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Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
Stress Level and Contributing Factors among Dental and Medical
Students: A Comparison between Old and New Curriculum
Prepared by: Fatma Ahmad
Naela Al- Bloushi
Supervisors: Dr. Qasem Al-Omari
Dr. Muawia Qudeimat
Elective study course No. 703
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
2 | P a g e
Content Page number
Abstract 3-4
Introduction 4-6
Materials and methods 6-7
Results 7- 10
Discussion 10-15
Conclusions 15
Limitations 16
Appendix 1 17-25
Appendix 2 26-30
Appendix 3 31-32
References 33-35
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
3 | P a g e
Abstract:
Objective: The aim of this study was to identify different resources of stress among
dental and medical students and to compare the effect of changing the curriculum on the stress
level in dental and medical students at Kuwait University.
Methods: This is a case control study conducted on undergraduate dental and medical
students (5th and 6th
year) in Kuwait university dental and medical school. A fifty- item self-
reported modified version of Dental Environment stress (DES) questionnaire was distributed
during academic spring semester 2013.Total sample size was 364, of which 187 respondents
were taken form pervious similar study measured stress level among dental and medical students
in the old curriculum. Out of the new 186 questionnaires, 159 received giving a response rate of
85.4%. A modified version of the self-administered Dental Environmental Stress (DES)
questionnaire was used. Stressors were classified into five major domains: Personal Factors,
Living Accommodations, Marital Status, Training Factors, and Academic Environment Factors.
The t-test was used in the compression of different sources of stress by gender, field of study,
level of study, GPA, marital status, and curriculum.
Results: females scored statistically significant higher values in all stressor domains. In
addition, the “dental environment” seems to be more stressful than “medical environment”.
Moreover, whether in dental or medical school, fifth year students appeared to be more stressed
than sixth year students. Undergraduate students with higher GPA were more stressed.
Additionally, students involved in old curriculum showed less stress compared to student
studying in the new curriculum.
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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Conclusions: studying the primary sources for stress among dental and medical students
emphasized the effect of gender, field of study, level of study, GPA, and marital status. In
addition, changing the curriculum from lecture oriented to a system based case-triggered
integrated system increased the stress level among undergraduate students.
Introduction:
Stress is defined as the body’s reaction to a change that requires a physical, mental, or
emotional adjustment or response. It is a prevalent and costly problem in today’s workplace.
Significant number of employee views their jobs as the number one stressor in their lives.
The profession of medicine and dentistry are considered to be extremely stressful. This is
true for all stages of dental career. Physicians suffer from especially high degrees of stress even
when compared with other health professions. Either diverse and extreme demands or lack of
resources which exceed the person’s coping capacities can be viewed as sources of occupational
stress1.
Stress has been described as two-edged sword that can either stimulate and motivate the
student to peak performance or reduce the students to ineffectiveness. Stress in dental and
medical students may be multifactorial arising from the academic environment and personal
factors2, 3
.
In a study done by Divaris and et al, post graduate dental students perceived the specialty
of prosthodontics as the highest demanding specialty. On the other hand, orthodontics was
considered as lowest demanding specialty. Regarding non clinical specialties, dental materials
considered as most stressful specialty whereas those in oral biology perceived the least stress4.
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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According to Amin and et al, the perceived stress among dental students attributed to
factors such as fear of failure, the load of academic and clinical work, unavailability of materials
for study and clinical training, performance pressure, and self-efficacy beliefs. It has been
reported that students who demonstrated high levels of stress tended to show lower grades for
clinical competency and contextual understanding. It was found that female students experienced
higher degree in emotional exhaustion than their male counterparts. The cause of high emotional
exhaustion probably related to pressures of study, examinations, competition and fulfillment of
minimum clinical requirements5.
A study done in Germany found that the factors affecting stress among undergraduate
dental students were divided into different aspects. Occupational factors include daily interaction
with patients, colleagues, and staff, time pressure, paper work, defective equipment or problems
in the treatment of patient, and possible conflicts, especially with clinical supervisors. With
regard to personal factors, examination phobia, lack of self-confidence, and difference between
reality and students' expectation proved to be considerable stressor1.
At Kuwait University, before the year 2008, the curriculum for medical and dental
students was lecture oriented. However, the education system was changed from lecture oriented
to a system based case-triggered integrated system 7 years ago. In the year 2010, two dental
students did an elective study on stress among fifth and sixth dental and medical students who
were following the old system was carried out. They found that females scored statistically
significant higher values in all of the stressors domains. Dental students in general reported
higher stress scores in almost all domains. Moreover, undergraduate students with higher GPA
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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experienced more stress than those with lower GPA. After the change in the curriculum, the aims
of this study were to:
1. Compare stress level in old system (lectures' oriented) to new system (system based case-
triggered integrated system) of education by comparing our results with previously conducted
study.
2. Identify the stress factors among undergraduate clinical years of dental and medical
students
3. To investigate whether specific stressors were related to gender, field of study, level of
study, GPA and material status
4. Compare stress level between dental students and medical students at Kuwait University.
Materials and Methods:
This study was carried out in the Faculty of Dentistry, Kuwait University (KU), which is public
university in Kuwait. Approval was obtained from health science centers’ ethical committee for
students study project and the dean of faculty prior to initiating the study.
Currently, the dental program of the faculty of dentistry in Kuwait University consists of
six and a half years. These years are divided into 4 pre-clinical years of basic sciences and 2 and
a half clinical years. On the other hand medical program consists of 7 years, which are divided
into 4 pre-clinical years of basic sciences and 3 clinical years. This case control questionnaire
study included 5th
& 6th
year dental and medical students only. The data were collected through
self-administered questionnaire (appendix 2) given to students after lectures and seminars. The
data were collected in a week that was free of any examination in order to eliminate stress due to
examinations. The results of the questionnaire were used to measure the stress level among the
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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medical and dental students and compare the results with previously conducted study. The
purpose of this survey explained to the students and confidentiality assured. Participation was
voluntary and verbal and written informed consent obtained from all participants.
Survey instrument: In order to investigate different sources of stress, a modified version
of the self-administered Dental Environment Stress (DES) questionnaire was used, which also
was used in the previous study, where it was further adjusted to be applicable for Kuwait
university students. The questionnaire sections included: demographic data (age, gender,
nationality, year of study, and marital status), level of study, field of study, and first choice of
study followed by 50 items related to possible sources of stress. These items were divided into
five major domains: 1 Personal factors (10 items), 2 Living accommodations (3 items), 3 marital
status (4 items), 4 training factors (17 items), and 5. Academic environment factors (16 items).
The students were asked to answer the questions in scale of 1-5 scores; 1(not stressful), 2(slightly
stressful), 3(fairly stressful), 4(highly stressful), 5(not applicable). The data was analyzed using
SPSS program version 20.0. Mean values, standard deviations, standard errors, and confidence
interval were calculated. Independent sample t-test was used to compare sources of stress by
gender, field of study, level of study, GPA, marital status, and curriculum.
Results:
A total of 364 questionnaires were collected, of which 159 was conducted this year and
187 taken from previous study. This year, a total of 159 students responded out of 186 Students
(overall response rate 85.4%). Of these 159 respondents, 75% were females and 25% were
males. The medical students were 114 students (72%) and dental students were 45 students
(28%). Of the dental students, 93% were females and 7% were males. In comparison, 67.5% of
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
8 | P a g e
medical students were females and32.5% were males. The percentage of non-single students was
19.5% (N=31) while the percentage of single students was80.5% (N=128). Most of the students
were Kuwaiti (91%) compared to non-Kuwaiti (9%). Fifty one percent of the students were in
the fifth year while forty nine percent were in sixth year. Majority of students had GPA 3 or less
(82.9%) while only 17.1% had GPA higher than 3. Table (1)
The means for each factor in the five main domains calculated. In the personal factors
domain, the mean value ranged from 0.77 to 2.09. Difficulty in making friends was the less
stressful factor (mean= 0.77) in this domain while the most stressful factor was reduced sleeping
time (mean= 2.09). In regards to living accommodation, having children at home causes high
stress level among the participants (mean= 1.71). Additionally, the most stressful domain was
marital status domain comparing to the rest main domains. In this domain, the mean scores range
from 3.01 to 3.17. Moreover, transition from pre-clinical to clinical years scores least mean value
(mean= 1.51). On the other hand, completing graduation requirements raise the stress level
among the students (mean=2.02). Finally, examination and grades causes the highest stress level
in academic environment domain (mean=2.26). However, expectation of dental / medical school
and what in reality it is like causes slight stress among the students (mean=1.49).
Table 2, shows the effect of gender on the mean scores of stressor domains. Females
experienced more stress than males in all stressor domains. In personal factors domains, females
had more difficulty in making friends. In addition, Participation in family activities was more
stressful to females. Among training factors, females had higher stress scores in the following
factors: transition from pre-clinical to clinical years, responsibilities for comprehensive patient
care, patients being late or not showing for their appointment, confidence in own clinical
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
9 | P a g e
decision, difficulty in learning clinical decision, difficulty in learning manual skills, and shortage
of allocated clinical time. Moreover, lack of confidence to be a successful student, lack of
confidence in self to be a successful dentist/ doctor, competition for grades, fear of failing a year,
amount of cheating in school, and fear of being unable to catch up if behind were significantly
higher in females. Males were not more than females stressed in any of the factors.
Table 3, indicates comparison between medical and dental students. Higher level of stress
among dental students was found in personal factors, living accommodation and academic
environment domains. However, medical students were more stressed in conflict with partner
over career decision (marital status domain). The training factors responsible for elevation of
stress level in dental students were transition from pre-clinical to clinical years, responsibilities
for comprehensive patient care, patients being late or not showing for their appointment,
completing graduation requirements, shortage of allocated clinical time, and difficulties in
communicating with staff. On the other hand, medical students were more concerned about
grades.
Table 4, shows the difference in the mean scores of stress between 5th
and 6th
year
students. Fifth year students showed more stress in conflict with parents over career decision,
atmosphere created by staff, concern about treatment grades, lack of confidence to be a
successful student, and competition for grades.
As shown in table 5, students with GPA more than 3 experienced more stress compared
to students with GPA less than 3 in 3 domains including personal factors, training factors, and
academic environment. Each domain contained several factors such as difficulty in making
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
10 | P a g e
friends, transition from pre-clinical to clinical years, fear of failing a year, and considering
entering some other field of work.
Table 6, shows the difference in the level of stress between single and non single
students. In regards to marital status, non single students were slightly more stressed due to
marital adjustment problems (mean 1.32), postpone having children (mean 1.61), having a dual
role as a spouse and a student ( mean 1.68), and conflict with partner over career decision (mean
1.03). However, single students were more stressed regarding grades competition.
The comparison between old and new curriculum is shown in table 7. New curriculum
students showed higher stress level in personal factors and academic environment domains. In
regards to marital status domain, marital adjustment problems, postponing having children, and
conflict with partner over career decision elevated the stress level among the new curriculum
students. In comparison, having a dual role as a spouse and a student caused higher stress level
among old curriculum students. Finally, when comparing different training factors,
responsibilities for comprehensive patient care and confidence in own clinical decision making
caused higher stress level in new curriculum students. On the other hand, difficulties in
communicating with staff, and conflict with supervisor over personal matters raised the stress
level among old curriculum students.
Discussion:
The aim of the study was to identify the perceived sources of stress among 5th
and 6th
undergraduate dental students at University of Kuwait, and compare it with their peers in
medicine. Also it aimed at comparing the stress level between the old system students to the new
one. At the time of the study, the studying program was a 6.5 years program consisting of 2 years
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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premedical, 2 years preclinical, and finally 2.5 years of clinical dental program. Through the first
four years of the program dental students study basic medical sciences and spend most of their
course with their medical peers. Having only one dental and one medical school in Kuwait
creates more pressure and stress on the students from the time of application. Moreover, the
number of seats provided for the undergraduate dental program is 1\3 of those seats available for
the medical undergraduate program. Also, seats in medical school are pre-distributed based on
the gender of the applicants, where 50% of the seats are allocated for females and 50% for males.
On the contrary, the seats in dentistry are given solely according to students’ GPA. It worth
mentioning that in order to get administered to the dental program, one must have attained a
higher GPA than those accepted at the medical program. Knowing all of that, one can only
imagine the amount of pressure in order to get administered to the dental school. That, combined
with challenges students face throughout the years of the program will create an accumulative
pressure, to even higher levels of stress. This study was conducted in order to assess whether
specific stressor domains were affected by gender, field of study (medicine-dentistry), level of
study (5th year- 6th year), GPA, marital status, and system (old vs. new). Identification of
potential stressors will enable creating more comfortable and less stressful environment which is
believed to enhance the academic performance of the students hence the final educational and
training outcomes. While the results of this study indicates that many findings are consistent with
international literatures, some findings may further enhance our understanding of dental student
stress
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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Gender:
Regarding the effect of gender in the present study, significant differences in stress scores
were found between males and females. This was in agreement with a study on Turkish6 and
Egyptian7 undergraduate dental students were females reported higher stress level. In the current
work, females were found to be more stressed about making friends. It has been suggested that
female students receive less peer support than male students8
and they also feel more pressure to
succeed in a male-dominated profession. In addition, female students were stressed in regards to
participation in family activities. This could be related to the cultural tradition in the Kuwaiti
society since females are expected to have a larger role in family activities. In terms of training
factors, females were more stressed regarding the responsibilities of the comprehensive patient
care, patients being late or not showing to their appointments, and the shortage of the allocated
clinical time. The fact that female students reported significantly higher stress was attributed in
the literature to their different patterns of response to stressful events. Sanders and Lushington
(1999), however, suggested that gender differences could be explained by the different patterns
of psychological morbidity between both genders and because males are less expressive of their
concerns and feelings9.
Field of study:
Dental schools are known to be highly demanding and stressful learning environment7.
This is reflected in the high scores given for "lack of time for relaxation", "deterioration of the
personal physical health, and "difficulty in participation in family activities". This might be due
to the fact that dental curriculum have higher number of studying subjects per year compared to
the medical curiculum, thus dental students are exposed to more exams more frequently. The
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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other factors that dental students were significantly more stressed about were related mainly to
clinical factors domain. Those factors included "transition from preclinical to clinical years",
"responsibilities of the comprehensive patient care", and "completing graduation requirements".
This could be explained logically by the differences between the dental and medical educational
programs, where each dental student is responsible for a certain number of patients with
comprehensive care and treatment planning. In comparison, the medical students are responsible
for daily rounds and group discussion of patient cases with no direct involvement in treatment
provision. In addition, completing graduation requirements and shortage of allocated clinical
time were stressful factors for dental students. This seemed to be related to the fact that clinical
training and evaluation system in dental program is based on unit requirements. Thus, successful
completion of those requirements is obviously a significant source of stress for dental students in
terms of patient compliance and cooperation which students have no control over. According to
Dodge et al (1993), students reported lower stress levels when clinical training and evaluation
were not based on unit requirements10
. This current study pointed that dental students are more
stressed when it comes to participation in family activities. This could be explained by the
extended working periods when compared to medical students. On average, dental program
official working hours exceeds medical program by five hours weekly. Not to mention that
dental students exposed to more exams compared to medical students. In addition, dental
curriculum requires more technical skills. However, medical students showed a higher stress
level when it comes to conflict with partner over career decision. A possible explanation to that
might be the fact that medical students serve at night shifts which is not preferable by most
Kuwaiti partners.
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
14 | P a g e
Level of study:
Regarding the relationship of the level of the study and perceived sources of stress, fifth
year students reported higher stress levels than the sixth year students. Similar concerns were
reported in previous studies carried out in Egypt7, India
11, and Turkey
6. This might be attributed
to the fact that they are relatively new to the clinical year's program. Their knowledge and
confidence are still developing. They may be overloaded by the high academic demands of their
year of study and the absence of clinical experience7. Interestingly, these findings were not
reported in the United States12
. Not to mention the new rules and regulations they have to
accustom with. Sedky (2012) reported that the transition into the clinical setting may be difficult
for many students7.
GPA:
In attempt of demonstrating the effect of the GPA on levels of stress, students with GPA
more than 3 scored higher levels in the personal domain factors, such as "difficulty in making
friends". The results can be explained by the fact that since these students are hard working they
don't have as much free time for their personal life responsibilities. However, when it comes to
the academic environment factors opposite patterns are observed. And students with lower GPA
scored higher levels of stress in these factors which were "fear of failing a year" and "considering
entering some other field of study". The reason behind that could be because this group of
students feels less competent than their fellow colleagues.
Marital status:
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
15 | P a g e
The results of the effect of the marital status are only to be expected. The group of non-
single students was more stressed about "marital adjustment issues", "postponing having
children", "having a dual role as a spouse and a student" and "conflict with partner over career
decision". This is coincident with results of the study conducted by Uraz (2013) that also
reported married students to be more stressed possibly due to the extra duties and obligations
they have towards their spouses and maybe children6. The current results may support previous
findings that the most highly stressed students had difficulty with domestic arrangements13
.
Curriculum:
The faculty has adopted a case triggered integrated curriculum for student intake of 2005
onwards. The new system is planned on a student centered principle, emphasizing the need for
self-learning and student motivation. Evidence based dentistry, small group learning, PBL
sessions, clinical skills lab, and early clinical exposure are salient features of this new
curriculum. This could explain why the students of the new curriculum are experiencing more
stress compared to their colleagues of the older system. The personal factors and the marital
status domain are properly justified due to lack of personal time, being in a self-study system.
However the training factors and the academic environment domain are probably due to the
variation of the knowledge and skills obtained individually.
Conclusions:
In conclusion, studying sources of stress among the dental students emphasized the effect
of gender, level of study, GPA, marital status, and the teaching system. The results of the
comparison of stress levels between dental and medical students confirmed the fact that dental
students are more stressed compared to their peers in medical field. Since stress could have
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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dramatic effect on efficiency of work, quality of life and student's psychological wellbeing,
efforts should be done to reduce it and improve the student’s health
Limitations of the study:
1. The overall number of dental students was smaller than medical students. A larger sample
of dental students would be more favorable in studying the perceived sources of stress
among students providing a more powerful analysis and stronger association.
2. Majority of students in dental school were females which might have influenced the final
results of the study.
3. The cross sectional study design didn’t allow us to establish causal relationships among
the variables.
Recommendations:
Some stress is inherent in studying dentistry. Nevertheless stress prevention and
interventional measures can reduce or eliminate many sources of stress.
1. The student centered learning environment should be polished to enhance the
collaborative and interpersonal support among students.
2. The clinical training and evaluation should not be based on unit requirements which were
potent stressor for the students.
3. Stress reduction protocol should be implemented including specific courses, faculty
incorporated advising system, and student counseling.
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
17 | P a g e
Appendix 1: Figures and Tables
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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Figure 1. shows the distribution of demographic variables of the study sample
0
20
40
60
80
100
120
140
160
180
200
pe
rce
nta
ge %
Demographic Data
Gender
Nationality
Marital status
Field of study
Level of study
GPA
System
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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Table1. Distribution of demographic variables of the study sample
Demographic Variables N % Total
Gender Males 40 25.2 159
Females 119 74.8
Nationality Kuwaiti 145 91.2 159
Non- Kuwaiti 14 8.8
Marital status Single 128 80.5 159
Non-single 31 19.5
Field of study Medicine 114 71.7 159
Dentistry 45 28.3
Level of
study
Fifth year 81 50.9 159
Sixth year 78 49.1
GPA Below 3 119 82.9 145
Above 3 26 17.1
Group Old 187 54 346
New 159 46
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
20 | P a g e
Table2. Statistically significant sources of stress according to gender of the participants
Domains
Statistically significant factors
Gender N Mean p Mean difference
Std. Error Difference
95% confidence interval
lower Upper
Personal factors Difficulty in making friends
Males 40 0.40 0.041
0.422 0.204 0.018 0.826 Females 118 0.82
Living 8accommodation
Participation in family activities
Males 40 0.93 0.018 0.478 0.200 0.084 0.873
Females 119 1.40
Training factors Transition from pre-clinical to clinical years
Males 40 1.27 0.005 0.540 0.188 0.169 0.911
Females 119 1.82
Responsibilities for comprehensive patient care
Males 40 1.55 0.002 0.535 0.169 0.201 0.869
Females 118 2.08
Patients being late or not showing for their appointment
Males 40 1.65 0.030 0.543 0.247 0.055 1.032
Females 119 2.19
Confidence in own clinical decision
Males 40 1.80 0.035 0.395 0.186 0.028 0.762
Females 118 2.19
Difficulty in learning clinical decision
Males 39 1.44 0.015 0.455 0.184 0.091 0.818
Females 119 1.89
Shortage of allocated clinical time
Males 40 1.48 0.000 0.728 0.187 0.359 1.098
Females 118 2.20
Academic environment
Lack of confidence to be a successful student
Males 40 1.33 0.016 0.522 0.215 0.097 0.948
Females 118 1.85
Lack of confidence in self to be a successful dentist/ doctor
Males 40 1.25 0.033 0.464 0.216 0.037 0.891
Females 119 1.71
Competition for grades Males 40 1.35 0.017 0.531 0.220 0.097 0.966
Females 118 1.88
Fear of failing a year Males 40 1.75 0.048 0.405 0.203 0.004 0.806
Females 116 2.16
Fear of being unable to catch up if behind
Males 40 1.85 0.009 0.464 0.176 0.116 0.811
Females 118 2.31
* Statistics based on the new study only
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
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Table 3. Statistically significant sources of stress according to field of study of the participants
* Statistics based on the new study only
Domains Statistically significant factors
Field of study
N Mean p Mean
Difference
Std. Error
Difference
95% confidence interval
lower upper
Personal factors Difficulty in making friends
Dentistry 45 1.02 0.031 0.429 0.197 0.041 0.818
Medicine 113 0.59
Lack of time for relaxation
Dentistry 45 2.42 0.015 0.413 0.168 0.082 0.745
Medicine 112 2.01
Personal physical health
Dentistry 45 2.00 0.031 0.387 0.178 0.036 0.739
Medicine 111 1.61
Living accommodation
Participating in family activities
Dentistry 45 1.67 0.006 0.535 0.191 0.158 0.913
Medicine 114 1.13
Marital status Conflict with partner over career decision
Dentistry 45 3.09 0.042 -0.474 0.231 -0.930 -0.018
Medicine 112 3.56
Training factors Transition from pre-clinical to clinical years
Dentistry 45 2.07 0.003 0.540 0.181 0.184 0.897
Medicine 114 1.53
Responsibilities for comprehensive patient care
Dentistry 45 2.38 0.000 0.599 0.161 0.281 0.917
Medicine 113 1.78
Patients being late or not showing for their appointment
Dentistry 45 2.44 0.024 0.541 0.238 0.071 1.011
Medicine 114 1.90
Concern about treatment grades
Dentistry 45 1.76 0.006 -0.516 0.186 -0.883 -0.149
Medicine 114 2.27
Completing graduation requirements
Dentistry 45 2.76 0.000 0.966 0.204 0.563 1.369
Medicine 114 1.79
Shortage of allocated clinical time
Dentistry 44 2.64 0.000 0.856 0.177 0.505 1.206
Medicine 114 1.78
Difficulties in communicating with staff
Dentistry 45 1.73 0.000 0.856 0.177 0.505 1.206
Medicine 114 1.33
Academic environment
Discrimination due to ethnic groups
Dentistry 45 2.29 0.044 0.578 0.285 0.015 1.142
Medicine 114 1.71
Amount of cheating in school
Dentistry 45 2.53 0.005 0.446 0.155 0.139 0.753
Medicine 114 2.09
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
Table 4. Statistically significant sources of stress according to level of study of the
participants
Domains
Statistically significant factors
Level of study
N Mean p Mean
Difference
Std. Error
Difference
95% confidence interval
lower upper
Personal factors
Conflict with parents over career decision
Fifth year 81 1.33
0.035 0.513 0.241 0.036 0.989
Sixth year 78 0.82
Training factors
Atmosphere created by staff
Fifth year 80 1.90 0.002 0.477 0.151 0.179 0.775
Sixth year 78 1.42
Concern about treatment grades
Fifth year 81 2.32 0.019 0.398 0.169 0.065 0.731
Sixth year 78 1.92
Academic environment
Lack of confidence to be a successful student
Fifth year 80 1.91 0.035 0.400 0.188 0.028 0.771
Sixth year 78 1.51
Competition for grades
Fifth year 80 1.98 0.017 0.462 0.191 0.084 0.840
Sixth year 78 1.51
* Statistics based on the new study only
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
23 | P a g e
Table 5. Statistically significant sources of stress according to GPA of the participants
Domains
Statistically significant factors
GPA N Mean p Mean
Difference
Std. Error
Difference
95% confidence interval
lower upper
Personal factors
Difficulty in making friends
3 119 0.60 0.041 -0.555 0.221 -0.991 -0.119
≥3 33 1.15
Training factors Transition from pre-clinical to clinical years
3 119 1.57 0.023 -0.429 0.204 -0.831 -0.026
≥3 33 2.00
Academic environment
Fear of failing a year
3 118 2.18 0.011 0.584 0.218 0.154 1.015
≥3 32 1.59
Considering entering some other field of work
3 118 2.21 0.029 0.121 0.195 -0.265 0.507
≥3 33 2.09
* Statistics based on the new study only
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
24 | P a g e
Table 6. Statistically significant sources of stress according to marital status of the
participants
* Statistics based on the new study only
Domains Statistically significant factors
Marital status
N Mean p
Mean
Difference
Std. Error
Difference
95% confidence interval
lower upper
Non single
29 1.03
Academic environment
Competition for grades
Single 127 1.65 0.022 -0.475 0.242 -0.954 0.003
Non single
31 2.13
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
25 | P a g e
Table 7. Statistically significant sources of stress according to Curriculum
* Statistics based on the new study only
Domains Statistically significant factors
Group N Mean p Mean
Difference
Std. Error
Difference
95% confidence interval
lower upper
Personal factors Reduced holidays compared to other students
Old 187 1.93 0.005 -0.295 0.112 -0.480 -0.039
New 158 2.19
Personal physical health
Old 187 1.67 0.010 -0.056 0.120 -0.291 0.179
New 156 1.72
Marital status Marital adjustment problems
Old 187 2.64 0.000 -0.838 0.157 -1.146 -0.530
New 156 3.47
postpone having children
Old 187 2.82 0.000 -0.727 0.145 -1.012 -0.441
New 156 3.54
Having a dual role as a spouse and a student
Old 187 2.84 0.000 0.731 0.140 -1.007 -0.455
New 156 3.57
Conflict with partner over career decision
Old 187 2.66 0.000 -0.769 0.162 -1.088 -0.450
New 157 3.43
Training factors Responsibilities for comprehensive patient care
Old 187 1.72 0.021 -0.233 0.109 -0.447 -0.019
New 158 1.95
Confidence in own clinical decision making
Old 187 1.71 0.025 -0.389 0.116 -0.618 -0.160
New 158 2.09
Difficulties in communicating with staff
Old 187 1.88 0.031 0.436 0.122 0.195 0.677
New 159 1.45
Conflict with supervisor over personal matters
Old 186 1.82 0.044 0.082 0.135 -0.183 0.347
New 158 1.74
Academic environment
Amount of assigned class work
Old 187 1.45 0.007 -0.475 0.122 -0.716 -0.235
New 159 1.92
Examination and grades
Old 187 2.11 0.021 -0.342 0.101 -0.541 -0.144
New 158 2.45
Discrimination due to ethnic groups
Old 187 1.71 0.001 -0.163 0.163 -0.484 0.158
New 159 1.87
Amount of cheating in school
Old 187 1.81 0.009 -0.406 0.108 -0.620 -0.193
New 159 2.21
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
26 | P a g e
Appendix 2: the questionnaire
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
27 | P a g e
Stress level and contributing factors among dental and medical students: A
comparison between old and new curriculum
Gender: female male
Year of birth: 19__ __
Nationality: Kuwaiti Non-Kuwaiti
Marital status: single engaged married (no children) married (children)
divorced widowed
Field of study: dentistry medicine
Study level: third year forth year fifth year sixth year
First choice of study: medicine dentistry pharmacy
others ( _______ )
Last GPA score: <2 2-2.5 2.5-3 3-3.5 3.5-4
I. Personal factors:
SN Not
stressful
Slightly
stressful
Fairly
stressful
Highly
stressful
Not applicable
1. Difficulty in making friends
2. Relationship with members of the
opposite sex
3. Lack of time for relaxation
4. Reduced holidays compared with
other students in the university
5. Financial responsibilities
6. Forced postponement of marriage
or engagement
7. Inadequate time for exercise
8. Reduced sleeping time
9. Personal physical health
10. Conflict with parents over career
decision
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
28 | P a g e
II. living accommodation:
Not
stressful
Slightly
stressful
Fairly
stressful
Highly
stressful
Not applicable
11. Participating in home/
family activities
12. Having children at home
13. Family restrictions on
studying outside home
after school hours
III. Marital status:
Not
stressful
Slightly
stressful
Fairly
stressful
Highly
stressful
Not applicable
14. Marital adjustment
problems
15. Necessity to postpone
having children
16. Having a dual (double)
role as a wife or husband
and a dental or medical
student
17. Conflict with partner over
career decision
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
29 | P a g e
IV. Training factors (clinical or laboratory):
Not
stressful
Slightly
stressful
Fairly
stressful
Highly
stressful
Not applicable
18. Transition from pre-
clinical to clinical years
19. Responsibilities for
comprehensive patient
care
20. Patients being late or not
showing for their
appointment
21. Confidence in own
clinical decision making
22. Difficulty in learning
clinical decision
23. Difficulty in learning
precision manual skills
required in pre-clinical
and laboratory work
24. Atmosphere created by
teaching/ clinical staff
25. Receiving criticism about
work
26. Concern about treatment
grades awarded
27. Inconsistency of feedback
on your work between
different instructors
28. Completing graduation
requirements
29. Shortage of allocated
clinical time
30. Difficulties in
communicating with
teaching/ supervising staff
31. Conflict with teacher/
supervisor over personal
matters
32. Unfairness in teacher/
staff distribution in some
classes/ clinics
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
30 | P a g e
V. Academic environment:
Not
stressful
Slightly
stressful
Fairly
stressful
Highly
stressful
Not applicable
33. Amount of assigned class
work
34. Difficulty of assigned
class work
35. Rules and regulations of
the school
36. Lack of input into
decision making process
of school
37. Lack of confidence to be
a successful dental,
medical student
38. Lack of confidence in self
to be a successful dentist/
doctor
39. Examination and grades
40. Competition for grades
41. Fear of failing a year
42. Expectation of dental
/medical school and what
reality it is like
43. Discrimination between
students due to gender
44. Discrimination between
students due to class
status
45. Discrimination between
students due to race and
ethnic groups
46. Amount of cheating in
dental/medical school
47. Lack of time to do
assigned school work
48. Considering entering
some other field of work
49. Fear of being unable to
catch up if behind
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
31 | P a g e
Ethical consideration:
Use of human subjects:
The use of human subjects in this study will be in accordance with internationally
accepted guidelines for the ethical treatment of human subjects participating in clinical studies.
The study protocol will be submitted to the appropriate ethical committee for approval. Informed
consent will be obtained from all participating subjects.
Study population:
The study subjects will be dental and medical students from Kuwait University. All
subjects qualifying for the study will be recruited without regard to color, race, or ethnic
background. There are no exclusion criteria based on color, race, or ethnic background of the
subjects
Informed consent:
All patients considered to participate in the study will be informed about the nature of the
study and all their questions answered. Only subjects consenting to participate will be included
in the study.
Patient safety:
No potential risks to the subjects are anticipated due to this study. No physical injuries or
side effects are expected since this will be survey-based study. Still, all measures will be taken to
assure patient safety during the conduct of this study.
Patient confidentiality:
Patient confidentiality will be protected throughout this study. No personal information
will be used except for the purposes of statistical analysis of the data and without reference to
individual subjects. No identification of study subjects will be made in any publication resulting
from this study.
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
32 | P a g e
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
33 | P a g e
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Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
34 | P a g e
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8
Students: Fatma Ahmad & Naela Al- Bloushi
Supervisor: Dr. Qasem Al-Omari, Dr. Muawia Qudeimat
35 | P a g e
20. Pöhlmann K, Jonas I, Ruf S, Harzer W. Stress, burnout and health in the clinical period
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J. 2013 Aug;13(3):429-36. Epub 2013 Jun 25