The Factors Causing Stress in Medical Students and their Impact on Academic Outcomes: A Narrative Qualitative Systematic Review

Authors

DOI:

https://doi.org/10.5195/ijms.2024.2218

Keywords:

Psychological Stressors, Medical Students, Medical School, Analysis , Stress, Academic Outcomes , Systematic Review, Qualitative Analysis , PRISMA Guidelines, Academic Pressure , Institutional Impact, Personality Traits , Social Relationships, Financial Stress , Narrative Review, Emotional Exhaustion , Burnout, Academic Performance , Mental Well-being, Resilience , Depression

Abstract

Background: This study investigated the causes of stress in medical students and the impact of stress on their academic outcomes. Much is known about the impact of stress on medical students but there is a gap in knowledge regarding the collated overview of literature in this area. This study sought to pull together disparate research to gain a clearer overview of the core drivers of stress.

Methods: Taking a meta-level approach, a narrative qualitative systematic review of previous systematic reviews was undertaken, following the PRISMA guidelines. This systematic review covered literature published from 2009-2023 where the focus was stress in students studying at medical schools in the United Kingdom. Findings were then assessed for commonly emerging themes.

Results: From an initial tranche of 3394 articles, a final set of eight systematic reviews was identified. The eight reviews drew on over 309 separate research projects and involved over 500,000 participants. A review of the key findings from each of the eight studies identified five themes: academic pressure, the impact of the institution, students’ personality traits, social relationships, and financial stress. The analysis provided clear evidence that stress amongst medical students results in negative academic outcomes.

Conclusion: The findings suggest a need to reduce stress to help medical students prevent a decline in their academic outcomes and health. From these findings it is recommended that medical schools examine their curriculum to identify areas where they feel they put undue academic pressure on their students and work on ways to remediate this situation.

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References

1. Cooper C, Dewe PJ. Stress. New Jersey: John Wiley & Sons: 2008.

World Health Organisation (WHO). Stress. Available from: https://www.who.int/news-room/questions-and-answers/item/stress#:~:text=Stress%20can%20be%20defined%20as,to%20your%20overall%20well%2Dbeing; updated February 21 2023; cited 28 July 28 2023.

Sutton S, Baum A, Johnston M. The SAGE handbook of health psychology. London: SAGE; 2004.

Salleh MR. Life Event, Stress and illness. Malaysian J Med Sci. 2008;15(4):9-18.

Timmins WG. The chronic stress crisis: How stress is destroying your health and what you can do to stop it. Bloomington: AuthorHouse; 2008.

Mental Health Foundation. UK Stress Survey. London: Mental Health Foundation; 2018.

Office of National Statistics (ONS). Coronavirus and first year higher education students. England: Office for National Statistics; 2021.

Macaskill A. The mental health of university students in the United Kingdom. Br J Guid & Counsel. 2013;41(4):426-41. DOI: https://doi.org/10.1080/03069885.2012.743110

Lane A, McGrath J, Cleary E, Guerandel A, Malone KM. Worried, weary and worn out: mixed-method study of stress and well-being in final-year medical students. BMJ Open. 2020 Dec 1;10(12):e040245. DOI: https://doi.org/10.1136/bmjopen-2020-040245

Bergmann C, Muth T, Loerbroks A. Medical students’ perceptions of stress due to academic studies and its interrelationships with other domains of life: a qualitative study. Med Educ Online. 2019;24(1):1603526. DOI: https://doi.org/10.1080/10872981.2019.1603526

Cecil J, McHale C, Hart J, Laidlaw A. Behaviour and burnout in medical students. Med Educ Online. 2014;19(1):25209. DOI: https://doi.org/10.3402/meo.v19.25209

Nair P, Keppell MJ, Lim CL, Mari T, Hassan N. Transforming curriculum through teacher-learner partnerships: IGI Global. 2020 DOI: https://doi.org/10.4018/978-1-7998-6445-5

Triado XM, Aparicio-Chueca P, Guardia-Olmos J, Jaría-Chacón N, Cebollero MP, Ejjaberi AE. Handbook of research on transnational higher education. Hershey: IGI Global; 2014

Gabbay H, Cohen A, Festinger E. Early predictors of persistence and performance in online language courses. In Glick D, Cohen A, Chang C, editors. Early warning systems and targeted interventions for student success in online courses. Hershey: IGI Global; 2020:200-17. DOI: https://doi.org/10.4018/978-1-7998-5074-8.ch010

Tubulingane BS, Angombe ST. Education quality and offerings intersection post pandemic for inclusive development: a case study. In: Mukerji S, Tripathi P, editors. Handbook of research on global institutional roles for inclusive development. Hershey: IGI Global; 2022:39-59. DOI: https://doi.org/10.4018/978-1-6684-2448-3.ch003

Rytkönen H, Parpala A, Lindblom-Ylänne S, Virtanen V, Postareff L. Factors affecting bioscience students’ academic achievement. Instr Sci. 2011;40(2):241-56. DOI: https://doi.org/10.1007/s11251-011-9176-3

Frazier P, Gabriel A, Merians A, Lust K. Understanding stress as an impediment to academic performance. J Am College Health. 2019;67(6):562-70. DOI: https://doi.org/10.1080/07448481.2018.1499649

Brew EA, Nketiah B, Koranteng R. A literature review of academic performance, an insight into factors and their influences on academic outcomes of students at senior high schools. Open Access Libr J. 2021;8(6):1. DOI: https://doi.org/10.4236/oalib.1107423

Humphrey JH. Anthology of stress revisited. New York: Novinka Books; 2005.

Bugaj T, Cranz A, Junne F, Erschens R, Herzog W, Nikendei C. Psychosocial burden in medical students and specific prevention strategies. Ment Health & Prev. 2016;4(1):24-30. DOI: https://doi.org/10.1016/j.mhp.2015.12.003

Saipanish R. Stress among medical students in a Thai medical school. Med Teach. 2009;25(5):502-6. DOI: https://doi.org/10.1080/0142159031000136716

Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: Causes, consequences, and proposed solutions. Mayo Clinic Proceedings. 2005;80(12):1613-22. DOI: https://doi.org/10.4065/80.12.1613

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906. DOI: https://doi.org/10.1016/j.ijsu.2021.105906

Joanna Briggs Institute. Critical appraisal tools. nd. Available from https://jbi.global/critical-appraisal-tools. Last updated February 21 2023; cited 28 July 28 2023.

Schunemann HJ, Brennan S, Akl EA, Hultcrantz M, Alonso Coello P, Xia J, et al. The development methods of official GRADE articles and requirements for claiming the use of GRADE - a statement by the GRADE Guidance Group. J Clin Epidemiol. 2023;159:79-84. DOI: https://doi.org/10.1016/j.jclinepi.2023.05.010

General Medical Council (GMC). Tomorrow's doctors: Recommendations on undergraduate medical education. London: GMC; 2009

Haykal KA, Pereira L, Power A, Fournier K. Medical student wellness assessment beyond anxiety and depression: A scoping review. Plos One. 2022;17(10):e0276894. DOI: https://doi.org/10.1371/journal.pone.0276894

Polle E, Gair J. Mindfulness-based stress reduction for medical students: a narrative review. Can Med Educ J. 2021;12(2):e74-80. DOI: https://doi.org/10.36834/cmej.68406

Humble N, Mozelius P. Content analysis or thematic analysis: Similarities, differences and applications in qualitative research. In European conference on research methodology for business and management studies. 2022;21(1):76-81. DOI: https://doi.org/10.34190/ecrm.21.1.316

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288 DOI: https://doi.org/10.1177/1049732305276687

Blair E. A reflexive exploration of two qualitative data coding techniques. J Methods & Meas Soc Sci. 2015;6(1):14-29. DOI: https://doi.org/10.2458/v6i1.18772

Atherley A, Dolmans D, Hu W, Hegazi I, Alexander S, Teunissen PW. Beyond the struggles: A scoping review on the transition to undergraduate clinical training. Med Educ. 2019;53(6):559-70. DOI: https://doi.org/10.1111/medu.13883

Gaston-Hawkins LA, Solorio FA, Chao GF, Green CR. The silent epidemic: Causes and consequences of medical learner burnout. Curr Psych Rep. 2020;22(12):2-9 DOI: https://doi.org/10.1007/s11920-020-01211-x

Ahmady S, Khajeali N, Sharifi F, Mirmoghtadaei ZS. Factors related to academic failure in preclinical medical education: A systematic review. J Adv Med Educ & Profess. 2019;7(2):74-85.

Mohmand S, Monteiro S, Solomonian L. How are medical institutions supporting the well-being of undergraduate students? A scoping review. Med Educ Online. 2022;27(1):2133986. DOI: https://doi.org/10.1080/10872981.2022.2133986

Hancock J, Mattick, K. Tolerance of ambiguity and psychological well-being in medical training: A systematic review. Med Educ. 2020;54(2):125-37. DOI: https://doi.org/10.1111/medu.14031

Yang L, Yuan J, Sun H, Zhao Y, Yu J, Li Y. Influencing factors of depressive symptoms among undergraduates: A systematic review and meta-analysis. PloS One. 2023;18(3):e0279050 DOI: https://doi.org/10.1371/journal.pone.0279050

Ong RSR, Wong RSM, Chee RCH, Quek CWN, Burla N, Loh CYL, et al. A systematic scoping review moral distress amongst medical students. BMC Med Educ. 2022;22(1):466. DOI: https://doi.org/10.1186/s12909-022-03515-3

Pisaniello MS, Asahina AT, Bacchi S, Wagner M, Perry SW, Wong M-L, et al. Effect of medical student debt on mental health, academic performance and specialty choice: A systematic review. BMJ Open. 2019;9(7):e029980. DOI: https://doi.org/10.1136/bmjopen-2019-029980

The image depicts a stressed medical student surrounded by books and study materials, with swirling lines and exclamation marks symbolizing stress. The background includes elements like a clock and medical symbols to emphasize the academic and medical context

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Published

2024-06-11 — Updated on 2024-07-09

How to Cite

Jeyapalan, T., & Blair, E. (2024). The Factors Causing Stress in Medical Students and their Impact on Academic Outcomes: A Narrative Qualitative Systematic Review. International Journal of Medical Students, 12(2), 195–203. https://doi.org/10.5195/ijms.2024.2218

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Vol. 12 No. 2 (2024)

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Review

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