Stressors and resources related to academic studies and improvements suggested by medical students: a qualitative study

Abstract

Background: Prior evidence suggests that medical students' mental health is poor and deteriorates during the course of academic studies. This qualitative study therefore aims to improve our understanding of medical students' perceptions of i) stressors related to their academic studies, ii) resources that may facilitate coping with those stressors and iii) suggestions to potentially reduce stress. Methods: Eight focus groups were conducted with medical students enrolled at a medical school in Germany until thematic saturation was reached. A topic guide was used to facilitate the discussion. Subsequently, focus group discussions were transcribed and content-analyzed using MaxQDA. Results: Organizational factors especially related to inadequate information flow as well as exams (e.g. repeat exams, scheduling, perceived unfair grading), poor theoretical and practical teaching quality, time and performance pressure, social interactions and individual characteristics (e.g. self-expectations, fear of failure) emerged as major contributors to stress. Resources perceived to facilitate coping with those stressors pertained to some other organizational aspects (e.g. flexibility, availability of contact persons), career prospects, practical training, social support, personal characteristics (e.g. knowledge base, past experience) and leisure time. Suggestions for improvement related primarily to organizational measures rather than individual-level measures. Conclusions: Besides well-known stressors (e.g. exams and high performance pressure), some new aspects emerged from our study including stress related to organizational factors and repeat exams. Accordingly, students' wishes for organizational-level interventions, including better information systems and better interweaving of practical and theoretical education, could be first target areas for improvement.

Students’ perspectives on interventions to reduce stress in medical school: A qualitative study

“…Secondly, students were asked about potential changes and interventions that could contribute to stress reduction in medical school. Previous research at our faculty already pointed out high stress levels and specific stressors of our medical students [29,30].…”

“…All focus groups were audio-recorded, transcribed and content analyzed by MD and JW according to Mayring [31] using MAXQDA 18. JW is experienced with occupational health and qualitative research [29]. Research questions were transformed into deductive main categories (students' suggestions, interventions from literature).…”

“…During analysis these categories were further broken down into sub-categories by inductive category formation. After MD completed the first coding round of 25% of the data, AL, an experienced qualitative researcher [29,30,32,33], reviewed the coding scheme. The coding scheme was then adapted and a second coding round was performed by MD.…”

“…Participants were recruited through social media or advertisement on campus of Heinrich-Heine-University of Düsseldorf in Germany. The only criteria for participation were to be currently enrolled as medical student and not having participated at our previous focus groups [29]. Participants of one focus group were recruited through a stress-management seminar.…”

Resources-based Strategies for Health Promotion of Students With Different General Conditions and Different Origins

“…information ow, exam scheduling, theoretical and practical teaching quality, time and performance pressure, social interactions and individual characteristics (e.g. self-expectation, fear of failure) has been shown to reduce stress [30]. These organizational factors could correspond to our recorded resources such as enjoyment of study and work or collegial and welcoming atmosphere in the environment.…”