Resilience and sense of coherence in first year medical students - a cross-sectional study

Abstract

Background: A broad range of studies show that medical students often have a significantly deteriorated mental health status. Although starting medical school with values comparable to the population average, only a few semesters later, medical undergraduates show increased rates of psychological risk states and some manifest mental illnesses, such as burnout and depression. In our survey we intentionally assessed mental health parameters from a salutogenetic, i.e. resource-oriented point of view.

Methods: We examined first-year medical students in a cross-sectional study and assessed sense of coherence (SOC) and resilience as parameters from the salutogenesis model by Antonovsky in a structured way using validated, self-administered questionnaires. In total, we examined 236 students of human medicine, dentistry and molecular medicine at the Friedrich-Alexander-University Erlangen-Nürnberg (FAU).

Results: Our analyses showed significantly higher values of resilience among male students compared to female students (p < 0.01). In contrast, even though a significant correlation between resilience and SOC was observed, only a non-significantly lower value of SOC was found in female students. Compared to the reference sample our medical students in their first year of study showed significantly lower values for resilience (p < 0.01) and SOC (p < 0.01).

Conclusion: Resilience and SOC are known to correlate with psychological stress (burnout parameters) and depression. In order to keep protective factors like SOC and resilience in medical students at a good and healthy level we see the necessity to address that problem proactively and educationally. Integrating training focused on the preservation of the students´ own mental health into the medical curriculum from the beginning of university courses, and throughout the whole medical study course, is essential and should be an obligatory training goal. Based on our study results, we also deem it necessary to think about ways to adapt the measures for the gender-specific needs of our students, e.g. dependent on their biological gender.

Keywords: Medical education; Mental health status; Resilience; Salutogenesis; Sense of coherence; Undergraduate medical students.

Fig. 1

Adapted salutogenesis model to show the role of SOC and resilience

Fig. 2

Frequency of resilience expressions according to RS-13 in the gender groups

Fig. 3

Frequency of resilience expressions according to RS-13 in the sub collectives

Fig. 4

Kernel density estimates of SOC L9 values in the gender groups

Fig. 5

Core density estimates of SOC L9 values in the subcollectives

Fig. 6

Relationship between resilience and SOC values