Exploring stress and coping skills of medical students: a repeated cross-sectional cohort study

Objectives: To examine stressors and coping skills as reflected in the student population at a southeastern United States medical school, including identifying key stressors over time and coping mechanisms used. Methods: Repeated cross-sectional cohort, mixed-methods study conducted between 2016 and 2022 at a four-year medical school program. Participants were students from seven classes, with two classes providing data during each of their four years of medical school. A census sampling approach was used, with survey data collected annually from each class across four years. Two surveys were used: the Perceived Stress Scale (PSS) and a modified Coping Orientation to Problems Experienced (COPE) Inventory. Open-text questions captured qualitative responses. Statistical analysis included Welch's t-tests, Pearson correlations, and Cronbach's alpha reliability testing. Qualitative data were examined through inductive thematic analysis. Results: Students reported moderate levels of perceived stress across all four years with fluctuations identified by year of study. There were no statistically significant differences in perceived stress based on student gender; however, qualitative findings identified gender differences related to coping strategies. Thematic analysis of qualitative data revealed three recurring categories of stressors: academic workload, residency application and match pressures, and personal life challenges. Stressors shifted from academic in the pre-clinical years to career concerns during the clinical years. Conclusions: This study highlights the presence of stress throughout medical school and underscores the importance of adaptive coping strategies and the need for phase-specific interventions to support student well-being. Future research should evaluate the effectiveness of interventions in reducing stress across training stages.