Johnson JC, Degenhardt BF, Smith CK, Wolf TM, Peterson DF. Tool for Predicting Medical Student Burnout From Sustained Stress Levels: Factor Analysis of the Medical Education Hassles Scale-R. J Am Osteopath Assoc 2018;118(3):170–180. doi: 10.7556/jaoa.2018.036.
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Acute stress during medical school affects the health of students and is associated with burnout. The Medical Education Hassles Scale-R (MEHS-R) is designed to measure acute stress among medical students. Researchers using the MEHS-R primarily report overall hassles scores, which are unable to discriminate between different categories of hassles encountered.
The present study examined the factor structure of the MEHS-R to identify subscales that would be useful to categorize hassles for research and assessment purposes.
Longitudinal, observational study.
Two osteopathic medical schools.
Five hundred six first-year medical students.
Main Outcome Measure:
The MEHS-R was administered at orientation and 9 to 10 times throughout the first year, classified into examination, vacation, and routine medical school activity periods. Students rated the 101 items on a 4-point scale (0=none to 3=a great deal) to indicate how much of a hassle each item had been during the previous week. Demographic subgroups were males, females, married students, single students, whites, and ethnic minorities.
Exploratory factor analysis was conducted on data collected at the first school during orientation. Seven subscales were identified: Academic and Time Pressures, Financial, Social, External Influences, Day-to-Day Functioning, Relationships With Immediate Family, and Health. Cronbach α were ≥0.75. Stability of these subscales was examined using confirmatory factor analysis. Both of the fit indices used indicated the 7-subscale model for the MEHS-R adequately fit the data obtained during examination and routine medical school activity periods, one fit index indicated adequate fit for the vacation period, and neither indicated adequate fit for the data from the second school. Of the 7 subscales, 5 had a strong correspondence with categories identified by the scale developers. Fit indices also indicated the 7-subscale model was adequately generalizable to the demographic subgroups with the exception of the ethnic minorities subgroup.
Exploratory factor analysis performed on the MEHS-R supported formation of subscales similar to categories identified during MEHS-R development. Results of the current study supported the use of the MEHS-R for the investigation of acute stress in medical students. In future research, targeted wellness interventions for medical students may be developed based on student responses to this instrument.
a Bolded factor scores denote the subscale(s) in which an item is included. Factor 1 is the Academic and Time Pressures subscale, factor 2 is the Financial subscale, factor 3 is the Social subscale, factor 4 is the External Influences subscale, factor 5 is the Day-to-Day Functioning subscale, combination of factors 6 and 8 is the Relationships With Immediate Family subscale, and factor 7 is the Health subscale.
b Cronbach α for Relationships With Immediate Family subscale.
Abbreviation: NA, not applicable.
a To remove the variability from repeated measurements from the same student, these analyses were performed on the residuals obtained from a repeated measures analysis of variance of each item.
b The MEHS-R was administered 9-10 times after orientation at the first medical school, which were classified as examination, vacation, or routine medical school activity periods for separate analyses, and 11 times at the second medical school, which were combined in 1 analysis.
Abbreviations: CFI, Bentler comparative fit index; NNFI, Bentler and Bonett nonnormed fit index.
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