While previous studies have considered medical student burnout and resilience at discrete points in students’ training, few studies examine how stressors and resilience-building factors can emerge before, and during, medical school. Our study focuses on students’ life stories to comprehensively identify factors contributing to student wellbeing. We performed a secondary analysis of life-story interviews with graduating fourth year medical students. These interviews were originally conducted in 2012 as part of the Project on the Good Physician, and then re-analyzed, focusing on student wellbeing. Respondents were encouraged to identify turning points in their life stories. De-identified transcripts were then coded using a consensus-based iterative process. 17 of 21 respondents reported feeling burned out at least once during medical school. Students identified three major stressors: negative role models, difficult rotations, and the United States Medical Licensing Examination Step 1. Two “motivational stressors”—financial concerns and personal life events—emerged as sources of stress that also motivated students to persevere. Finally, students identified four factors—positive role models, support networks, faith and spirituality, and passion—that helped them reframe stressors, making the struggle seem more worthwhile. These findings suggest that a life-story approach can add granularity to current understandings of medical student wellbeing. Initiatives to reduce stress and burnout should extend beyond the immediate medical school context and consider how past challenges might become future sources of resilience. This study also provides an example of secondary analysis of qualitative data, an approach which could be useful to future research in medical education.
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The Gold Humanism Honors Society recognizes peer-nominated medical students, residents, fellows, and attendings who demonstrate compassion in patient care. See http://www.gold-foundation.org/programs/ghhs/.
These stressors emerged in parts 2 and 5 of the interview guide (see Table 1), where respondents were asked to identify key moments (including high points and low points), and burnout, respectively.
Abdulghani, H. M., Irshad, M., Al Zunitan, M. A., Al Sulihem, A. A., Al Dehaim, M. A., Al Esefir, W. A., et al. (2014). Prevalence of stress in junior doctors during their internship training: A cross-sectional study of three Saudi medical colleges’ hospitals. Neuropsychiatr Dis Treat, 10, 1879–1886.
al Khalidi, M., Barton, J., Gentile, N., Gosztonyi, S., & Ronchi, E. (2015). The positive impact of negative role models (Report from the course “Introduction to teaching and learning in the Higher Education”). Retrieved from Genombrottet, Lunds tekniska högskola. http://portal.research.lu.se/ws/files/5921756/8056083.pdf.
American Psychological Association. (2017). The road to resilience. Retrieved from http://www.apa.org/helpcenter/road-resilience.aspx.
Beckman, H. (2015). The role of medical culture in the journey to resilience. Academic Medicine, 90(6), 710–712.
Beresin, E. V., Milligan, T. A., Balon, R., Coverdale, J. H., Louie, A. K., & Roberts, L. W. (2016). Physician wellbeing: A critical deficiency in resilience education and training. Academic Psychiatry, 40(1), 9–12.
Bore, M., Kelly, B., & Nair, B. (2016). Potential predictors of psychological distress and well-being in medical students: A cross-sectional pilot study. Advances in Medical Education and Practice, 7, 125–135.
Brazeau, C., Shanafelt, T., Durning, S. J., Massie, F. S., Eacker, A., Moutier, C., et al. (2014). Distress among matriculating medical students relative to the general population. Academic Medicine, 89(11), 1520–1525.
Cook, D. A., Andriole, D. A., Durning, S. J., Roberts, N. K., & Triola, M. M. (2010). Longitudinal research databases in medical education: Facilitating the study of educational outcomes over time and across institutions. Academic Medicine, 85(8), 1340–1346.
Cook, A. F., Arora, V. M., Rasinski, K. A., Curlin, F. A., & Yoon, J. D. (2014). The prevalence of medical student mistreatment and its association with burnout. Academic Medicine, 89(5), 749–754.
Dunn, L. B., Iglewicz, A., & Moutier, C. (2008). A conceptual model of medical student well-being: Promoting resilience and preventing burnout. Academic Psychiatry, 32(1), 44–53.
Dyrbye, L. N., Eacker, A., Durning, S. J., Brazeau, C., Moutier, C., Massie, F. S., et al. (2015). The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Academic Medicine, 90(7), 961–969.
Dyrbye, L. N., Massie, F. S., Eacker, A., Harper, W., Power, D., Durning, S. J., et al. (2010a). Relationship between burnout and professional conduct and attitudes among US medical students. Jama-Journal of the American Medical Association, 304(11), 1173–1180.
Dyrbye, L. N., Power, D. V., Massie, F. S., Eacker, A., Harper, W., Thomas, M. R., et al. (2010b). Factors associated with resilience to and recovery from burnout: A prospective, multi-institutional study of US medical students. Medical Education, 44(10), 1016–1026.
Dyrbye, L. N., & Shanafelt, T. (2016). A narrative review on burnout experienced by medical students and residents. Medical Education, 50(1), 132–149.
Dyrbye, L. N., Thomas, M. R., Huntington, J. L., Lawson, K. L., Novotny, P. J., Sloan, J. A., et al. (2006a). Personal life events and medical student burnout: A multicenter study. Academic Medicine, 81(4), 374–384.
Dyrbye, L. N., Thomas, M. R., Massie, F. S., Power, D. V., Eacker, A., Harper, W., et al. (2008). Burnout and suicidal ideation among US medical students. Annals of Internal Medicine, 149(5), 334–370.
Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006b). Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic Medicine, 81(4), 354–373.
Dyrbye, L. N., West, C. P., Satele, D., Boone, S., Tan, L., Sloan, J., et al. (2014). Burnout among U. S. medical students, residents, and early career physicians relative to the general U. S. population. Academic Medicine, 89(3), 443–451.
Eley, D. S., & Stallman, H. (2014). Where does medical education stand in nurturing the 3Rs in medical students: Responsibility, resilience and resolve? Medical Teacher, 36(10), 835–837.
Fares, J., Al Tabosh, H., Saadeddin, Z., El Mouhayyar, C., & Aridi, H. (2016). Stress, burnout and coping strategies in preclinical medical students. North American Journal of Medical Sciences, 8(2), 75–81.
Goldhagen, B. E., Kingsolver, K., Stinnett, S. S., & Rosdahl, J. A. (2015). Stress and burnout in residents: Impact of mindfulness-based resilience training. Advances in Medical Education and Practice, 6, 525–532.
Greenhill, J., Fielke, K. R., Richards, J. N., Walker, L. J., & Walters, L. K. (2015). Towards an understanding of medical student resilience in longitudinal integrated clerkships. BMC Medical Education, 15, 137.
Haglund, M. E. M., aan het Rot, M., Cooper, N. S., Nestadt, P. S., Muller, D., Southwick, S. M., et al. (2009). Resilience in the third year of medical school: A prospective study of the associations between stressful events occurring during clinical rotations and student well-being. Academic Medicine, 84(2), 258–268.
Hamid, S., & Singaram, V. S. (2016). Exploring the relationship between demographic factors, performance and fortitude in a group of diverse 1st-year medical students. African Journal of Health Professions Education, 8(1), 99–103.
Heaton, J. (1998). Secondary analysis of qualitative data. Social Research Update, Department of Sociology, University of Surrey, 20. http://www.soc.surrey.ac.uk/sru/SRU22.html. Retrieved from http://www.soc.surrey.ac.uk/sru/SRU22.html.
Heaton, J. (2004). Reworking qualitative data. London: SAGE.
Hinds, P. S., Vogel, R. J., & Clarke-Steffen, L. (1997). The possibilities and pitfalls of doing a secondary analysis of a qualitative data set. Qualitative Health Research, 7(3), 408–424.
Howe, A., Smajdor, A., & Stockl, A. (2012). Towards an understanding of resilience and its relevance to medical training. Medical Education, 46(4), 349–356.
Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21.
Jackson, E. R., Shanafelt, T. D., Hasan, O., Satele, D. V., & Dyrbye, L. N. (2016). Burnout and alcohol abuse/dependence among US medical students. Academic Medicine, 91(9), 1251–1256.
Kavalieratos, D., Siconolfi, D. E., Steinhauser, K. E., Bull, J., Arnold, R. M., Swetz, K. M., et al. (2017). “It Is Like Heart Failure. It Is Chronic … and It Will Kill You”: A qualitative analysis of burnout among hospice and palliative care clinicians. Journal of Pain and Symptom Management, 53(5), 901–910.
Kligler, B., Linde, B., & Katz, N. T. (2013). Becoming a doctor: A qualitative evaluation of challenges and opportunities in medical student wellness during the third year. Academic Medicine, 88(4), 535–540.
Kotter, T., Tautphaus, Y., Obst, K. U., Voltmer, E., & Scherer, M. (2016). Health-promoting factors in the freshman year of medical school: A longitudinal study. Medical Education, 50(6), 646–656.
Long-Sutehall, T., Sque, M., & Addington-Hall, J. (2010). Secondary analysis of qualitative data: A valuable method for exploring sensitive issues with an elusive population? Journal of Research in Nursing, 16(4), 335–344.
Lyndon, M. P., Strom, J. M., Alyami, H. M., Yu, T. C., Wilson, N. C., Singh, P. P., et al. (2014). The relationship between academic assessment and psychological distress among medical students: A systematic review. Perspectives on Medical Education, 3(6), 405–418.
Matheson, K. M., Barrett, T., Landine, J., McLuckie, A., Soh, N. L. W., & Walter, G. (2016). Experiences of psychological distress and sources of stress and support during medical training: A survey of medical students. Academic Psychiatry, 40(1), 63–68.
Mazurkiewicz, R., Korenstein, D., Fallar, R., & Ripp, J. (2012). The prevalence and correlations of medical student burnout in the pre-clinical years: A cross-sectional study. Psychology Health & Medicine, 17(2), 188–195.
McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5(2), 100–122.
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1245–1251.
Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., et al. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students a systematic review and meta-analysis. Jama-Journal of the American Medical Association, 316(21), 2214–2236.
Santen, S. A., Holt, D. B., Kemp, J. D., & Hemphill, R. R. (2010). Burnout in medical students: Examining the prevalence and associated factors. Southern Medical Journal, 103(8), 758–763.
Schnittker, J., & Bacak, V. (2014). The increasing predictive validity of self-rated health. PLoS ONE, 9(1), e84933.
Scholz, M., Neumann, C., Steinmann, C., Hammer, C. M., Schroder, A., Essel, N., et al. (2015). Development and correlation of work-related behavior and experience patterns, burnout and quality of life in medical students from their freshmanship to the first state examination. Psychotherapie, Psychosomatik, Medizinische Psychologie, 65(3–4), 93–98.
Slavin, S. J., Schindler, D. L., & Chibnall, J. T. (2014). Medical student mental health 3.0: Improving student wellness through curricular changes. Academic Medicine, 89(4), 573–577.
Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53(1), 80–93.
Tempski, P., Santos, I. S., Mayer, F. B., Enns, S. C., Perotta, B., Paro, H., et al. (2015). Relationship among medical student resilience, educational environment and quality of life. PLoS ONE, 10(6), e0131535.
Thompson, G., McBride, R. B., Hosford, C. C., & Halaas, G. (2016). Resilience among medical students: The role of coping style and social support. Teaching and Learning in Medicine, 28(2), 174–182.
University of Chicago Program on Medicine and Religion. (2017). Project on the Good Physician. Retrieved from https://pmr.uchicago.edu/projects/research/good-physician.
Varpio, L., Ajjawi, R., Monrouxe, L. V., O’Brien, B. C., & Rees, C. E. (2017). Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking. Medical Education, 51(1), 40–50.
West, C. P., Dyrbye, L. N., Satele, D. V., Sloan, J. A., & Shanafelt, T. D. (2012). Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. Journal of General Internal Medicine, 27(11), 1445–1452.
West, C. P., Dyrbye, L. N., Sloan, J. A., & Shanafelt, T. D. (2009). Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. Journal of General Internal Medicine, 24(12), 1318–1321.
Ziegelstein, R. C. (2018). Creating structured opportunities for social engagement to promote well-being and avoid burnout in medical students and residents. Academic Medicine, 93(4), 537–539.
Zunhammer, M., Eberle, H., Eichhammer, P., & Busch, V. (2013). Somatic symptoms evoked by exam stress in university students: The role of alexithymia, neuroticism, anxiety and depression. PLoS ONE, 8(12), e84911.
Zunhammer, M., Eichhammer, P., & Busch, V. (2014). Sleep quality during exam stress: The role of alcohol, caffeine and nicotine. PLoS ONE, 9(10), e109490.
This project was supported by the New Science of Virtues Project at The University of Chicago through a grant from the John Templeton Foundation. This project was also supported by pilot grants from the Center for Health Administration Studies and the Bucksbaum Institute for Clinical Excellence at The University of Chicago. TMJ is grateful for salary support from the Canadian Institutes of Health Research (CIHR; No. 140811). We thank Kelly Harris and Annikea Miller for their research assistance on this study. Lastly, we thank Furr Curlin for his overall mentorship and support of the Project on the Good Physician.
Conflict of interest
All authors declare that they have no conflict of interest.
This study was approved by the University of Chicago Institutional Review Board.
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Jenkins, T.M., Kim, J., Hu, C. et al. Stressing the journey: using life stories to study medical student wellbeing. Adv in Health Sci Educ 23, 767–782 (2018). https://doi.org/10.1007/s10459-018-9827-0
- Medical education
- Medical students
- Life stories
- Secondary qualitative data analysis