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The Sources and Consequences of Stress Among Medical Students

Amanda Foster

Texas A&M University-Corpus Christi

1301: Composition I

Frances Johnson

19 November 2021
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The Sources and Consequences of Stress Among Medical Students

The psychological health of medical students and physicians has been commonly looked

at and studied due to the elevated rates of mental illness, stress, and burnout among these groups

of people. Several studies have suggested that there are many different factors that contribute to

the significant amount of stress on medical students, including gender and assessment (Lyndon et

al., 2014). Mirza et al. (2021) concludes that when the prevalence of depressive disorders and

stress are stratified by gender, female medical students and physicians were found to have higher

rates. Earlier studies suggest that interpersonal conflict, including hostile relations between

faculty members and students, has been a remarkable source of stress for medical students

(Spiegel et al., 1986). However, a more current synthesis is needed on these findings. Therefore,

the present research works to report and clarify the current conversation among scholars on the

topic of the causes and effects of stress among medical students. The purpose of this literature

review is to depict the conversation between scholars, which aims to define the sources of stress

in medical students, along with the effects that it has on sleep quality and cognitive behavior and

performance.

Sources of Stress Among Medical Students

Substantial amounts of stress are one of the most reported issues among medical students

across the world. Many factors contribute to the loads of stress that medical students undergo,

including the extensive curricula, numerous academic requirements, and frequent, difficult

examinations (Almojali et al., 2017). Gazzaz et al. (2018) demonstrates that there is evidence
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growing on how extensive research in the medical sciences causes a rapid expansion in medical

knowledge that medical students must retain and understand, which leads to high levels of stress.

Given these points, it is important to understand the causes and consequences of human distress,

in which medical schools should make a change and strive to promote students’ mental health

and well-being (Dyrbye et al., 2005).

Adapting To a New Learning Environment

One strong predictor of stress in medical students is the transition that they must undergo into

a brand new nerve-racking learning environment. Dyrbye et al. (2005) states that first year medical

students face high levels of stress due to adapting to the new learning environment, which consists of

exposure to death and human suffering. This causes students to feel anxious and hesitant in the work

area in which they must interact with dying patients, which is something they have not seen or

encountered before. To add to this, Vyas et al. (2017) denotes that one of the strongest predictors of

stress is academic expectations and satisfaction. Medical students may feel pressured to do well on

exams, due to the fact that their test scores depict if they move along in their career path (Dyrbye et

al., 2005). Rahman et al. (2013) concludes that the tremendous number of tests/exams which students

were not used to from undergraduate school were the chief sources of stress, and that schools may

provide unsuitable teaching methods which installs fear into students of failure in examinations.

Transitioning from a less challenging curriculum to a higher frequency in exams results in high levels

of stress in first year medical students, along with the new exposure to death.

Burnout Among Medical Students

In addition, medical students encounter high levels of stress due to burnout and emotional

exhaustion. Throughout the world, there are extreme rates of burnout in residents and practicing

physicians, in which students must learn a broad range of knowledge and skills, advance in their
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research projects, and become independent problem solvers with a constant pressure to do well

(Mousavi et al., 2018). There is a substantial amount of burnout among preclinical medical

students in which medical education is extremely difficult and time demanding, and tremendous

amounts of commitment and dedication are needed (Gazzaz et al., 2018). All in all, medical

students face immense amounts of stress due to several identified sources including the

adjustment to the new academic environment, academic pressure, and burnout (Lyndon, 2014).

The Association of Stress with Sleep Quality

Furthermore, stress has several negative impacts on the health of the human body, including

the amount of sleep that medical students get. Low amounts of sleep in students engenders several

problems in which sleep difficulties can precipitate into several life dimensions, including mental,

emotional, physical, social, academic, and professional problems (Safhi et al., 2020). Alotaibi et al.

(2020) demonstrates that psychological distress is considered as a triggering factor for sleep

disturbance, and that medical students with higher stress levels tend to have more sleep disorders.

The Cause of Poor Sleep Quality

The cause of medical students' sleep disorders is due to the fact that they may not consider

sleep as a top priority in context of their academic requirements as they reduce their sleeping time to

have more hours of studying and extra workload (Almojali et al., 2017). Students' prioritizing

obligations over sleep conveys that a high level of stress due to the workload of medical school and

frequent tests is a major predictor and contributor to poor sleep quality among medical students.

Safhi et al. (2020) adds to this discussion of sleep disorders by denoting that students are likely to

develop poor sleeping habits especially in the weeks preceding an examination. While healthy adults

should aim to receive between 7 and 9 hours of sleep each night, medical students on average receive

only 6.75 hours (Vyas et al., 2017). Moreover, medical students tend to have poor sleep quality due

to the stress and pressure that comes with frequent examinations.

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Effects of Sleep Disorders on Students’ Health

Poor sleep quality has several impacts on medical students’ mental and physical health.

Medical students who suffer from poor sleep quality due to chronic stress will lead to inheriting

unhealthy behaviors such as consuming a lot of unhealthy food and being less likely to exercise

(Safhi et al., 2020). With this, students will be more susceptible to chronic diseases. (Safhi et al.,

2020). In addition, Almojali et al. (2017) highlights that there is a correlation of sleep quality with

GPA, in which students who have a lower GPA tend to be poor sleepers. Poor sleep quality is

associated with a lack of concentration, impaired memory function, and lowered academic

performance which impairs students' abilities to complete cognitive tasks (Almojali et al., 2017).

Alotaibi et al. (2020) states that sleep is vital for the enhancement of working memory capacity and

memory consolidation. Overall, high levels of stress in medical students can lead to poor quality of

sleep which is strongly linked to emotional disturbance including feeling of anger, tension,

depression, exhaustion, and overall low life satisfaction,  (Safhi et al., 2020).  

How Stress Among Medical Students Affects Academic Assessment

In addition, stress has a negative correlation to academic assessment, in which it can hinder

work effectiveness and lead to poor academic performance. Specific stressors, such as interpersonal

conflicts with team members, have a big influence on clerkship grades (Dyrbye et al., 2005). Gazzaz

et al. (2018) further states how students with higher stress levels tend to have lower marks, while

students with lower stress levels tend to have higher marks on their exams. All in all, increased levels

of stress have been found to be related to lower academic performance (Alotaibi et al., 2020).

The Impact of Stress on Cognitive Functions

High levels of stress, which is common in medical students, induces lack of concentration

and impaired memory function (Almojali et al., 2017). This impact on students’ cognitive behavior

leads to trouble and failure in examinations (Almojali et al., 2017). Sohail (2013) asserts that a high
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level of stress may have a negative effect on the cognitive functioning of students and their ability to

learn. Too much stress can negatively interfere with a student’s preparation, concentration and

performance (Sohail, 2013). Due to the fact that medical students are overloaded with tremendous

amounts of information to study with limited time to internalize it, the individuals create a feeling of

distress because they do not handle all topics covered and, therefore, are not successful during the

examination period (Melaku et al., 2015). The loads of stress that medical students exhibit, which

leads to low self-esteem in the academic area, also causes them to resort to cheating to pass their

exams, rather than using their own knowledge (cite). Melaku et al. (2015) states that the excessive

amount of stress in medical training engenders students to be tempted to cheat on exams and to have

difficulties in solving interpersonal conflicts, decreased attention, reduced concentration, loss of

objectivity, and increased incidence of errors.

Stress Among Medical Students Leads to Substance Abuse

Additionally, stress has a negative impact on medical students’ decisions, in which people

who experience stress are more vulnerable to drug and alcohol use. Use of drugs and alcohol leads to

impaired academic performance, in which the use of these harmful substances negatively affects

cognitive behavior. People under chronic stress are found to drink more alcohol and eat less

nutritious foods than non-stressed individuals (Melaku et al., 2015). Medical students are likely to

develop patterns of smoking and drinking due to the fact that it helps them alleviate stress. Sohail

(2013) adds to this fact by stating that smoking and alcohol intake to relieve stress is popular among

both males and females in medical school. Drug and alcohol abuse have negative impacts on

academic performance in which it impairs cognitive behavior. Alotaibi et al. (2020) supports this fact

by conveying that drug abuse among medical students leads to dropping out of school, a lack of

interest in studying, a low concentration span, and declining grades. Overall, the high rates of
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substance abuse in medical students due to the high levels of stress causes confusion and cognitive

impairment which can negatively affect academic assessment.

Conclusion
On the whole, medical students have high levels of stress due to the daily life stressors

and the extra stress of academic burden, lack of relaxation time, breadth and depth of material to

be learned, and repeated formative and summative examinations in a competitive environment

(Gazzaz et al., 2018). It is important to bring awareness of this issue to society, and more

importantly, the medical school administration, in which there are ways to improve students’

assessment processes. The complicated topic of mental health and stress of medical students

should be addressed, and academic departments can make a difference (Mousavi et al., 2018).

There are several sources that generate high levels of stress in medical students, which leads to

many negative consequences including an impact on their sleep quality and academic

performance.
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References

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