Reconociendo el estrés académico... conocer para prevenir

Abstract

Los objetivos de la investigación son determinar el nivel del estrés académico (EA) en estudiantes de medicina (EM) y realizar un análisis comparativo entre EM avanzados de la carrera (4º-5º-6º año). Material y métodos Estudio protocolizado, descriptivo, transversal a través de una encuesta autoadministrada anónima, vía internet. Se incluyó datos sociodemográficos, motivo de elección de la carrera y el inventario SISCO modificado para EM que evalúa estresores (E), reacciones físicas (RF), psicológicas (RP), comportamentales (RC) y afrontamiento (A) con una escala tipo Likert mediante 5 adverbios (de “nunca" a “siempre") para cada situación. Se agregaron preguntas del equipo investigador. Criterios de inclusión: EM de 4º, 5º y 6º año. Análisis estadístico: medidas de tendencia central, de dispersión y test exacto de Fisher. Resultados Se incluyeron 241 EM, de Universidad Pública 61%, mujeres 68%, 4º 34%, 5º 40%, 6º 26%. Edad promedio 24 años (DS±2.87). El 55% tiene pareja, 3% tiene hijos, 71% vive con familia. Eligieron la carrera por gusto 81%, Interés por la ciencia 54%, académico 26% y social 24%, proyección económica 17%, mandato familiar 2% y ninguno por vocación. El 34% cree que el prestigio de la carrera es excesivo. El 94% refiere en los últimos 6 meses preocupación o nerviosismo. Análisis comparativo E: siempre percibe más sobrecarga de tarea 5° vs 4° (74 vs 52%; p <0.02). Las evaluaciones “siempre" inquietan más a 5° vs 4° (80 vs 63%; p<0.03). No le molesta la personalidad de los profesores significativamente a 5° vs 6º (77 vs 50%; p<0.02). Sobre RF tiene menos problemas para dormir 4° y 6° que 5° (22% y 21% vs 37%; p<0.05). Se siente significativamente más cansados 5° vs 6° (61 vs 42%; p<0.02). Tiene más “dolor de cabeza" 5° vs 4° (36 vs 22%; p <0.05); más diarrea/constipación 5° vs 4° (40 vs 20%; p=0.008) y 5° vs 6° (39 vs 20%; p <0.01). RP: se siente más “triste" 5° vs 6° (28 vs 16%; p<0.08) y se puede concentrar menos 4º vs 6° (73 vs 58%; p=0.09). RC tiene menos conflictos 4° vs 6° (86 vs 96%; p<0.04). También respondieron que “trabaja duro, pero sin resultados óptimos" 5° vs 6° (33 vs 18%; p<0.05). Se siente siempre más frustrados 5° vs 6° (37 vs 21%; p<0.04). “Lo social le molesta" más frecuente a 5° vs 4° (24 vs 11%; p <0.03) y 5° vs 6° (24 vs 4%; p=0.001) y “tener sexo no le entusiasma" más frecuente a 5° vs 4° (22 vs 5%; p<0.01) y 5° vs 6° (22 vs 4%; p=0.001); pero “se ha enfermado menos" 5° vs 6° (27 vs 14%; p=0.07). Del análisis comparativo de A (hacer plan de tareas, religiosidad y verbalización) el “nunca" usarlas y “ocasionalmente" fueron más frecuentes, pero pNS. Tuvo peor rendimiento académico (RA): 5° vs 6º (94 vs 81% p=0.01) y 5º vs 4° (94 vs 85% p=0.08). Se encontró al menos una dimensión afectada en todos los EM encuestados. Conclusiones Los EM de 5° son los más estresados. El EA impacta negativamente en el proceso de aprendizaje y con ello en el RA, pero sobre todas las cosas es predecesor de burnout por lo que deben hacerse intervenciones para mejorar las estrategias de afrontamiento.The goal of this study is to determine the level of academic stress (AS) in medical students (MS) and to carry out a comparative analysis among advanced undergraduates in the 4th, 5th and 6th year of their career. Materials and methods The protocol-based, descriptive, cross-sectional study was carried out by means of an anonymous on-line, self- administered survey. It included socio-demographic data, information on career choice, the SISCO inventory for academic stress adapted to medical students (S), data on physical reactions (PR), psychological reactions (PsR), behavioral reactions (BR) and coping strategies(C) on a Likert scale of 5 frequency adverbs ranging from “never" to “always" for each situation. The research team also added questions of their own. Only 4th, 5th and 6th-year MS were considered for inclusion in the study. The statistical analysis consisted of central tendency and dispersion measures and Fisher’s exact test. Results Two hundred and forty-one (241) medical students (MS) were included in the study. The sample consisted of 61% public university undergraduates, 68 % female, 34% 4th-year, 40% 5th-year, and 26% 6th-year MS. The average age of the participants was 24 years old (SD±2.87). At the time of the study, 55% said they had a partner,3% had children and 71% lived at the family home. The reasons given for their choice of career were varied: 81% stated own preference, 54% an interest in science, 26% an academic interest and 24% a desire for high social status. In addition, 17% cited economic prospects, 2% the continuance of a family tradition and no participants asserted medicine to be their “calling"; 34% found the career to have been accorded excessive status; 94% declared they had been nervous or worried within the previous six months. The comparative analysis yielded that 74% 5th-year vs. 52% 4th-year MS felt distressed by excessive workload (p<0.02); 80% 5-year vs. 63% 4th-year MS found themselves “always" worried by exams (p<0.03); 77% 5th-year vs. 50% 4th year MS were not bothered by the personality of their professors. Regarding PR, 4th and 6th year MS found it easier to fall asleep than 5th year MS (22%, 21% and 37% respectively; p<0.05). A larger percentage of 5th-year MS said they were “significantly more tired" than 6th-year MS (62 vs. 42%; p<0.02). 5th-year MS suffered from headaches more than 4th year MS (36 vs. 22% p<0.05) as well as from diarrhea and constipation (40 % vs. 20%; p<0.08); 5th year were also higher than 6th year on the latter point (39% vs. 20%; p=0.01). With regard to PsR, 28% 5th-year and 16% 6th-year MS said they were feeling “sad" (p<0.08). 4th-year had shorter attention spans than 6th year MS (73 vs. 58%; p=0.09); As for BR, 4th-year MS said they had fewer conflicts in their lives than 6th year MS (86 vs. 96 %; p<0.04). More 5th-year than 6th – year MS said they “work hard without achieving optimal results" (33 vs. 18%; p<0.05) and felt “always" more frustrated (37 vs. 21%; p<0.04). 5th year MS found themselves more often bothered by social activities than 4th year MS (24 vs. 11%; p<0.003). 5th –year MS more often found sex unexciting than 4th year MS (22 vs. 5%; p= 0.01) and 6th – year MS (22 vs. 4%; p=0.001) 5th-year MS said they fell ill less frequently than 6th-year MS (27 vs. 14%; p=0.07). For the comparative analysis, C participants were asked about coping strategies (e.g. drawing up task plans, resorting to religion/ spirituality and voicing concerns). The prevailing answer “never" and “occasionally" proved statistically non-significant. Academic performance (AP) was lower for 5th-year than 6th year (94 vs. 81%;p=0.01) and 5th year performed less satisfactorily than 4th year on this point (94 vs. 85%;p=0.08). We found that all participants were affected in at least one of the previous dimensions. Conclusions 5th – year MS were found to suffer from stress the most. We know that academic stress impacts the leaning process directly and takes a toll on academic performance; but above all is a precursor of burnout. The current situation calls for interventions aimed at improving coping strategies.Fil: Gasull, Andrea Silvana. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Elaskar, María Cielo. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Di Lorenzo, Gabriela. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Miranda, Raúl. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Lascano, Soledad. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Carena, José. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Salomón, Susana. Universidad Nacional de Cuyo. Facultad de Ciencias Médica