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Abstract

Background– Stress among medical personnel is crucial, as it can cause the adverse health outcome to individuals who suffer from the stress as well as their clinical practice performance, which may cause serious outcomes to patients. This study focuses on the interns who received their medical degree overseas because they may have more stress due to their required clinical work and license examination. We conducted our study to determine the stress level, coping strategies, and associated factors among foreign bachelor’s medical interns in Bangkok, Thailand.

Method – A cross-sectional study design was conducted among 49 interns from Bangkok Metropolitan Administration Hospitals. Stress was assessed using the Suanprung stress test and the Brief COPE inventory (Thai version). Descriptive analysis, Chi-square tests, and multiple linear regression analysis were used to investigate the association between stress, coping strategies and other potential factors.

Results– The prevalence of problematic stress among foreign bachelor’s medical interns was 69.4%. Factors associated with problematic stress were being female (p = 0.047) and having a lower monthly income (p < 0.001). These medical interns predominantly used adaptive coping strategies (acceptance, active coping, and planning), rather than maladaptive coping strategies (self-distraction, self-blame, and venting). Practicing religion and being on duty in certain departments had significant associations with adaptive coping strategies, whereas high stress levels were significantly associated with maladaptive coping strategies.

Conclusion – This is the first study in Thailand to evaluate coping strategies in these medical interns. These interns are recognized as vulnerable to the negative effects of stress.

Keywords: Foreign bachelor's medical interns, Stress, Coping strategies

References

[1] Lazarus RS. Coping theory and research: past, present, and future. Psychosom Med 1993 May-Jun;55(3):234-47. https://doi.org/10.1097/00006842-199305000-00002.

[2] Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA 2016 Dec 6;316(21): 2214-36. https://doi.org/10.1001/jama.2016.17324.

[3] Thomas NK. Resident burnout. JAMA 2004 Dec 15;292(23):2880-9. https://doi.org/10.1001/jama.292.23.2880.

[4] Gundersen L. Physician burnout. Ann Intern Med 2001 Jul 17;135(2):145-8. https://doi.org/10.7326/0003-4819-135-2-200107170-00023.

[5] Carter AO, Elzubeir M, Abdulrazzaq YM, Revel AD, Townsend A. Health and lifestyle needs assessment of medical students in the United Arab Emirates. Med Teach 2003 Sep;25(5):492-6. https://doi.org/10.1080/01421590310001605633.

[6] Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc 2005 Dec;80(12):1613-22. https://doi.org/10.4065/80.12.1613.

[7] Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001;52:397-422. https://doi.org/10.1146/annurev.psych.52.1.397.

[8] Eva EO, Islam MZ, Mosaddek AS, Rahman MF, Rozario RJ, Iftekhar AF, et al. Prevalence of stress among medical students: a comparative study between public and private medical schools in Bangladesh. BMC Res Notes 2015 Jul 30;8: 327. https://doi.org/10.1186/s13104-015-1295-5.

[9] Apiwatanasiri C, Somaketrarin K, Suraprayoon K, Leurmprasert K, Wankaew N, Homchampa P. Stress and coping in medical students at Clinical Level, Khon Kaen University. Srinagarind Med J 2007;22:416-24.

[10] Norphun N, Pitanupong J, Jiraphan A. Stress and coping strategies among Thai medical students in a southern medical school. Siriraj Med J 2020;72(3):238-44.

[11] Saipanish R. Stress among medical students in a Thai medical school. Med Teach 2003 Sep;25(5):502-6. https://doi.org/10.1080/0142159031000136716.

[12] Omigbodun OO, Odukogbe AT, Omigbodun AO, Yusuf OB, Bella TT, Olayemi O. Stressors and psychological symptoms in students of medicine and allied health professions in Nigeria. Soc Psychiatr Psychiatr Epidemiol 2006 May;41(5):415-21. https://doi.org/10.1007/s00127-006-0037-3.

[13] Abdulghani HM, Irshad M, Al Zunitan MA, Al Sulihem AA, Al Dehaim MA, Al Esefir WA, et al. Prevalence of stress in junior doctors during their internship training: a cross sectional study of three Saudi medical colleges' hospitals. Neuropsychiatric Dis Treat 2014 Sep 25;10:1879-86. https://doi.org/10.2147/NDT.S68039.

[14] Daugherty SR, Baldwin Jr DC, Rowley BD. Learning, satisfaction, and mistreatment during medical internship: a national survey of working conditions. JAMA 1998 Apr 15;279(15):1194-9. https://doi.org/10.1001/jama.279.15.1194.

[15] Abdulghani HM, AlKanhal AA, Mahmoud ES, Ponnamperuma GG, Alfaris EA. Stress and its effects on medical students: a cross-sectional study at a college of medicine in Saudi Arabia. J Health Popul Nutr 2011 Oct;29(5):516-22. https://doi.org/10.3329/jhpn.v29i5.8906.

[16] Gobbur SB, Nigudgi SR, Reddy S. Prevalence of stress among post graduate doctors at mahadevappa rampure medical college kalaburagi, Karnataka. Int J Commun Med Public Health 2016;3:576-80.

[17] Guruprakash KV, Mehta SG, Atul B, Prakash J, Divinakumar KJ, Khan SA. A study of relationship between perceived stress, coping pattern, burnout, and general psychopathology among the postgraduate medical students. Ind Psychiatr J 2018 Jan-Jun;27(1):141-6. https://doi.org/10.4103/ipj.ipj_20_18.

[18] Neufeld A, Malin G. How medical students cope with stress: a cross-sectional look at strategies and their sociodemographic antecedents21; 2021 May 25. p. 299. https://doi.org/10.1186/s12909-021-02734-4(1).

[19] The medical council of Thailand. Information of Foreign Medical School [updated 2022 March 12; cited 2022 May 8]. Available from: https://tmc.or.th/foreign_med.php.

[20] Center for medical competency assessment and accreditation. Application for the 1st and 2nd examination assessment [updated 2017 November 8; cited 2022 May 8]. Available from: https://cmathai.org/news/detail/385.

[21] Nganvivattavorn S. Stress and depression as a medical intern, Police general hospital. J Psychiatr Assoc Thailand 2021;64(4):373-84.

[22] Mahatnirunkul S, Pumpisanchai W, Tapanya P. The construction of Suan Prung stress test for Thai population. Bulletin of Suan Prung 1997;13:1-11.

[23] Numsang T, Tantrarungroj T. Validity and reliability of the Brief COPE inventory: Thai version. J Psychiatr Assoc Thailand 2018;63:191-8.

[24] Hussein OM, Zainal NZ, AbdeL-Latif ME. Prevalance of stress among international post-graduate doctors at the university malaya medical centre (UMMC), kuala lumpur. J Clin Diagn Res 2012;6(5):859-62.

[25] Al-Dubai SA, Al-Naggar RA, Alshagga MA, Rampal KG. Stress and coping strategies of students in a medical faculty in Malaysia. Malays J Med Sci 2011 Jul;18(3):57-64.

[26] 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 Aug 2;7:26. https://doi.org/10.1186/1472-6920-7-26.

[27] Del Piccolo L, Donisi V, Raffaelli R, Garzon S, Perlini C, Rimondini M, et al. The psychological impact of COVID-19 on healthcare providers in obstetrics: a cross-sectional survey study. Front Psychol 2021 Apr 9;12:632999. https://doi.org/10.3389/fpsyg.2021.632999.

[28] Holmgren R, Nilsson Sundstrom E, Levinsson H, Ahlstrom R. Coping and financial strain as predictors of mental illness in over- indebted individuals in Sweden. Scand J Psychol 2019 Feb;60(1):50-8. https://doi.org/10.1111/sjop.12511.

[29] Richardson T, Elliott P, Roberts R. The relationship between personal unsecured debt and mental and physical health: a systematic review and meta-analysis. Clin Psychol Rev 2013 Dec;33(8):1148-62. https://doi.org/10.1016/j.cpr.2013.08.009.

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