British medical students suffer an inordinate amount of stress compared to other university students: fact or fiction?

Dear editor

High levels of stress in medical students are a commonly accepted phenomenon within the medical education community and as a result medical schools are often arraigned for not doing enough.¹ Several studies in the UK have reported that medical students suffer significantly higher levels of stress than the age-matched general population.¹ However, it can be argued that comparisons with the general population are misleading. All university students experience high levels of stress due to the demands of the course, a new environment and learning to manage financially, emotionally, and socially with less parental support. Therefore it is more pertinent to determine if medical students in the UK suffer greater levels of stress compared to age-matched peers in other university courses.

We conducted a systematic review of the literature in November 2014, selecting studies which compared British medical students with other students. We identified that only two studies within the last two decades compared medical student stress in the UK with other university courses. A cross-sectional study conducted at the University of York compared 1st year medical, dental, and nursing students.² Dental students scored significantly higher on the perceived stress scale at the end of the academic year compared to medical students (mean score =19.3 versus 15.1, P=0.02). In contrast, Carson et al³ at the University of Edinburgh found psychological stress as measured by the 60-item General Health Questionnaire was more prevalent in 1st year medical students compared to all other university students (46% versus 42%) but this was not significant.

Both studies suffered from significant limitations. Apart from assessing only 1st year students, they used inappropriate time points such as the start or end of the year when stress levels are particularly low and high. Furthermore, the Edinburgh study collected data from 91% of the year group but the York study managed only 33% (44 students).

Excessive levels of stress can lead to burnout, dropping out, psychiatric problems, and impact on future performance. However, some stress is necessary to drive students to perform better, build character, and prepare them for the demands of future medical practice. The current evidence is inadequate in answering whether medical students suffer a disproportionate amount of stress compared to their peers. More robust studies are needed to answer this question before British medical schools and regulatory bodies can be lambasted for putting too much pressure on medical students or not doing enough to support stressed students.

Disclosure

The author has no conflicts of interest to disclose.

---

References

1.	Adams J. Straining to describe and tackle stress in medical students. Med Educ. 2004;38(5):463–464.
2.	Birks Y, McKendree J, Watt I. Emotional intelligence and perceived stress in healthcare students: a multi-institutional, multi-professional survey. BMC Med Educ. 2009;9:61.
3.	Carson AJ, Dias S, Johnston A, et al. Mental health in medical students. A case control study using the 60 item General Health Questionnaire. Scott Med J. 2000;45(4):115–116.