An investigation of self-structure, social identity and norms in medical student wellbeing

Abstract

Medical students suffer from a higher prevalence of mental health problems than is seen in the general population. While the literature examining medical student distress has been extensive, it has been focused on establishing the prevalence of mental health problems and the associated adverse outcomes. It is argued in this thesis that there is a need for the field to move beyond the study of the prevalence of medical student distress towards the examination of factors that contribute to medical student wellbeing. We suggest several social psychological factors that may contribute to making some medical students more resilient and others more vulnerable during the course of their training. First, we suggest that the structure of medical students’ selfconcepts is likely to differ to other students and may impact upon their wellbeing. Second, it is proposed that medical students are likely to benefit from a strong sense of identification with their group. Third, it is proposed medical student wellbeing may suffer as an indirect outcome of unhealthy norms associated with the medical student group, such as excessive alcohol consumption. A model is suggested to describe the effects of these factors, individually, and in combination, on medical student wellbeing. Five studies are reported that assess the various components of this model and their contribution to medical student wellbeing. Study 1 provides insight into the types of stressors that impact upon medical student wellbeing, demonstrating that the stressors that are specific to medical school make a contribution to depression over and above the contribution of personal stressors. Study 2 demonstrates that medical students experience greater wellbeing when they identify more strongly with fellow medical students. We also find some evidence for the role of norms in promoting unhealthy behaviours. The results of Study 3 showed that medical student wellbeing is more closely associated with selfstructure than is the wellbeing of other students. Specifically, it was found that for medical students only, a lower level of self-concept variability was associated with greater wellbeing. Study 4 examines the transition to medical school and shows that self-structure can change over the first six months of training as a result of the stressors students’ experience. It is also found that students with a more complex self-structure experienced a stronger association between stressors and depression over the six-month period. In Study 5 the full model of medical student wellbeing is assessed. The results are largely consistent with the previous four studies and demonstrate that higher levels of group identity and lower levels of self-complexity are independently associated with greater medical student wellbeing. The results also support the potentially detrimental role of some unhealthy norms. The original model is revisited and we explore how the data from the five studies supported or did not support each component of the model. The implications, both practical and theoretical are discussed. It is concluded that social psychological factors make a promising contribution to explaining wellbeing and vulnerability in the unique context of medical education.