Prevalence of Fatigue in Medical Students: Associations with Lifestyle Factors and Executive Functions

This study evaluated the prevalence of fatigue in medical students and explored the potential role of lifestyle correlates and everyday executive abilities. Students in the first three years of medical school at the VU University Medical Center Amsterdam took part in a survey study (N = 701; response rate = 67%). Fatigue symptoms were measured using the Checklist Individual Strength. The prevalence of high fatigue within the current sample was 31%. This is relatively high compared to that of peers in the general working population. Moreover, the level of fatigue was related to fatigue duration, with higher levels of fatigue associated with longer duration. Surprisingly, lifestyle factors played a minimal role in fatigue. Of all examined factors, only sports, sleep quality, study satisfaction, medical conditions and living situation were significant correlates of fatigue. That is, students who reported higher sleeping problems or suffered from a disease reported higher levels of fatigue, whereas students who spent more time on sports, who had higher study satisfaction, or who lived away from their parents reported lower fatigue. In a subgroup, we observed that students who reported high planning or selfcontrol ability were less fatigued. Thus, whereas lifestyle factors played a minimal role, our expectation of an important connection between fatigue and executive functions was confirmed. FATIGUE IN MEDICAL STUDENTS | 35 INTRODUCTION Fatigue is a common complaint in young adults (Bültmann, Kant, Kasl, Beurskens, & van den Brandt, 2002) and in adolescents (Fowler, Duthie, Thapar, & Farmer, 2005; ter Wolbeek, van Doornen, Kavelaars, & Heijnen, 2006). It refers to a perceived lack of physical or mental energy that interferes with desired activities (Multiple Sclerosis Council 1998). University students are potentially vulnerable to fatigue given their typical lifestyle (e.g., various social activities, drinking behavior and lack of sleep) in combination with academic requirements. Correspondingly, research suggests that medical students are particularly susceptible to fatigue (Tanaka, Fukuda, Mizuno, Kuratsune, & Watanabe, 2009) and to fatigue-related mental health conditions such as burnout (Galán, Sanmartín, Polo, & Giner, 2011; Mosley et al., 1994). Research also suggests that fatigue can be an early stage of more severe health problems such as chronic fatigue syndrome (CFS; Huibers et al., 2004). The current study therefore aimed to contribute to the understanding of fatigue and potential risk factors by exploring the prevalence and lifestyle correlates of fatigue in students in the first stage of medical school. In general, fatigue is known to arise from a variety of causes. These range from medical conditions and physiological states, to an unhealthy lifestyle and psychosocial stress (see DeLuca, 2005 for an overview). Fatigue can have a serious impact on the quality of life and well-being (DeLuca, 2005), but also on school performance (Nagane, 2004) and school attendance (Fowler et al., 2005). In medical students, higher levels of fatigue have been related to higher levels of perceived stress (Tanaka et al., 2009). This may result from their highly demanding school program (Hafferty, 1998). However, the environment of medical students comprises much more than the demanding medical curriculum. Most students have an extensive social life in which they develop new friendships and are engaged in student societies. Also family (academic) background, engagement in sports, and additional jobs could strongly influence the amount of support they receive, how much time and effort they invest in their studies, and their physical or mental state. We therefore expect that these factors and activities may contribute to fatigue in medical students.