Stress in a graduate medical degree

Medical courses are inherently stressful because of the nature of the course, the workload and, for some students, financial issues. These stressors can lead to impaired judgement, reduced concentration and self-esteem, and increased anxiety, manifesting in turn in depression and even suicide.

In 1997, as a first-year medical student of the graduate program at Sydney University, I attended the conference of the Australian and New Zealand Association of Medical Education. The conference explored facets of stress for medical students and found that medical students were indeed stressed. However, the causes of the stress were not explored, and neither were the ways of managing this stress. I decided to examine the level of stress in students in my year.

There are fundamental differences between the undergraduate and graduate medical courses and in the type of students enrolled. As opposed to the predominantly lecture-based, didactic undergraduate courses, the graduate course emphasises self-directed learning in problem-based, small-group tutorials. Graduate students have an advantage in that they have had previous experience of university education. In 1997 the average age of the students in my year was 24.5 years. They therefore had different life experiences to younger undergraduate students.

I hypothesised that stress in the first year of the graduate course would reflect financial, personal and living issues; time management problems; the new format of the course and the problem-based learning structure; using computers; and, for some students, the requirement to move residence to study. Examination pressures were not applicable in the first year.

A study was devised to assess overall stress and the effect of these eight potential stressors.