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Psychological Stress and Burnout in Medical Students: A Five-Year Prospective Longitudinal Study

Undergraduate students experience psychological challenges during their training. Several studies show that many students do not complete their studies or fail their exams due to stress and burnout. Besides, some researchers have noted higher psychological distress among medical students, which varies with gender and educational level. In the article “Psychological stress and burnout in medical students: a five-year prospective longitudinal study,” Guthrie et al. sought to investigate the psychological distress and signs of burnout among medical students. Also, they evaluated the factors that forecast the psychological distress among medical students in their fifth year of study. (1) While the study produced significant results suggesting that few students experience psychological stress during their study course, the study findings had limitations regarding the Sample size and the use of self-reported questionnaires.

Guthrie et al. conducted a prospective longitudinal study at Manchester University involving 204 first-year medical students. All the subjects were required to provide information on various stressors from their first year to their final year of study, a duration of five years. The researchers used different self-reported questionnaires to obtain data: the 12-item general health questionnaires were used to obtain the demographic details, psychological status of students before joining the university, general health status, and parents’ occupation. Besides, the Maslach Burnout Inventory was used to assess the relationship between burnout and occupational stress. In contrast, the Course stress questionnaire recorded medical course activities such as examinations and laboratory experiments. Statistical analysis was done using the forward stepwise regression analysis to predict the students’ psychological morbidity throughout their medical training. The most significant results were as follows: out of the 204 participants, only 172 (88 males and 84 females) responded to the questionnaires. Besides, 157 students returned their questionnaires in their fourth year of study, 155 in their fifth year. However, ten students dropped out of school but returned their questionnaires at the end of four years. The researchers did not observe any significant difference regarding psychological distress in relation to the year of study or gender. Also, there was no difference in the students’ alcohol consumption based on the year of study. On the other hand, students with a higher stress score were associated with school dropout and failing exams.

Despite the outcomes, this study faced critical shortcomings based on the sample size and self-reported questionnaires. First of all, Guthrie et al. used first years only to conduct their study. Apart from that, they used 204 medical students only besides sampling Manchester University students only. This makes it difficult to generalize the results for a larger population. For the generalization of results to be reliable, the researchers need to consider adequate sample size and inclusivity of participants. Sampling one locality may not generate best of the results. Bahdanau et al. argue that generalization of results also requires sufficient references from the previously conducted research. (2) In this article, although the researchers have referenced the previous study, their findings vary in that Guthrie et al. demonstrate a small number of students experiencing psychological stress, hence undermining generalization. Secondly, the researchers’ employment of the questionnaire limited the study. Secondly, the students were required to fill in a questionnaire containing 22- questions on stress. Without a doubt, the possibility of acquiring inaccurate information is high and thus, cannot be ignored. Besides, Guthrie et al. did not demonstrate how the data of the questionnaire was validated. As such, it cannot be concluded that the findings are accurate. Students are identified by inconsistency; thus, validation of information is required. In Saris and Gallhofer’s research, results demonstrate the possibility of faulty findings due to wrong information provided in the questionnaire. (3) On the contrary, some researchers may have a different view on the sample and data collection method. Al Saadi et al.’s study, involving a larger sample, obtained similar results, claiming that the sample size was not a limiting factor. (4) Besides, Cohen et al. demonstrate confidence in using the questionnaires. (5) However, the claim that the sample size and self-scale reports could not affect the general outcome is untrue since Guthrie et al. only revealed a small association between psychological stress and medical students. Thus, the lack of a significant finding was likely caused by the small sample and poor data collection.

In conclusion, the study established that a few students continuously have psychological illnesses during medical training; still, the small sample and self-reported questionnaires undermined the generalization of findings. The authors focused on an important subject outlining the prevalence of psychological morbidity among medical students. Results show a small number of students affected in the first year of research and rarely in the subsequent years. However, the assessment of first-year medical students from only one university limited the generalization of findings to medical students from different training institutions. In addition, the questionnaires were likely to provide false information regarding the psychological status of the students due to their self-reported nature. As such, there is a need for a more detailed report to establish the actual prevalence of stress in medical students. Further studies should also investigate the psychological distress among medical students from other schools.


  1. Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: a five-year prospective longitudinal study. Journal of the Royal Society of Medicine. 1998 May; 91(5):237-43. Available at:
  2. Bahdanau D, Murty S, Noukhovitch M, Nguyen TH, de Vries H, Courville A. Systematic generalization: what is required and can be learned? arXiv preprint arXiv:1811.12889. 2018 Nov 30. Available at:
  3. Saris WE, Gallhofer IN. Design, evaluation, and analysis of questionnaires for survey research. John Wiley & Sons; 2014 Apr 14. Available at:
  4. Al Saadi T, Addeen SZ, Turk T, Abbas F, Alkhatib M. Psychological distress among medical students in conflicts: a cross-sectional study from Syria. BMC medical education. 2017 Dec; 17(1):1-8. Available at:
  5. Cohen L, Manion L, Morrison K. Questionnaires. Research methods in education 2017 Oct 12 (pp. 471-505). Routledge. Available at:


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