Elsevier

Mayo Clinic Proceedings

Volume 80, Issue 12, December 2005, Pages 1613-1622
Mayo Clinic Proceedings

SPECIAL ARTICLE
Medical Student Distress: Causes, Consequences, and Proposed Solutions

https://doi.org/10.4065/80.12.1613Get rights and content

The goal of medical education is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions; however, some aspects of training may have unintended negative effects on medical students' mental and emotional health that can undermine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. On a personal level, this distress can contribute to substance abuse, broken relationships, suicide, and attrition from the profession. On a professional level, studies suggest that student distress contributes to cynicism and subsequently may affect students' care of patients, relationship with faculty, and ultimately the culture of the medical profession. In this article, we review the manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress.

Section snippets

METHODS

The intent of this work was to summarize the central themes of medical student distress reported in the literature and to highlight selected studies exploring the prevalence, causes, and consequences of student distress as well as strategies to reduce student distress and promote well-being. Articles were identified by searching MEDLINE and PubMed for English language articles published between 1966 and 2004 with use of the search terms medical student AND depression, suicide, stress, burnout,

Stress

Medical students experience substantial stress from the beginning of the training process.3, 5, 35, 36, 37, 38, 39, 40, 41, 42 Although some degree of stress is a normal part of medical training and can be a motivator for some individuals, not all students find stress constructive.43 For many individuals, stress arouses feelings of fear, incompetence, uselessness, anger, and guilt and can be associated with both psychological3, 4, 10, 38, 44, 45 and physical morbidity.10, 46

Students use various

Adjustment To The Medical School Environment

The sources of stress for medical students vary by year in training. The first-year medical student is faced with the challenges of being uprooted from family and friends and adapting to a demanding new learning environment. Human cadaver dissection is a well-recognized stress for many students,3 but other sources of distress, such as a substantially increased scholastic workload3, 49 and concern for academic performance,41 also characterize this transition. Attempting to master a large volume

Impaired Academic Performance

Stress and performance are related intimately. Performance measures such as grades and clinical evaluations can be sources of stress and anxiety.39 Although these states of distress may reciprocally affect grades,20 the degree of their influence may be subtle and depend on personality.97, 98, 99, 100 In 1 study, both grades in the preclinical years and clerkship examination scores could be predicted as well by psychosocial characteristics (anxiety, depression, loneliness, neuroticism,

REDUCING STUDENT DISTRESS: IDEAS FOR MEDICAL SCHOOLS AND MEDICAL EDUCATORS

Understanding the causes and consequences of student distress is important (Figure 1), but medical schools need to go beyond identifying distress and strive to promote well-being for all students. Well-being is distinct from the mere absence of distress and includes achieving a high QOL in multiple domains (physical health, mental health, emotional health, spiritual health, etc).133, 134 Promoting and nuturing well-being during medical school and equipping graduates with the skills necessary to

AREAS OF NEEDED RESEARCH

Although much is known about student distress, little is known about student well-being, how it can be fostered, and its potential to enhance learning and professional development. Validated tools are available to measure various domains of QOL and should be used for such studies.164, 165, 166, 167, 168, 169, 170, 171 Research is needed to identify personal and program factors that enhance students' QOL (physical health, emotional health, spiritual health, etc), assess the efficacy of support

CONCLUSIONS

Medical school is a stressful period of physician training. Many medical students experience substantial distress, which contributes to poor academic performance, academic dishonesty, cynicism, and substance abuse. Medical educators need to be aware of the manifestations, causes, and consequences of student distress, and medical schools need to develop and evaluate programs to support struggling students and promote student well-being. Additional research is needed to identify personal and

Acknowledgments

We are grateful to Dr Jarrett W. Richardson for his critical review of the submitted manuscript.

REFERENCES (171)

  • EA Guthrie et al.

    Embarking upon a medical career: psychological morbidity in first year medical students

    Med Educ

    (1995)
  • KJ Moffat et al.

    First year medical student stress and coping in a problem-based learning medical curriculum

    Med Educ

    (2004)
  • M Aktekin et al.

    Anxiety, depression and stressful life events among medical students: a prospective study in Antalya, Turkey

    Med Educ

    (2001)
  • E Guthrie et al.

    Psychological stress and burnout in medical students: a five-year prospective longitudinal study

    J R Soc Med

    (1998)
  • JL Givens et al.

    Depressed medical students' use of mental health services and barriers to use

    Acad Med

    (2002)
  • DC Clark et al.

    Vicissitudes of depressed mood during four years of medical school

    JAMA

    (1988)
  • MC Rosal et al.

    A longitudinal study of students' depression at one medical school

    Acad Med

    (1997)
  • TH Mosley et al.

    Stress, coping, and well-being among third-year medical students

    Acad Med

    (1994)
  • PP Vitaliano et al.

    A biopsychosocial model of medical student distress

    J Behav Med

    (1988)
  • SR Raj et al.

    Health-related quality of life among final-year medical students

    CMAJ

    (2000)
  • S Ball et al.

    Self-care in medical education: effectiveness of health-habits interventions for first-year medical students

    Acad Med

    (2002)
  • GR Parkerson et al.

    The health status and life satisfaction of first-year medical students

    Acad Med

    (1990)
  • AJ Carson et al.

    Mental health in medical students: a case control study using the 60 item General Health Questionnaire

    Scott Med J

    (2000)
  • DA Spiegel et al.

    Medical student stress and clerkship performance

    J Med Educ

    (1986)
  • M Hojat et al.

    Students' psychosocial characteristics as predictors of academic performance in medical school

    Acad Med

    (1993)
  • M Hojat et al.

    Empathy in medical students as related to academic performance, clinical competence and gender

    Med Educ

    (2002)
  • W Woloschuk et al.

    Attitude change during medical school: a cohort study

    Med Educ

    (2004)
  • M Hojat et al.

    An empirical study of decline in empathy in medical school

    Med Educ

    (2004)
  • SJ Crandall et al.

    Medical students' attitudes toward providing care for the underserved: are we training socially responsible physicians?

    JAMA

    (1993)
  • AG Rezler et al.

    Affect and research in medical education

    Med Educ

    (1984)
  • L Eron

    The effect of medical education on attitudes: a follow-up study

    J Med Educ

    (1958)
  • TM Wolf et al.

    A retrospective study of attitude change during medical education

    Med Educ

    (1989)
  • L Eron

    Effect of medical education on medical students' attitudes

    J Med Educ

    (1955)
  • AG Rezler et al.
  • M Gutgesell et al.

    Exercise and alcohol consumption among medical students

    Acad Med

    (1999)
  • LG Croen et al.

    A longitudinal study of substance use and abuse in a single class of medical students

    Acad Med

    (1997)
  • D Clark et al.

    Alcohol-use patterns through medical school: a longitudinal study of one class

    JAMA

    (1987)
  • R Mangus et al.

    Tobacco and alcohol use among 1996 medical school graduates

    JAMA

    (1998)
  • MG Daly et al.

    Examining stress and responses to stress in medical students and new medical graduates

    Med J Aust

    (2002)
  • C Kiessling et al.

    First year medical students' perceptions of stress and support: a comparison between reformed and traditional track curricula

    Med Educ

    (2004)
  • JA Toews et al.

    Analysis of stress levels among medical students, residents, and graduate students at four Canadian schools of medicine

    Acad Med

    (1997)
  • SM Stewart et al.

    Predicting stress in first year medical students: a longitudinal study

    Med Educ

    (1997)
  • SM Stewart et al.

    A prospective analysis of stress and academic performance in the first two years of medical school

    Med Educ

    (1999)
  • J Firth

    Levels and sources of stress in medical students

    Br Med J (Clin Res Ed)

    (1986)
  • AN Supe

    A study of stress in medical students at Seth G.S. Medical College

    J Postgrad Med

    (1998)
  • BS Linn et al.

    Stress in junior medical students: relationship to personality and performance

    J Med Educ

    (1984)
  • JG Bramness et al.

    Effect of medical school stress on the mental health of medical students in early and late clinical curriculum

    Acta Psychiatr Scand

    (1991)
  • R Tyssen et al.

    Factors in medical school that predict postgraduate mental health problems in need of treatment: a nationwide and longitudinal study

    Med Educ

    (2001)
  • CL Park et al.

    Coping style as a predictor of health and well-being across the first year of medical school

    Health Psychol

    (2003)
  • M Stern et al.

    Medical students' differential use of coping strategies as a function of stressor type, year of training, and gender

    Behav Med

    (1993)

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