Why do students struggle in their first year of medical school? A qualitative study of student voices

Abstract

Background Struggling at medical school incorporates academic failure, course disruption and early course exit. Struggling is usually multi-factorial involving academic, personal, financial and health factors. Struggling students may fail to engage with available support. First year students are particularly susceptible as they transition to university and a professional career. Methods The study aim was to explore medical students’ own voices on struggling and assess how they match up to existing literature. During one academic year, all first year medical students at the University of Birmingham (UK) who opted to leave or were required to withdraw (n = 52) were asked to participate in an individual exit interview. Fifteen students responded and fourteen (27%) agreed to be interviewed. Interviews were face to face (n = 10), telephone (n = 3) and via email (n = 1). Interviews were unstructured and led by a general open question. Framework analysis identified key data themes. Results Students described year one of medical school as a critical transition. They simultaneously needed to adapt to being a university student, a medical student and a doctor. A six-group typology of students emerged, each of which struggled with one or more of these adaptations. The groups were: wrong degree choice, mental health problems, acute crisis, at capacity, slow starter and family rock. Some students experienced an isolated problem from within this typology. Most had a multi-factorial story of struggling. Mental health problems and acute crises were the most common issues. Early professional identity formation was a key hurdle. Help-seeking behaviours were varied. Conclusions This study explores the narratives of medical students who struggled from an early stage and presents a data-driven typology of their issues. It advances existing qualitative understanding of this topic, which to date is predominantly derived from educator perceptions and not specific to early course issues. Although our results broadly cohere with existing knowledge, we also present novel findings which may reflect our focus on first year students. Issues around early professional identity formation may reflect the increasing emphasis on professionalism in medical school curricula. Listening to these narratives could help university staff to identify students at risk of struggling for targeted support.

The effectiveness of problem based learning in improving critical thinking, problem-solving and self-directed learning in first-year medical students: A meta-analysis

“…The adaptation process for first-year medical students is an important problem because it is one of the factors that significantly affect educational outcomes [ 1 ]. Struggling can occur at any time, but first-year students are particularly susceptible as they adapt to new learning methods at university [ 2 ]. A study on the adaptation process of first-year medical students involving 200 participants showed that 63% of students had problems adapting to the learning process [ 3 ].…”

A balancing act–finding one´s way to health and well-being: A qualitative analysis of interviews with Swedish university students on lifestyle and behavior change

“…Plotnikoff et al [ 19 ] examining the effectiveness of interventions targeting physical activity, nutrition, and weight-loss behaviors among university students, highlight that participant numbers were notably small and most participants female in the included studies. Also, the number of qualitative studies investigating university students´ lived experience and preconceptions on multiple lifestyle and behavior change is limited [ 23 – 26 ].…”

Assessment of dropout rates in the preclinical years and contributing factors: a study on one Thai medical school

“…Negative experiences during clinical placement, which might be related to mental issues, could lead to dropout in nursing education, whereas academic difficulty played a major role in early dropout students [ 16 ]. Within the initial years of medical education, which mental problems are common causes of academic struggles [ 17 ], dropout was also associated with entry qualifications, such as admission test scores and different admission programs [ 18 , 19 ].…”