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Commentaries
Medical student stress
Despite two decades of studies studying economics or physical educa- independent variables are all ones
describing the high stress levels of tion, though the economics students which are strongly symptom related.
medical students, junior doctors and, are also beginning to show clinically The one variable which seems to stand
more recently, consultants, we have signi®cant levels. The response rate for out in Table 2 as being particularly
very few papers which compare these the medical and economics groups problematic for medical students is
groups with others at the same stage of stays quite high over the year and so the dissatisfaction with lecturers: 4á1 for
their lives. In fact, there have been comparison over time does suggest that them, compared to 1á6 and 1á5 for
recent papers which have doubted there is something about their experi- economics and PE students, respec-
strongly that the medical profession has ences during that year which has in¯u- tively. This would be an important
any particularly unusual symptomatol- enced their rise in symptoms. This is ®nding to explore with the medical
ogy.1 Other studies of health workers not the case with the PE students and it deans.
as a whole show that there are may be that a number of their very high These ®ndings of an overall lack of
other groups, such as nurses and man- scorers in year one have now dropped difference in the stressors experienced
agers, who show equally high stress out or at least not responded. during year one of undergraduate life to
levels.2 Nevertheless, most studies do some extent con®rm those of Bjorksten
show that doctors are much more et al.8 who compared medical students
stressed than the rest of the public Medical students had similar with other health-oriented groups such
(British Household Panel Survey), and problems to others, but viewed as dentists, pharmacists and nurses.
the more interesting question remains them more intensely They found that medical students had
as to whether this is the result of the similar problems to the others, but
dispositions of those entering medi- viewed them more intensely. Similarly,
cine,3 or whether it is caused by the In fact, by second year almost half Heins et al.9 found that medical stu-
process of medical socialization over of the medical students are scoring dents perceived a variety of potential
the long period of training and beyond. above threshold on the GHQ, much dif®culties no differently than their peers
more than have been shown in British in law, psychology or chemistry. How-
studies5 or Canadian6 and it may be ever, they found that medical students
Most studies do show that that pressures on Turkish students are did report having less sleep, less time for
doctors are much more stressed much greater than those in Britain. recreation and for personal care, and less
than the rest of the public Medical schools even within one time to spend with friends than any of
country are likely to select and train the other groups. The present study has
differently, with resulting differences in not considered these time factors but
The paper by Aktekin et al. in this symptom levels and stressors,7 and they certainly differentiate the groups
issue4 adds to the exploration of this these are likely to be greater when dif- increasingly over time.
question by addressing it at entry into ferent countries and cultures are com-
medical school and comparing medical pared. However, the important message
undergraduates with two other groups remains that, on symptoms at least, these Self-criticism is the foremost
of students, considering both the levels young ®rst-year students are within the characteristic predicting stress
of stress and possible sources. The normal range and no different to their and depression
results suggest that there is nothing peers and it is something about the
unusual, in terms of psychological shared experience of being a student,
symptoms, about those who enter and perhaps also the particular experi- Some of these results may be
medicine, but that some medical stu- ence of being a medical student, which explained by attention to personality
dents become considerably more stres- causes the sharp increase in symptoms. and the types of people who enter dif-
sed and depressed over their ®rst year The authors use a mixture of poten- ferent professions. A recent paper that
as undergraduates than do those tial stressors and levels of satisfaction as looked at pharmacy, nursing and med-
a way of explaining these results. Cer- ical students found that the main
tainly most things seem to get worse for predictors of distress were students'
Correspondence: Dr Jenny Firth-Cozens, medical and economics students over perfectionism and `imposter' feelings.10
Centre for Clinical Psychology and Health-
that year, though the regressions are not This very much ®ts the ®ndings of a
care Research, University of Northumbria at
Newcastle, Coach Lane Campus, Newcastle particularly helpful in trying to unravel longitudinal study of doctors which
upon Tyne NE7 7XA, UK the possible causes since the signi®cant shows self-criticism to be the foremost
6 Ó Blackwell Science Ltd M ED I C A L E D UC A T I O N 2001;35:6±7
13652923, 2001, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.2001.00832.x by Peter Pazmany Catholic University, Wiley Online Library on [18/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Medical student stress · J Firth-Cozens 7
characteristic predicting stress and 2 Wall TD, Bolden RI, Borril CS, 7 Firth J. Levels and sources of
depression over 10 years.3 It may be Carter AJ, Golya DA, Hardy GE stress in medical students. BMJ
that perfectionism or self-criticism is a et al. Minor psychiatric disorder in 1986;292:1177±80.
problem for all students, but is a trait NHS trust staff: occupational and 8 Bjorksten O, Sutherland S, Miller C,
more common in those in medicine or gender differences. Br J Psychiatry Stewart T. Identi®cation of medical
one which interacts most unfavourably 1997;171:519±23. student problems and comparison
with the medical role.11 3 Firth-Cozens J. Individual and organ- with those of other students. J Med
The psychological make-up of medi- izational predictors of depression in Educ 1983;58 (10):759±67.
cal students and doctors is likely to general practitioners. Br J Gen Prac 9 Heins M, Fahey SN, Leiden LI.
continue to be a source of interest 1998;48:1647±51. Perceived stress in medical, law and
around the world, not only because of 4 Aktekin M. Anxiety, depression and graduate students. J Med Educ
the ease with which they can be followed, stressful life events among medical 1984;59 (3):169±79.
nor the special dif®culties experienced students: a prospective study in 10 Henning K, Ey S, Shaw D. Perfec-
within their role, but especially because Antalya, Turkey. Med Educ 2001; tionism, the impostor phenomenon
of the important links between their 2 35:12±17. and psychological adjustment in
stress levels and the quality of care they 5 Guthrie E, Black D, Bagalkote H, medical, dental, nursing and phar-
give.12 Getting things right for patients Shaw C, Campbell M, Creed F. macy students. Med Educ 1998;32
means ®rst getting things as good as we Psychological stress and burnout (5):456±64.
can for those who will deliver their care. in medical students: a ®ve-year 11 Firth-Cozens J. The psychological
prospective longitudinal study. J Roy problems of doctors. In: Firth-
Jenny Firth-Cozens Soc Med 1998;91 (5):237±43. Cozens J, Payne R, eds. Stress in
Newcastle upon Tyne 6 Toews JA, Lockyer JM, Dobson DJ, Health Professionals: Psychological and
Simpson E, Brownell AK, Brenneis F Organizational Causes and Interven-
et al. Analysis of stress levels among tions. Chichester: J Wiley & Son Ltd,
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Ó Blackwell Science Ltd ME D I C AL ED U C AT I ON 2001;35:6±7
