Background: Stress is defined as a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize. Medical school is recognized as a stressful environment that may have a negative effect on students’ academic performance, physical health, and psychosocial well-being. This stress when it exceeds the limit of tolerability causes various physical and mental health problems. Identifying this root cause will help us to put a barrier to many future mental health problems in a student’s life.Methods: It was a cross-sectional study done in Mysore Medical College among undergraduate students. Perceived stress scale was used to assess the level of stress and Medical student’s Stressor questionnaire was used to assess the source of stress.Results: A total of 303 students were included in the final analysis. Among them 51.5% were male and 48.5% were females. The age group of the students ranged between 18 and 24 with a mean age of 20.48 and standard deviation (SD) of 0.4. The mean and SD of PSS score is 17.7 and 5.5. The prevalence of mild, moderate and severe stress was 20%, 74% and 6% respectively. Majority of the students (40.9%) considered academic related stressors to be the source of high stress.Conclusions: In our study though majority of the students were stressed (80%), only 6% were severely stressed. The coping strategies adopted by the students like resorting to sleep and music/dance appeared to be appropriate methods of handling stress.

Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this ‘how we did it’ paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.

To reduce TB deaths in resource-limited settings, triaging at diagnosis can identify those with immediate need for comprehensive assessment and inpatient care. n This type of differentiated TB care model was successfully implemented in Tamil Nadu, India, without additional stress on the health system. n Half of the patients referred as a result of triaging were very severely undernourished, which implies a need for capacity-building of inpatient care facilities in clinical management of very severe undernutrition in adults.nThe identification of predictors of not being triaged and comprehensively assessed will inform ongoing and future improvements to the care model.