Trends in medical students' stress, physical, and emotional health throughout training

Background: Medical student wellness, including physical health, emotional health, and levels of perceived stress, appears to decline during training, with students reporting high levels of depression, anxiety, and burnout as early as the first year of medical school. The impact of curricular changes on health and stress remains unclear, and a modified curriculum that compresses training of the foundational sciences and its effect on wellness has not been studied. Oregon Health & Science University School of Medicine has recently instituted a unique competency-based model, which provides an important opportunity to assess the effects of curricular change on student wellness. Objective: Assess the effects of curricular change on student wellness. Design: Medical students at a single institution were administered the SF-8, an 8-item health-related quality of life survey, as well as the Perceived Stress Scale, a 10-item scale that measures the degree to which life situations are appraised as stressful, at baseline (matriculation) and at the end of Year 1, 2 and 3. Individual variables were assessed over time, as well as a trend analysis of summary domain scores over the 4 time periods. Results: Physical, emotional, and overall health were highest at baseline and lowest at the end of Year 1, after which they improved but never again reached baseline levels. Physical health declined less than emotional health. Perceived stress levels did not change over time but remained moderately high. There were no differences in health or perceived stress based on demographic variables. Conclusions: In a competency-based curriculum, physical, emotional and overall health significantly worsened during Year 1 but improved thereafter, while perceived stress remained unchanged. Early in training, stress and poor overall health may be related to concerns about self-efficacy and workload. Although advanced students show improved wellness, concerns remained about emotional difficulties, such as anxiety and irritability, and feeling a lack of control.