title: The process of coping with stress by Taiwanese medical interns: a qualitative study.
abstract: BACKGROUND
  Internship, the transition period from medical student to junior doctor, is highly stressful for interns in the West; however, little is known about the experience of interns in coping with stress in Taiwan. This study aimed to develop a model for coping with stress among Taiwanese interns and to examine the relationship between stress and learning outcomes.
  
  
  METHODS
  For this qualitative study, we used grounded theory methodology with theoretical sampling. We collected data through in-depth interviews and participant observations. We employed the constant comparative method to analyse the data until data saturation was achieved.
  
  
  RESULTS
  The study population was 124 medical interns in a teaching hospital in northern Taiwan; 21 interns (12 males) participated. Data analysis revealed that the interns encountered stressors (such as sense of responsibility, coping with uncertainty, and interpersonal relationships) resulting from their role transition from observer to practitioner. The participants used self-directed learning and avoidance as strategies to deal with their stress.
  
  
  CONCLUSIONS
  A self-directed learning strategy can be beneficial for an intern's motivation to learn as well as for patient welfare. However, avoiding stressors can result in less motivation to learn and hinder the quality of care. Understanding how interns experience and cope with stress and its related outcomes can help medical educators and policy makers improve the quality of medical education by encouraging interns' self-directed learning strategy and discouraging the avoidance of stressors.
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, Taiwan. abucastor@hotmail.com.|Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, NO.5, Fusing Street, Kwei-Shan, Taoyuan, Taiwan. abucastor@hotmail.com.
authors.forename: Chun-Hao
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Graduate Institute of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, Taiwan. wtang@mail.cgu.edu.tw.
authors.forename: Woung-Ru
authors.initials: WR
authors.lastname: Tang
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, Taiwan. ckbjimmy@gmail.com.
authors.forename: Wei-Hung
authors.initials: WH
authors.lastname: Weng
authors.affiliation: Institute of Brain Science, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Beitou, Taipei, 11221, Taiwan. yuhsuanmed@gmail.com.
authors.forename: Yu-Hsuan
authors.initials: YH
authors.lastname: Lin
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, Taiwan. psycychen@yahoo.com.tw.|Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, NO.5, Fusing Street, Kwei-Shan, Taoyuan, Taiwan. psycychen@yahoo.com.tw.|Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, 222, Maijin Road, Keelung, Taiwan. psycychen@yahoo.com.tw.
authors.forename: Ching-Yen
authors.initials: CY
authors.lastname: Chen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D019555:Physician-Nurse Relations; D036301:Qualitative Research; D013315:Stress, Psychological; D013624:Taiwan