Academic Psychiatry

, Volume 32, Issue 1, pp 44–53 | Cite as

A Conceptual Model of Medical Student Well-Being: Promoting Resilience and Preventing Burnout

  • Laura B. Dunn
  • Alana Iglewicz
  • Christine Moutier
Special Article



This article proposes and illustrates a conceptual model of medical student well-being.


The authors reviewed the literature on medical student stress, coping, and well-beingand developed a model of medical student coping termed the “coping reservoir.”


The reservoir can be replenished or drained by various aspects of medical students’ experiences. The reservoir itself has an internal structure, conceptualized as consisting of the individual’s personal traits temperament and coping style. The coping reservoir metaphor is used to highlight the dynamic nature of students’ experiences, with potential outcomes including enhanced resilience and mental health versus distress and burnout.


Medical student well-being is affected by multiple stressors as well as positive aspects of medical training. Attention to individual students’ coping reservoirs can help promote well-being and minimize burnout; formal and informal offerings within medical schools can help fill the reservoir. Helping students cultivate the skills to sustain their well-being throughout their careers has important payoffs for the overall medical education enterprise, for promotion of physician resilience and personal fulfillment, and for enhancement of professionalism and patient care. This and other models of coping should be empirically validated.


Medical School Medical Student Coping Style Academic Psychiatry Medical Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Hafferty FW, Franks R: The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 1994; 69: 861–871PubMedCrossRefGoogle Scholar
  2. 2.
    Dyrbye LN, Thomas MR, Shanafelt TD: Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med 2006; 81: 354–373PubMedCrossRefGoogle Scholar
  3. 3.
    Dyrbye LN, Thomas MR, Huntington JL, et al: Personal life events and medical student burnout: a multicenter study. Acad Med 2006; 81: 374–384PubMedCrossRefGoogle Scholar
  4. 4.
    Rosenthal TL, Rosenthal RH, Edwards NB: Students’ self-ratings of stress in medical school: a replication across 20 months. Behav Res Ther 1990; 28: 171–173PubMedCrossRefGoogle Scholar
  5. 5.
    Supe AN: A study of stress in medical students at Seth G.S. Medical College. J Postgrad Med 1998; 44: 1–6PubMedGoogle Scholar
  6. 6.
    Firth J: Levels and sources of stress in medical students. Br Med J (Clin Res Ed.) 1986; 292: 1177–1180CrossRefGoogle Scholar
  7. 7.
    Stewart SM, Lam TH, Betson CL, et al: A prospective analysis of stress and academic performance in the first two years of medical school. Med Educ 1999; 33: 243–250PubMedCrossRefGoogle Scholar
  8. 8.
    Stewart SM, Betson C, Lam TH, et al: Predicting stress in first year medical students: a longitudinal study. Med Educ 1997; 31: 163–168PubMedCrossRefGoogle Scholar
  9. 9.
    Toews JA, Lockyer JM, Dobson DJ, et al: Analysis of stress levels among medical students, residents, and graduate students at four Canadian schools of medicine. Acad Med 1997; 72: 997–1002PubMedCrossRefGoogle Scholar
  10. 10.
    Kiessling C, Schubert B, Scheffner D, et al: First year medical students’ perceptions of stress and support: a comparison between reformed and traditional track curricula. Med Educ 2004; 38: 504–509PubMedCrossRefGoogle Scholar
  11. 11.
    Daly MG, Willcock SM: Examining stress and responses to stress in medical students and new medical graduates. Med J Aust 2002; 177: S14–5PubMedGoogle Scholar
  12. 12.
    Newbury-Birch D, Walshaw D, Kamali F: Drink and drugs: from medical students to doctors. Drug Alcohol Depend 2001; 64: 265–270PubMedCrossRefGoogle Scholar
  13. 13.
    Mangus RS, Hawkins CE, Miller MJ: Tobacco and alcohol use among 1996 medical school graduates. JAMA 1998; 280: 1192–1193, 1195PubMedCrossRefGoogle Scholar
  14. 14.
    Clark DC, Eckenfels EJ, Daugherty SR, et al: Alcohol-use patterns through medical school: a longitudinal study of one class. JAMA 1987; 257: 2921–2926PubMedCrossRefGoogle Scholar
  15. 15.
    Croen LG, Woesner M, Herman M, et al: A longitudinal study of substance use and abuse in a single class of medical students. Acad Med 1997; 72: 376–381PubMedCrossRefGoogle Scholar
  16. 16.
    Gutgesell M, Reeve R, Parsons B, et al: Exercise and alcohol consumption among medical students. Acad Med 1999; 74: 750–751PubMedCrossRefGoogle Scholar
  17. 17.
    Tyssen R, Vaglum P, Gronvold NT, et al: Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors. J Affect Disord 2001; 64: 69–79PubMedCrossRefGoogle Scholar
  18. 18.
    Carson AJ, Dias S, Johnston A, et al: Mental health in medical students: a case control study using the 60 item General Health Questionnaire. Scott Med J 2000; 45: 115–116PubMedGoogle Scholar
  19. 19.
    Rosal MC, Ockene IS, Ockene JK, et al: A longitudinal study of students’ depression at one medical school. Acad Med 1997; 72: 542–546PubMedCrossRefGoogle Scholar
  20. 20.
    Parkerson GR Jr, Broadhead WE, Tse CK: The health status and life satisfaction of first-year medical students. Acad Med 1990; 65: 586–588PubMedCrossRefGoogle Scholar
  21. 21.
    Ball S, Bax A: Self-care in medical education: effectiveness of health-habits interventions for first-year medical students. Acad Med 2002; 77: 911–917PubMedCrossRefGoogle Scholar
  22. 22.
    Vitaliano PP, Maiuro RD, Russo J, et al: A biopsychosocial model of medical student distress. J Behav Med 1988; 11: 311–331PubMedCrossRefGoogle Scholar
  23. 23.
    Mosley TH Jr, Perrin SG, Neral SM, et al: Stress, coping, and well-being among third-year medical students. Acad Med 1994; 69: 765–767PubMedCrossRefGoogle Scholar
  24. 24.
    Clark DC, Zeldow PB: Vicissitudes of depressed mood during four years of medical school. JAMA 1988; 260: 2521–2528PubMedCrossRefGoogle Scholar
  25. 25.
    Givens JL, Tjia J: Depressed medical students’ use of mental health services and barriers to use. Acad Med 2002; 77: 918–921PubMedCrossRefGoogle Scholar
  26. 26.
    Guthrie E, Black D, Bagalkote H, et al: Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J R Soc Med 1998; 91: 237–243PubMedCentralPubMedGoogle Scholar
  27. 27.
    Aktekin M, Karaman T, Senol YY, et al: Anxiety, depression and stressful life events among medical students: a prospective study in Antalya, Turkey. Med Educ 2001; 35: 12–17PubMedCrossRefGoogle Scholar
  28. 28.
    Moffat KJ, McConnachie A, Ross S, et al: First year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 2004; 38: 482–491PubMedCrossRefGoogle Scholar
  29. 29.
    Guthrie EA, Black D, Shaw CM, et al: Embarking upon a medical career: psychological morbidity in first year medical students. Med Educ 1995; 29: 337–341PubMedCrossRefGoogle Scholar
  30. 30.
    Roberts LW, Warner TD, Lyketsos C, et al: Perceptions of academic vulnerability associated with personal illness: a study of 1,027 students at nine medical schools. Collaborative research group on medical student health. Compr Psychiatry 2001; 42: 1–15PubMedCrossRefGoogle Scholar
  31. 31.
    Thomas NK: Resident burnout. JAMA 2004; 292: 2880–2889PubMedCrossRefGoogle Scholar
  32. 32.
    Woloschuk W, Harasym PH, Temple W: Attitude change during medical school: a cohort study. Med Educ 2004; 38: 522–534PubMedCrossRefGoogle Scholar
  33. 33.
    Levine RE, Litwins SD, Frye AW: An evaluation of depressed mood in two classes of medical students. Acad Psychiatry 2006; 30: 235–237PubMedCrossRefGoogle Scholar
  34. 34.
    Lindeman S, Laara E, Hakko H, et al: A systematic reviewon gender-specific suicide mortality in medical doctors. Br J Psychiatry 1996; 168: 274–279PubMedCrossRefGoogle Scholar
  35. 35.
    Schernhammer ES, Colditz GA: Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004; 161: 2295–2302PubMedCrossRefGoogle Scholar
  36. 36.
    Frank E, Biola H, Burnett CA: Mortality rates and causes among U.S. physicians. Am J Prev Med 2000; 19: 155–159PubMedCrossRefGoogle Scholar
  37. 37.
    Gross CP, Mead LA, Ford DE, et al: Physician, heal thyself? Regular source of care and use of preventive health services among physicians. Arch Intern Med 2000; 160: 3209–3214PubMedCrossRefGoogle Scholar
  38. 38.
    Novack DH, Epstein RM, Paulsen RH: Toward creating physician-healers: fostering medical students’ self-awareness, personal growth, and well-being. Acad Med 1999; 74: 516–520PubMedCrossRefGoogle Scholar
  39. 39.
    Dyrbye LN, Thomas MR, Shanafelt TD: Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc 2005; 80: 1613–1622PubMedCrossRefGoogle Scholar
  40. 40.
    Frank E, Kunovich-Frieze T: Physicians’ prevention counseling behaviors: current status and future directions. Prev Med 1995; 24: 543–545PubMedCrossRefGoogle Scholar
  41. 41.
    Ratanawongsa N, Wright SM, Carrese JA: Well-being in residency: a time for temporary imbalance. Med Educ 2007; 41: 273–280PubMedCrossRefGoogle Scholar
  42. 42.
    Chandavarkar U, Azzam A, Mathews CA: Anxiety symptoms and perceived performance in medical students. Depress Anxiety 2006; 24: 103–111CrossRefGoogle Scholar
  43. 43.
    Gabbard GO: The role of compulsiveness in the normal physician. JAMA 1985; 254: 2926–2999PubMedCrossRefGoogle Scholar
  44. 44.
    Burns DD: Feeling Good: The New Mood Therapy. New York, Avon Books, 1980Google Scholar
  45. 45.
    Rospenda KM, Halpert J, Richman JA: Effects of social support on medical students’ performances. Acad Med 1994; 69: 496–500PubMedCrossRefGoogle Scholar
  46. 46.
    Dornan T, Littlewood S, Margolis SA, et al: How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach 2006; 28: 3–18PubMedCrossRefGoogle Scholar
  47. 47.
    Basch MF: Understanding Psychotherapy. New York, Basic Books, 1988Google Scholar
  48. 48.
    Shapiro SL, Schwartz GE, Bonner G: Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med 1998; 21: 581–599PubMedCrossRefGoogle Scholar
  49. 49.
    Hauer KE, Teherani A, Dechet A, et al: Medical students’ perceptions of mentoring: a focus-group analysis. Med Teach 2005; 27: 732–734PubMedCrossRefGoogle Scholar
  50. 50.
    Rose GL, Rukstalis MR, Schuckit MA: Informal mentoring between faculty and medical students. Acad Med 2005; 80: 344–348PubMedCrossRefGoogle Scholar
  51. 51.
    Jackson VA, Palepu A, Szalacha L, et al: “Having the right chemistry:” a qualitative study of mentoring in academic medicine. Acad Med 2003; 78: 328–334PubMedCrossRefGoogle Scholar
  52. 52.
    Ramanan RA, Taylor WC, Davis RB, et al: Mentoring matters: mentoring and career preparation in internal medicine residency training. J Gen Intern Med 2006; 21: 340–345PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Buddeberg-Fischer B, Herta KD: Formal mentoring programmes for medical students and doctors-a review of the medline literature. Med Teach 2006; 28: 248–257PubMedCrossRefGoogle Scholar
  54. 54.
    Hojat M, Robeson M, Damjanov I, et al: Students’ psychosocial characteristics as predictors of academic performance in medical school. Acad Med 1993; 68: 635–637PubMedCrossRefGoogle Scholar

Copyright information

© Academic Psychiatry 2006

Authors and Affiliations

  • Laura B. Dunn
    • 1
  • Alana Iglewicz
    • 2
  • Christine Moutier
    • 3
  1. 1.Department of Psychiatry and Helen Diller Family Comprehensive Cancer CenterUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of PsychiatryUniversity of CaliforniaSan DiegoUSA
  3. 3.Department of Psychiatry and the School of Medicine Office of Student AffairsUniversity of CaliforniaSan DiegoUSA

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