Volume 58 - Number 1 January - 2014 (Current issue) ISSN 0019-5499

Effect of stress on academic performance in medical students –
a cross sectional study

Mukesh Kumar, Sachin Sharma, Surbhi Gupta, Supriya Vaish and Rajesh Misra

Abstract

Introduction- Stress, a universal phenomenon, affects an individual's productivity either by increasing it ('eustress') or decreasing it ('distress'). It is widely acknowledged that the medical fraternity is predisposed to enormous stress. The same may be true for the budding medicos - the undergraduate medical students. In our study we attempted to identify situations that predisposed the medical students to stress and their effects on academic performance and to suggest certain coping mechanisms.

Objectives- firstly to explore common sources of stress in medical students, secondly to establish correlation of stress, gender, attendance, and academic performance if any.

Method- 114 medical undergraduates were assessed for the common sources of stress and the level of stress using semi structured Performa and stress scale. The results were compared and correlated with various variables like attendance, demographic factors, average marks etc. Pearson correlation coefficient was used for statistical correlation amongst different variables.

Results & Conclusions- Stress shows beneficial effects in females when compared to males. High attendance and better day to day performance in female medical students was associated with more amount of stress when compared to male students. Thus, stress among medical students should be acknowledged and attempts should be made to alleviate it.

Introduction

'Stress' a universal phenomenon, affects an individual's productivity either by increasing ('eustress') or decreasing it (distress), as 'stress' is handled differently by different people (1, 2). Every year a large number of under-graduate medical students enrol for the different medical courses across the country. However, weak academic performance and high failure rate remains a persistent problem (3). For students detention based on attendance and failing before attaining final medical degree provide extra burden on the students as well as on the parents (4, 5, 6). Poor academic
performance and poor attendance is often indicative of difficulties in adjusting to new environment. On one hand, studies have reported that stress can be inversely related to academic performance, on the other hand, studies failed to detect an association between stress and academic performance (7, 8). Interestingly, perceived stress and coping may be influenced by stress as well (9).

Our study is an attempt to identify stress causing situations in the life of a medical student and to examine the effect of those situations on academic performance. We also explore the correlation of stress with gender, age, attendance and propose ways of coping with stress, which in turn will help students in improving their academic performance.

Material and Methods

After obtaining ethical clearance from the Institutional Ethics Committee at the commencement of the study, all first year medical students who had enrolled in 2010-2011 at Subharti Medical college, Meerut (N=114, males=52, females=62) were taken up for the study. Following a written consent from students, they were given a self designed semi structured performa which included socio-demographic details including age, sex, domicile, current residence, stress score & Cumulative grade points, during their practical hours in the department of pharmacology (i.e. after passing their Ist professional exams) after obtaining permission from the lab coordinator. A list of stressors as well as the amount of stress amongst the medical students was calculated using the standardized stress scale by Girdano et al (10)Cumulative grade points and attendance were calculated based on the record available in the department. A total of 10 CGP (cumulative grade points) are calculated based on the performance (%) in group discussion (10%), day to day assessment (15%), seminars (12.5%), Ist terminal exams (25%) and IInd terminal exams (37.5%), during their stay in the department i.e. before appearing in Ist professional exams (annexure-I). Stress scale consisted of a list of 25 questions based on the events that occurred in the life of the students. Students were asked to tick in the right hand column for each of those events that happened to them during the last 12 months (annexure-II). In each class students took approximately 10 minutes to complete the questionnaire. Each question carried certain marks according to its importance in causing stress in the life of a college student. A total score (annexure-III) was calculated for each student separately and they were classified in to three groups on the basis of the scores obtained- low stress level group (less than 150 points), border line range group (150-300), and high stress level group (more than 300 points). The level of stress was then correlated with the variables like age, sex, academic performance and attendance using Pearson correlation coefficient as our statistical tool.



114 students (males-52 females-62) who gave the informed consent and fully completed the performa were taken up for the study. The mean age of male students was 19.97+1.337 and 19.839+1.081 years in case of female students. The Stress scale scores were found to be 231.673+93.063 in males and 249.951+113.034 in females. Cumulative grade points were 4.374+1.319 in males and 4.965+1.294 in females, attendance 73.577+14.308 in males and 77.919+11.659 in females. Thus, all in three parameters- stress scale scores, cumulative grade points and attendance, female students scored higher points (Table I).

On the basis of gender distribution and stress levels, maximum number of students 53% (61) students showed medium level of stress (males 30, females



Results

Results were analysed and expressed in terms of percentages and p value was determined using statistical calculator. A total of 140 students of class X participated in the study consisting of 82 boys and 58 girls. The mean age of all the study participants was 15.4 years (SD+0.864) with mean age of boys at 15.46 years (SD+0.975) and girls 14.75 years (SD+0.431). The fasting blood sugar was correlated with BMI, WHR and Family history of the participants and tabulated as given below :




31), followed by 29% (33) students who showed high level of stress (males 13, females 20). More number of female students showed higher level of stress as compared to male students (Fig. 1).


A total of 47% (54) students earned more than 50% of cumulative grade points in Ist professionals, with female students (34) outnumbering the male students (20). Similarly, female students (41) show better attendance as compared to male students (27). 60% students showed more than 75% attendance (Table II). The correlation between cumulative grade points, attendance and stress in male students and female students is shown in Table III & IV.



Discussion

The main research question in this paper was to explore the relationship between perceived stress levels and academic performance (i.e. cumulative grade points and attendance), and to show its relation to other demographic factors such as age and sex.



Keeping in view the prior knowledge of higher levels of stress in professional courses including medical, we conducted a survey of undergraduate medical students (11-16). In our study, male students' cumulative grades and stress were found to be inversely correlated i.e. as the level of stress increased from mild to severe the cumulative grades also decreased. This finding suggests that stress has a negative impact on the academic performance of the medical students which can be explained on the basis of the fact that higher stress impairs the performance which is due to the deterioration of the cognitive skills or higher cognitive functions for e.g. impaired concentration, poor retention and poor recall, startle response, mental fatigue (17-24). It can further be stressed upon that the varying effects of stress on performance is often compared to or known as "inverted-u" which has an impact on the cognitive areas of learning as well neuroplasticity (25). In contrast to this finding, interestingly, in our study it was observed that in female students increasing amount of stress was having a beneficial effect on cumulative grade points i.e. the stress was related to the improved academic performance. This contrasting finding in case of female students may be explained on the basis the phenomenon of 'eustress' where an individual is motivated high enough because of stress to move to action to get things accomplished (26-27). Takemuray Y, Kikuchi S and Inaba y have reported the similar results where the stress has been associated with improvement in performance (28-29). In our study we also found that both measures of academic success i.e. cumulative grade points and attendance were positively correlated to one another. The students who showed better attendance (irrespective of gender) earned higher cumulative grade points. This finding is consistent with prior research work (30).

Our study found high levels of stress and its significant role on the academic performance of the medical students. Knowing about the stressors and its impact on students is the first step in highlighting the need for acknowledging, identifying, and attempting to reduce the levels of stress in them.

Conclusions

Keeping in view the fact that the undergraduate medical students are the future medical professionals on whose shoulders the physical as well as mental health of the public lies, it is of utmost importance that the stress and the mental health of these young budding professionals is taken care of. Authors have generated a list of stressors that were reported to be of important value regarding the stress by the students themselves who were under the study. It is thus planned that these stressors will also be included in the further study that is underway. It is also proposed that keeping in view the increased propensity of medical students to be under stress, stress management in form of incorporating and inculcating coping mechanisms should be included in medical curriculum. Some de- stressing techniques including relaxation exercises, yogic exercises, time management, and participation in extra-curricular activities to should be taught to the medical students from the first year in the college, which would indirectly improve the functioning and academic performance of the students.

Acknowledgements

We want to acknowledge the help and support of the Department of Psychiatry in the work. The authors are grateful to Dr. Rajesh Misra, Professor and Head Department of Physiology, SMC, Meerut for providing us the method of CGP formulation.

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