title: Beyond prevalence to process: the role of self and identity in medical student well-being.
abstract: BACKGROUND
  Problematic stress levels among medical students have been well established. This stress can lead to depression, suicidal ideation, substance abuse, burnout and cynicism, having a negative effect on students and their patients.
  
  
  METHODS
  We propose to move towards examining the processes underlying well-being in some medical students and vulnerability in others. We draw upon social psychological literature to propose that self-complexity, medical student identity and associated norms all have the capacity to influence medical students' well-being in both positive and negative ways.
  
  
  RESULTS
  We identify two key dilemmas facing medical students with regard to the social psychological factors investigated. First, a diverse set of interests and a high level of self-complexity is thought to buffer against the effects of stress and might also be beneficial for medical practitioners, but the intensive nature of medical education makes it difficult for students to pursue outside interests, leading to a strongly focused identity. Second, a strong group identity is associated with high levels of social support and improved well-being, but unhealthy group norms may have a greater influence on individuals who have a strong group identity, encouraging them to engage in behaviours that place their well-being at risk. A model is proposed outlining how these potentially contradictory social psychological processes may combine to impact upon medical students' well-being.
  
  
  CONCLUSIONS
  There is great scope for investigating the role of self-complexity, identity and norms in the medical education context, with room to investigate each of these factors alone and in combination. We highlight how our proposed model can inform medical educators as to the students who may be most vulnerable to the effects of stress and the potential interventions from which they may benefit. We conclude that social psychological factors make a valuable contribution to understanding the complex issue of well-being in medical education.
authors.affiliation: ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia; School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK.
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Mavor
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: McNeill
authors.forename: Katrina
authors.initials: K
authors.lastname: Anderson
authors.forename: Annelise
authors.initials: A
authors.lastname: Kerr
authors.forename: Erin
authors.initials: E
authors.lastname: O'Reilly
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Platow
mesh_terms: D002055:Burnout, Professional / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D006801:Humans; D008960:Models, Psychological; D015995:Prevalence; D011593:Psychology, Social; D055500:Resilience, Psychological; D012649:Self Concept; D012925:Social Conformity; D012933:Social Identification; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D013337:Students, Medical / Q000523:psychology*; D059020:Suicidal Ideation