Basic psychological needs, more than mindfulness and resilience, relate to medical student stress: A case for shifting the focus of wellness curricula

Abstract

Purpose

Medical student distress is an increasing concern in medical education. Addressing this issue requires a comprehensive understanding of what factors influence learners’ stress in medical school. Grounded in Self-Determination Theory (SDT), this study explores the relative association between medical students’ mindfulness, resilience, basic psychological needs, and perceived stress. Materials and methods: Of all year 1–4 medical students at our institution, 197 (49%) completed an online survey, measuring satisfaction and frustration of their basic psychological needs (autonomy, competence, relatedness), mindfulness, resilience, and perceived stress. Variables were assessed in relation to perceived stress, controlling for students’ gender and year.

Results

Higher mindfulness, resilience, and need satisfaction were associated with lower perceived stress. Conversely, need frustration was associated with higher perceived stress. When students' need frustration was included in the model, the association between mindfulness, resilience, and perceived stress weakened. Third years reported more autonomy frustration than all other years. Compared to males, females in second and fourth year reported higher stress, lower mindfulness and resilience, and less competence fulfilment.

Conclusions

Findings of this study suggest that, while mindfulness and resilience are important qualities for medical student well-being, their stress-protective benefits may diminish when students’ basic psychological needs are frustrated in medical school. Addressing potentially need-thwarting aspects of the learning environment is therefore recommended, to help reduce student stress and promote their well-being. Preliminary suggestions on how this might be achieved are discussed, from an SDT perspective.

Keywords:

• Medical student
• basic psychological needs
• stress
• mindfulness
• resilience

Ethical approval

This study received ethical approval from the institutional Research Ethics Board in April 2018.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information – funding

This study was supported by funds from the Office of the Vice Dean of Research, for the College of Medicine Dean’s Summer Research Projects.

Glossary

Mindful awareness: A non-evaluative, receptive, moment-to-moment attention or awareness (Brown and Ryan 2003). This inner resource supports more autonomous functioning and basic psychological need satisfaction, and thereby facilitates well-being.

Resilience: Refers to an individual’s positive adaptations and ability to thrive in the face of adversity, such as stress or trauma (Luthar, Cicchetti and Becker 2000).

Perceived stress: The degree to which situations in one’s life are appraised as stressful—that is, how unpredictable, uncontrollable, or overloaded people find their lives (Cohen 1994).

Data availability statement

Data from this study can be made available upon reasonable request.

Additional information

Notes on contributors

Adam Neufeld

Adam Neufeld, MD, MSc, is a Resident in the Department of Family Medicine at the University of Calgary. His areas of research are in medical education and positive psychology.

Annik Mossière

Annik Mossière, PhD, is a registered Clinical Psychologist, who practices in Calgary, Alberta. Her research interests are in clinical and forensic psychology.

Greg Malin

Greg Malin, MD, PhD, is a faculty member in the Department of Academic Family Medicine, and Academic Director for the Undergraduate Medical Education program at the University of Saskatchewan. His areas of interest are in medical education and self-determination.