Psychological Stress and Burnout in Medical Students

Undergraduate students are prone to psychological distress during their training. Previous studies have shown that students pursuing courses with complex syllabuses and many study years, such as medicine, are highly associated with stress and burnouts and are likely to drop out of school. Besides, Fares et al.¹ state that the intensity and the pre-disposing nature of medical training can lead to psychological stress and burnout. In this article, “Psychological stress and burnout in medical students: a five-year prospective longitudinal study,” Guthrie et al.² assessed the psychological morbidity and the associated symptoms of burnout among medical students during their undergraduate training. Even though the study suggested that a significant group of medical students experience psychological stress and burnout throughout their undergraduate training, there were notable limitations related to the replicability of findings, self-reported questionnaires, and generalization of the findings.

The experiment included 204 first-year medical students from Manchester University, approved by the University of Manchester’s ethics committee. The authors followed a 5- year prospective longitudinal cohort study. Two main questionnaires were used in this trial. The first assessment tools were GHQ-12 (a 12-item General Health Questionnaire), which included questions about the participants’ demographic details and general health and psychological health before entering medical school. The second questionnaire was the Maslach burnout inventory (a 22-item self-report questionnaire) that measured the link between burnout and occupational stress. The researchers found that students who were assessed two or more times reported high prevalence of feelings of psychological stress than those who were assessed on just one occasion. Additionally, the study found no significant difference in gender differences and psychological distress and burnout in medical school. The study highlighted depersonalization and personal accomplishments as the significant influencers of burnout and distress. Factors such as gender difference, alcohol consumption, and poor performance in the examination influenced the experience of distress and burnout. A study highlighted that improving personal engagement, positive reinterpretation, student-oriented mentorship programs, and evaluation systems are essential in solving the problems of burnout and psychological distress among medical students.

Despite establishing that medical students are prone to occupational stress and burnouts throughout their undergraduate training, the findings had three notable shortcomings. First, the researchers failed to outline the criteria through which the factors were determined. Thus, repeating this kind of study to verify the findings could be a bit difficult. It was found that a small percentage of students experience distress and burnout throughout medical school. However, the data used to arrive at this conclusion may not be representative. This can lead to heuristic bias and eventually contribute to statistical errors. According to Richie and Josephson³, heuristic cognitive biases can cause biases in the clinical decision, limiting future research for educational interventions. Secondly, the researchers used various questionnaires to obtain data. However, the questionnaires were self-reported. For instance, participants’ respondents to the 12-item general health questionnaire, the 22-item course stress questionnaire, and the 22-item maslach burnout inventory based on their interpretation and perception, increasing the chances of bias information. According to Boni et al.⁴, self-scale reports are highly associated with erroneous reports, limiting outcomes’ accuracy and reliability. Thirdly, this study’s findings could not be generalized to the larger population of medical students. Although Guthrie et al. assessed the prevalence of stress in medical students from the first to the final year of study, the findings could only relate to those in that school. In a similar survey by Arif et al.⁵ conducted in two medical training institutions, they obtained that the prevalence of stress and burnouts differed in each school due to variations in lifestyle and social interactions. As such, failure to assess the prevalence of psychological stress in multiple schools limited the generalization of Guthrie et al.’s findings. Some scholars may have different opinions regarding the data collection tools and generalization of findings. For instance, Fares et al.¹ claim that medical students have similar syllabuses and undergo similar clinical training; hence the prevalence of stress and burnout can be generalized to multiple schools. While this claim may seem valid, Arif et al.⁵ refute this claim since their study revealed that the severity of psychological stress in medical students varied from one school to the other.

In conclusion, this survey indicated that medical students with psychological distress and burnout in their first year of study are likely to continue with the condition up to their final year of study. Nevertheless, the findings were undermined by the self-report questionnaires, limited generalization of findings, and poor replication of results. The questionnaires revealed that many medical students drop out of school and fail exams due to high-stress scores. Nevertheless, the questionnaires were self-reported, hence undermining the accuracy of findings. In addition, the assessment of medical students from only one learning institution prevented the generalization of findings to medical students in different schools. Finally, this study’s findings could not be replicated, hence limiting future assessments. Further studies with samples from different schools should be conducted to ascertain the prevalence of stress in medical students.

Reference

1. Arif NMNA, Roslan NS, Ismail SB, Nayak RD, Jamian MR, Mohamad Ali Roshidi AS, et al. Prevalence and Associated Factors of Psychological Distress and Burnout among Medical Students: Findings from Two Campuses. [Internet]. Int J Environ Res Public Health 2021 Aug 10. [Cited 2021 Nov 1]. Available from: https://www.mdpi.com/1660-4601/18/16/8446
2. 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. [Internet]. J R Soc Med 1998 May 30. [Cited 2021 Nov 1]. Available from: http://journals.sagepub.com/doi/10.1177/014107689809100502
3. Fares J, Al Tabosh H, Saadeddin Z, El Mouhayyar C, Aridi H. Stress, burnout and coping strategies in preclinical medical students. [Internet]. N Am J Med Sci. 2016 [Cited 2021 Nov 1]. Available from: http://www.najms.org/text.asp?2016/8/2/75/177299
4. Richie M, Josephson SA. Quantifying Heuristic Bias: Anchoring, Availability, and Representativeness. [Internet]. Teach Learn Med. 2018 Jan 2. [Cited 2021 Nov 1]. Available from: https://www.tandfonline.com/doi/full/10.1080/10401334.2017.1332631
5. Boni RA dos S, Paiva CE, de Oliveira MA, Lucchetti G, Fregnani JHTG, Paiva BSR. Burnout among medical students during the first years of undergraduate school: Prevalence and associated factors. [Internet]. Bianchi C, editor. PLoS One. 2018 Mar 7. [Cited 2021 Nov 1]. Available from: https://dx.plos.org/10.1371/journal.pone.0191746