Are Medical Students Prepared to Model Healthy Behaviors for Their Future Patients? A Survey Comparing Aged-Matched Peers

Abstract

Background

Osteopathic medical students (OMS) who establish healthy behaviors for themselves are more likely to counsel their future patients on appropriate self-care. This study compared the lifestyle habits of OMS with those of age-matched peers in other areas of study, which served as the control group.

Method

In the fall of 2018, a survey was administered to OMS of the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) (group I) and graduate programs from the same school (group II), to assess their lifestyle habits. Questions on demographics were additionally included.

Results

There were 398 total responses: 83.2% (N = 331) from group I and 16.9% (N = 67) from group II, with 25 being the mean age of the respondents. Group I (53.2%) reported to studying at least 5–10 h per day, while 20.1% reported to studying more than 10 h. Group II reported 37.3% and 9.0%, respectively, of study time. Group I exercised more times per week (2–3 times) than group II and for a longer duration (30–60 min). Group I slept more than group II (6–8 h), yet reported to using more substances to stay awake.

Conclusions

OMS studied, exercised, and slept more than age-matched peers, but used more substances to stay awake. Aspects of this study are encouraging, but suggest that further evaluation is needed for schools to assist students establish lifelong habits to encourage the wellness of their future patients.

Electronic supplementary material

The online version of this article (10.1007/s40670-020-00960-x) contains supplementary material, which is available to authorized users.

Introduction

The doctor-patient relationship is a pivotal component in the management of overall patient well-being. Medical students spend many years training to become physicians, who will have the responsibility for counseling their patients about disease prevention. Therefore, adopting healthy lifestyle behaviors for themselves early in their education will help them develop the confidence and skills needed to advise their future patients on wellness options to maintain optimum health [1, 2]. This is especially true for the practice of osteopathic medicine, whose tenets embrace a more holistic approach to diagnosis and treatment of disease.

Upon matriculation into medical school, students generally report healthier lifestyles than their aged-matched peers [3]. However, medical school imposes considerable stressors that may alter these habits for the worse, and burnout is observed to be significantly more prevalent in medical students than in graduate students of the same age group [3–6]. This correlates with negative effects on medical student health outcomes, oftentimes leading to self-medication habits to cope with symptoms that could otherwise have been managed by appropriate lifestyle decisions [7, 8]. Self-medication is defined by the World Health Organization (WHO) as “the selection and use of medicine by individuals to treat self-recognized illness and symptoms” [9, 10]. When done in concordance with medical guidelines, self-medication can be a useful solution to resolve minor health problems, such as insomnia and seasonal allergies.

The main objectives of this study were as follows: (1) to examine the number of hours osteopathic medical students (OMS) and similarly aged students spend on coursework study, (2) to investigate the multifaceted ways in which an osteopathic medical student’s health habits significantly differ from those of similarly aged peers in other fields of study, (3) to evaluate the self-medication habits of these two groups. To date, this is the first study which compares the lifestyle practices specifically of OMS with those of graduate students of the same age. While our stated hypothesis is that the stress of medical school does negatively impact the health habits of osteopathic students compared with similarly aged peers, quantifying these differences may help further promote increased self-care training into osteopathic medical school curriculums. Since many osteopathic medical students do ultimately select careers in primary care (family medicine, internal medicine, and pediatrics) [11], such guidance will help them establish appropriate habits, which they can model for their future patients, especially in regard to preventative care medicine [12].

Methods

Survey Design

A fifty-question survey was developed by adapting the design of previous studies including a University of North Florida’s study of diet and exercise of college freshmen [13]. The Fantastic Lifestyle questionnaire [14] and others [15, 16] also provided an additional validated reference for the creation of this survey (Supplemental data 1). Before the survey was distributed, an institutional review board (IRB) approval was obtained which highlighted the objectives of the study and provided the questions which would be asked of these students. The surveys were distributed electronically to the school email of these students on a school-approved platform (RedCap, Nashville, TN) to first and second year (preclinical years) osteopathic medical students of the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM; both Long Island and Arkansas campuses) and those of other NYIT graduate programs (including the schools of physical therapy, occupational therapy, mechanical and electrical engineering, teaching, clinical nutrition, physician assistant) (all students of these programs were pursuing masters’ degrees; M.S.), in October of the 2018–2019 academic year. Students were chosen from these two specific groups (DO and M.S.) to obtain a similar age (~ 25 years old). Therefore, undergraduates were not included. Reminders were sent once within a 2-week period. The survey took approximately 10 min to answer and the respondents were assured of anonymity and could opt out at any time. Both groups included in the study were asked questions on demographics (age, gender, ethnicity, marital status, past education, and current field of study). There were also specific questions included with regard to lifestyle (sugar and fast-food consumption, exercise, tobacco and alcohol use, sleep habits, and self-medication practices). All the responses collected included the option of “prefer not to answer” to facilitate the completion of the survey and eliminate stress. A Pearson chi-square test in addition to a Student’s 2-tailed t test was used to evaluate for the significance of relationships, with α = 0.05 set for all tests. GraphPad Prism, Version 8 (San Diego, CA), was used to perform the analysis.

Results

Demographics

There were a total of 398 respondents in the study from a total of 1186 survey invites (33.5% response rate). Of this number, 83.2% (N = 331) were first and second year students from the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) and 16.9% (N = 67) were M.S. students of NYIT. The respondents were approximately 25 years of age and of primarily of Caucasian background (61.8%). For the purpose of this work, group I consisted of osteopathic medical students (DO) and group II were graduate students of the same age. There were no significant differences between the two groups in terms of age (p = 0.75), ethnicity (p = 0.23), or marital status (p = 0.21). There was a significant difference in terms of gender, with group II having a significantly higher number of females answering the survey (p = 0.01) vs males from the same category. The results of demographic data are summarized in Table 1.

Table 1.

Comparing demographic data between groups I and II

	Cases (n = 331)	Controls (n = 67)
	Mean (SD)		pvalue
Age	24.95 (3.71)	25.13 (4.57)	0.75
	N(%)		pvalue
Gender
Female	178 (53.5)	50 (74.6)	0.01
Male	153 (45.9)	17 (25.4)
Prefer not to answer	2 (0.60)	0.00 (0.00)
Ethnicity
American Indian or Alaska Native	1 (0.30)	0 (0.00)	0.21
Asian	87 (26.10)	9 (13.4)
Black or African American	11 (3.30)	4 (6.00)
Hispanic or Latino	16 (4.8)	3 (4.50)
Native Hawaiian or other Pacific Islander	1 (0.30)	1 (1.50)
Prefer not to answer	17 (5.10)	2 (3.00)
White	199 (59.80)	47 (70.10)
Marital status
Married/domestic partner	50 (15.0)	11 (16.4)	0.88
Prefer not to answer	1 (0.30)	0 (0.00)
Separated	2 (0.60)	0 (0.00)
Single	280 (84.10)	56 (83.60)

Specific Habits

Objective 1: Examination of Study Time between Groups I and II

The difference in study time between the two groups was significant (Fig. 1). It was observed that 53.2% of group I reported to studying at least 5–10 h and 20.1% used more than 10 h, while group II reported 37.3% and 9.0%, respectively (p = 0.0001). This was interesting to note, as there were no significant differences reported between groups (p = 0.97) when comparing ability to cope with stress.

Fig. 1.

Comparing study time (hours) between groups I and II

Objective 2: Investigation of Specific Health Habits between Groups I and II

When evaluating self-care habits, there was a significant difference reported in how frequently the groups exercised (p = 0.027), with group I exercising more (2–3 times per week on average) than group II, at 42.4% and 31.3%, respectively (Fig. 2). Group I (55.2%) also exercised for a longer duration than their group II (43.4%) peers (p = 0.01), with most participants reporting to 30–60 min of activity per session (Fig. 3). Types of exercise varied from walking, running, Pilates and yoga, to weight training and team sports. With respect to sleep habits, it was found that group I (73.9%) did sleep for a significantly longer duration (6–8 h), when compared with group II (56.7%) students (p = 0.003) (Fig. 4).

Fig. 2.

Comparing exercise frequency (per week) between groups I and II

Fig. 3.

Comparing exercise time (minutes) between groups I and II

Fig. 4.

Comparing sleep time (hours) between groups I and II

Objective 3: Evaluation of Self-medication Habits between Groups I and II

Despite this report of longer sleep duration, group I (55.9%) was more likely to use substances (caffeinated beverages, prescription, and non-prescription drugs) to stay awake than their group II (35.9%) counterparts (p = 0.005) (Fig. 5). However, neither group was found to have significant self-medicating habits with other substances (prescription drugs, over-the-counter pain relievers, or cold, flu, and allergy medications). There were no statistically significant differences when comparing sleep quality and how well rested students reported to being (p = 0.54). It was interesting to note that when respondents from group I were unable to get sleep, they reported to be more likely to use some substance or technique to combat their suboptimal quality of sleep (p = 0.005), with sleep hygiene having the highest response, at 60.8% (Fig. 6). Lastly, it should be noted that there were no significant differences in diet (including fast food, salty snacks, sweetened drinks, and dietary supplements), tobacco, and alcohol usage among groups I and II, since the start of the osteopathic or the masters of science programs.

Fig. 5.

Comparing the use of substances to stay awake between groups I and II

Fig. 6.

Comparing sleep methods between groups I and II

Discussion

This study compared the lifestyle habits between OMS and graduate students of the same age. Medical students train to become physicians, who are charged with promoting healthy choices to their future patients, with the objective of preventing chronic disease. To provide appropriate counseling, these future physicians need to establish wellness habits for themselves early in their education [17–19].

Objective 1: Examination of Study Time between Groups I and II

The number of hours group I and group II spend on their area of study was evaluated. It was not unexpected that the respondents from group I exceeded the number of daily hours (53.2% reported to studying at least 5–10 h and 20.1% using more than 10 h) of study time as compared with group II. The preclinical curriculum of an OMS is rigorous, with additional hours of their training learning the core principles and techniques of osteopathic manipulative treatment (OMT) [20]. This imposes a disproportionately negative impact on student’s lifestyle choices, as there is a documented increase in stress levels over the course of medical school, peaking in the second year [21].

Objective 2: Investigation of Specific Health Habits between Groups I and II

An osteopathic medical student’s lifestyle habits differed from those of their aged-matched peers. This was observed in their exercise habits. Group I reported to both exercising at least 2–3 times per week and at 30–60-min intervals, which was significantly greater than group II. This is in accordance with CDC guidelines that recommend at least 150 min per week of moderate-intensity or 75 min per week of vigorous-intensity aerobic physical activity [3, 22, 23]. Additionally, this was consistent with one study that evaluated sixteen US medical schools to find that personal physical activity habits of medical students are higher than those of age-matched peers in these populations during a 4-year period [3]. Students who maintain their exercise habits are also observed to have less burnout and improved quality of life [22]. It was encouraging to note that similar results were observed for the osteopathic students in our study, as these future physicians will be primary in endorsing the importance of physical activity to their patients.

When comparing restful habits, group I respondents had a greater duration of sleep than group II (6–8-h duration). This was in contrast to recent published studies, where a majority of medical students sleep an inadequate amount of time during their 4 years of education [23–25]. Lack of sleep is correlated with an increase in depression, burnout, and reduced academic and professional performance, resulting in a negative quality of patient care overall [23–25]. When questioned about methods to induce sleep, group I respondents cited the use of sleep hygiene as their primary mechanism, instead of the traditional use of alcohol and prescription and non-prescription drugs to achieve relaxation. Sleep hygiene is defined as the incorporation of proper sleep habits, which improve the quantity and quality of sleep and include the avoidance of depressants, stimulants, and the consumption of late evening heavy meals, while limiting the use of electronic devices before bedtime [26–28]. This may be due to the fact that those we surveyed were osteopathic medical students, who take a holistic approach to the learning of medicine. This group of students is likely introduced to the concept of sleep hygiene early on in their medical training. It could also be argued that perceptions have changed over the years, since there is increasing medical student awareness of the importance of a healthy lifestyle. It should be mentioned that our study population was limited students in their preclinical years, not those involved in clerkships. Further study is needed to determine if being in a consistent clinical setting has a change in the sleep habits of OMS.

Objective 3: Evaluation of Self-medication Habits between Groups I and II

Self-medication is both time and cost efficient, without the need for physician consultation. However, promotion by the internet, media, advertisements, or using another’s leftover medication can negatively impact this practice [29]. It was observed that 49.5% of group I and 58.2% of group II responded to almost never participating in self-medication. However, there was significance reported between group I and group II in using substances to stay awake. This can be correlated to the first objective where it was observed that group I had a greater number of study hours than group II, thus warranting a need of stimulant medication to achieve their academic goals. There are no documented studies in the USA, which examine the nonmedical use of prescription medications in medical school students, especially in osteopathic programs. However, several published reports in Europe have observed that the competition and stress of the medical school environment do indeed make students more vulnerable to the misuse of opioids, tranquilizers, and stimulants [29, 30]. Substance use can negatively affect the professional and personal lives of students, which includes the possibility of suicidal ideations and illicit drug use [31]. Therefore, a closer evaluation of self-medication habits of osteopathic medical students should be a goal of future studies.

Limitations

While this study provides an elementary step to understanding the lifestyle practice differences which exist between osteopathic medical students and age-similar graduate students, it is limited in responses, primarily for the students of the control group (group II). Students may also not have chosen to respond to the survey as they might have experienced some anxiety with participation in a study that questioned them about their personal lifestyle choices. In addition, our study only examines the student perspectives from one school. Therefore, the study should be expanded to include other osteopathic medical schools, with a consideration given to comparing students enrolled in schools located in different geographical areas and even some focus given to the role of ethnic diversity on lifestyle practices, since our survey respondents were mainly Caucasian. It would also be interesting to compare the health practices of students training at allopathic medical schools with those at osteopathic schools. The differences in lifestyle practices of the students following each year of premedical education, while they are on clinical clerkships, should also be observed. Later, this can be expanded to evaluate the habits of resident physicians through various levels of their specialty training. Lastly, since respondents from the control group were from other allied health professions, it would be appropriate to further study their self-care habits, as they too have a role in providing some aspect of patient care.

Conclusion

This study compared the lifestyle habits of OMS with those of age-similar graduate students. We observed differences between these groups, which included exercise frequency and duration, hours of sleep, and study time. These were reported to be significantly higher for the osteopathic medical students. With respect to achieving sleep, appropriate sleep hygiene was found to be a well-used method for OMS, while the same group also reported using substances to stay awake. The data obtained here can help faculty and administrators of osteopathic medical schools encourage an environment where both the personal and professional development for their students is supported, as they work to improve their skills to advocate for their future patients on appropriate self-care.

Compliance with Ethical Standards

Before the survey was distributed, an institutional review board (IRB) approval was obtained which highlighted the objectives of the study and provided the questions which would be asked of these students.

Conflict of Interest

The authors declare that there are no conflicts of interest.