Worried, weary and worn out: a mixed methods study of stress and wellbeing in final year medical students

Objectives: Although there is much focus on burnout and psychological
distress amongst doctors, studies about stress and wellbeing in medical
students are limited but could inform early intervention and prevention
strategies. Design: The primary aim of this mixed methods, cross-sectional
survey was to compare objective and subjective levels of stress in Final
Year Medical students (2017) and to explore their perspectives on the
factors they considered relevant to their wellbeing. Setting: University
College Dublin, the largest University in Ireland. Participants: 161 of
235 medical students participated in this study (response rate 69%).
Results: 65.2% of students scored over accepted norms for the Perceived
Stress Scale (34.8% low; 55.9% moderate; 9.3% high). 35% scored low; 28.7%
moderate and 36.3% high on the Subjective Stress Scale. Thematic Analysis
identified worry about exams, relationships, concern about future,
work-life balance and finance; 1 in 3 students reported worry,
irritability and hostility; many felt worn out. Cognitive impacts included
over-thinking, poor concentration, sense of failure, hopelessness and
procrastination. Almost a third reported sleep and appetite disturbance,
fatigue and weariness. A quarter  reported a “positive
reaction” to stress. Positive strategies to manage stress included
connection and talking, exercise, non-study activity  and
meditation. Unhelpful strategies included isolation and substance use. No
student reported using the college support services or sought professional
help. Conclusions: Medical students experience high levels of
psychological distress, similar to their more senior doctor colleagues.
They are disinclined to avail of traditional college help services. Toxic
effects of stress may impact their cognition, learning, engagement and
empathy and increase patient risk and adverse outcomes. The focus of
wellbeing in doctors should be extended upstream and embedded in the
curriculum where it could prevent future burnout, improve retention to the
profession and deliver better outcomes for patients.