Stress Management of Post Graduate Medical Student

1. Stress Management
of
Post Graduate Medical
Student
Dr. Md. Yunus
Additional Professor
&
Co-ordinator
Medical education Unit, NEIGRIHMS
drmdyunus@hotmail.com

2. Objectives of This Talk
1. Recognize common stressors in the medical profession
2. Describe the continuum associated with unmanaged stress
3. Assess personal risk for burnout
4. Analyze the expectations and risk factors for Medical Student
that increase risk for burnout
5. Apply learned skills that enrich personal resilience, manage
stress & prevent burnout
6. Identify resources for assistance
7. Recognize when medical students need professional help

3. • Committee on Physician Health and Rehabilitation 401 W. 15th Street, Austin, TX 78701(512) 370-
1300www.texmed.org

4. • Results: The prevalence of stress among the international
doctors was 54% (95% CI: 44–63%).
• The highest levels of stress were reported for “Anxiety and
Insomnia” and the lowest level was reported for “Severe
Depression”
• Journal of Clinical and Diagnostic Research. 2012 June, Vol-6(5): 859-862

5. J Postgrad Med. 1998 Jan-Mar;44(1):1-6.
A study of stress in medical students at Seth G.S.
Medical College
• RESULTS:
• Majority of medical students (175/238-73%)
perceived stress
• Stress was found to be significantly more in
Second and Third MBBS students rather than
First MBBS levels (p < 0.05)

6. • The evaluation showed that the participants rated the overall
workshop as highly useful (86.9%) and as having achieved the
objectives (86.2%).

7. William Osler,
Father of modern medicine
• Said it beautifully
“Medicine arose out of the primal
sympathy of man with man; out of
the desire to help those in sorrow,
need, & sickness”
This relationship arises out of pain & suffering of one person,
& offer of hope by another

8. WHAT IS STRESS ?
Stress is the reaction people have to
excessive pressures or other types of
demand placed upon them
It arises when they worry that they can’t
cope
HELP ME!

9. STRESS
• Stress is a part of being alive
• The only time there is a total
absence of stress is in death

10. Definition of Stress
• Stress is an internal process that occurs when a person is
faced with a demand that is perceived to exceed the resources
available to respond to it effectively
• where failure to deal with the demand effectively has
important and undesirable consequences
• Stress is very subjective, as it is our unique reaction to events
• Stress is defined as “our reaction to events, environmental or
internal, that tax or exceed our adaptive resources.”

11. S = P > R
• Stress occurs when the pressure is greater than the resource

12. CHRONIC STRESS DIAGRAM

13. TYPES OF STRESSORS
•External
•Internal

14. EXTERNAL STRESSORS
• Physical Environment
• Social Interaction
• Organisational
• Major Life Events
• Daily Hassles
I got the answer

15. INTERNAL STRESSORS
• Choice of Lifestyle
• Negative self - talk
• Mind traps
• Personality traits

16. TYPES OF STRESS
• Negative stress
• Positive stress
Let me think…..

17. NEGATIVE STRESS CYCLE

18. POSITIVE STRESS
• Keeps you motivated
• Makes you perform
better under pressor

19. Eustress or positive
stress occurs when
your level of stress is
high enough to
motivate you to move
into action to get
things accomplished
EUSTRESS

20. SYMPTOMS OF STRESS
• Physical symptoms
• Mental symptoms
• Behavioural symptoms
• Emotional symptoms

21. Physical Symptoms of Stress

22. MENTAL SYMPTOMS
• Lack of concentration
• Memory lapses
• Difficulty in making decisions
• Confusion
• Disorientation
• Panic attacks

23. BEHAVIOURAL SYMPTOMS
• Appetite changes - too much or too little
• Eating disorders - anorexia,
• Increased intake of alcohol & other drugs
• Increased smoking
• Restlessness
• Fidgeting
• Nail biting

24. EMOTIONAL SYMPTOMS
• Bouts of depression
• Impatience
• Fits of rage
• Fearfulness
• Deterioration of personal hygiene

25. STRESS RELATED ILLNESSES
Stress is not the same as ill-health, but has
been related to such illnesses as;
• Cardiovascular disease
• Immune system disease
• Asthma
• Diabetes

26. Effects of Stress
• Digestive disorders
• Ulcers
• Skin complaints - psoriasis
• Headaches and migraines
• Pre-menstrual syndrome
• Depression

27. COSTS OF STRESS
80% of all modern diseases have their origins in
stress
Many working days per year are lost directly from
stress - related illness

29. The Challenges in Medical College
• The best years of your life? Expectations..
• Even positive change is stressful
• Greater academic demands
• Unstructured time
• Decreased adult availability
• Being on your own in a new environment
• Changing relations with family

30. Stressors in Medical Institute
• Dramatic lifestyle changes
• Heavy academic
workload/clinical caseload
• Perceived need to excel at all
costs
• Lack of control/autonomy
• Responsibility for patients
• Exposure to infections
• Limited support systems
• Inadequate training for
working with patients &
families
• Frenetic, intense pace of
training
• Repetitive single tasks/scut-
work
• Problems without solutions
• Death & dying
• Time pressure & demands
• Disillusionment

31. Academic stressors
• Students never have enough time to study
• Experiences fears of increasing responsibility,
death of patients, fear of Failure

32. Clinical stressors
• Clinical stressors include difficulties in dealing with the chain of
command/ pecking order common for students
• Coping with hierarchy & the authoritative environment is troubling
for students
• “Student compares medical training to military training”
• Both recruit young people full of leadership potential and
essentially break their autonomous will through a rigorous
hierarchy
• Students are thrown into the hospital wards-definitely
front-line duty like in War

33. Expectation From doctors
• The culture of medicine has created an unrealistic
expectation of doctors to always put the patient first and
to deny their own needs
• In their role as healer, it is hard for physicians to
accept help for themselves, or reveal that they are
facing personal challenges

34. The Process of Stress
1. Stress leads to arousal
2. Person selects a coping response
3. If effective, arousal decreases
4. If ineffective, arousal increases, resulting in
escalation of stress level
5. Unresolved stress leads to burnout
6. Burnout leads to unethical behaviours

36. Three Stages of Burnout
• Stage 1 — Stress Arousal
• Stage 2 — Energy Conservation
• Stage 3 — Exhaustion

37. Stage 1 — Stress Arousal
• Irritability, anxiety
• Insomnia
• Forgetfulness/Poor concentration
• Gastrointestinal disorders
• Headaches
• Self-medication
With the presence of any two of these, on may be experiencing Stage
1 stress arousal

38. Stage 2 — Energy Conservation
• Lateness, procrastination
• Excessive time off
• Decreased sex drive
• Fatigue
• Social withdrawal
• Increased substance abuse
• Again, any two of these symptoms may signal that one is in Stage 2 of the
burnout cycle

39. Stage 3 — Exhaustion
• Chronic sadness or depression
• Suicidal ideation
• Chronic GI problems & /or headaches
• Social isolation
• Substance Use Disorders
• Unethical behaviours (disruptive behaviour, boundary
violations)

40. Definition of Burnout
• Burnout is a state of mental & / or physical
exhaustion caused by excessive and prolonged stress
• Burnout syndromes are characterized by three
features:
– Emotional exhaustion,
– Depersonalization (cynicism), &
– Diminished sense of personal accomplishment

41. Burnout Survey Results
• Fifty percent of all medical students were
assessed with significant burnout in a large
multicenter study
• Physician burnout has a negative impact on
patient outcomes

42. Risk Factors for Burnout
• Perfectionism & control to reveal emotions equals
weakness
• Pressure that patients should always come first
– Overachievers: Type A personality
– Reluctance to ask for help
– Belief that physicians do not have needs

43. Negative Outcomes
• Addictive behaviours
• Relationship distress
• Emotional/Behavioral problems
• Loss/Lack of spirituality
• Academic consequences
• Death/Suicide

44. Current Medical Student Drug Use
• 10 to 15 percent of all health care professionals will
inappropriately use drugs or alcohol at some point during
their careers
• 15 percent of medical students scored positive for at-risk
drinking.
• 33.4 percent of medical students reported using one or
more illicit drugs in the past year.
• 16.8 percent of medical students report lifetime use of
“club drugs” (MDMA,cocaine)

45. Susceptibility to Depression
• More than 20 percent of medical students have symptoms of
depression
(12 percent — probable major depression and
9 percent —probable mild/moderate depression)
• Up to 9 percent of students reported suicidal ideation
• Prevalence of depression increases over the course of
medical school, with a higher risk of stress/depression
associated with transition to clinical care rotations (third
year)

46. What is ’Stress Management’?
The
art
of
taking
care
of
oneself

47. Our goal is not to eliminate stress but
to learn how to manage and use it to
help us
.

48. STRESS CONTROL
ABC STRATEGY

49. ABC STRATEGY
A = AWARENESS
What causes you stress?
How do you react?

50. ABC STRATEGY
B = BALANCE
There is a fine line between
positive / negative stress
How much can you cope with
before it becomes negative ?

51. ABC STRATEGY
C = CONTROL
What can you do to help yourself
combat the negative effects of
stress ?

52. Tips to Handle Stress
• Work smarter, not harder
• Carry reading material with you
• Accept the fact that time will be spent on
activities outside your control
• Record daily activities, achievements,
goals, sources of delay, & time wasted
to realize hidden opportunities

53. Tips to Handle Stress
• Always maintain a short task list
• Continually ask yourself ”What is the best use of
my time right now”?
• Be physically active to relieve tension
• Make quick decisions
• Carefully mix work & breaks
• Have a positive attitude
• Relax

54. Suicide Is Preventable
• Feelings of hopelessness
• Continuing thoughts or wishes for death,
• Feelings of being trapped
• Personal losses such as death of a loved one
• A broken relationship are signals that a
consultation with a health professional would
be beneficial

55. Self-Assessment Exercise
Self-assessment exercise to assess your own personal stress level
• This exercise is for your own use and does not need to be returned
to Me
• How often do you … Calculate your total score as follows:
(a) almost always (a) = 4 points;
(b) often (b) = 3 points;
(c) seldom (c) = 2 points;
(d) almost never (d) = 1 point
Total = ------
1. Find yourself with insufficient time to do things you really enjoy?
2. Wish you had more support/ assistance?
3. Lack sufficient time to complete your work most effectively?

56. Self-Assessment Exercise Conti…..
4. Have difficulty falling asleep because you have too much onyour mind?
5. Feel people simply expect too much from you?
6. Feel overwhelmed?
7. Find yourself becoming forgetful or indecisive because you have too much
on your mind?
8. Consider yourself to be in a high pressure situation?
9. Feel you have too much responsibility for one person?
10. Feel exhausted at the end of the day?

57. Overload
• This exercise was designed to assess your level
of stress due to overload
• Overload or over-stimulation, refers to the state
in which the demands around you exceed your
capacity to meet them

58. Four major factors in overload
(1)Time pressures
(2) Excessive responsibility or accountability
(3) Lack of support &
(4) Excessive expectations from yourself & those
around you
Any one or a combination of these factors can result in stress
from overload
• A total of 25-40 points indicates a high stress level, one
that could be psychologically and physiologically
debilitating

59. Preventing Burnout
• Maintain a sense of optimism
• Work on friendships and support systems
• Take care of yourself/do not overextend yourself:
– Exercise regularly/eat right
– Get enough sleep and
– Take time to play
• Keep a sense of humor
• Have a hobby that is relaxing & enjoyable
• Choose specialty residency wisely; remember you can change your mind
• Get help if you need it
• The key is to not try to avoid stress altogether, but to recognize and
manage the stress in our lives in such a way that we avoid the negative
consequences of stress

60. EXERCISE

61. EXERCISE AND STRESS
• Exercise increases blood flow to the brain which is good for us
• Exercises also releases hormones, and stimulates the nervous system
in ways that are good for us
• Exercise produces chemicals in the body such as beta-endorphin,
which is proven to have a positive effect on how we feel

62. Balanced DIET
• AVOID Caffeine, Tobacco and Alcohol

63. YOGA/DHYANA
• Exercise burns up adrenaline and produces helpful chemicals
and positive feelings

64. SLEEP AND REST
• .

65. Mental Techniques
. M - Money Management, Minimize needs, Meditation
• E - Earnest Expectations, Enjoy the work you do
• N - Avoid Negative thinking
• T - Try to be happy Today
• A - Accept and Adopt Reality
• L - Avoid Loneliness
• H - Develop good Hobbies
• E - Live in good Environment. Express yourself clearly
• A - Be Active and have positive Attitude
• L - Try to Learn more & Manage Life
• T - Have realistic Targets & Tackle one at a time
• H - Maintain Healthy life style

67. Potential Barriers
• Stigma
• Residency
• Professional Carrier

69. Summary
• Stress is inevitable
• Burnout is preventable, treatable, & manageable
• Identify coping strategies that work best for you
• Help is available

71. Created by Dr. Md. Yunus for Medical
Students to Beat Stress & Enjoy the
work & world
Email: drmdyunus@hotmail.com
Web: www.neigrihms.nic.in