Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Research Letter

Health-related quality of life among final-year medical students

Satish R. Raj, Christopher S. Simpson, Wilma M. Hopman and Michael A. Singer
CMAJ February 22, 2000 162 (4) 509-510;
Satish R. Raj
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Christopher S. Simpson
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Wilma M. Hopman
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael A. Singer
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

Clinical clerkship, which represents the end of medical school and the beginning of postgraduate training, is a period of particularly high stress.[1–3] Often for the first time, medical students are exposed to patient care responsibilities and "on-call" periods. They must also make major career decisions and apply to residency programs.

Guthrie and colleagues4 found that the psychological well-being of a group of students in their final year of medical school was best predicted by their mental health scores in their first undergraduate year. Tile and associates5 reported that first-year internal medicine residents had significantly better mental health scores and a trend toward better social functioning and general health perception than a combined group of second- and third-year residents. These observations suggest that the process of medical training is associated with a decline in the psychosocial domains of health status.

We longitudinally measured the health-related quality of life of a group of final-year medical students over 10 months. We were interested in differences between our study group and the general population as well as in changes in our study group over time.

Participants were recruited from the Faculty of Medicine at Queen's University, Kingston, Ont. Ethical approval for the study was obtained from the Queen's University Research Ethics Board. All 73 students in the Class of 1997 were invited to complete the self-administered Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) on 4 occasions: in May, August and November 1996 and in February 1997. The SF-36 is a generic health status questionnaire designed to assess 8 health status domains: physical functioning (10 items), role limitations due to physical (4 items) or emotional (3 items) problems, social functioning (2 items), bodily pain (2 items), mental health (5 items), vitality (4 items) and general health perceptions (5 items).6 One additional item that is not scored asks the respondent to compare his or her current health with that of 1 year ago. Each domain is scored out of 100, a higher score indicating less limitation, better functioning or less pain. A change of 5 points is considered to be clinically and socially relevant. Participation was voluntary and anonymous. Consent was assumed if the SF-36 was completed and returned. Fifty-seven (78%) students returned the first survey, and 20 (27%) completed all 4. The mean age (26 years) and sex distribution (55% female) of these 20 respondents did not differ significantly from those of the entire class (mean age 28 years, 52% female).

Fig. 1 presents the survey scores of the students who completed all 4 questionnaires. Repeated-measures analysis of variance revealed a significant deterioration in 3 domains: vitality (F = 4.14; p = 0.01), role limitations due to physical problems (F = 4.13; p = 0.01) and role limitations due to emotional problems (F = 3.37; p = 0.025). These findings imply that the students as a group felt more tired and worn out and that they were having more difficulty with work or other daily activities as a result of physical health and emotional problems as the year progressed. The remaining 5 domains did not change significantly over the academic year. For comparative purposes, Fig. 1 also illustrates the scores for the US general population aged 25-34 years.6 Most of the domain scores were similar between the student group and the US general population except for general health perceptions; they were much lower among the students, which suggests that they perceived themselves as less healthy and more likely to become ill than others.

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

Fig. 1: Scores from a general health status questionnaire (SF-36 survey6) administered to medical students 4 times during their final year; results of those who completed all 4 surveys are displayed. Domains covered by the survey were physical functioning (PF), role limitations due to physical problems (RLP), bodily pain (BP), social functioning (SF), mental health (MH), role limitations due to emotional problems (RLE), vitality (VT) and general health perceptions (GHP). *Significant deterioration over time (p < 0.05).

To test for bias we compared the scores of those who completed the first survey with the scores of those who completed all 4, and the scores of those who completed the fourth survey with the scores of those who completed all 4. We found no significant differences in any of the domains.

Our study was prompted by Tile and associates' findings of lower SF-36 scores among second- and third-year internal medicine residents than among first-year residents.5 The students in our study displayed a deterioration in 3 domains as the year progressed, which suggests that changes in health status may begin in the clerkship year or even earlier. Further research to identify the determinants of change during medical training, by following a single cohort of students through medical school and postgraduate training, is needed.

Dr. Raj was supported in part by a Donald Wilson Fellowship from the Educating Future Physicians of Ontario Project.

Competing interests: None declared.

Acknowledgments

Want an easy way to check out the line-up in the next issue of CMAJ?

CMAJ now offers an email alert service. We'll send the table of contents for each issue of the journal to interested readers via email. The URL for each article is provided so that you can go directly to the full text online of any article that piques your curiosity.

Register on our Web site (www.cma.ca/cmaj) for this free service.

Footnotes

  • See related article page 515

    Reprint requests to: Dr. Michael Singer, Department of Medicine, Queen's University, Etherington Hall, Kingston ON K7L 3N6; fax 613 533-2923; hopmanw@post.queensu.ca

References

  1. 1.↵
    Styles WM. Stress in undergraduate medical education: "the mask of relaxed brilliance." Br J Gen Pract 1993;43:46-7.
    OpenUrlFREE Full Text
  2. 2.
    Wolf TM. Stress, coping and health: enhancing well-being during medical school. Med Educ 1994;28:8-17.
    OpenUrl
  3. 3.↵
    Toews JA, Lockyer JM, Dobson DJ, Brownell AK. Stress among residents, medical students, and graduate science (MSc/PhD) students. Acad Med 1993;10:S46-S48.
  4. 4.↵
    Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: a five-year prospective study. J R Soc Med 1998;91:237-43.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    Tile L, Singer M, Simpson C, Hopman W. Health status assessment of post-graduate trainees in Internal Medicine. Ann R Coll Physicians Surg Can 1995;28:403-6.
    OpenUrl
  6. 6.↵
    Ware JE. SF-36 health survey manual and interpretation guide. Boston: Health Institute, New England Medical Centre; 1993.
PreviousNext
Back to top

In this issue

CMAJ
Vol. 162, Issue 4
22 Feb 2000
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Health-related quality of life among final-year medical students
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Health-related quality of life among final-year medical students
Satish R. Raj, Christopher S. Simpson, Wilma M. Hopman, Michael A. Singer
CMAJ Feb 2000, 162 (4) 509-510;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Health-related quality of life among final-year medical students
Satish R. Raj, Christopher S. Simpson, Wilma M. Hopman, Michael A. Singer
CMAJ Feb 2000, 162 (4) 509-510;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Jung at heart: assessing one's suitability for medical training
  • Google Scholar

More in this TOC Section

  • Neonatal exposure to active pulmonary tuberculosis in a health care professional
  • How should abridged scientific articles be presented in journals? A survey of readers and authors
  • Predictive value of a self-reported history of varicella infection in determining immunity in adults
Show more Research letter

Similar Articles

Collections

  • Topics
    • Medical education, residency, internship

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire