Medical students and physicians are exposed to a high number of stressful and demanding
situations in their everyday academic and working life. Furthermore, they represent a group
that is supposed or expected to master demanding situations. When doctors doubt their
capability in difficult situations, it may have consequences for their mental health and for
patient care. Therefore, knowledge about predictors and factors associated with perceived
mastery is important for improving both the education of doctors and the quality of their work
situation. If we can find predictors as early as in the final year of medical school, we can help
individuals at risk of developing low perceived mastery for as long as 20 years of their career.
However, there is a lack of studies on risk factors for low perceived mastery or factors
associated with increased perceived mastery, and how these factors influence patient
counselling.
This thesis consists of three papers from a large prospective study, the Longitudinal
Study of Norwegian Medical Students and Doctors (NORDOC). This is the most
comprehensive nationwide study in the field with the longest follow-up period in Norway and
internationally. Two cohorts of medical students, those in their first year (the Student Cohort)
and those in their final year (the Young Doctor Cohort) of all medical schools in Norway,
have been followed up with postal questionnaires at six measurement points since 1993 (the
last survey was launched in 2014). In the first paper, long-term predictors of perceived
mastery of clinical work ten and twenty years after medical school were identified. In the
second paper, two subgroups with low vs. increased perceived mastery over a ten-year period
were compared. The third paper examines the influence of physicians’ own lifestyle habits
(use of alcohol and physical activity) on their preventive counselling on similar lifestyle
habits among their patients. In addition, this paper examines the possible impact of
physicians’ perceived mastery of clinical work and the personality trait of vulnerability on
their patient counselling.
Important findings are 1) the risky avoidant coping behavior of using alcohol to cope
with stress during medical school predicted physicians’ low perceived mastery of clinical
work both early in their career (Paper I), and as long as 20 years after medical school (Paper
II). Another important finding is 2) that vulnerable personality traits, measured during
medical school, had a negative impact on both physician’s perceived mastery of their clinical
work (Paper II) and on their patient counselling (Paper III), as long as 20 years after
graduation. Vulnerable personality traits consist of e.g. fear of being criticized or a belief that others do things better than oneself. These two findings therefore indicate the importance of
giving medical students and young doctors support in how to handle stressful situations, such
as being criticized, and how to develop healthy coping strategies to better handle stress and
high demands.
In the first paper, we found medical recording skills and identification with the role of
being a doctor to be predictors of high perceived mastery, while in paper two we found taking
up leading positions to be associated with increased perceived mastery. This indicates a
further finding, namely 3) that learning skills, developing and taking up new positions at work
could be causes or consequences of approaching behavior. We also found that doctors with a
high level of vulnerable personality traits counselled less frequently about physical activity
(Paper III). However, when they themselves were physically active, they counselled more
often on exercise. This indicates that vulnerable personality traits can be compensated by
other factors, and perhaps then be an asset. Interventions that promote learning of new skills,
challenging oneself in new demanding situations via guidance or group meetings, or
practicing early in practical settings could help medical students and young doctors to develop
higher levels of perceived mastery in stressful situations.