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 Table of Contents  
INVITED PERSPECTIVE/VIEWPOINT
Year : 2021  |  Volume : 37  |  Issue : 2  |  Page : 143-147

Medical students' wellness from the perspective of ergonomics and occupational mental health


1 Departments of Psychiatry and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
3 Department of Transfusion Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission27-Feb-2021
Date of Acceptance06-Jun-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. Ravi Gupta
Departments of Psychiatry and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_47_21

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  Abstract 


Issues related to human factor – ergonomics influence the health of the students and contribute to their well-being. Human factor – ergonomics should be considered since the distinction between mind and body or mental and physical health is more artificial than actual. Perturbation in one affects the other; hence, simple steps to alter ergonomics can improve medical students' overall well-being and quality of life.

Keywords: Ergonomics, mental health, well being


How to cite this article:
Gupta R, Gupta R, Negi G. Medical students' wellness from the perspective of ergonomics and occupational mental health. Indian J Soc Psychiatry 2021;37:143-7

How to cite this URL:
Gupta R, Gupta R, Negi G. Medical students' wellness from the perspective of ergonomics and occupational mental health. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Aug 2];37:143-7. Available from: https://www.indjsp.org/text.asp?2021/37/2/143/320205




  Introduction Top


Conceptually, well-being is defined as an individual judgment that includes satisfaction from life and positive feelings.[1] Well-being is associated with longevity, productivity, sociability, reduced risk of disease, and faster recovery.[1] Although genes determine the behavior and emotions, and thus the well-being of a person, their expression is dependent upon several factors, viz., neuroplasticity (modified by the internal milieu of the body, as well as learning), social factors, environmental factors, and life events.[1] Social relationships have been reported as one of the strongest predictors for well-being.[1] At the more significant level, well-being is governed by the availability of necessities of life, effective governance, developing acceptable social norms, and improving trust through appropriate policies.[1]

Emotional well-being may be defined as the presence of positive emotions, good self-esteem, presence of resilience that translates into self-actualization, self-efficacy, and behavior that promotes health.[2] Many factors thus influence the well-being of a subject. This is explained in [Figure 1].
Figure 1: Interaction between genetic and social factors to improve the well-being of a person. Note that all elements of the system work in a feed-forward manner and regulate the activity of the earlier domains. This model provides a framework for improving well-being at an individual and community level by planning and executing appropriate interventions[2]

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A detailed discussion of all the aspects is beyond the purview of this paper. However, two fundamental elements: ergonomics as well as occupational mental health will be covered in this paper.


  Ergonomics Top


Ergonomics is the science that explores the interaction between humans and their working environment that includes study and application related to several components that can broadly be divided into two categories – human-related factors and environmental factors.[3] Human-related factors are individualized and include anthropometric and biomechanical measures, sensory-motor capabilities, cognitive functions, knowledge of medical conditions and equipment, motivation, and stress.[3] On the other hand, environmental factors include designing of rooms, furniture, and machines.[3] These factors influence the motivation and learning of trainees and are, therefore, necessary for dexterity and quality of patient care.[3] Thus, these factors are to be optimized to impart good quality training, reduce work-related injuries to the medical professionals, including medical students, and provide the best possible care to the patient by reducing the chances of errors.[3] However, during medical training, methods and means adopted for the trainees must be robust on parameters of validity, reliability, appropriateness, and affordability to match critical competencies to be achieved.[3]

Extent of problem

The poorly designed learning environment and the absence of knowledge regarding ergonomics among medical students and professionals result in many problems that include musculoskeletal pain, burnout, and fatigue, and these influence the choice of specialty during residency programs.[4],[5],[6],[7] A few common issues related to poor ergonomics are discussed here.

Medical students often spend long hours sitting on a chair and table during undergraduate and postgraduate training due to an exhaustive curriculum. Students tend to read, work, or use computer systems during this period. Despite the common-sense understanding, a study reported that most medical students did not find their chairs comfortable, and there was a need for different designs for both genders.[8] Discomfort arose because of discordance between knee height and desk clearance; second, they found the seat too low or deep.[8] These conditions necessitate the need for knowledge of ergonomics among medical students to prevent the development of medical conditions such as backache and dry eyes.

Interestingly, contrary to the claims of having knowledge of good posture by most medical students, only one-third are actually aware of good posture while sitting.[7] Moreover, knowledge regarding computer ergonomics appears to be lacking among medical students.[7] Another study reported that most dental students' body posture was ergonomically incorrect, increasing the risk of musculoskeletal pain in a sizable proportion.[5] Prolonged incorrect posture during use of laboratory or operating microscope can lead to musculoskeletal injuries, such as chronic pain syndrome, including shoulder, neck, back aches, and fatigue, and may occasionally lead to serious permanent damages. Thus, increasing the understanding of ergonomically designed microscopes and importance of correct posture can help modify and optimize the working conditions.

Eyes are affected by spending a long time on the screen, and dry-eye syndrome develops in some; because screen use is associated with dysfunction of  Meibomian gland More Detailss and goblet cells of the conjunctiva, reduced blink rate, and corneal photo-toxicity.[9]

After their surgery posting, a survey of medical students revealed that three-fourth reported some musculoskeletal pain.[4] Most affected areas were feet and lower back followed by knees, shoulders, upper back, and neck, mainly during standing in an operating room.[4] One-third of the students reported that they would not opt for surgery since it was physically demanding, and the literature also supports ergonomic problems among surgeons.[4]

The occurrence of problems could be related to several factors, e.g. ergonomics is not included in the medical curriculum, absence of checklist for assessing the postures during working hours, and lack of knowledge about ergonomics and consequent musculoskeletal problems among medical students.[5]

Most of us do not even realize the difficulty faced by left-handed persons, especially when handling the instrument and some intervention as a part of their duty. One study has shown that left-handed medical professionals face difficulty in handling simple tools such as scissors, needle holders, laryngoscopes, jokey of ultrasonography machines, and endoscopy instruments.[10] In addition, they faced problems in taking correct positions at surgical tables and dental chairs.[10]

These problems can influence motivation and cognitive functions and pave the way for negative emotions in medical professionals. If these problems remain unaddressed, they can create a vicious cycle, resulting in poor performance and dissatisfaction. Thus, such factors determine work outcomes and play an essential role in the efficiency and safety of patients.[11]


  Occupational Mental Health Issues among Medical Students and Professionals Top


Occupational health is the highest degree of physical, mental, and social well-being of workers in all occupations. It deals with all aspects of health and safety at the workplace and has a strong focus on the primary prevention of hazards.

Undergraduate course in medicine is one of the most stressful courses.[12] Many factors may be responsible for the stress. Ergonomic factors can lead to stress through direct as well as indirect pathways [Figure 2]. In addition, other sources of stress include the expectation of the students from themselves, expectations of parents, teachers, and peers, responsibility for the well-being of the patients, extensive curriculum, repeated examinations, time constraints for hobbies and leisure activities, long working hours, absence of confidante, to name a few.[12],[13]
Figure 2: Interaction of human factors and ergonomics determines well-being. Human factors, as well as environmental factors, influence each other to determine the status of well being among students and health professionals

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A systematic review from India reported that more than half of the medical students experience stress, while 40% suffer from depression, with a higher prevalence among female medical students.[12] Emotional and behavioral issues are rarely recognized by medical students and professionals in India.[13] Even when recognized, help is rarely sought due to the stigma associated with mental health issues and fear of adverse responses from colleagues, feeling of guilt, and shame, to name a few.[13] Prevailing matters, in turn, influence the ability to discharge the duties besides having other health-related, economic, and social impacts.[13]

Burn-out is another major issue reported among medical students, with a prevalence between 7.0% and 75%.[14] It is related to the fatigue arising out of academic demands, indifference to the work, and absence of perceived competency.[14]

Sleep disturbances and poor sleep quality are other issues among medical students, with nearly half of the medical students reporting poor sleep quality and one-third reporting excessive daytime sleepiness.[15] Disrupted sleep is associated with poor academic performance among medical students, leading to distress, anxiety, reduced motivation, and burn-out to start a vicious cycle where both factors act in a feed-forward manner.[16] Sleep disruption is also associated with an enhanced likelihood of addiction, especially with alcohol.[17]

Several behavioral factors are associated with the well-being of medical students that includes adequate coping, regular physical exercise, lower striving for perfection and lack of over-exertion, a perception that faculty prioritizes student's education, and neuroticism.[18]


  Solutions Top


Ergonomics aims to prevent occupational injuries and provide enabling environment to improve learning and reducing the risk of human errors while dealing with patients. Several strategies have been explored, e.g. improving the design of furniture. Ergonomically designed furniture can be beneficial in improving the output of the system.[8] Specialists in ergonomics should be available in medical fields, e.g. in health administration. Similarly, manufacturers of medical equipment should be encouraged to employ/consult such experts.[3]

Ergonomic principles should be used during the medical training, e.g. simulators that focus on relevant but straightforward surgical tasks (task primitives) have been developed for surgical training.[3] Such methods are cost-effective without negatively affecting the quality of training. They improve students comfort and confidence and can ultimately translate into patient safety.[3]

Human factor/ergonomics approaches can be followed to improve well-being. At present, health systems are designed to focus on functioning of individuals rather than the system (work–environment, equipment, and persons).[11] It leads to the misconception that change of behavior of individuals can reduce the chances of errors and improve functioning. There is a need to shift the focus on the overall functioning of the system. Moreover, ergonomic issues must be considered at the conception stage of the project and should be assessed thoroughly after implementation, and should be redesigned, if required.[11] These measures can improve the performance of the system as well as well-being of humans involved in the system.[11]

Keeping medical students emotionally healthy is challenging. However, individual and several system-wide interventions, e.g. establishment of wellness clinics, time off from studies, regular physical activity, and mindfulness, have been found to be effective, though the effect sizes vary across studies.[13],[18],[19]

Physical activity and exercise should be considered part of the medical curriculum considering their benefits concerning health.[19] Physical activity has many effects that range from benefits to cardiovascular and musculoskeletal systems, reducing the risk of metabolic syndrome, and improving sleep quality. Besides these effects, physical activity also improves mood, positive self-esteem, and cognition.[19]

Sleep has a bidirectional relationship with stress, performance, and well-being. The optimal duration and good-quality sleep are necessary for learning, memory consolidation, good immunity, enhanced self-esteem, physical energy, and regulation of mood and motivation. On the other hand, poor sleep quality or deprivation can have a harmful effect. Despite this fact, medical students and health professionals are often sleep deprived.[15] Some simple measures may be followed to improve sleep among medical professionals – these may include sleep hygiene practices (regular sleep-wake schedule, prioritization of sleep, avoiding stimulants such as coffee and ethanol in the evening), attention to environmental factors (noise below 35 dB level, ambient temperature, adequate ventilation), and emotional well-being.[20]

Each medical school should inculcate the health-promoting practices in the culture of the organization. It has multiple elements that need to be addressed and includes an environment that is physically and socially supportive; support from the leadership, administration, and faculty members; feeling of working in a team; encouragement from peers; and finally, student involvement.[21] However, it must be remembered that mental health issues are intricately linked to several factors that also include society and culture as well. Example, mindfulness-based interventions have been tried to address issues such as stress, anxiety, depression, and burn-out among medical students across many studies.[22] However, such interventions have been effective in reducing stress and depression in most but not all of the studies.[22] Hence, the “one shoe fits all” approach may not work, and using the principles of human factor ergonomics, interventions need to be designed for the specific needs and from time to time.[21]

Some medical colleges such as the Government Medical College, Chandigarh, and All India Institute of Medical Sciences, Delhi, run wellness clinics for students.[13] All India Institute of Medical Sciences (AIIMS), Rishikesh, has started a similar facility with “Youth Centre” for the students and faculty members. It is staffed by two psychologists who are the primary points of contact for students. To avoid stigmatization, this facility has been started in the residential area of the Institute and designed to prevent the feeling of a formal outpatient department. Department of Psychiatry provides back up support, whenever required. So far, our experience has been encouraging, and many students are approaching it.

Other measures taken at AIIMS Rishikesh to improve the well-being of students include development of indoor and outdoor sports facilities for students, organization of regular cultural programs from Spic Macay, and creation of hobby clubs such as Book Club, Photography, Film, Music, Mind, and Energy Club. A humanities department has also been formed in the Institute to integrate humanities (philosophy, ethics, history, comparative literature, and religion), social science (psychology, sociology, anthropology, cultural studies, health geography), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. The students are also introduced to a variety of modules such as stress management, time management, and conflict management at the beginning of their course through a structured foundation program. It helps them to adjust well to the new life phase and the associated challenges.


  Conclusion Top


Issues related to human factor – ergonomics influence the health of the students and contribute to their well-being. This should be considered since the distinction between mind and body, or mental and physical health is more artificial than actual. Perturbation in one affects the other; hence, simple measures to alter human factor – ergonomics can improve the overall well-being and quality of life of medical students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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