The Medical Student Stress Scale - CENTILE … OF SCHOLARLY CONCENTRATION The Medical Student Stress Scale: Development of a New Measure of Medical Student Stress Using Modern Measurement

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


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


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


I feel depressed


I feel emo3onally exhausted


I am fearful of failing


I am overly self-‐cri3cal


I feel overwhelmed by everything there is to do


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!

The Medical Student Stress Scale - CENTILE … OF SCHOLARLY CONCENTRATION The Medical Student Stress Scale: Development of a New Measure of Medical Student Stress Using Modern Measurement

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