Sie sind auf Seite 1von 5

Critical Analysis of the Medical Student Stressor Questionnaire (MSSQ)

Introduction:
We recommend reading the Critical Analysis of the Medical Student Stressor Questionnaire,
which covers the basic descriptive and psychometric information, including the number of
items, instrument purpose, and psychometric (i.e., validity) data and can help determine if the
Medical Student Stressor Questionnaire meets your needs. If you are interested in getting
more detailed information about the items in the instrument or have decided to consider using
the Medical Student Stressor Questionnaire, we recommend reviewing the Medical Student
Stressor Questionnaire instrument file and scoring guide.

Educational Objectives:
1. To describe the purpose and basic properties of the Medical Student Stressor
Questionnaire, including number of items and scales, and psychometric properties;
2. To describe the application of the Medical Student Stressor Questionnaire to the field of
health sciences education;
3. To evaluate the relative strengths and weaknesses of the Medical Student Stressor
Questionnaire; and
4. To provide the Medical Student Stressor Questionnaire and supplemental materials to
aid in its administration.

Resource files:
 Critical Analysis of the Medical Student Stressor Questionnaire
 Medical Student Stressor Questionnaire Instrument – 20 item
 Medical Student Stressor Questionnaire Manual and Scoring Guide, which includes the
40-item instrument

A. Original Citation: Yusoff MSB, Rahim AFA, Yaacob MJ. The development and validation of
the Medical Student Stressor Questionnaire (MSSQ). ASEAN Journal of Psychiatry 2010;
11(1):13-24.

B. Brief Description/Purpose: The Medical Student Stressor Questionnaire (MSSQ) was


developed to identify sources of stress in medical students. The authors define a stressor as
a personal or environmental event that causes stress. They categorize medical student
stressors into six groups: 1) academic related stressors; 2) intrapersonal and interpersonal
related stressors; 3) teaching and learning-related stressors; 4) social related stressors; 5)
drive and desire related stressors; and 6) group activities related stressors.

The MSSQ is a self-reported, self-scored instrument with 40 items asking respondents to


rate the intensity of stressors on a scale of 0-causing no stress at all to 4-causing severe
stress. A 20-item instrument has also been validated1. There is no time limit for
completing the assessment (most finish in 15 minutes). The MSSQ is free of charge, but the
authors ask that demographic and de-identified data be shared.

C. Development and Psychometrics: The MSSQ was designed to identify stressors of medical
students. Forty items were developed after a review of literature. The items were
administered to 141 final year medical students to test face validity (whether a test appears
to measure the target variable). Discussion with experts in the field of Medical Education
and Psychiatry determined content validity (do items measure the intended variable). The
40 items were then administered to 761 medical students across all 5 years of medical
school at Universiti Sains Malaysia.

Cronbach’s alpha (CA) was 0.95 for the entire instrument, indicating high internal
consistency. Factor analysis was used for construct validity and all items distributed into six
groups. Each of the 40 items loaded above a 0.3 cutoff value and was included in the
survey. The CA of the 6 stressor groups are below, indicating high internal consistency
above the acceptable cut-off point of 0.62.

Table 1: Cronbach’s alpha value of stressor groups


Stressor Group Cronbach’s Alpha
Academic Related Stressors 0.921
Inter- and Intrapersonal Related Stressors 0.895
Teaching and Learning Related Stressors 0.858
Social Related Stressors 0.710
Drive and Desire Related Stressors 0.646
Group Activities Related Stressors 0.728

D. Additional Studies Reporting Validity Evidence: Research using the MSSQ has not been
conducted by researchers other than the developing authors, however they report
additional validity evidence:
 To explore construct validity and internal consistency, Yusoff3 surveyed medical
students from 4 different medical schools in Malaysia (n=375). The results were
similar to the pilot study in that the CA of the MSSQ was 0.95 and all items loaded
onto 6 stressor groups with factor loading values more than 0.3, indicating a valid
and reliable instrument for use with that population.
 To confirm reliability and validity, Yusoff performed a confirmatory factor analysis
using the same sample as the study referenced above1. Goodness of fit indices
suggested that the six-factor, 40-item model had poor fit and needed modification.
Multiple items were removed and re-analyzed. The final model consisting of 20
items and six factors had a good fit with the latent constructs. CA of the 20-item
model was 0.92 and each item had a corrected-item total correlation of more than
0.3 indicating high internal consistency. Composite reliability analysis, measuring
construct reliability, of the 20-item model was >0.6 (good) and average variance
extracted analysis (measuring convergent validity) was >0.5 (adequate).
 To investigate stability of the MSSQ in measuring stressors, CA and intra-class
correlations (ICC) were used to measure internal consistency and agreement level
across three administrations of the MSSQ for 167 first-year Malaysian medical
students4. The 40-item MSSQ was administered at month 4, 6 and 8 of the first year.
CA for the entire instrument at the different intervals ranged from 0.96-0.97
indicating high level of internal consistency across time. Each of 6 groups had alpha
values between 0.72-0.95 suggesting very good to high levels of consistency across
time. ICC for the six groups ranged from 0.47-0.62 indicating an acceptable level of
agreement between the three measurements.

E. Application to Health Sciences Education & Health Sciences Education Research:


Currently, the only research on the MSSQ has focused on medical students, not other areas
of health sciences education.

In the original development of the MSSQ, Yusoff, et. al. examined prevalence and sources of
stress among medical students in Malaysia5,6. They found that academic related problems
was the major stressor among medical students in all years and that year of study was the
most significant factor associated with medical student stress with a slight bi-modal pattern
of stress (stress was highest years 2, 4 and dipped lower years 1, 3, 5).

The authors used the MSSQ to design a medical students’ well-being workshop7,8,9,10. The
workshop was a half-day and open to all medical students. Participants were given the
General Health Questionnaire (GHQ-12) to measure level of stress, the MSSQ to recognize
main stressors, and the Brief COPE questionnaire to identify their coping styles. Participants
were given information on problems related to stress in medical school and the relationship
between stress and success. They learned stress reduction and coping methods. Level of
stress measured after the workshop was significantly lower than before participating8,9.
They found that students who attended the workshop had statistically lower anxiety and
depression scores during stressful examination periods than students who did not attend10.

F. Commentary: The MSSQ has both strengths and weaknesses. Many instruments used
today measure level of stress or amount of stress of medical students11,12 but none
specifically look at where this stress is coming from (stressors) like the MSSQ. The reliability
and validity data seem to be solid and support it as a valid instrument; however it has only
been used on Malaysian medical students. Because the nature of medical school in the
United States and characteristics of American medical students may be different, research
needs to be conducted with this population. An investigation of the role of cultural factors
on stressors may be able to add culturally relevant domains for the MSSQ. This is an
opportunity for research and collaboration among medical educators at US medical schools.
If validated in the US, the MSSQ could be a very useful tool for interventions. It could allow
medical schools to design wellness programs for students and be used for individual
assistance.

The original MSSQ contains 40-items however a confirmatory factor analysis yielded only 20
items. Both versions indicate reliability and validity but research with the MSSQ has used
the 40-item instrument. No specific reasoning for using one or the other has been
discussed by the authors. Self-reported and self-scoring instruments come with their own
hazards and students13, medical students in particular, may not want to report how stressed
they are feeling for fear of judgment or future consequences14. The response statements
on the MSSQ could be leading and students may have a hard time distinguishing between
levels (mild or moderate; moderate or high; high or severe)13,14. In addition, the scoring
seems a bit confusing particularly for students who may not be familiar with assessments so
they may need guidance to score the MSSQ or administrators may need to calculate the
scores. The target audience of the MSSQ is medical students so caution needs to be used in
its application to other health professions learners, although it may be a good blueprint for
new instrumentation in that area.

Overall, the MSSQ is a promising instrument to measure the types of stressors that medical
students face and I hope it encourages researchers in Medical Education to validate the
instrument with US medical students.

G. Additional Citations:
1. Yusoff MSB. A confirmatory factory analysis study on the Medical Student Stressor
Questionnaire among Malaysian medical students. Education in Medicine Journal 2011;
3(1):44-53.
2. Downing, S.M. Reliability: on the reproducibility of assessment data. Medical Education
2004,; 38:1006-1012
3. Yusoff MSB. A multicenter study on validity of the Medical Student Stressor
Questionnaire (MSSQ). International Medical Journal 2011; 18(1):14-18.
4. Yusoff, MSB. The stability of MSSQ to measure stressors among medical students.
International Medical Journal 2013; 20(2):1-3.
5. Yusoff MSB, Rahim AFA, Yaacob MJ. Prevalence and sources of stress among Universiti
Sains Malaysia Medical Students. Malaysian Journal of Medical Science 2010; 17(1):30-
37.
6. Yusoff MSB, Yee LY, Wei LH, Siong TC, Meng LH, Bin LX, Rahim AFA. A study on stress,
stressors and coping strategies among Malaysian medical students. International Journal
of Students’ Research 2011; 1(2):45-50.
7. Yusoff MSB. Impact of summative assessment on first year medical students’ mental
health. International Medical Journal 2011; 18(3): 172-175.
8. Yusoff MSB, Rahim AFA. Impact of medical student well-being workshop on the medical
students’ stress level: A preliminary study. ASEAN Journal of Psychiatry 2010; 11(1): 56-
63.
9. Yusoff MSB, Rahim AFA. Experiences from a medical students’ well-being workshop.
Medical Education 2009; 43:1108-1109.
10. Yusoff MSB. Effects of a brief stress reduction intervention on medical students’
depression, anxiety and stress level during stressful period. ASEAN Journal of Psychiatry
2011; 12(1): 71-84.
11. Cohen S, Kamarck T, Mermelstein S. A global measure of perceived stress. Journal of
Health and Social Behavior. 1983; 24(4): 385–396.
12. Dyrbye LN, Szydlo DW, Downing SM, Sloan JA, Shanafelt TD. Development and
preliminary psychometric properties of a well-being index for medical students. Medical
Education, 2010; 10(8): 275-278.
13. Razavi T. Self reported measures: an overview of concerns and limitations of
questionnaire use in occupational stress research. Available from:
http://www.management.soton.ac.uk/Research/Publications/Documents/01-175.pdf
[retrieved 20 August 2014].
14. Walter G, Soh NLW, Jaconelli SN, Lampe L, Malhi GS, Hunt G. Medical students’
subjective ratings of stress levels and awareness of student support services about
mental health. Postgraduate Medical Journal, 2013; 89(1052):311-315.

H. Author’s Information:
Tammy T. Salazar, Ph.D.
Director of Academic Support
Assistant Professor of Family and Community Medicine
Office of Student Affairs
Texas Tech University Health Sciences Center at El Paso
Paul L. Foster School of Medicine
5001 El Paso Dr. – MEB
El Paso, TX 79905
Office phone: 915-215-4365
tammy.salazar@ttuhsc.edu

Das könnte Ihnen auch gefallen