Document Type : Original Article
Authors
1 Department of Physiology, Government Doon Medical College, Dehradun, Uttarakhand, India
2 Vascular Health Researcher, Department of Sports and Exercise Physiology, School of Sport and Exercise, University of Gloucestershire, UK
Abstract
BACKGROUND: A growing body of literature now identifies higher levels of anxiety, depression, and
stress among medical students as a distinct mental health domain. The competency‑based medical
education (CBME) curriculum was introduced to revamp the existing curriculum with an aim to garner
constructive impact on the mental health of undergraduate medical students. As such, we sought
to draw comparisons between the mental health of medical students, studying the old (2018 batch)
and the new (2019 batch) medical education systems in India.
MATERIALS AND METHODS: We designed a survey that contained structured questions
pertained to anxiety (HAM‑A, GAD‑7), depression (HAM‑D, BDI), and stress (PSS) amongst medical
undergraduate students of 2018 and 2019 batches at the Government Doon Medical College (GDMC),
Dehradun, India.
RESULTS: Contrasting the 2018 and 2019 batches, the introduction of CBME resulted in a significant
two‑fold decrease in moderate anxiety, as exhibited by both HAM‑A (6.0 vs 3.0, P = 0.016) and
GAD‑7 (3.5 vs 1.0, P = 0.037) scales, although no significant change in mild and severe anxiety, and
overall depression (BDI: P = 0.05, HAM‑D: P = 0.05) or stress (PSS: P = 0.86) was found.
CONCLUSION: The CBME system has made a significant impact on the mental health of
undergraduate medical students for anxiety, albeit its effect on depression and stress remains
equivocal. Future studies are warranted to compare the effect of CBME in other undergraduate and
postgraduate courses across the country to help predict the psychological impact of the newfangled
CBME education system.
Keywords
- Chahal S, Nadda A, Govil N, Gupta N, Nadda D, Goel K, et al.
Suicide deaths among medical students, residents and physicians
in India spanning a decade (2010–2019): An exploratory study
using on line news portals and Google database. Int J Soc
Psychiatry 2022;68:718‑28.
2. Alvi T, Assad A, Ramzan M, Khan FA. Depression and
anxiety among medical students. J Coll Physicians Surg Pak
2010;20:122‑6.
3. Oura MJ, Moreira AR, Santos P. Stress among Portuguese medical
students: A national cross‑sectional study. J Environ Public Health
2020;2020:6183757.
4. Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR
et al.Competency‑based medical education: Theory to practice.
Med Teach. 2010;32 (8):638‑45. doi: 10.3109/0142159X.2010.501190.
PMID: 20662574.
5. NMC. Competency Based Assessment. 2019. Available from:
https://www.nmc.org.in/wp‑content/uploads/2020/01/
UG‑Curriculum‑Vol‑I.pdf. [Last accessed on 2022 Apr 18].
6. Junaid MA, Auf AI, Shaikh K, Khan N, Abdelrahim SA.
Correlation between academic performance and anxiety in
medical students of Majmaah university‑KSA. J Pak Med Assoc
2020;70:865‑8.
7. Sarkar S, Gupta R, Menon V. A systematic review of depression,
anxiety, and stress among medical students in India. J Mental
Health Hum Behav 2017;22:88‑96.
8. Pandey A, Pandey AK, Sureka P, Singh A, Gupta S. Stress
and depressive symptoms among undergraduate medical
students of different professional years at a Medical College in
Northern India‑ A cross‑sectional study. J Clin Diagnostic Res
2021:15:VC01‑5.
9. Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of
depression amongst medical students: A meta‑analysis. Med
Educ 2016;50:456‑68.
10. Supe AN. A study of stress in medical students at Seth G.S.
Medical College. J Postgrad Med 1998;44:1‑6.
11. Brahmbhatt KR, Nadeera VP, Prasanna KS, Jayram S. Perceived
stress and sources of stress among medical undergraduates in a
private medical college in Mangalore, India. International Journal
of Biomedical and Advance Research 2013;4:128-36. Available
from: https://doi.org/10.7439/ijbar.v4i2.299.
12. Sreeramareddy CT, Shankar PR, Binu VS, Mukhopadhyay C,
Ray B, Menezes RG. Psychological morbidity, sources of stress
and coping strategies among undergraduate medical students of
Nepal. BMC Med Educ 2007;7:26.
13. Ibrahim AK, Kelly SJ, Adams CE, Glazebrook C. A systematic
review of studies of depression prevalence in university students.
J Psychiatr Res 2013;47:391‑400.
14. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al.
Global, regional, and national incidence, prevalence, and years
lived with disability for 310 diseases and injuries, 1990–2015:
A systematic analysis for the Global Burden of Disease Study
2015. Lancet 2016;388:1545‑602.
15. Ross S, Cleland J, Macleod MJ. Stress, debt and undergraduate
medical student performance. Med Educ 2006;40:584‑9.
16. Mao Y, Zhang N, Liu J, Zhu B, He R, Wang X. A systematic review
of depression and anxiety in medical students in China. BMC Med
Educ 2019;19:327. - 17. Fawzy M, Hamed SA. Prevalence of psychological stress,
depression and anxiety among medical students in Egypt.
Psychiatry Res 2017;255:186‑94.
18. Brokalaki H, Matziou V, Thanou J, Zirogiannis P, Dafni U,
Papadatou D. Job‑related stress among nursing personnel in
Greek dialysis units. EDTNA ERCA J 2001;27:181‑6.
19. Antoniou AS, Cooper CL, Davidson MJ. Levels of job
dissatisfaction and work‑related stressors experienced by
medical doctors in Greek hospitals. J Compassionate Health
Care 2016;3:4.
20. Hori D, Tsujiguchi H, Kambayashi Y, Hamagishi T, Kitaoka M,
Mitoma J, et al. The associations between lifestyles and mental
health using the General Health Questionnaire 12‑items are
different dependently on age and sex: A population‑based
cross‑sectional study in Kanazawa, Japan. Environ Health Prev
Med 2016;21:410‑21.
21. Wang YH, Shi ZT, Luo QY. Association of depressive symptoms
and suicidal ideation among university students in China.
Medicine 2017r; 96:e6476.
22. Bore M, Kelly B, Nair B. Potential predictors of psychological
distress and well‑being in medical students: A cross‑sectional
pilot study. Adv Med Educ Pract 2016;7:125‑35.
23. Moutinho IL, Maddalena N de CP, Roland RK, Lucchetti AL,
Tibiriçá SH, Ezequiel O da S, et al. Depression, stress and anxiety
in medical students: A cross‑sectional comparison between
students from different semesters. Rev Assoc Med Bras (1992)
2017;63:21‑8.
24. Shi M, Liu L, Wang ZY, Wang L. The mediating role of resilience
in the relationship between big five personality and anxiety
among Chinese medical students: A cross‑sectional study. PLoS
One 2015;10:e0119916.
25. Kumar SG, Kattimani S, Sarkar S, Kar S. Prevalence of depression
and its relation to stress level among medical students in
Puducherry, India. Ind Psychiatry J 2017;26:86‑90.
26. Waqas A, Rehman A, Malik A, Muhammad U, Khan S,
Mahmood N. Association of Ego defense mechanisms with
academic performance, anxiety and depression in medical
students: A mixed methods study. Cureus 2015;7:e337.
27. van Venrooij LT, Barnhoorn PC, Giltay EJ, van Noorden MS.
Burnout, depression and anxiety in preclinical medical students:
A cross‑sectional survey. Int J Adolesc Med Health 2015;29:/j/
ijamh. 2017.29.issue‑3/ijamh‑2015‑0077/ijamh‑2015‑0077.xml.
doi: 10.1515/ijamh‑2015‑0077.
28. Romo‑Nava F, Tafoya SA, Gutiérrez‑Soriano J, Osorio Y,
Carriedo P, Ocampo B, et al. The association between chronotype
and perceived academic stress to depression in medical students.
Chronobiol Int 2016;33:1359‑68.
29. Piumatti G. Motivation, health‑related lifestyles and depression
among university students: A longitudinal analysis. Psychiatry
Res 2018;260:412‑7.
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