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Medical students who face poor health in Iran
Medical students' health-related quality of life: roles of social and behavioral factors. Jamali A, et al. Medical Education 2013; 47: 1001-1012.
Reviewed by Michael Ryan


What was the study question?
How does health-related quality of life (HR-QoL) relate to Middle-Eastern medical students' training, demographic, social, and behavioral variables?

How was the study done?
The authors conducted a cross-sectional, multi-institutional, survey-design study at three medical schools in Tehran, Iran. 1350 subjects representing a cross-section of training levels (basic science years to internship) were invited. Participants responded to a variety of demographic, social, and behavioral questions and completed the Short Form Health Survey (SF-36), a validated HR-QoL assessment tool. Results were analyzed to assess the correlation between variables and HR-QoL scores.

What were the results?
HR-QoL worsened significantly (p<0.001) as training progressed. Male gender, living with parents, daily physical activity, and non-smoking status were independently associated with higher scores on physical and mental components of HR-QoL while participation in organizations was independently associated with higher scores on the mental component of the HR-QoL. Secondary analysis revealed that medical students scored lower in all aspects of the HR-QoL than age-matched members of the general Iranian population.

What was the study question?
How does health-related quality of life (HR-QoL) relate to Middle-Eastern medical students' training, demographic, social, and behavioral variables?

How was the study done?
The authors conducted a cross-sectional, multi-institutional, survey-design study at three medical schools in Tehran, Iran. 1350 subjects representing a cross-section of training levels (basic science years to internship) were invited. Participants responded to a variety of demographic, social, and behavioral questions and completed the Short Form Health Survey (SF-36), a validated HR-QoL assessment tool. Results were analyzed to assess the correlation between variables and HR-QoL scores.

What were the results?
HR-QoL worsened significantly (p<0.001) as training progressed. Male gender, living with parents, daily physical activity, and non-smoking status were independently associated with higher scores on physical and mental components of HR-QoL while participation in organizations was independently associated with higher scores on the mental component of the HR-QoL. Secondary analysis revealed that medical students scored lower in all aspects of the HR-QoL than age-matched members of the general Iranian population.

What are the implications of these findings?
This study confirms the findings of other international studies while demonstrating specific at-risk populations in traditional Middle-Eastern cultures. Educators working with students from such cultures should consider more intense efforts to improve HR-QoL particularly with those at greater risk for lower HR-QoL including women and students living away from family and social support systems.

Editor's Note: This well-done study raises several other interesting questions. Among them: do students who suffer from poor quality of life in internship continue to suffer after training? And do students from traditional Middle Eastern backgrounds who attend US medical schools have the same risk factors as those in Iranian medical schools? (JG)

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