Main Article Content
OBJECTIVES: To explores the distressful emotional experiences and coping strategies of undergraduate medical students from a public-sector medical college of Khyber Pakhtunkhwa, Pakistan.
METHODS: A qualitative narrative inquiry based on cognitive appraisal theory of emotion was conducted from May 2018 to October 2019. Semi-structured interviews were conducted with a purposive sample of 15 undergraduate students of a public-sector medical college of Khyber Pakhtunkhwa, Pakistan having high risk of psychological distress, as identified through Kessler psychological distress scale. The narratives were transcribed verbatim and analyzed using framework analysis.
RESULTS: Out of 15 students, 8 (53.3%) were females and 7 (46.7%) were males. All students were residing in hostels. Out of 15 students, 4 (26.7%) were from first professional year, 2 (13.3%) were from 4th year and 3 (20.0%) each from 2nd, 3rd & final professional year MBBS class. The participants reported intrapersonal, interpersonal and systemic experiences resulting in feelings of shame, inadequacy, insult, anger and sadness. The severity of distress reduced from first to final professional year. They adopted various coping strategies for example, some kept quiet and/or submitted, while others confronted and/or looked for means to divert attention. Some cried out loud and others prayed and/or used sleeping pills.
CONCLUSION: The undergraduate medical students experience emotionally difficult and diverse intrapersonal, interpersonal and systemic situations. They use emotions-focused, problem-focused and meaning-focused strategies to cope up in such situations. Medical students need to be protected from preventable causes of morbidity and mortality. The institutions should offer student counseling services in the campuses.
Work published in KMUJ is licensed under a
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
2. Benbassat J. Changes in wellbeing and professional values among medical undergraduate students: a narrative review of the literature. Adv Health Sci Edu 2014;19(4):597-610.
3. Shah M, Hasan S, Malik S, Sreeramareddy CT. Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC Med Educ 2010 Jan 15;10:2. DOI: 10.1186/1472-6920-10-2.
4. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, et al. Personal life events and medical student burnout: a multicenter study. Acad Med 2006 Apr;81(4):374-84. DOI: 10.1097/00001888-200604000-00010.
5. Guthrie E, Black D, Shaw C, Hamilton J, Creed F, Tomenson B. Embarking upon a medical career: psychological morbidity in first year medical students. Med Educ 1995 Sep;29(5):337-41. DOI: 10.1111/j.1365-2923.1995.tb00022.x.
6. Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J R Soc Med 1998 May; 91(5):237–43. DOI: 10.1177/014107689809100502.
7. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross‐sectional study. Med Educ 2005 Jun;39(6):594-604. DOI: 10.1111/j.1365-2929.2005.02176.x.
8. Yusoff MSB, Rahim AFA, Yaacob MJ. Prevalence and sources of stress among Universiti Sains Malaysia medical students. Malays J Med Sci 2010;17(1):30-7.
9. Rees CE, Monrouxe LV, McDonald LA. Narrative, emotion and action: analysing ‘most memorable’professionalism dilemmas. Med Educ 2013 Jan;47(1):80-96. DOI: 10.1111/j.1365-2923.2012.04302.x.
10. Monrouxe LV, Rees CE. “It’s just a clash of cultures”: emotional talk within medical students’ narratives of professionalism dilemmas. Adv Health Sci Educ Theory Pract 2012 Dec;17(5):671-701. DOI: 10.1007/s10459-011-9342-z.
11. Imran N, Tariq KF, Pervez MI, Jawaid M, Haider II. Medical students’ stress, psychological morbidity, and coping strategies: a cross-sectional study from Pakistan. Acad Psychiatry 2016 Feb;40(1):92-6. DOI: 10.1007/s40596-015-0413-y.
12. Shaikh BT, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, et al. Students, stress and coping strategies: a case of Pakistani medical school. Educ Health (Abingdon) 2004 Nov;17(3):346-53. DOI: 10.1080/13576280400002585.
13. Jadoon NA, Yaqoob R, Raza A, Shehzad MA, Zeshan SC. Anxiety and depression among medical students: a cross-sectional study. J Pak Med Assoc 2010;60(8):699-702.
14. Hashmi AM, Aftab MA, Naqvi SH, Sajjad W, Mohsin M, Khawaja IS. Anxiety and depression in Pakistani medical students: a multicenter study. Health Med 2014;8(7):813-20.
15. Moors A, Ellsworth PC, Scherer KR, Frijda NH. Appraisal theories of emotion: State of the art and future development. Emot Rev 2013;5(2):119-24. DOI: 10.1177/1754073912468165.
16. Lazurus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.
17. Prince G. A dictionary of narratology: U of Nebraska Press; 2003.
18. Folkman S, Lazarus RS, Dunkel-Schetter C, DeLongis A, Gruen RJ. Dynamics of a stressful encounter: cognitive appraisal, coping, and encounter outcomes. J Pers Soc Psychol 1986 May;50(5):992-1003. DOI: 10.1037//0022-35184.108.40.2062.
19. Slade T, Grove R, Burgess P. Kessler psychological distress scale: normative data from the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2011 Apr;45(4):308-16. DOI: 10.3109/00048674.2010.543653.
20. Sreeramareddy CT, Shankar PR, Binu V, Mukhopadhyay C, Ray B, Menezes RG. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ 2007 Aug 2;7:26. DOI: 10.1186/1472-6920-7-26.
21. Sani MH, Mahfouz MS, Bani IA, Alsomily AH, Alagi D, Alsomily NY. Prevalence of stress among medical students in Jizan University, Kingdom of Saudi Arabia. Gulf Med J 2012;1(1):19-25.
22. Fawzy M, Hamed SA. Prevalence of psychological stress, depression and anxiety among medical students in Egypt. Psychiatry Res 2017 Sep;255:186-94. DOI: 10.1016/j.psychres.2017.05.027.
23. Marjani A, Gharavi A, Jahanshahi M, Vahidirad A, Alizadeh F. Stress among medical students of Gorgan (South East of Caspian Sea), Iran. Kathmandu Univ Med J (KUMJ) Jul-Sep 2008;6(23):421-5. DOI: 10.3126/kumj.v6i3.1726.
24. Chowdhury R, Mukherjee A, Mitra K, Naskar S, Karmakar PR, Lahiri SK. Perceived psychological stress among undergraduate medical students: Role of academic factors. Indian J Public Health Jan-Mar 2017;61(1):55-7. DOI: 10.4103/0019-557X.200253.
25. Sherina M, Rampal L, Kaneson N. Psychological stress among undergraduate medical students. Medical J Malays 2004;59(2):207-11.
26. Deepa R, Panicker AS. A phenomenological approach to understand the challenges faced by medical students. Qual Rep 2016;21(3):584-602.
27. Schoenmakers EC, van Tilburg TG, Fokkema T. Problem-focused and emotion-focused coping options and loneliness: how are they related? Eur J Ageing 2015 Feb 11;12(2):153-61. DOI: 10.1007/s10433-015-0336-1
28. Ashton C, Kamali F. Personality, lifestyles, alcohol and drug consumption in a sample of British medical students. Med Educ 1995 May;29(3):187-92. DOI: 10.1111/j.1365-2923.1995.tb02828.x.
29. Ai AL, Peterson C, Bolling SF, Rodgers W. Depression, faith-based coping, and short-term postoperative global functioning in adult and older patients undergoing cardiac surgery. J Psychosom Res 2006 Jan;60(1):21-8. DOI: 10.1016/j.jpsychores.2005.06.082.
30. Smith TB, McCullough ME, Poll J. Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psychol Bull 2003 Jul;129(4):614-36. DOI: 10.1037/0033-2909.129.4.614.