Stress and behavior patterns throughout medical education – a six year longitudinal study

Abstract

Background Medical education has a reputation for being demanding and stressful. However, longitudinal surveys across the whole course of study considering risks and resources are rare. Methods For the evaluation of stress and coping we administered the standard instruments Perceived Medical School Stress Scale (PMSS), Hospital Anxiety and Depression Scale (HADS), Work-Related Behavior and Experience Patterns (AVEM), Maslach Burnout Inventory (MBI), and a short form of the Coping Orientations to Problems Experienced Scale (Brief COPE) in three consecutive cohorts of medical students (N = 377) at one German university. Students were surveyed at the beginning of their studies (t0) and again during each consecutive summer semester (t1-t6). Results Stress and symptoms of anxiety and depression increased in the first two years of medical studies but decreased again towards their end. Consistently, freshmen medical students presented with a large proportion of the healthy pattern at t0 (56 %) that decreased to 30 % at t2, and increased up to 44 % at t6. Correspondingly, the proportion with the burnout-related risk pattern B increased from 9 to 16 % at t2, again decreasing to 7 % at t6. Over the whole course of study there was an almost continuous increase of the unambitious pattern S from t0 13 to 40 % at t6. Characteristic differences especially between the healthy pattern and the risk patterns regarding stress, mental health symptoms and coping were observed. Female students showed a higher vulnerability for stress, anxiety and depression as well as lower proportions with a healthy pattern, and higher proportions with risk patterns for overexertion and burnout. Conclusions The development of stress, symptoms and behavior and experience patterns especially in the first two years, demonstrating increasing study-related stress in the preclinical years, as well as the high proportion with an unambitious pattern at the end of the course of study emphasize the need for prevention and health promotion at both the individual and contextual levels.

Psychological distress and well-being among students of health disciplines in Geneva, Switzerland: The importance of academic satisfaction in the context of academic year-end and COVID-19 stress on their learning experience

“…A score of 8 or above indicates the presence of depression or anxiety [ 31 ]. The HADS was previously used among medical students in a longitudinal study over six years [ 33 ]. The HADS Cronbach’s alpha for our study sample was 0.84 for the depression subscale and .84 for the anxiety subscale.…”

Life satisfaction, resilience and coping mechanisms among medical students during COVID-19

“…Several studies emphasize on the importance of undertaking assessment of coping strategies at the beginning of medical education to diagnose a specific trend in physicians’ career development [ 52 , 53 ]. Evidence indicates that coping strategies of students can change over time with decreased use of active coping strategies and increased use of emotional coping strategies, although emotional strategies were associated with poorer clinical academic performance [ 54 ].…”

Neuroticism among medical students at a federal public university: a cross-sectional analysis

“…For Torralba, Jose, and Byrne (2020), medical students' vulnerability is related to the hierarchical nature of the profession and the complexity, uncertainty, and ambiguity inherent in medical conditions. In a study conducted by Voltmer et al (2021), it was observed that female medical students had lower proportions of a healthy lifestyle and, consequently, higher vulnerability to mental illness.…”