|Year : 2019 | Volume
| Issue : 2 | Page : 92-97
Resilience, psychological well-being, and coping strategies in medical students
Sonika1, Shalini1, Rajesh Kumar2
1 BSc (Hons.) Nursing Students, Department of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Assistant Professor, Department of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
|Date of Web Publication||21-Jan-2020|
Dr. Rajesh Kumar
Department of Nursing, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand
Source of Support: None, Conflict of Interest: None
Introduction: The period of transition from school to medical education is critical and students faced many challenges and have a stressful life. Coping and resilience level of a student determine psychological well-being for higher professional competence and learning. The study aims to determine impacts of coping, and resilience on psychological well-being among medical students. Materials and Methods: A cross-sectional descriptive survey was conducted by randomly enrolling 151 MBBS students at All India Institute of Medical Sciences, Rishikesh, Uttarakhand. The information on personal and professional domains, coping, resilience and psychological well-being was sought by using sociodemographic profile sheet, resiliency scale for adult, BREF-COPE (Coping Orientation to Problems Experienced), and Ryff's psychological well-being scale. Appropriate descriptive and inferential statistics was applied to formulate results. Results: Resilience did not show significant relationship with psychological well-being in medical students. However, it was found that high level of resilience enables to predict more autonomy (P < 0.05), personal growth (P < 0.05), help in findings meaning in life (P < 0.05) and develop strong structural aspects (P < 0.05) in physical structure. Further, higher resilience enables to more use of self-distraction (P < 0.05). Likewise, it was also evident that better level of psychological well-being enables students to use more active coping (P < 0.05), positive reframing (P < 0.05), and acceptance coping strategies (P < 0.05). Conclusion: Higher level of resilience will help the medical graduates to buffer day to day stressors and enalbles to use more positive coping strategies. Discussion and Recommendation: Improvement in social and personal life of the health sciences students should be kept in mind along with clinical competency. Development of resilience to tolerate day to day life hassles is a healthy practice to have a positive augmentation of psychological well-being. The study recommended to implicit educational training centered on resilience and positive coping strategies in future.
Keywords: Coping, medical students, psychological well-being, resilience
|How to cite this article:|
Sonika, Shalini, Kumar R. Resilience, psychological well-being, and coping strategies in medical students. Indian J Psy Nsg 2019;16:92-7
|How to cite this URL:|
Sonika, Shalini, Kumar R. Resilience, psychological well-being, and coping strategies in medical students. Indian J Psy Nsg [serial online] 2019 [cited 2020 Jul 6];16:92-7. Available from: http://www.ijpn.in/text.asp?2019/16/2/92/276346
| Introduction|| |
The transition of students from school education to medical education may expose the students for many challenges. Numerous risk factors responsible for fueling stress among health science students such as shifting away from home to hostel life, lost of social and parents support, parents expectation, time management, exposure to unexpected situation, i.e., death, infection and bloodshed and adjustment among other team members.
Chronic exposure and unable to resolve stress lead many negative consequences on physical and psychological health. However, each individual reacts to these stressors in their own different ways. Mechanism of resilience and coping in relation to these stressors plays an important role in mandating balance in life. Assessment of resilience and coping among health sciences students important to know the strength lies within and helps to plan intervention strategies.
Coping strategies are the ways that help students to handle stress and enable an individual to maintain balance between different spheres of life. These are cognitive and behavioral effects to manage day to day life stressors. Coping mechanism helps an individual to regain the emotional equilibrium after a stressful experience. Coping work as a buffer or stabilizing cushion in maintaining psychological adaptation during stressful events.
An individual may use problem or emotion focused coping strategies to alleviate day to day stress. In problem solving coping strategies, individual try to find the alternative solution for the problem while internal emotion is being regulated in emotion focused coping strategies. Research evidenced that coping contributes much in determining psychological well-being. Further, it is documented that higher level coping is associated to least adjustment issues among health sciences students.
Resilience is a similar concept to coping that play a crucial role in dealing stress and adversity. Resilience helps in 'bouncing back' an individual to the previous normal state of living. Resilience enables a student to develop realistic plan, positive self-image, capacity to handle strong feelings and impulses and develop good communication skills. A resilient individual may show features of locus of control, perseveration, problem solving ability, self-efficacy, high moral, and confidence. A resilience person is expected to show productive mental and physical health.
Resilience is a set of attributes demonstrated by an individual over a period to succeed, to live and to develop a positive way despite stress and adversity. Resilience is a combination of optimistic thinking, religious faith and social support in an individual. Resilience emphasizes development of healthy coping mechanism, and leadership skills that subsequently aid students to face variant challenges of medical field, i.e., high workload, vigorous emotional, and physical demands of the profession. Resilient individuals have the ability to sustain their physical as well as psychological health and handle stressful situation in a judicious manner.
Psychological well-being is a sense of feeling healthy leading to complete awareness of personal integrity along with the spiritual element of life. Research also advocated that resilience is efficacious in enhancing psychological well-being of an individual. It is evidenced that psychological well-being is dependent of resilience level of an individual. A positive psychological well-being is an important element of personality for a medical student for professional and personal contentment.
Therefore, training to develop and use resilience and healthy coping ways can be a part of medical curriculum to help students in getting adjusted with stressful educational and working environment.
| Materials and Methods|| |
A cross sectional descriptive survey was carried by randomly selecting 151 medical students at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand. Information was sought by using sociodemographic profile sheet and Resilience scale for Adults (RSA), BREF-COPE and Ryff's Psychological well-being. A detail of the instruments is given in below section.
Sociodemographic data sheet
It consisted information regarding personal, professional and other daily life related events i.e., age, gender, year of the study, parents education, occupation, monthly family income, and distance from home to hostel/campus. The tool sought validation from the experts in the field of medical, administration and education.
Resiliency scale for adults
The original RSA was modified for the present study by reducing items to the interest of the population. It is 33 items 5 point Likert rating scale measure protective factors among adult. 33 items were broadly classified under 5 domains; (1) social competency (6 items), (2) social resources (7 items), (3) family cohesion (6 items), (4) personal competency (10 items) and structural styles (4 items). Scale is on continuous scale and does not have category or cut point for total scale score. Getting higher score indicates higher resilience in a subject in specific area and scale as well. Instrument tested for reliability and expressed 0.80 (Cronbach's alpha = 0.80) for the present study.
It is standardized coping checklist given by Carver CS (1997) to measure coping strategies commonly used in day-to-day life to handle stress. The 28 items are grouped under 14 domains (2 items each) in a 4-point scale; (1) I haven't been using this, (2) I have been doing this little, (3) I have been doing this a medium amount, and (4) I have been doing this a lot. This coping checklist is publically testes and had fairly good validity and reliability (test-re-test (r) =0.90).
Ryff' psychological well-being scale
The scale consisted 42 items on a six-point scale: strongly agree = 6 to strongly disagree = 1. 42 items are grouped under six domains (7 items for each); (1) autonomy, (2) environmental mastery, (3) personal growth, (4) positive relation, (5) purpose in life, and (6) self-acceptance. Each domain score ranges from 7 to 42. Scale is on continuous scale and does not have category or cut point for total scale score. Getting higher score indicates higher psychological well-being in a subject in specific area and scale as well. The scale test–retest reliability was 0.82.
A brief research proposal was submitted to Institutional Ethical Committee at AIIMS, Rishikesh, Uttarakhand for ethical approval. Ethical permission was obtained after due clarification of related ethical principles, i.e., confidentiality, consent, and anonymity during and after data collection and dissemination of findings.
Method of data collection
A formal permission was obtained from concerned authority before proceeding to data collection. The students were called in their respective classrooms at the same time. The data was collected with the help two other faculty members. The students were explained about study objectives and a written informed consent was obtained from all students. All tools were administered at same time to collect information about sociodemographic and profession related variables, resilience factors, coping styles and psychological well-being among medical students. It took approximately 15–20 min to collect the data. Data was analyzed using SPSS version 20 and analyzed by using descriptive and inferential statistics.
| Results|| |
[Table 1] represents the personal profile of the medical students. The mean age of the students was 20.14 (±1.36) years. Majority students (89.4%) were female, single (97.4%) and belong to nuclear family (73.5%). Further, 32.5% students studying in 1st year followed by 23.2% in 3rd year MBBS course. 65.9%, 47.8% father and mother educated up to graduation and senior secondary school, respectively.
Around 45% father of medical students was working in govt sector while 83.4% mothers were homemakers with a monthly income more than 10,001 rupees (74.8%). Around 44.4% students belong to a distance more than 500 km from campus.
[Table 2] represents the relationship between resilience and psychological well-being status of medical students. Findings represent that there is no significant relationship between resilience and psychological well-being. However, further findings suggested that higher resilience level enable to predict greater autonomy (P< 0.05), personal growth (P< 0.05), find a purpose in life (P< 0.05), and development of better structural aspects (P< 0.05). Likewise, it may be interpreted that a higher level of resilience is a protective and growing factor for development of few traits of personality.
|Table 2: Relationship between resilience and psychological well-being (n=151)|
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[Table 3] represents the relationship between resilience and coping strategies in medical students. Finding represents that higher level of resilience in medical students leads to more use of self-distraction (P< 0.05) coping strategies. However, it was also reflecting that a high level of resilience leads to less use of active coping (P< 0.05), substance abuse (P< 0.05), emotional support (P< 0.05), instrumental support (P< 0.05), behavioral disengagement (P< 0.05), ventilation (P< 0.05), positive reframing (P< 0.05), planning (P< 0.05), humor (P< 0.05), acceptance (P< 0.05), and self-blaming (P< 0.05) for own mistakes [Table 3].
[Table 4] show the findings related to psychological well-being ad coping strategies. Findings revealed that higher psychological well-being leads to lesser use of self-distraction (P< 0.05), active coping strategies (P< 0.05), denial (P< 0.05), substance abuse (P< 0.05), emotional support (P< 0.05), behavioral disengagement (P< 0.05), ventilation (P< 0.05), planning (P< 0.05), humor (P< 0.05), and self-blame (P< 0.05) as a coping strategy. However, it was also evident that higher level of psychological well-being leads to more use of positive reframing (P< 0.05) and acceptance (P< 0.05) coping in medical students [Table 4].
|Table 4: Relationships between psychological well-being and coping strategies (n=151)|
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| Discussion|| |
The present study is cross-sectional in nature to explore the resilience, coping and psychological well-being among randomly selecting 151 medical students. The study findings in each variable represent impressive result in medical undergraduates. The present study reflects no significant relationships between resilience and psychological well-being among medical students. However, it was found that higher resilience potential to lead more autonomy, personal growth, development of better structural aspects and able to find purpose in life. These study findings are in line with the work conducted by Picardi et al., Hurtes and Allen, and further with the work of Beasley et al.
Further, similar trend was observed in the work conducted by Sagone and Caroli which reported that higher resilience is directly related to better psychological; well-being except for purpose in life. Likewise, in the present work, resilience did not find correlation with psychological well-being among medical students. Contradictory results reported in the study conducted of Innes which reported that higher level of resilience potentiate to enhance psychological well-being effectively. Similar, findings reported in the work completed in a UK study, which also suggested no variations among resilience and psychological well-being. The reason of these contradictory findings is unknown.
The present study findings reported interesting results in regards to relationship between coping strategies and psychological well-being. It reported that higher level of psychological well-being potential to use positive reframing and acceptance in medical students. These results are consistent with the work conducted by Loukzadeh and Mazloom Bafrooi, Portocarrero and Bernardes, Mayordomo, which reported that use of adaptive coping strategies depend on level of psychological well-being. Likewise, in the work of Gonzalez et al. and Figueroa et al. reported that level of psychological well-being potentiates the use of different coping strategies.
Further, the relationship between resilience and coping strategies revealed that resilience was positively correlated with self-distraction and lesser use of substance use, and use of self-blame in students. These data proved that medical students with high level of resilience would able to manage stress by using self-distraction and less use of substance use and avoiding self-blame for their own mistakes. These results found consistent with the study on university students, which represent that high level of resilience leads students to deal stress and challenges by positively distracting and problem solving. Likewise, in a study conducted on MBBS students by Somaiya et al. also reported a strong positive relationship between problem solving and resilience level. In another work, it is also proved that higher resilient individual shows lower use of denial, avoidant coping and behavioral disengagement.
| Conclusion|| |
Study conducted on undergraduates' medical students revealed to us the different coping styles, resilience and psychological well-being. It is clear from the study that higher level of resilience potentiates the students to use more adaptive and positive coping strategies and vice-versa. Similarly, high level of psychological well-being also equally enables the students to adopt positive and healthy coping mechanism for stress management and adjustment in the environment. This observation develop insight in to medical teachers and faculty to develop students-oriented training programme to stress management and offer support workshop like mentor strategic communication focusing on building resilience to develop positive attitude toward life.
Limitations and recommendations
The present work should be considered preliminary in the field and can be seen under many limitations, i.e., small sample size, and limited to single setting and use of cross-sectional design. One-time cross-sectional design may unable to prove causality between variables. Study recommend replicating the work on large and different types of health sciences students to compare these above variables. Findings of a large population enables the researcher and teacher to plan intervention considering all aspects of resilience through adding adaptive coping strategies.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]