Eight male and ten female students in addition to eight male and seven female medical interns were interviewed in four different focus group discussions (Table 1).
It was observed by the two interviewers that the participants were comfortably expressing their views and experiences and were unlikely to have been discouraged to speak freely. Some participants adopted active coping strategies while others adopted avoidant strategies (Table 2). Examples of active coping strategies included cognitive self-rewarding, planning and time management, and socialising and communicating. On the other hand, examples of avoidant strategies were avoiding medical discussions with friends, building relationships with the other sex, smoking and physical exercise. The following themes emerged from the focus group discussions:
Participants felt that doctors are respected by the society. The medical profession was viewed by male participants as prestigious and this is an emotional reward for them. This self-satisfaction reward compensates for the stress they feel throughout the medical school years. For example, a participant noted:
“We have a stressful life, but I think we are greatly satisfied. Sometime I compare myself to my relatives and I believe that I have a better social status, everybody is praising medical students. You are a doctor, you have something ... So, I am stressed, but I’m doing good” (Male1, student)
Male participants believed that stress is an inherent part of life that is inevitable and is lifelong. If a person wants a better social and financial life, it should be handled and dealt with in a healthy way.
“Consultants have good lives, they’re used to stressful situations all the time, so they are okay with it” (Male14, intern)
“For myself, I realized that I have to live with this stress, because I think having the stress at work or during studies, is healthier. Otherwise, I’m not going to survive it” (Male1, student)
Planning and time management
Students came up with different views regarding planning and time management during the focus group discussions. Some felt that practising a self-created pre-set schedule to manage time was a good way to reduce stress before the exams.
“I used to create a time table … like a schedule for every hour what I should study. I organize myself. That’s what relieves my stress, because I see that I will finish well before the exams” (Male7, student)
Other students, however, had an opposite view, as shown by the following comment from an intern:
“No, I cannot follow a self-set schedule. It’s like having someone nagging on your head and that makes me more stressed. Besides, what if I couldn’t follow that schedule? I’ll be living in constant guilt and stress all at once!” (Female15, intern)
Female participants observed that their married colleagues managed their time and stress effectively. A single female student noted:
“you see them [married students] always taking advantage of their free time in the college by studying and finishing something in the classes alone while we are hanging because they have responsibilities at home” (Female1, student)
Another single female student added:
“Married students may be busier than us, but they have a clearer vision of what they want from life so their plan to achieve what they want with the minimum amount of stress seems doable.” (Female8, student)
Nonetheless, the only married participant reported:
“I have a four-year-old son, so my journey will never be as easy as it is with my friends. In addition to taking care of myself and my studies, I have to take care of a house, a son and a husband. It’s overwhelming sometimes” (Female15, intern)
Socializing and communication
To lessen the stress, students spend time with family and attend gatherings, where no one speaks about medicine.
“If I am stressed I go and sit with my family, I don’t show that I am stressed. They usually ask whether the studies are going well. I assure them and change the topic, this is how I relieve my stress. (Female4, student)
Unlike their male counterparts, female participants resort to instant and materialistic self-rewards which were seen as pleasurable experiences that gave them a feeling of happiness. This helped counterbalancing the negative feelings of stress. For example:
“I literally reward myself when I finish a number of chapters or do well in the exams. I even may treat myself with ice-cream or throw a party to celebrate the achievement … we look forward to that” (Female5, student)
Engaging in recreational activities
Most participants accepted that engaging in recreational activities or hobbies such as, reading, physical exercise or voluntarily work helps to relieve stress and feel relaxed. Others believed that it’s a way of self-distraction rather than stress-relieving per se. For example, they may accuse themselves with “wasting their time” and may feel guilty after spending time doing what they like to do. One intern noted:
“I started going to the gym … to control the stress … most of the time I feel guilty after going to the gym because I could spend my time studying for the exams or working on research” (Male9, intern)
Other participants believed that they were not able to pursue their hobbies because of their busy schedules or as a way to avoid the guilt they may feel afterwards.
Avoiding medical discussions
Male participants mentioned that in order to reduce stress they may resort to non-medical friends or colleagues who refrain from medical and study-related discussions. This was believed to be common among medical students but hard to maintain.
“Actually, I really hate to hang out with some medical students, because I know exactly what we’re going to discuss, it is all about studying, exams, professors... Even if we say: Do not discuss medical stuff! we eventually do” (Male4, student)
On the other hand, the latter issue perceived among female participants as a way to control their own stresses rather than a self-distraction per se. One female participant explained that she doesn’t like to accompany some students as she believed that stress is a contagious feeling:
“Some people are all the time stressed to an extent that you do not want to hear them talking and you cannot talk to them. I know what I am capable of and I do not want to be surrounded by negative people” (Female8, student)
Building relationships with the other sex
Most male participants believed that most students tend to have relationships with the other sex because they claim this releases their stress.
“Being in an emotional relationship is something to distract you from medicine and the stresses of medicine” (Male4, student)
He further explained:
“It’s just talking to the other sex that gives you relief from or a way out of stress. They do not have to be from the same profession or anything. Because being emotionally stable, I think helps … it is kind of getting support” (Male4, student)
When asked about the success of building relationships with the other sex in relieving stress, participants noted the following:
“I think it’s not helping at all. It will not relieve stress nor make them study more, but they have to do it. It’s a distraction. Kind of trying something new, whatever that is” (Male5, student)
Female students, however, believed that talking to male colleagues is more than a distraction and helps to relieve their stress.
“I mean that stress will be relieved because he is more understanding. If I go and talk to a girl she might be thinking that I am incapable of doing things, girls usually judge you … I am just trying to be open in this issue” (Female10, student)
On the other hand, a number of participants from both sexes considered these relationships as “waste of time” and “religiously not acceptable”.
Participants acknowledged that smoking is not an effective strategy to relieve stress; however, they do smoke when they are stressed. One participant explained the smoking phenomenon as:
“One of the ways to escape stress is to try other new things in life” (Male7, student)
Another participant explained:
“If I’m under stress or anybody is under stress, will not start smoking, but if he is a previous or a frequent smoker, and he is under stress, he will start or smoke more” (Male8, student)
All participants admitted that they have never been offered a cigarette by their friends and colleagues,
“Even those who do smoke do not offer a cigarette to relieve your stress … Even if we ask, they would say no. Most of them know that this is wrong” (Male10, intern)
A female participant explained:
“I have noticed that after the second or third year of studying, especially in the medical field, girls in the university dormitory start to smoke cigarettes or water pipe but I do not see that it relieves their stress. They believe that the stress they are going through has forced them to smoke” (Female10, student)
One male intern thinks that facing seriously stressful situations like that in the academia, in a young age may lead to taking “impulsive decisions” or “irrational decisions” to deal with stress; and smoking is one of them.
In general, participants initially started smoking as a pleasurable activity that helped in escaping stress, but later they perceive it as an additional emotional burden that needs to be dealt with. One participant mentioned:
“Now it [smoking] is not a pleasure it’s a burden” (Male6, intern)
Although some participants engage in physical exercise as a way to relieve their stress, few mentioned that they engage in exercise to escape from studying. For example, one participant, who had the lowest GPA among the group, mentioned that she took physical exercise as a way to escape from studying. She explained:
“I have been overweight since I was born however, two years ago, I decided to take an action. In my mind, I know that has nothing to do with improving my health, but rather to avoid studying” (Female5, student)