The positive and negative consequences of stress and its relationship with coping in medical students: A qualitative study

Abstract

Rates of mental health problems among medical students have prompted efforts to reduce stress during medical training. However, stress can be motivating and is a feature of clinical work. This qualitative study explores what makes an experience stressful, and how medical students respond to such experiences. In-depth interviews were conducted with a purposive sample of 15 medical students. Experiences were distressing when they threatened students’ self-perception, goals or coping mechanisms, or when they reminded the student of distressing past events. Moderate stress was motivating and could build resilience. Students selected coping mechanisms based on their availability, acceptability, likely outcome and their previous experience of using these mechanisms. Social support, extra-curricular activities and exercise were helpful. High levels of distress, poor self-esteem and course factors, including remote placements, impaired engagement with coping strategies. Perception of stressors as being insurmountable or beyond one’s control, led to increasing distress and the adoption of avoidant coping strategies. University strategies need to consider the beneficial effects of stress and seek to bolster coping resources as well as minimising unnecessary sources of stress.

Keywords:

• Stress
• coping
• medical student
• student support
• undergraduate
• medical education research
• ethics/attitudes
• professionalism

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

PM, LB and JS’s time was partly funded by the NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust. The views expressed in this article are those of the authors and do not necessarily represent those of the NHS, the NIHR, or the Department of Health and Social Care. This work was supported by the Royal College of Psychiatrists under a General Adult Faculty Small Project Grant.

Notes on contributors

Amy Elizabeth Manley

Amy Elizabeth Manley is a psychiatrist. She conceived the original idea, designed the study, gathered and analysed the data and wrote the first draft of the paper.

Lucy Biddle

Lucy Biddle is a social scientist. She second coded a sample of transcripts.

Lucy Biddle, Jelena Savović and Paul Moran advised on the analysis and interpretation of data and contributed to the final drafting of the paper. All authors work within a medical school.

Jelena Savović

Lucy Biddle, Jelena Savović and Paul Moran advised on the analysis and interpretation of data and contributed to the final drafting of the paper. All authors work within a medical school.

Paul Moran

Lucy Biddle, Jelena Savović and Paul Moran advised on the analysis and interpretation of data and contributed to the final drafting of the paper. All authors work within a medical school.