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Stress Management
of
Post Graduate Medical
Student
Dr. Md. Yunus
Additional Professor
&
Co-ordinator
Medical education Uni...
Objectives of This Talk
1. Recognize common stressors in the medical profession
2. Describe the continuum associated with ...
• Committee on Physician Health and Rehabilitation 401 W. 15th Street, Austin, TX 78701(512) 370-
1300www.texmed.org
• Results: The prevalence of stress among the international
doctors was 54% (95% CI: 44–63%).
• The highest levels of stre...
J Postgrad Med. 1998 Jan-Mar;44(1):1-6.
A study of stress in medical students at Seth G.S.
Medical College
• RESULTS:
• Ma...
• The evaluation showed that the participants rated the overall
workshop as highly useful (86.9%) and as having achieved t...
William Osler,
Father of modern medicine
• Said it beautifully
“Medicine arose out of the primal
sympathy of man with man;...
WHAT IS STRESS ?
Stress is the reaction people have to
excessive pressures or other types of
demand placed upon them
It ar...
STRESS
• Stress is a part of being alive
• The only time there is a total
absence of stress is in death
Definition of Stress
• Stress is an internal process that occurs when a person is
faced with a demand that is perceived to...
S = P > R
• Stress occurs when the pressure is greater than the resource
CHRONIC STRESS DIAGRAM
TYPES OF STRESSORS
•External
•Internal
EXTERNAL STRESSORS
• Physical Environment
• Social Interaction
• Organisational
• Major Life Events
• Daily Hassles
I got ...
INTERNAL STRESSORS
• Choice of Lifestyle
• Negative self - talk
• Mind traps
• Personality traits
TYPES OF STRESS
• Negative stress
• Positive stress
Let me think…..
NEGATIVE STRESS CYCLE
POSITIVE STRESS
• Keeps you motivated
• Makes you perform
better under pressor
Eustress or positive
stress occurs when
your level of stress is
high enough to
motivate you to move
into action to get
thi...
SYMPTOMS OF STRESS
• Physical symptoms
• Mental symptoms
• Behavioural symptoms
• Emotional symptoms
Physical Symptoms of Stress
MENTAL SYMPTOMS
• Lack of concentration
• Memory lapses
• Difficulty in making decisions
• Confusion
• Disorientation
• Pa...
BEHAVIOURAL SYMPTOMS
• Appetite changes - too much or too little
• Eating disorders - anorexia,
• Increased intake of alco...
EMOTIONAL SYMPTOMS
• Bouts of depression
• Impatience
• Fits of rage
• Fearfulness
• Deterioration of personal hygiene
STRESS RELATED ILLNESSES
Stress is not the same as ill-health, but has
been related to such illnesses as;
• Cardiovascular...
Effects of Stress
• Digestive disorders
• Ulcers
• Skin complaints - psoriasis
• Headaches and migraines
• Pre-menstrual s...
COSTS OF STRESS
80% of all modern diseases have their origins in
stress
Many working days per year are lost directly from
...
The Challenges in Medical College
• The best years of your life? Expectations..
• Even positive change is stressful
• Grea...
Stressors in Medical Institute
• Dramatic lifestyle changes
• Heavy academic
workload/clinical caseload
• Perceived need t...
Academic stressors
• Students never have enough time to study
• Experiences fears of increasing responsibility,
death of p...
Clinical stressors
• Clinical stressors include difficulties in dealing with the chain of
command/ pecking order common fo...
Expectation From doctors
• The culture of medicine has created an unrealistic
expectation of doctors to always put the pat...
The Process of Stress
1. Stress leads to arousal
2. Person selects a coping response
3. If effective, arousal decreases
4....
Three Stages of Burnout
• Stage 1 — Stress Arousal
• Stage 2 — Energy Conservation
• Stage 3 — Exhaustion
Stage 1 — Stress Arousal
• Irritability, anxiety
• Insomnia
• Forgetfulness/Poor concentration
• Gastrointestinal disorder...
Stage 2 — Energy Conservation
• Lateness, procrastination
• Excessive time off
• Decreased sex drive
• Fatigue
• Social wi...
Stage 3 — Exhaustion
• Chronic sadness or depression
• Suicidal ideation
• Chronic GI problems & /or headaches
• Social is...
Definition of Burnout
• Burnout is a state of mental & / or physical
exhaustion caused by excessive and prolonged stress
•...
Burnout Survey Results
• Fifty percent of all medical students were
assessed with significant burnout in a large
multicent...
Risk Factors for Burnout
• Perfectionism & control to reveal emotions equals
weakness
• Pressure that patients should alwa...
Negative Outcomes
• Addictive behaviours
• Relationship distress
• Emotional/Behavioral problems
• Loss/Lack of spirituali...
Current Medical Student Drug Use
• 10 to 15 percent of all health care professionals will
inappropriately use drugs or alc...
Susceptibility to Depression
• More than 20 percent of medical students have symptoms of
depression
(12 percent — probable...
What is ’Stress Management’?
The
art
of
taking
care
of
oneself
Our goal is not to eliminate stress but
to learn how to manage and use it to
help us
.
STRESS CONTROL
ABC STRATEGY
ABC STRATEGY
A = AWARENESS
What causes you stress?
How do you react?
ABC STRATEGY
B = BALANCE
There is a fine line between
positive / negative stress
How much can you cope with
before it beco...
ABC STRATEGY
C = CONTROL
What can you do to help yourself
combat the negative effects of
stress ?
Tips to Handle Stress
• Work smarter, not harder
• Carry reading material with you
• Accept the fact that time will be spe...
Tips to Handle Stress
• Always maintain a short task list
• Continually ask yourself ”What is the best use of
my time righ...
Suicide Is Preventable
• Feelings of hopelessness
• Continuing thoughts or wishes for death,
• Feelings of being trapped
•...
Self-Assessment Exercise
Self-assessment exercise to assess your own personal stress level
• This exercise is for your own...
Self-Assessment Exercise Conti…..
4. Have difficulty falling asleep because you have too much onyour mind?
5. Feel people ...
Overload
• This exercise was designed to assess your level
of stress due to overload
• Overload or over-stimulation, refer...
Four major factors in overload
(1)Time pressures
(2) Excessive responsibility or accountability
(3) Lack of support &
(4) ...
Preventing Burnout
• Maintain a sense of optimism
• Work on friendships and support systems
• Take care of yourself/do not...
EXERCISE
EXERCISE AND STRESS
• Exercise increases blood flow to the brain which is good for us
• Exercises also releases hormones, ...
Balanced DIET
• AVOID Caffeine, Tobacco and Alcohol
YOGA/DHYANA
• Exercise burns up adrenaline and produces helpful chemicals
and positive feelings
SLEEP AND REST
• .
Mental Techniques
. M - Money Management, Minimize needs, Meditation
• E - Earnest Expectations, Enjoy the work you do
• N...
Potential Barriers
• Stigma
• Residency
• Professional Carrier
Summary
• Stress is inevitable
• Burnout is preventable, treatable, & manageable
• Identify coping strategies that work be...
Created by Dr. Md. Yunus for Medical
Students to Beat Stress & Enjoy the
work & world
Email: drmdyunus@hotmail.com
Web: ww...
Me  stress mm of pg student
Me  stress mm of pg student
Me  stress mm of pg student
Me  stress mm of pg student
Me  stress mm of pg student
Me  stress mm of pg student
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Stress Management of Post Graduate Medical Student

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Me stress mm of pg student

  1. 1. Stress Management of Post Graduate Medical Student Dr. Md. Yunus Additional Professor & Co-ordinator Medical education Unit, NEIGRIHMS drmdyunus@hotmail.com
  2. 2. Objectives of This Talk 1. Recognize common stressors in the medical profession 2. Describe the continuum associated with unmanaged stress 3. Assess personal risk for burnout 4. Analyze the expectations and risk factors for Medical Student that increase risk for burnout 5. Apply learned skills that enrich personal resilience, manage stress & prevent burnout 6. Identify resources for assistance 7. Recognize when medical students need professional help
  3. 3. • Committee on Physician Health and Rehabilitation 401 W. 15th Street, Austin, TX 78701(512) 370- 1300www.texmed.org
  4. 4. • Results: The prevalence of stress among the international doctors was 54% (95% CI: 44–63%). • The highest levels of stress were reported for “Anxiety and Insomnia” and the lowest level was reported for “Severe Depression” • Journal of Clinical and Diagnostic Research. 2012 June, Vol-6(5): 859-862
  5. 5. J Postgrad Med. 1998 Jan-Mar;44(1):1-6. A study of stress in medical students at Seth G.S. Medical College • RESULTS: • Majority of medical students (175/238-73%) perceived stress • Stress was found to be significantly more in Second and Third MBBS students rather than First MBBS levels (p < 0.05)
  6. 6. • The evaluation showed that the participants rated the overall workshop as highly useful (86.9%) and as having achieved the objectives (86.2%).
  7. 7. William Osler, Father of modern medicine • Said it beautifully “Medicine arose out of the primal sympathy of man with man; out of the desire to help those in sorrow, need, & sickness” This relationship arises out of pain & suffering of one person, & offer of hope by another
  8. 8. WHAT IS STRESS ? Stress is the reaction people have to excessive pressures or other types of demand placed upon them It arises when they worry that they can’t cope HELP ME!
  9. 9. STRESS • Stress is a part of being alive • The only time there is a total absence of stress is in death
  10. 10. Definition of Stress • Stress is an internal process that occurs when a person is faced with a demand that is perceived to exceed the resources available to respond to it effectively • where failure to deal with the demand effectively has important and undesirable consequences • Stress is very subjective, as it is our unique reaction to events • Stress is defined as “our reaction to events, environmental or internal, that tax or exceed our adaptive resources.”
  11. 11. S = P > R • Stress occurs when the pressure is greater than the resource
  12. 12. CHRONIC STRESS DIAGRAM
  13. 13. TYPES OF STRESSORS •External •Internal
  14. 14. EXTERNAL STRESSORS • Physical Environment • Social Interaction • Organisational • Major Life Events • Daily Hassles I got the answer
  15. 15. INTERNAL STRESSORS • Choice of Lifestyle • Negative self - talk • Mind traps • Personality traits
  16. 16. TYPES OF STRESS • Negative stress • Positive stress Let me think…..
  17. 17. NEGATIVE STRESS CYCLE
  18. 18. POSITIVE STRESS • Keeps you motivated • Makes you perform better under pressor
  19. 19. Eustress or positive stress occurs when your level of stress is high enough to motivate you to move into action to get things accomplished EUSTRESS
  20. 20. SYMPTOMS OF STRESS • Physical symptoms • Mental symptoms • Behavioural symptoms • Emotional symptoms
  21. 21. Physical Symptoms of Stress
  22. 22. MENTAL SYMPTOMS • Lack of concentration • Memory lapses • Difficulty in making decisions • Confusion • Disorientation • Panic attacks
  23. 23. BEHAVIOURAL SYMPTOMS • Appetite changes - too much or too little • Eating disorders - anorexia, • Increased intake of alcohol & other drugs • Increased smoking • Restlessness • Fidgeting • Nail biting
  24. 24. EMOTIONAL SYMPTOMS • Bouts of depression • Impatience • Fits of rage • Fearfulness • Deterioration of personal hygiene
  25. 25. STRESS RELATED ILLNESSES Stress is not the same as ill-health, but has been related to such illnesses as; • Cardiovascular disease • Immune system disease • Asthma • Diabetes
  26. 26. Effects of Stress • Digestive disorders • Ulcers • Skin complaints - psoriasis • Headaches and migraines • Pre-menstrual syndrome • Depression
  27. 27. COSTS OF STRESS 80% of all modern diseases have their origins in stress Many working days per year are lost directly from stress - related illness
  28. 28. The Challenges in Medical College • The best years of your life? Expectations.. • Even positive change is stressful • Greater academic demands • Unstructured time • Decreased adult availability • Being on your own in a new environment • Changing relations with family
  29. 29. Stressors in Medical Institute • Dramatic lifestyle changes • Heavy academic workload/clinical caseload • Perceived need to excel at all costs • Lack of control/autonomy • Responsibility for patients • Exposure to infections • Limited support systems • Inadequate training for working with patients & families • Frenetic, intense pace of training • Repetitive single tasks/scut- work • Problems without solutions • Death & dying • Time pressure & demands • Disillusionment
  30. 30. Academic stressors • Students never have enough time to study • Experiences fears of increasing responsibility, death of patients, fear of Failure
  31. 31. Clinical stressors • Clinical stressors include difficulties in dealing with the chain of command/ pecking order common for students • Coping with hierarchy & the authoritative environment is troubling for students • “Student compares medical training to military training” • Both recruit young people full of leadership potential and essentially break their autonomous will through a rigorous hierarchy • Students are thrown into the hospital wards-definitely front-line duty like in War
  32. 32. Expectation From doctors • The culture of medicine has created an unrealistic expectation of doctors to always put the patient first and to deny their own needs • In their role as healer, it is hard for physicians to accept help for themselves, or reveal that they are facing personal challenges
  33. 33. The Process of Stress 1. Stress leads to arousal 2. Person selects a coping response 3. If effective, arousal decreases 4. If ineffective, arousal increases, resulting in escalation of stress level 5. Unresolved stress leads to burnout 6. Burnout leads to unethical behaviours
  34. 34. Three Stages of Burnout • Stage 1 — Stress Arousal • Stage 2 — Energy Conservation • Stage 3 — Exhaustion
  35. 35. Stage 1 — Stress Arousal • Irritability, anxiety • Insomnia • Forgetfulness/Poor concentration • Gastrointestinal disorders • Headaches • Self-medication With the presence of any two of these, on may be experiencing Stage 1 stress arousal
  36. 36. Stage 2 — Energy Conservation • Lateness, procrastination • Excessive time off • Decreased sex drive • Fatigue • Social withdrawal • Increased substance abuse • Again, any two of these symptoms may signal that one is in Stage 2 of the burnout cycle
  37. 37. Stage 3 — Exhaustion • Chronic sadness or depression • Suicidal ideation • Chronic GI problems & /or headaches • Social isolation • Substance Use Disorders • Unethical behaviours (disruptive behaviour, boundary violations)
  38. 38. Definition of Burnout • Burnout is a state of mental & / or physical exhaustion caused by excessive and prolonged stress • Burnout syndromes are characterized by three features: – Emotional exhaustion, – Depersonalization (cynicism), & – Diminished sense of personal accomplishment
  39. 39. Burnout Survey Results • Fifty percent of all medical students were assessed with significant burnout in a large multicenter study • Physician burnout has a negative impact on patient outcomes
  40. 40. Risk Factors for Burnout • Perfectionism & control to reveal emotions equals weakness • Pressure that patients should always come first – Overachievers: Type A personality – Reluctance to ask for help – Belief that physicians do not have needs
  41. 41. Negative Outcomes • Addictive behaviours • Relationship distress • Emotional/Behavioral problems • Loss/Lack of spirituality • Academic consequences • Death/Suicide
  42. 42. Current Medical Student Drug Use • 10 to 15 percent of all health care professionals will inappropriately use drugs or alcohol at some point during their careers • 15 percent of medical students scored positive for at-risk drinking. • 33.4 percent of medical students reported using one or more illicit drugs in the past year. • 16.8 percent of medical students report lifetime use of “club drugs” (MDMA,cocaine)
  43. 43. Susceptibility to Depression • More than 20 percent of medical students have symptoms of depression (12 percent — probable major depression and 9 percent —probable mild/moderate depression) • Up to 9 percent of students reported suicidal ideation • Prevalence of depression increases over the course of medical school, with a higher risk of stress/depression associated with transition to clinical care rotations (third year)
  44. 44. What is ’Stress Management’? The art of taking care of oneself
  45. 45. Our goal is not to eliminate stress but to learn how to manage and use it to help us .
  46. 46. STRESS CONTROL ABC STRATEGY
  47. 47. ABC STRATEGY A = AWARENESS What causes you stress? How do you react?
  48. 48. ABC STRATEGY B = BALANCE There is a fine line between positive / negative stress How much can you cope with before it becomes negative ?
  49. 49. ABC STRATEGY C = CONTROL What can you do to help yourself combat the negative effects of stress ?
  50. 50. Tips to Handle Stress • Work smarter, not harder • Carry reading material with you • Accept the fact that time will be spent on activities outside your control • Record daily activities, achievements, goals, sources of delay, & time wasted to realize hidden opportunities
  51. 51. Tips to Handle Stress • Always maintain a short task list • Continually ask yourself ”What is the best use of my time right now”? • Be physically active to relieve tension • Make quick decisions • Carefully mix work & breaks • Have a positive attitude • Relax
  52. 52. Suicide Is Preventable • Feelings of hopelessness • Continuing thoughts or wishes for death, • Feelings of being trapped • Personal losses such as death of a loved one • A broken relationship are signals that a consultation with a health professional would be beneficial
  53. 53. Self-Assessment Exercise Self-assessment exercise to assess your own personal stress level • This exercise is for your own use and does not need to be returned to Me • How often do you … Calculate your total score as follows: (a) almost always (a) = 4 points; (b) often (b) = 3 points; (c) seldom (c) = 2 points; (d) almost never (d) = 1 point Total = ------ 1. Find yourself with insufficient time to do things you really enjoy? 2. Wish you had more support/ assistance? 3. Lack sufficient time to complete your work most effectively?
  54. 54. Self-Assessment Exercise Conti….. 4. Have difficulty falling asleep because you have too much onyour mind? 5. Feel people simply expect too much from you? 6. Feel overwhelmed? 7. Find yourself becoming forgetful or indecisive because you have too much on your mind? 8. Consider yourself to be in a high pressure situation? 9. Feel you have too much responsibility for one person? 10. Feel exhausted at the end of the day?
  55. 55. Overload • This exercise was designed to assess your level of stress due to overload • Overload or over-stimulation, refers to the state in which the demands around you exceed your capacity to meet them
  56. 56. Four major factors in overload (1)Time pressures (2) Excessive responsibility or accountability (3) Lack of support & (4) Excessive expectations from yourself & those around you Any one or a combination of these factors can result in stress from overload • A total of 25-40 points indicates a high stress level, one that could be psychologically and physiologically debilitating
  57. 57. Preventing Burnout • Maintain a sense of optimism • Work on friendships and support systems • Take care of yourself/do not overextend yourself: – Exercise regularly/eat right – Get enough sleep and – Take time to play • Keep a sense of humor • Have a hobby that is relaxing & enjoyable • Choose specialty residency wisely; remember you can change your mind • Get help if you need it • The key is to not try to avoid stress altogether, but to recognize and manage the stress in our lives in such a way that we avoid the negative consequences of stress
  58. 58. EXERCISE
  59. 59. EXERCISE AND STRESS • Exercise increases blood flow to the brain which is good for us • Exercises also releases hormones, and stimulates the nervous system in ways that are good for us • Exercise produces chemicals in the body such as beta-endorphin, which is proven to have a positive effect on how we feel
  60. 60. Balanced DIET • AVOID Caffeine, Tobacco and Alcohol
  61. 61. YOGA/DHYANA • Exercise burns up adrenaline and produces helpful chemicals and positive feelings
  62. 62. SLEEP AND REST • .
  63. 63. Mental Techniques . M - Money Management, Minimize needs, Meditation • E - Earnest Expectations, Enjoy the work you do • N - Avoid Negative thinking • T - Try to be happy Today • A - Accept and Adopt Reality • L - Avoid Loneliness • H - Develop good Hobbies • E - Live in good Environment. Express yourself clearly • A - Be Active and have positive Attitude • L - Try to Learn more & Manage Life • T - Have realistic Targets & Tackle one at a time • H - Maintain Healthy life style
  64. 64. Potential Barriers • Stigma • Residency • Professional Carrier
  65. 65. Summary • Stress is inevitable • Burnout is preventable, treatable, & manageable • Identify coping strategies that work best for you • Help is available
  66. 66. Created by Dr. Md. Yunus for Medical Students to Beat Stress & Enjoy the work & world Email: drmdyunus@hotmail.com Web: www.neigrihms.nic.in

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