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Medical School’s Toll on the Health of Students

Stress is an especially dangerous condition when continuously experienced, which can lead to chronic stress. A growing number of individuals among the general population are beginning to face chronic stress, among those medical students, putting them at risk for poor mental health and cardiovascular disease. This article explores such impacts as well as effective techniques to lower stress for those at risk.

By Yesha Shukla

Published 4:20 EST, Sunday, December 12th, 2021

Introduction

Medical students have been known to possess one of the highest levels of stress when compared to those of other professions. This stress can lead to damaging repercussions such as impaired sleeping, poor academic performance, medical errors, cardiovascular disease, and poor mental health. Thus, the toll of medical school must be thoroughly understood, not only by those intending to pursue or actively pursuing the medical field but by the general population.

What Is Stress?

As defined by the National Cancer Institute, stress is the “body’s response to physical, mental, or emotional pressure.” Caused by a range of normal life activities or an out-of-the-ordinary, negative event, stress can lead to chemical changes in the body, triggering a “fight-or-flight” response—raising blood pressure, heart rate, and blood sugar levels. Stress impacts everyone. Whether it be from work, school, or an individual’s personal life, it comes with the same consequences and is equally dangerous.
For medical students, particularly the preclinical years are the most stressful. Here, they face several stressors simultaneously– adjustment to the new environment, educational debt, heavy workload, sleep deprivation, difficult patients, and career planning. All of these can lead to catastrophic consequences for their general health, from mental to physical.

Impact On Mental Health

One of the key findings among medical students is their raised levels of anxiety and depression. Studies on the prevalence of psychological distress among this population found that 40-79% of medical students experience high levels of anxiety in comparison to roughly 14% in the general population of a similar age group. Additionally, depression among medical students is more prominent as well at 12.9% versus 7.8% in the general population.


Other relevant studies have found that first-year medical students actually face greater psychological distress when compared to third or fourth-year medical students. In a large UK study using the 12-item General Health Questionnaire, 30.6% of first-year students were found to have some sort of mental distress compared to 21.9% of fifth-year medical students. Using the same scale in Turkey, 47.9% of second-year students experienced emotional disorders while a smaller percentage of about 29.2% of students in an alternate field, economics, were found to experience emotional disorders.


Such a high prominence of stress in medical students is very alarming due to the additional alternate impacts it can lead to. Poor mental health can lead to changes in appetite, procrastinating, increased use of alcohol or drugs, and the exhibition of greater nervous behaviors such as nail-biting, fidgeting, and pacing. Over time, these effects can add up, leading to medical students entering a downward spiraling effect where their psychological conditions only worsen.

Increased Risk Of Cardiovascular Disease

Physical impacts have also been observed due to these stressors faced by medical students. Constant stress, such as what medical students often face, is identified as chronic stress and can lead to an increased risk of cardiovascular disease. In a 2017 study, researchers used images of the amygdala—the part of the brain involved with fear and stress—and discovered associations between emotional stress and cardiovascular disease episodes.


Physiologically, stress leads to an increase in the hormone cortisol released in the body. Studies suggest that high levels of this hormone can increase blood cholesterol, triglycerides, blood sugar, and blood pressure—all common risk factors for heart disease. More specifically, for example, high blood pressure poses a risk for heart attack and stroke; thus, it is essential that the chronic stress faced by medical studies be reduced to prevent such life-threatening effects.

Techniques To Lower Stress

Due to an increase in chronic stress among the general population, many relaxation and destressing techniques have been researched. Meditation has proven to be one of the most effective. However, this broad activity has specific exercises which have been identified as especially effective. Among these is breathing focus in which long, slow, deep breaths are taken, disengaging the mind from distracting thoughts and sensations. Another is guided imagery where individuals create soothing scenes, places, or experiences in their minds to relax and focus on. Many apps have been developed which provided online recordings of calming scenes and sounds for maximum effect. Mindfulness meditation is another technique in which an individual focuses on their breathing while sitting comfortably and bringing their attention to the present moment, away from concerns about the past or future. Lastly, yoga, tai chi, and qigong are all ancient arts that combine breathing with a series of postures or flowing movements. These physical exercises offer a mental focus that, similar to the other techniques, distracts from racing thoughts. 

Conclusion 

It is no surprise that medical students face the impacts of stress in their daily lives. This stress is in no way healthy and can develop into conditions such as chronic stress, putting them at severe risk for poor mental health and cardiovascular diseases. Therefore, they must make time to do things they love and practice meditation techniques in some form to distract themselves from their immense workload and personal life struggles.

Yesha Shukla, Youth Medical Journal 2021

References

American Heart Association News. (2020, February 4). Chronic stress can cause heart trouble. American Heart Association. Retrieved October 31, 2021, from https://www.heart.org/en/news/2020/02/04/chronic-stress-can-cause-heart-trouble.

Corliss, J. (2019, September 10). Six relaxation techniques to reduce stress. Harvard Health Publishing. Retrieved October 31, 2021, from https://www.health.harvard.edu/mind-and-mood/six-relaxation-techniques-to-reduce-stress.

Hardeman, R. R., Przedworski, J. M., Burke, S. E., Burgess, D. J., Phelan, S. M., Dovidio, J. F., Nelson, D., Rockwood, T., & van Ryn, M. (2015). Mental well-being in first year medical students: A comparison by race and gender. Journal of Racial and Ethnic Health Disparities, 2(3), 403–413. https://doi.org/10.1007/s40615-015-0087-x

Jafari, N., Loghmani, A., & Montazeri, A. (2012). P-1011 – Mental Health of medical students in different levels of training. European Psychiatry, 27, 107–112. https://doi.org/10.1016/s0924-9338(12)75178-7

Kang, S., & Wojcik, S. (n.d.). Stress can increase your risk for heart disease. Health Encyclopedia. Retrieved October 31, 2021, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=2171

Marks, H. (2021, August 19). Stress symptoms: Physical effects of stress on the body. WebMD. Retrieved October 31, 2021, from https://www.webmd.com/balance/stress-management/stress-symptoms-effects_of-stress-on-the-body.

National Cancer Institute. (n.d.). NCI Dictionary of Cancer terms. National Cancer Institute. Retrieved October 31, 2021, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/stress.

Tawakol, A., Ishai, A., Takx, R. A. P., Figueroa, A. L., Ali, A., Kaiser, Y., Truong, Q. A., Solomon, C. J. E., Calcagno, C., Mani, V., Tang, C. Y., Mulder, W. J. M., Murrough, J. W., Hoffmann, U., Nahrendorf, M., Shin, L. M., Fayad, Z. A., & Pitman, R. K. (2017). Relation between resting amygdalar activity and cardiovascular events: A longitudinal and cohort study. The Lancet, 389(10071), 834–845. https://doi.org/10.1016/s0140-6736(16)31714-7

By Yesha Shukla

Yesha Shukla is a student at Dulaney High School in Maryland, United States. She is interested in the fields of family medicine, pediatric radiology, and maternal fetal medicine.

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