European Journal of Cardiovascular Medicine

Medical education is one of the most intellectually and emotionally demanding academic journeys. It requires students to navigate an intense curriculum, adapt to evolving medical knowledge, and develop essential clinical skills, all within a high-pressure environment. Medical students often face a combination of academic, personal, and social challenges that can significantly impact their mental well-being [1-2]. The rigorous nature of medical training contributes to heightened stress levels, which, if left unmanaged, can adversely affect academic performance, personal relationships, and future professional efficiency [3-5]. Understanding the stress factors medical students encounter is crucial in fostering a more supportive educational environment. Broadly, stress factors in medical students can be categorized into academic and personal stressors [6]. Academic stressors stem from demanding coursework, long study hours, frequent high-stakes examinations, and immense pressure to excel. The competitive nature of medical school, coupled with expectations from faculty, peers, and family, exacerbates stress levels [6-7]. Furthermore, clinical responsibilities add another layer of complexity, as students are exposed to patient care, medical decision-making, and the emotional challenges associated with witnessing suffering and death. Insufficient faculty support and inadequate mentorship often leave students struggling to cope with these pressures, increasing their vulnerability to burnout, anxiety, and depression [8]. Personal stressors, on the other hand, include financial burdens, difficulty maintaining a healthy work-life balance, social isolation, and mental health struggles [9-10]. Many students relocate for their studies, leading to homesickness and a lack of emotional support systems. Financial constraints, particularly for self-funded students or those relying on educational loans, further contribute to stress and uncertainty [11]. The demanding nature of medical education often leaves little time for self-care, exercise, or social interactions, compounding feelings of exhaustion and frustration. Additionally, navigating personal relationships while coping with the demands of medical school can be overwhelming, leading to emotional distress and, in some cases, psychological disorders.

The impact of stress on medical students is profound and multifaceted. Chronic stress can lead to sleep disturbances, reduced cognitive function, and poor concentration, all of which negatively affect academic performance [12-14]. If not properly managed, stress can also result in substance abuse, depression, anxiety disorders, and, in extreme cases, suicidal tendencies. High stress levels not only affect students’ well-being but can also diminish empathy and compassion—critical qualities in the medical profession. Furthermore, excessive stress contributes to professional burnout, which can have long-term consequences on the quality of healthcare services provided by future physicians. Several studies have attempted to analyse stress factors among medical students, but stress triggers vary based on institutional policies, cultural backgrounds, and geographical location [15-17]. A structured survey-based analysis provides valuable insights into the specific academic and personal challenges faced by medical students. By gathering data directly from students, institutions can identify key stressors and implement targeted interventions. These interventions may include stress management workshops, peer support programs, psychological counselling, and structured mentorship opportunities. Some universities have introduced wellness initiatives, mindfulness programs, and academic support services to help students cope with stress, but more comprehensive efforts are needed to address this growing concern effectively. The primary objective of this study is to identify and analyse the main academic and personal stressors affecting medical students through a systematic survey-based approach. The findings will provide medical institutions with a clearer understanding of the stress landscape and guide the development of strategies to create a healthier and more supportive learning environment. By tackling both academic and personal stressors, medical schools can enhance student well-being, foster resilience, and ultimately improve their overall educational experience and professional preparedness. This study will also explore various coping mechanisms adopted by students and highlight best practices that can be implemented on a broader scale to mitigate stress and promote a balanced medical education experience.

This study used a cross-sectional survey approach to examine stress levels among medical students. The poll sought to uncover academic and emotional pressures, as well as coping techniques utilized by students during both the preclinical and clinical stages of their education. The study attempted to evaluate stress levels and compare preclinical and clinical students. The survey consists of a structured questionnaire designed to capture qualitative and quantitative data related to stress levels, coping mechanisms, and contributing factors. The study employs a cross-sectional design, collecting data from a sample of 100 medical students.

2.1 Sample Size and Selection

A total of 50 medical students took part in the study. The sample size for this study is 50 medical students from different academic years. Participants were selected using a convenience sampling technique, allowing voluntary participation while ensuring a diverse representation across preclinical and clinical phases of medical education.  The sample consists of:

Preclinical students (N = 20) are medical students in their early years of study who are largely focused on theoretical courses and basic sciences.

Clinical students (N = 30) are medical students in their last years who participate in hospital rotations and provide patient care.

Participants were chosen by convenience sampling, with students freely participating in the survey. The data for this study was collected through an anonymous, self-administered Google Form. The questionnaire was designed to ensure participant confidentiality 

2.2 Inclusion Criteria:

• Medical students currently enrolled in a recognized medical institution.
• Students from both preclinical (first and second year) and clinical (third to final year) phases.
• Students who voluntarily agree to participate in the anonymous survey.

2.3 Exclusion Criteria:

• Students who have previously withdrawn or taken a break from medical education due to non-stress-related reasons.
• Students diagnosed with severe mental health disorders unrelated to academic stress.
• Students who do not complete the survey in full.

2.4 Ethical Considerations

Since the study is based on an anonymous survey and does not collect personally identifiable information, formal ethical approval is not required. Participation in the survey is entirely voluntary, and respondents are informed that their responses will remain confidential and used solely for research purposes. No sensitive personal data is collected, ensuring that the study adheres to ethical research practices while minimizing risks to participants.

2.5 Data Analysis

Descriptive statistics were employed to estimate the frequency distribution of the study variables. Descriptive analysis for categorical variables are provided as frequencies and percentages. The chi-square test was performed to determine independence. Statistical significance was determined at a p-value of <0.05. All collected data was analyzed with SPSS Version 26. Microsoft Excel was also utilized for domain computations.

The findings show that a considerable majority (78%) of students experience moderate to high levels of stress, with academic pressures being the most common. Academic stress was indicated by 85% of students, closely followed by exam-related worry (72%), and an excessive workload (68%). A lack of faculty support (55%) led to academic stress, while clinical obligations were a significant stressor for clinical students (62%). Personal pressures were particularly important, with financial restrictions affecting 60% of students, social isolation affecting 58%, and family expectations causing stress for 52%. 65% of students reported having trouble balancing academic, clinical, and personal duties. Exercise (45%) and peer support (40%) were the most popular coping measures, whereas meditation and mindfulness (30%) and professional counseling (25%) were less common. These findings indicate that students experience a significant level of stress, underlining the need for improved support systems and appropriate coping techniques. The data collected has been summarised in table 1. The different factors have been represented in figure 1.

Table 1: Data breakup for the study

Figure 1: Types of stress factors and their prevalence among medical students

3.1 Prevalence of Stress Among Medical Students

The study findings indicate that 78% of medical students experience moderate to high levels of stress. This significant proportion highlights the demanding nature of medical education and the widespread impact of stress among students. Stress levels tend to vary based on academic year, with students in later clinical years reporting higher stress due to increasing responsibilities, patient interactions, and expectations for clinical competency.

3.2 Academic Stressors

Academic pressure emerged as the most frequently reported stressor, affecting 85% of students. Examination-related anxiety was prevalent among 72% of respondents, as students face frequent, high-stakes assessments that determine their progression and future career prospects. Additionally, 68% of students cited excessive workload as a major stressor, struggling to balance lecture attendance, self-study, and clinical duties. Lack of faculty support was reported by 55% of students, reflecting the need for improved mentorship and academic guidance. Clinical responsibilities posed significant stress for 62% of students, particularly those in their final years, as they transition into patient care roles while preparing for licensing examinations.

3.3 Personal Stressors

Financial constraints were a major concern for 60% of students, especially those funding their education independently. Social isolation affected 58% of students, with limited time available for social interactions due to academic commitments. Family expectations contributed to stress for 52% of respondents, particularly among those from backgrounds with high parental expectations for academic excellence. A substantial 65% of students found it challenging to maintain a healthy work-life balance, as long study hours and clinical rotations left little time for self-care and recreational activities.

3.4 Coping Mechanisms

Students employed various coping strategies to manage stress, with 45% engaging in exercise and 40% relying on peer support. Meditation and mindfulness were practiced by 30% of respondents, while only 25% sought professional counselling, highlighting the need for structured mental health support within medical institutions.

3.5 Statistical Findings

A strong positive correlation (p < 0.05) was found between academic stress and anxiety levels. Personal stressors significantly impacted students’ concentration and cognitive performance, reinforcing the urgent need for targeted interventions to mitigate stress and improve well-being.

The findings of this study reveal that stress among medical students is a prevalent and multifaceted issue, predominantly driven by academic and personal stressors. The high levels of stress reported by students highlight the urgent need for institutions to implement targeted interventions aimed at stress reduction and mental health support. Academic stressors remain a major concern, with examination-related anxiety and excessive workload ranking as the most significant contributors [18]. The pressure to perform well in assessments, combined with an overwhelming curriculum, places students under immense strain [19-20]. Furthermore, inadequate faculty support exacerbates stress, indicating a need for improved academic mentorship, guidance, and student-friendly teaching methodologies [21-23]. Personal stressors such as financial constraints, social isolation, and family expectations add another layer of difficulty for students [24-27]. The inability to maintain a balanced lifestyle affects students’ emotional and physical well-being [28]. Institutions should consider financial aid programs, structured mentorship, and wellness initiatives to provide students with the necessary support systems. While students employ various coping mechanisms, the relatively low percentage seeking professional counselling suggests a stigma surrounding mental health support. Medical schools should work toward normalizing mental health discussions, integrating stress management programs, and ensuring accessibility to professional psychological services.

Our study aligns with the study by Ragab et al., 2021, emphasizing the significant impact of academic and personal stressors on medical students [29]. While our results indicated that 78% of students experienced moderate to high levels of stress, with academic pressure (85%) being the most commonly cited stressor, the referenced study reported an overall stress prevalence of 31.7% (p < 0.05). Both studies highlight time pressure, heavy workload, and examination frequency as major sources of academic stress, reinforcing the demanding nature of medical education. Additionally, our findings showed that senior students, particularly those in their clinical years, reported higher stress levels, which is consistent with the referenced study’s conclusion that fourth- and fifth-year students were significantly more stressed than first-year students. Furthermore, the study found that female medical students experienced greater academic stress than males (odds = 0.901, p = 0.000153), which aligns with our observation that stress levels varied based on personal and academic factors.

Our study also aligns with the findings from the study by Al-Shahrani et al., 2023 at King Khalid University, which also reported high academic stress among medical students [30]. While we found that 78% of students experienced moderate to high stress, their study reported an even higher rate, with 85.5% perceiving moderate-to-severe stress. Both studies highlight academic stressors, such as exams and workload, as the most significant challenges. Additionally, their study emphasized teaching- and learning-related stress (93.9%) and group activities (88.3%) as major contributors, which parallels our findings on faculty support and peer interactions. Notably, they found that drive and desire-related stressors were the least significant (65.8%), suggesting that intrinsic motivation helps reduce stress. Both studies reinforce the importance of implementing stress management programs to support students' well-being and academic performance.

Our study once again aligns with the findings by Nitin et al., 2020, reinforcing the high prevalence of academic stress among medical students [31]. While this study found that 77.3% of students experienced moderate stress and 5.7% severe stress, our study similarly reported that 78% of students faced moderate to high stress levels, primarily due to exams, workload, and faculty support. Additionally, both studies highlight the significance of coping mechanisms, with this research noting that only a small percentage (1.2%) had good coping skills, while our study found that students relied on exercise, peer support, and mindfulness. Interestingly, their study observed gender differences in coping behaviours, with females using active problem-solving strategies more effectively, while males relied on passive emotional coping. Our study did not specifically assess gender-based coping differences, but both findings emphasize the need for structured interventions, including counselling and stress management programs, to help students develop healthier coping mechanisms and enhance their well-being.

This study underscores the substantial burden of academic and personal stressors on medical students, highlighting the urgent need for institutional support systems. Implementing structured mental health programs, providing professional counselling, and fostering a positive academic environment are crucial to mitigating stress and enhancing student well-being. By addressing these stress factors, medical institutions can help cultivate resilience and ensure better academic and professional outcomes for future healthcare professionals. Future research should explore long-term interventions to reduce stress and improve student resilience in medical education.