The Cost of Education: Medical Student Stress during Clerkships

Introduction: Physicians and physicians-in-training experience sustained stress, leading to increased rates of burnout, anxiety, depression, and suicide. This study explored stress patterns in third year students during clerkships at a U.S. medical school.

Methods: Students completed an anonymous modified mental health professional stress survey during three successive clerkships and rated six stress factors on a Likert-type scale, from 0 to 3. Statistical analysis included descriptive statistics and linear mixed-effects regression models. Results: Twenty nine survey responses were collected. Overall, stress due to workload, professional self-doubt, and home-work conflicts was significantly higher than stress associated with patient-related difficulties, organizational structure, and difficulties with other healthcare workers (all p values < 0.05). On Internal Medicine and Surgery, more than 75% of students worked over 60 hours/week and reported the highest level of home-work conflicts. Women had significantly lower work-related interpersonal stress scores than men (p = 0.04).

Conclusion: Medical students encounter complex stressors during clerkships. Potential strategies to help improve the learning climate are discussed, such as duty hour limits, reduced workload, teaching time management skills, fostering emotional intelligence qualities, and team-building exercises involving all learners.

Med Sci Educ 2011; 21(4): 360-366