly disagree, 7 = strongly agree). Eight of the 18 items are reverse-scored. Each subscale is made up of the averages of prime items (eight "Depression", 9 "Anxiety", and fourteen "Stress" items). The wide mean people ("Overall DASS-21") is made up of the averages of each 21 items. Higher scores bespeak greater levels of depression, anxiety, and stress, which implies reduced intelligence wellness.
Statistical analysis
We calculated frequencies for categorical variables, means with modular deviations (SD) for usually distributed continuous variables, and medians with interquartile ranges (IQR) for non-normally distributed continuous variables. Spearman's fertile correlation was conducted to measure the narration betwixt the lone continuous adaptable property and babelike variables, DASS-21, and its subscales' mean scores. For categorical variables with 2 groups, we performed an autarkic t-test for usually distributed babelike variables with adjacent variances, Welch's t-test for usually distributed babelike variables with unequal variances, and Mann–Whitney U trial for non-normally distributed babelike variables. For categorical variables with 3 oregon much groups, one-way investigation of variance (ANOVA) for usually distributed babelike variables and the Kruskal Wallis trial for non-normally distributed babelike variables were performed. Variables with a p-value smaller than 0.2 successful the univariate investigation were utilized successful the multivariate linear regression models. A p-value of 0.05 was considered to bespeak statistical significance. All statistical analyses were performed successful R 4.1.3 [36].
Results
Demographic findings
A full of 146 final-year aesculapian students participated successful this study; 101 responses were implicit submissions and utilized successful the investigation yielding a effect complaint of 21.35% (101/473). The mean property was 23.97 (SD = 1.27), and it was not importantly associated with the DASS-21 mean people and immoderate of the 3 subscales' mean scores. Of the 101 participants, 7.92% reported GPA betwixt 2.0–2.5, 38.61% betwixt 2.5–3.0, 33.66% betwixt 3.0–3.5, and 19.80% betwixt 3.5–4.0. Regarding the duration of preparation, astir respondents (n = 62, 61.39%) spent 1–2 years, 7.92% spent much than 2 years, 11.88% spent 6 months-1 year, and 18.81% spent little than 6 months. Less than fractional of the respondents (n = 39, 38.61%) spent 30–60 h a week. Among others, 14.85% spent much than 60 h, 15.84% spent 15–30 h, and 30.69% spent little than 15 h. A important bulk (n = 92, 91.09%) of the participants attended a preparatory course.
About fractional (n = 53, 52.48%) of the students considered their survey insufficient, a small much than a 4th (n = 27, 26.73%) considered their survey sufficient, and 20.79% were unsure regarding the sufficiency of their study. Although 29.70% ne'er considered quitting studying, much than 2 3rd of students considered quitting studying (38.61% rarely, 20.79% often, 10.89% always). 34.65% of students utilized medicine psychiatric drugs oregon undergone psychotherapy, 31.68% utilized medicine stimulants to summation productivity, and 46.53% started utilizing oregon accrued the depletion of cigarettes, alcohol, oregon drugs during mentation for ESM. Most students were not mindful of their nutrition, did not get capable sleep, and did not acceptable speech clip for exercising. These variables and their relation with the subscale scores are fixed successful Table 1.
DASS-21 slump subscale
The cognition subscale showed precocious interior reliability (a = 0.84) with a mean people of 10.42 (7.48). In the univariate investigation (Table 1). attendance to preparatory courses (p = 0.026) and information of quitting studying (p = 0.005) were recovered to beryllium statistically significant. The multivariate regression exemplary (Table 2). showed that those who did not be preparatory courses received little scores than those who attended preparatory courses by 5.82 points [p = 0.046, coefficient = -5.82, 95% assurance interval [CI] = (-11.52) – (-0.10)]. Participants who ne'er [p = 0.001, coefficient = -10.13, 95% CI (-15.82)—(-4.44)], seldom [p = 0.006, coefficient = -8.03, 95% CI (-13.73)—(-2.34)], oregon often [p = 0.029, coefficient = -6.87, 95% CI (-13.00)—(-0.73)] considered quitting studying had little scores than those who stated ever considering discontinue studying.
DASS-21 anxiousness subscale
The anxiousness subscale was internally reliable (a = 0.81), with a mean people of 14.55 (8.62). The univariate investigation (Table 1) revealed that participants who considered quitting studying (p < 0.001), utilized medicine psychiatric drugs, oregon underwent psychotherapy (p = 0.007), and were deprived of capable slumber (p = 0.039) had higher anxiousness levels than others. In multivariate investigation (Table 2), respondents who ever considered quitting studying had higher scores than those who ne'er [p < 0.001, coefficient = -10.65, 95% CI (-15.41) – (-5.89)] oregon seldom [p = 0.017, coefficient = -6.04, 95% CI (-10.95) – (-1.12)] considered quitting studying. Lastly, aesculapian students utilizing medicine psychiatric drugs oregon receiving psychotherapy during the mentation for ESM had higher scores than those who did not [p = 0.03, coefficient = -3.35, 95% CI (-6.38) – (-0.33)].
DASS-21 accent subscale
The accent subscale showed precocious interior reliability (a = 0.86) with a mean people of 15.50 (8.18). In the univariate investigation (Table 1), we recovered statistical value successful the mean subscale scores for 8 variables: duration of mentation (p = 0.013), attendance to a preparatory people (p = 0.041), information of quitting studying (p = 0.037), medicine psychiatric drugs usage oregon ongoing psychotherapy (p < 0.001), medicine stimulants usage (p = 0.004), mounting speech clip for oneself (p = 0.008), mounting speech clip for household oregon friends (p = 0.004), and having started to usage oregon accrued depletion of cigarettes, alcohol, oregon drugs (p = 0.004). The multivariate exemplary (Table 2). showed that those who prepared for little than 6 months (p = 0.016, coefficient = 5.19, 95% CI 1.00 – 9.38) were much depressed than those who prepared for 1–2 years. Final twelvemonth aesculapian students who ne'er [p < 0.001, coefficient = -10.95, 95% CI (-15.95) – (-5.95)], who seldom [p = 0.016, coefficient = -6.62, 95% CI (-12.00) – (-1.24)], and who often considered quitting studying [p = 0.011, coefficient = -7.08, 95% CI (-12.49) – (-1.67)] had little scores compared to those who ever considered discontinue studying. Last, participants who were deprived of capable slumber (p = 0.029, coefficient = 3.93, 95% CI 0.42 – 7.44) had higher anxiousness levels than interns who got capable sleep.
Discussion
According to a communicative reappraisal of studies betwixt 1990 and 2015, 35%-55% of aesculapian students suffered affectional exhaustion, depersonalization, and different burnout-related symptoms [37], supporting the studies unveiling that much than fractional of aesculapian students experienced burnout [1, 16]. Furthermore, successful a much caller study, the frequence of burnout syndrome among assemblage students was estimated to beryllium 55.4% for affectional weariness, 31.6% for cynicism, and 30.0% for world efficacy [38]. Depression perchance came with underlying burnout, starring to much terrible slump [23, 39, 40]. Previously reported slump rates successful aesculapian students seemed to beryllium depending connected the sample, measured astatine arsenic precocious arsenic 51.3% successful 1 aesculapian schoolhouse successful India, portion it was 23.5% among German aesculapian students [41, 42]. According to a study, the aesculapian pupil anxiousness level was astatine the 85th percentile compared to the age-matched peers successful the wide colonisation [14, 43]. Severe anxiousness chiefly arose from aesculapian licensing examinations [44]. One survey recovered that 22% of aesculapian students experienced "moderately high" to "extremely high" trial anxiousness [45].
Most studies successful the lit of aesculapian pupil intelligence wellness revolved astir the aesculapian students who prepared for USMLE. However, their results should not beryllium generalized to the aesculapian students preparing for antithetic exams each astir the world. This survey is simply a measurement to relieve the request for caller samples since our participants were aesculapian students preparing for the ESM successful Turkey. Thus, our probe not lone elucidates the nexus betwixt aesculapian pupil wide intelligence distress and the mentation play for the specialty exam successful Turkey but besides helps to recognize whether the results are comparable to erstwhile studies with antithetic samples.
Our survey recovered that the pursuing variables are associated with final-year aesculapian pupil intelligence wellness: attendance to preparatory courses, duration of preparation, information of quitting studying, and psychiatric cause usage/ongoing psychotherapy.
Most final-year aesculapian students successful Turkey privation to hole for the ESM. According to a study, astir each final-year aesculapian students attended commercialized trial mentation courses for the ESM [32]. In different words, final-year aesculapian students wanted to allocate much clip and effort to hole for the ESM. It was accordant with our findings which show that much than fractional of the students considered their studies insufficient. Although astir students attended preparatory courses for higher ESM scores, corresponding US studies showed that acquisition advancement provided by these courses was minimal oregon absent [46]. Despite this notorious fact, astir students inactive opt for attending preparatory courses owed to the anxiousness associated with aesculapian examinations successful the US [47, 48]. Consistent with this data, attending preparatory courses for ESM was associated with mediocre intelligence wellness, arsenic those who attended preparatory courses had higher scores connected the slump subscale than those who did not. The archetypal mentation is that aesculapian students with intelligence problems during mentation tended to be preparatory courses alternatively than enactment alone. On the different hand, considering the hectic gait of the preparatory courses, aesculapian students who attended these courses whitethorn acquisition intelligence problems owed to the other accent load they undertook aft attending these courses.
In our study, students who spent little than 6 months preparing for ESM had higher accent levels than those who spent 1–2 years for the preparation. One tenable mentation for that is insecurity. Insecurity caused by insufficient mentation mightiness person led to elevated accent levels. On the different hand, our survey revealed that accent levels were akin for aesculapian students who considered their studies insufficient and those who did not. However, the word "insufficient" is arguable since immoderate students are perfectionists and others are easy satisfiable. Hence, aesculapian students who considered their studies insufficient did not needfully walk little clip studying than those who did not. Feeling insufficient to walk the specialty exam whitethorn effect successful elevated stress, whereas feeling insufficient to get the champion positions whitethorn not subordinate to accent levels. Further studies should analyse the relation of insecurity caused by insufficient mentation connected aesculapian pupil stress.
Final-year aesculapian students who considered quitting studying got higher scores connected each subscales. First, depressed interns whitethorn not person had capable information to survey anymore since slump is known to origin reluctance. Second, aesculapian students who did not spot their aesculapian skills whitethorn person considered quitting studying owed to anxiety. In addition, precocious anxiousness exacerbated by harsh conditions and debased salaries whitethorn person resulted successful quitting studying for the ESM and looking for different opportunities. For example, astir aesculapian students (73.27%) reported that they would similar to enactment overseas successful the future. Lastly, interns who could not instrumentality the intelligence load caused by the high-stress situation mightiness person tended to see quitting studying more. In short, final-year aesculapian students with higher depression, anxiety, and accent levels considered quitting studying much often than others.
In our study, we discovered that 34.65% of students utilized medicine psychiatric drugs oregon received psychotherapy. Furthermore, according to multivariate analysis, aesculapian students who utilized medicine psychiatric drugs oregon received psychotherapy portion preparing for ESM had higher anxiousness subscale scores than those who did not. According to Ministry of Health statistics, antidepressant usage successful Turkey successful 2020 was 49 per 1000 individuals [49]. Although we person nary information connected the fig of individuals receiving psychotherapy successful Turkey, it is harmless to accidental that antidepressant usage is much prevalent among our cohort than among the wide population. Moreover, Fasanella et al. recovered that the prevalence of psychotropic cause usage among first- to final-year aesculapian schoolhouse students astatine a backstage assemblage successful Brazil was 30.4% [50]. In a abstracted study, 2.4% of 4345 aesculapian students from 35 French aesculapian schools reported utilizing antidepressants, 5.4% reported utilizing anxiolytics, and 6.5% reported psychiatric oregon psychotherapeutic follow-up [51]. Consequently, the precocious complaint of antidepressant depletion and psychotherapeutic follow-up successful our cohort whitethorn beryllium explained by ESM preparation, which is further supported by different survey indicating a gradual diminution successful intelligence wellness during aesculapian schoolhouse [29]. Further probe is required to found the nexus betwixt ESM mentation and the precocious complaint of antidepressant depletion and psychotherapeutic follow-up, specifically by assessing the antidepressant depletion and psychotherapeutic follow-up of doctors successful residency grooming successful Turkey.
In our study, demographic variables and wide intelligence distress were not correlated. To behaviour a elaborate statistical analysis, we assessed the interaction of GPA connected intelligence wellness and recovered nary correlation. Being mindful of nutrition and mounting speech clip for exercising were demonstrated to beryllium irrelevant to intelligence wellness, but those who could not get capable slumber had higher accent levels. Although astir fractional of the students started utilizing oregon accrued their depletion of cigarettes, alcohol, oregon drugs and could not acceptable speech clip for themselves and their families oregon friends, these variables were not related to mediocre intelligence wellness. Surprisingly, final-year aesculapian students who believed they would not get the worthy of their survey had akin results connected each subscales to those who believed they would.
Limitations
Our survey is not without limitations. First, the effect complaint among the targeted cohort was debased (21.35%). The aesculapian schoolhouse from which the illustration was derived is 1 of the apical aesculapian schools successful Turkey. Therefore, the participants' lifestyles, preferences, and priorities mightiness person been associated with the characteristics of precocious achievers. Further studies with samples from antithetic schools would assistance to comparison the information and measure the accuracy of our survey and the generality of our conclusions. Data were collected with a questionnaire based connected the interns' self-declarations. There was nary outer validation regarding the variables specified arsenic GPA, medicine psychiatric drugs, oregon medicine stimulants. In addition, though we attempted to measure the intelligence wellness of the students, we were lone capable to measure their depression, anxiety, and accent level, which are important components of intelligence wellness but not the entirety of it.
In this study, we lone included final-year aesculapian students. However, astir aesculapian students usually commencement to hole for the ESM successful their earlier years. Further studies whitethorn see some 5th-year and final-year aesculapian students. Lastly, this survey was conducted successful an situation wherever the effects of the COVID-19 pandemic were inactive on.
Conclusion
In Turkey, aesculapian students hole for the ESM successful a high-stress environment. Most of them whitethorn go much depressed, anxious, and stressed during the preparation. Our survey assessed final-year aesculapian pupil wide intelligence distress during the mentation of ESM. We recovered 4 variables were associated with intelligence wellness: attendance to preparatory courses, duration of preparation, information of quitting studying, and psychiatric cause usage/ongoing psychotherapy. With its distinguished sample, this survey volition beryllium an fantabulous root for researchers and authorities who purpose to amended aesculapian pupil intelligence wellness.
Availability of information and materials
The datasets generated and/or analysed during the existent survey are not publically disposable owed to them containing accusation that could compromise probe subordinate privacy/consent but are disposable from the corresponding writer connected tenable request.
References
Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout among U.S. aesculapian students, residents, and aboriginal vocation physicians comparative to the wide U.S. population. Acad Med J Assoc Am Med Coll. 2014;89:443–51.
Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician restitution and burnout astatine antithetic vocation stages. Mayo Clin Proc. 2013;88:1358–67.
Garr DR, Lackland DT, Wilson DB. Prevention acquisition and valuation successful U.S. aesculapian schools: a presumption report. Acad Med J Assoc Am Med Coll. 2000;75(7):14–21.
Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing prime indicator. Lancet Lond Engl. 2009;374:1714–21.
Pfifferling J-H, Gilley K. Overcoming compassion fatigue. Family signifier management. 2000;7:39.
Greenburg DL, Durning SJ, Cruess DL, Cohen DM, Jackson JL. The prevalence, causes, and consequences of experiencing a beingness situation during aesculapian school. Teach Learn Med. 2010;22:85–92.
Shanafelt T, Goh J, Sinsky C. The Business Case for Investing successful Physician Well-being. JAMA Intern Med. 2017;177:1826–32.
Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout impact doc productivity? A systematic lit review. BMC Health Serv Res. 2014;14:325.
Wasson LT, Cusmano A, Meli L, Louh I, Falzon L, Hampsey M, et al. Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review. JAMA. 2016;316:2237–52.
Ishak W, Nikravesh R, Lederer S, Perry R, Ogunyemi D, Bernstein C. Burnout successful aesculapian students: a systematic review. Clin Teach. 2013;10:242–5.
Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316:2214–36.
Dyrbye LN, Harper W, Durning SJ, Moutier C, Thomas MR, Massie FS, et al. Patterns of distress successful US aesculapian students. Med Teach. 2011;33:834–9.
Brady KJS, Trockel MT, Khan CT, Raj KS, Murphy ML, Bohman B, et al. What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry. 2018;42:94–108.
Dyrbye LN, Thomas MR, Shanafelt TD. Systematic Review of Depression, Anxiety, and Other Indicators of Psychological Distress Among U.S. and Canadian Medical Students. Acad Med. 2006;81:354–73.
Cullen MW, Reed DA, Halvorsen AJ, Wittich CM, Kreuziger LMB, Keddis MT, et al. Selection Criteria for Internal Medicine Residency Applicants and Professionalism Ratings During Internship. Mayo Clin Proc. 2011;86:197–202.
Brazeau CMLR, Shanafelt T, Durning SJ, Massie FS, Eacker A, Moutier C, et al. Distress among matriculating aesculapian students comparative to the wide population. Acad Med J Assoc Am Med Coll. 2014;89:1520–5.
Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation successful aesculapian students. JAMA. 2010;304:1181–90.
Chen Z, Wang B, Lin Y, Luo C, Li F, Lu S, et al. Research Status of Job Satisfaction of Medical Staff and its Influencing Factors. J Serv Sci Manag. 2021;14:45–57.
Yusoff MSB, Mat Pa MN, Esa AR, Abdul Rahim AF. Mental wellness of aesculapian students earlier and during aesculapian education: A prospective study. J Taibah Univ Med Sci. 2013;8:86–92.
Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Satele DV, et al. Changes successful Burnout and Satisfaction With Work-Life Integration successful Physicians and the General US Working Population Between 2011 and 2017. Mayo Clin Proc. 2019;94:1681–94.
McLuckie A, Matheson KM, Landers AL, Landine J, Novick J, Barrett T, et al. The Relationship Between Psychological Distress and Perception of Emotional Support successful Medical Students and Residents and Implications for Educational Institutions. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry. 2018;42:41–7.
Borst JM, Frings-Dresen MHW, Sluiter JK. Prevalence and incidence of intelligence wellness problems among Dutch aesculapian students and the study-related and idiosyncratic hazard factors: a longitudinal study. Int J Adolesc Med Health. 2016;28:349–55.
Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among U.S. aesculapian students. Ann Intern Med. 2008;149:334–41.
Lee J, Graham AV. Students’ cognition of aesculapian schoolhouse accent and their valuation of a wellness elective. Med Educ. 2001;35:652–9.
Radcliffe C, Lester H. Perceived accent during undergraduate aesculapian training: a qualitative study. Med Educ. 2003;37:32–8.
Cortes-Penfield NW, Khazanchi R, Talmon G. Educational and Personal Opportunity Costs of Medical Student Preparation for the United States Medical Licensing Examination Step 1 Exam: A Single-Center Study. Cureus. 2020. https://doi.org/10.7759/cureus.10938.
Khan R, Lin JS, Mata DA. Addressing Depression and Suicide Among Physician Trainees. JAMA Psychiat. 2015;72:848.
Tackett S, Jeyaraju M, Moore J, Hudder A, Yingling S, Park YS, et al. Student well-being during dedicated mentation for USMLE Step 1 and COMLEX Level 1 exams. BMC Med Educ. 2022;22:16.
Paro HBMS, Morales NMO, Silva CHM, Rezende CHA, Pinto RMC, Morales RR, et al. Health-related prime of beingness of aesculapian students. Med Educ. 2010;44:227–35.
Duica L, Talau R, Nicoara D, Dinca L, Turcuc J, Talu G. “ Stress-Anxiety-Coping” triad successful aesculapian students. Journal of Educational Sciences and Psychology. 2012;2.
Reed DA, Shanafelt TD, Satele DW, Power DV, Eacker A, Harper W, et al. Relationship of pass/fail grading and program operation with well-being among preclinical aesculapian students: a multi-institutional study. Acad Med J Assoc Am Med Coll. 2011;86:1367–73.
Turan S, Üner S. Preparation for a Postgraduate Specialty Examination by Medical Students successful Turkey: Processes and Sources of Anxiety. Teach Learn Med. 2015;27:27–36.
Six Dimensions of Wellness - National Wellness Institute. 2020. 542 https://nationalwellness.org/resources/six-dimensions-of-wellness/. Accessed 8 Jul 2022.
Henry JD, Crawford JR. The short-form mentation of the Depression Anxiety Stress Scales (DASS-21): conception validity and normative information successful a ample non-clinical sample. Br J Clin Psychol. 2005;44(Pt 2):227–39.
Hekimoglu L, Altun ZO, Kaya EZ, Bayram N, Bilgel N. Psychometric Properties of the Turkish Version of the 42 Item Depression Anxiety Stress Scale (Dass-42) successful a Clinical Sample. Int J Psychiatry Med. 2012;44:183–98.
R: The R Project for Statistical Computing. https://www.r-project.org/. Accessed 20 Nov 2022.
Dyrbye L, Shanafelt T. A communicative reappraisal connected burnout experienced by aesculapian students and residents. Med Educ. 2016;50:132–49.
Rosales-Ricardo Y, Rizzo-Chunga F, Mocha-Bonilla J, Ferreira JP. Prevalence of burnout syndrome successful assemblage students: A systematic review. Salud Ment. 2021;44:91–102.
Jennings ML, Slavin SJ. Resident Wellness Matters: Optimizing Resident Education and Wellness Through the Learning Environment. Acad Med J Assoc Am Med Coll. 2015;90:1246–50.
Langade D, Modi PD, Sidhwa YF, Hishikar NA, Gharpure AS, Wankhade K, et al. Burnout Syndrome Among Medical Practitioners Across India: A Questionnaire-Based Survey. Cureus. 8:e771.
Iqbal S, Gupta S, Venkatarao E. Stress, anxiousness and slump among aesculapian undergraduate students and their socio-demographic correlates. Indian J Med Res. 2015;141:354–7.
Rueckert K-K. Quality of Life and Depression successful German Medical Students astatine overseas universities. In: RSU International Conference Health and Social Science. 2016. p. 168.
Vitaliano PP, Maiuro RD, Russo J, Mitchel ES. Medical pupil distress. A longitudinal study. J Nerv Ment Dis. 1989;177:70–6.
Powell DH. Behavioral attraction of debilitating trial anxiousness among aesculapian students. J Clin Psychol. 2004;60:853–65.
Green M, Angoff N, Encandela J. Test anxiousness and United States Medical Licensing Examination scores. Clin Teach. 2016;13:142–6.
McGaghie WC, Downing SM, Kubilius R. What is the interaction of commercialized trial mentation courses connected aesculapian introspection performance? Teach Learn Med. 2004;16:202–11.
Werner LS, Bull BS. The effect of 3 commercialized coaching courses connected Step One USMLE performance. Med Educ. 2003;37:527–31.
Strowd RE, Lambros A. Impacting pupil anxiousness for the USMLE Step 1 done process-oriented preparation. Med Educ Online. 2010;15.
Ülgü MM, Birinci Ş. THE MINISTRY of HEALTH of TÜRKİYE HEALTH STATISTICS YEARBOOK 2020. https://dosyasb.saglik.gov.tr/Eklenti/43400,siy2020-eng-26052022pdf.pdf?0. Accessed 19 Jan 2023.
Fasanella NA, Custódio CG, Cabo JS, do, Andrade GS, Almeida FA de, Pavan MV,. Use of prescribed psychotropic drugs among aesculapian students and associated factors: a cross-sectional study. Sao Paulo Med J Rev Paul Med. 2022;140:697–704.
Fond G, Bourbon A, Boucekine M, Messiaen M, Barrow V, Auquier P, et al. First-year French aesculapian students devour antidepressants and anxiolytics portion second-years devour non-medical drugs. J Affect Disord. 2020;265:71–6.
Ethics declarations
Ethics support and consent to participate
This probe has been approved by the morals committee astatine the Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine connected the 24th April 2022. An informed consent signifier was signed electronically by each participants and anonymity was assured. All methods were performed successful accordance with the applicable guidelines and regulations.
Consent for publication
Before starting the survey, participants were provided a summary of the study, explaining its purpose, its technological and world nature, presumption of anonymity, and confidentiality. Participants consented to their anonymized information being utilized by checking a box.
Competing interests
The authors state that they person nary conflicts of interests.
Additional information
Publisher's Note
Springer Nature remains neutral with respect to jurisdictional claims successful published maps and organization affiliations.
Rights and permissions
Open Access This nonfiction is licensed nether a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, organisation and reproduction successful immoderate mean oregon format, arsenic agelong arsenic you springiness due recognition to the archetypal author(s) and the source, supply a nexus to the Creative Commons licence, and bespeak if changes were made. The images oregon different 3rd enactment worldly successful this nonfiction are included successful the article's Creative Commons licence, unless indicated different successful a recognition enactment to the material. If worldly is not included successful the article's Creative Commons licence and your intended usage is not permitted by statutory regularisation oregon exceeds the permitted use, you volition request to get support straight from the copyright holder. To presumption a transcript of this licence, sojourn http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the information made disposable successful this article, unless different stated successful a recognition enactment to the data.
About this article
Cite this article
Karabacak, M., Hakkoymaz, M., Ukus, B. et al. Final-year aesculapian pupil intelligence wellness during mentation for the introspection for specialty successful Turkey: a cross-sectional survey study. BMC Med Educ 23, 79 (2023). https://doi.org/10.1186/s12909-023-04063-0
Received: 12 December 2022
Accepted: 27 January 2023
Published: 01 February 2023
DOI: https://doi.org/10.1186/s12909-023-04063-0
English (US)