Theme
3II International
INSTITUTION
University of Medicine and Pharmacy 'Iuliu Hatieganu' - Social Sciences
**University of Twente, Institute of Innovation and Governance Studies, Netherlands
The number of international students in Romanian Medical Universities is growing in recent years, together with the increase of travel to study within the EU. International students are a special group for every university, because they face a lot of stressful situations in the host country due, for instance, to different academic demands, cultural context, language differences. There are differences between long term study (such as deciding to migrate to pursue a complete degree), or short term study (such as an exchange programme of one semester). A particularly interesting case is represented by the recent increase in international student who decide to study Medicine abroad. Longer duration of studies, impact of following this specific degree in a foreign language, cultural differences, are expected to weigh in more in this field of study than in a different one.
Objective: The purpose of this study was to assess associations between psychological adaptation and stress coping strategies in international and domestic students studying General Medicine at the University of Medicine and Pharmacy ''Iuliu Hatieganu'' Cluj-Napoca, Romania
Method: The study recruited 421 first year students: 267 Romanian and 154 international students (English section). The participation in the study was 90 % of the students. Stress-coping strategies were measured by Coping Orientation of Problem Experience questionnaire. STAI Anxiety Scale was used to measure anxiety. NEO-FFI was used to measure personality. Academic stress was measures by Medical Student Stressor Questionnaire MSSQ. Written consent was obtained from the participants. Completion of the questionnaires was voluntary. Permission was obtained from the medical schools and Ethical Committee of University of Medicine and Pharmacy ''Iuliu Hațieganu'' prior to the start of the study. The questionnaires were distributed to students 2 months after the beginning of the first semester.
Table 1: Demographics characteristics of the sample
|
Romanian students |
International students (english section) |
||
|
men |
women |
men |
women |
sex (N, %) |
86, 32.2% |
181, 67.8% |
79, 51.3% |
75, 48.7% |
age (Mean ± SD) |
19.77±2.32
|
19.08±.92
|
21.02±3.21
|
20.34±2.85
|
Parents (N, %) |
||||
doctors (yes) ( |
41 (15.3%) |
44 (28.6%) |
||
mother, higher education |
206 (76.9%) |
105 (68.2%) |
||
father, higher education |
190 (70.9%) |
112 (72.7%) |
||
marital status (N, %) |
||||
single |
171 (64%) |
110 (71.4%) |
||
in a relationship |
96 (36%) |
42 (27.3%) |
||
married |
|
2 (1.3%) |
A total of 267 Romanian student responded. 181 (67.8%) were female students. Average age was 19 year in female students and 19.8 years in male students. 76.9% students' mothers' education and 70.9% students' fathers' education were higher education. 15.3% of the students had one of both parents physicians. Students' relationship status were 171 (64%) single and 96 (36%) in a relationship.
A total of 154 International students (English section) responded. 75 (48.7%) were female students. Average age was 20.34 year in female students and 21.2 years in male students. 68.2% students' mothers' education and 72.7% students' fathers' education were higher education. 28.6% of the students had one of both parents physicians. Students' relationship status were 110 (71.4%) single, 42 (27.3%) in a relationship and 2 (1.3%) married. The international students came from 19 countries. The students come from EU country (41.6% from Germany), but also from places such as US and Canada. Also there are a lot of students from Arab countries and Israel.
Table 2: The main stressors ranked by mean degree of stress as perceived by the medical students (identified by the MSSQ)
Stressor |
Mean Value |
Tests/examinations |
2.9142 |
Falling behind in reading schedule |
2.6978 |
Large amount of content to be learnt |
2.7948 |
Lack of time to review what have been learnt |
2.7313 |
Heavy workload |
2.3955 |
Participation in class presentation |
2.2761 |
Need to do well (imposed by others) |
2.0485 |
Feeling of incompetence |
2.2985 |
Unable to answer questions from patients |
2.3209 |
Talking to patients about personal problems |
1.6754 |
Facing illness or death of the patients |
2.2388 |
Verbal or physical abuse by other student(s) |
1.4328 |
Verbal or physical abuse by teacher(s) |
1.8246 |
Verbal or physical abuse by personnel(s) |
1.3806 |
Conflict with teacher(s) |
1.8769 |
Unwillingness to study medicine |
1.3955 |
Parental wish for you to study medicine |
1.0112 |
Not enough feedback from teacher (s) |
1.4739 |
Uncertainty of what is expected of me |
1.6754 |
Lack of recognition for work done |
1.791 |
The stressors ranked based on the degree of stress they caused as perceived by the students is shown in Table 2. All the stressors were related to academic matters. The top stressors are exams, falling behind in learning schedule, large amount of content to be learnt, heavy workload and lack of time to review what have been learnt.
Table 3 Correlations between academic stress and personality variables
STAI-Y2 trait anxiety |
Spearman's rho |
.466** |
p |
.000 |
|
N |
267 |
|
Neuroticism |
Spearman’s rho |
.449** |
p |
.000 |
|
N |
267 |
|
Extraversion |
Spearman’s rho |
-.158** |
p |
.010 |
|
N |
267 |
|
Openness |
Spearman’s rho |
-.019 |
p |
.758 |
|
N |
267 |
|
Agreeableness |
Spearman’s rho |
-.029 |
p |
.637 |
|
N |
267 |
|
Conscientiousness |
Spearman’s rho |
-.127* |
p |
.037 |
|
N |
267 |
We performed correlations between academic stress and personality variables. STAI trait anxiety and neuroticism were significantly and positively correlated with academic stress. Conscientiousness and Extraversion were significantly and negatively correlated with academic stress.
Several studies have examined the relationship between personality type and stress. Personality traits may influence a person’s perception of or reaction to stressful situations (Vollrath, 2001).
Medical students carry certain personality traits such as perfectionism or performance-based self-esteem, that make them vulnerable to mental distres (Enns, 2001 & Dahlin, 2007). The students from our sample have showed high scores on neuroticism and conscientiousness. Neuroticism is strongly associated with a propensity to experience negative emotions (Matthews, Deary, &Whiteman, 2009). In our study STAI trait anxiety and neuroticism were significantly and positively correlated with academic stress.
The differences between male and female students are similar with other researches, Coulston (2012) had found higher scores on neuroticism in females than in males, which is in accordance with a higher depression rate for women in the general population (Dahlin, 2005).
Regarding academic stress, the top stressors were related with academic matters: test and examinations, large amount of contents to be learnt, lack of time to review what has been learnt, falling behind in reading schedule and heavy workload. The findings are similar with others studies, although the instruments used to measured academic stressors were different (Firth 1986, Gutrie 1998, Saipanish 2003, Yosoff 2010).
- Vollrath, M., 2001 Personality and stress. Scand J Psychol 42: 335–347.
- Enns, M. W., Cox, B. J., Sareen, J., & Freeman, P. 2001 Adaptive and maladaptive perfectionism in medical students. Med Educ, 35, 1034−1042
- Dahlin M., Joneborg N., Runeson B., 2007 Performance-based self-esteem and burnout in a cross-sectional study of medical students. Med Teach, 29:43-48.
- Matthews, G., Deary, I. J., & Whiteman, M. C. 2009 Personality traits. Cambridge: Cambridge University Press.
- Coulston C., Vollmer-Conna U., Malhi G. 2012 Female medical students: who might make the cut? Psychiatry Res. 30, 200(2-3):457-463.
- Dahlin M., Joneborg N., Runeson B. 2005 Stress and depression among medical students: a cross sectional study, Med Educ 39:594-604.
- Firth, J. 1986Levels and sources of stress in medical students Br Med J (Clin Res Ed);292(6529):1177-80.
- Guthrie E., Black D., Bagalkote H., Shaw C., Campbell M., Creed F. 1998 Psychological stress and burnout in medical students: a five-year prospective longitudinal study J R Soc Med 91(5):237-43.
- Saipanish, R., 2003 Stress among medical students in a Thai medical school. Med Teach 25(5):502-6.
- Yusoff, M.S.B., Rahim, A.F.A., Yaacob, M.J. 2010 The development and validity of the Medical Student Stressor Questionnaire (MSSQ), ASEAN J Psychiatr, 11(1). Available online at http://www.aseanjournalofpsychiatry.org/oe11105.htm.