European Journal of Cardiovascular Medicine

Stress, defined as physical, mental, emotional, or financial strain, is an inevitable challenge encountered in various aspects of life ⁽¹⁾. Pursuing an MBBS degree is highly demanding, requiring students to undergo rigorous academic training. Consequently, the field of medical education is often accompanied by significant levels of stress ⁽²⁾. First-year medical students, in particular, are exposed to a unique set of stressors, including a demanding academic curriculum, the need to adapt to new environments (such as hostel life), and the pressure of high parental and self-expectations. This early period in medical education is critical, as it forms the foundation for future clinical learning and professional identity.

While moderate stress may enhance learning and performance, excessive and chronic stress can lead to detrimental outcomes. From the very outset, medical students are subjected to stress due to academic workload, clinical exposure, and personal adaptation challenges ⁽³⁾, ⁽⁴⁾.

Medical colleges globally hold the responsibility of ensuring that students attain comprehensive knowledge and practical skills essential for professional practice ⁽⁵⁾. To achieve these objectives, institutions employ structured curricula incorporating lectures, hands-on simulations, mentorship programs, and supervised practical training.

However, while these methodologies aim to enhance student competency, certain aspects of training inadvertently exert adverse effects on physical and mental well-being ⁽⁶⁾, ⁽⁷⁾

Numerous studies have indicated that first-year medical students are particularly prone to stress, anxiety, and burnout ⁽⁸⁾. The rigorous academic expectations, unfamiliar learning environments, and social adjustments can collectively contribute to psychological distress, ultimately influencing both their academic progress and career trajectories ⁽⁹⁾, ⁽¹⁰⁾.

Studies have consistently shown that medical students experience higher levels of stress compared to their non-medical peers. According to a systematic review by Quek et al. (2019), the global prevalence of anxiety among medical students is estimated at 33.8% ⁽¹¹⁾, while Indian studies report stress prevalence as high as 65% among first-year students (Sharma et al., 2020) ⁽¹²⁾. This research primarily seeks to evaluate stress conributing factors experienced by first-year medical students in a private medical college in Gujarat.

There is an urgent need to assess and understand the specific stressors faced by first-year medical students,

Especially in the Indian context, where cultural and systemic factors may amplify stress responses. Identifying these factors can inform targeted interventions such as stress management training, academic mentoring, peer support systems, and institutional policy reforms to promote student well-being and academic success.

Aims & Objectives:

• To identify major stress-contributing factors (academic, social, personal, and environmental).
• To evaluate the effect of stress on academic performance and engagement.

Sample Size: 150 participants

Study Design: Cross-sectional study

Inclusion Criteria: First-year medical students who voluntarily consent to participate in the study.

Exclusion Criteria: Students unwilling to participate will be excluded.

Data Collection Tools:

• Demographic Data Questionnaire
• Medical Students Stress Inventory for First-Year Undergraduate Students (MSSI-1st Year UG)

A pre-designed, pre-validated semi structured questionnaire designed to assess stress contributing factors and their effects mentioning in 5 point likert scale from Strongly disagree to Strongly agree among first year UG medical students.

• To collect data for the study, the questionnaire has been tested on a pilot sample and it's reliability had been confirmed with statistical tool.

The questionnaire will be distributed to study participants via online mode using Google Forms

Out of a total of 137 medical students who participated in the study, sociodemographic characteristics are as mentioned below:  Age:  58 (43.9%) were 18 years of age &49 (37.1%) were 19 years of age.

Father's Education:  below graduate 31. 8%, Rest were Graduate and above.

Mother's Education: below Graduate 40.2 %, Rest were Graduate and above.

 Language medium of school study.

English 52.3%.   Gujarati 47.7%

Current living place: 46.2% students have beenstaying in local city & Rest are staying in hostel/ pg.

Sex: 52 (38%) were male and 85 (62%) were female. This indicates that the study sample had a higher representation of female students compared to male students.

Among the 137 medical students included in the study, 33 students (24%) belonged to rural areas, while 104 students (76%) came from urban backgrounds. This shows a predominant representation of urban students in the study population.

Demographic Summary

Total Students: 137

Sex: Female = 62%, Male = 38%

Residential Background: Urban = 54.1%, Rural = 45.9%

Living Situation: Majority live in hostels

Out of 150 students, 137 students had participated in the study & completed Google form. We have combined total number of Agreed & Strongly Agreed scores and mentioned as total percentage of affected students in each stress contributing factor.

Table no:1  Observations and Results

Graph no: 1 Stress Contributing Factors

Discussion points and conclusion, recommendations:

This study evaluated the key stress-contributing factors among first-year undergraduate medical students and identified those associated with higher stress levels.

In discussion with stress contributing factors, ours findings reflect that academic and time-related pressures are the dominant contributors to stress in this group, which aligns with patterns observed both in Indian and international literature.

Comparison with Indian Studies

A study by Pradeepa et al. (2019) from Tamil Nadu reported that academic stress was the most significant factor, affecting 80.7% of first-year medical students ⁽¹³⁾, corroborating our top finding where 89.1% students reported "less time for studying and revising topics" as a primary stressor. Similarly, our second most common stressor—time management difficulties (85.4%)—was also highlighted in Indian settings, where students often struggle to balance the intense medical curriculum with personal routines. In line with this, students in our study also reported the huge volume of information to memorize (84%) and lower academic performance compared to school (82.5%) as significant contributors to stress.

“Lack of time for extracurricular activities” (80.3%) was also prominent, echoing findings from Sharma et al. (2020), who noted that students often compromise hobbies and leisure time, leading to emotional exhaustion and reduced coping resources. ⁽¹²⁾

Additionally, viva/practical exam anxiety (76.7%), fear of failure (73.7%), and high self-expectations (72.9%) reflect psychological burdens that are consistent with findings from European literature, indicating a broader, cross cultural pattern of academic stress among medical students. ⁽¹⁴⁾

These internal pressures are often magnified in the competitive environment of medical education.

Comparison with Global Studies

Globally, similar stress patterns are observed. A large cross-sectional study from Saudi Arabia (BMC Med Educ, 2023) ⁽¹⁵⁾ found that academic overload, lack of time, and exam-related anxiety were the leading contributors to stress—mirroring our top-ranked factors.

The Czech Republic national sample (2023) also supports our findings, particularly noting how students struggled with academic self-expectations, limited support, and fear of failure, all of which overlap with our findings (items ranked 9, 10, and 20).

Interestingly, interpersonal issues such as “difficulty forming new friendships” (32.8%) and “conflict with peers/seniors” (32.1%) were less prominent in our cohort, possibly due to cultural norms in Indian academic environments that discourage open confrontation, or early bonding through shared residential setups.

Issues like “homesickness” (24.8%) and “language/cultural barriers” (15.3%) were relatively low in our sample, which may reflect increasing regional representation and language integration in Indian medical colleges. However, these remain critical concerns in international settings, particularly in multicultural or cross-border medical schools.

Psychosocial and Environmental Stressors

Factors such as “lack of personal attention from teachers” (33.6%), “problems with teaching in English Language” (28.4%), and “difficulty adjusting with roommates” (11.7%) indicate a need for improved mentoring, language support, and hostel infrastructure—echoing findings from both Indian and global contexts.

Notably, only 13.9% reported “difficulty understanding diagrams/flowcharts,” suggesting that the majority were comfortable with visual academic content, possibly due to increasing use of digital learning tools.

Emerging Patterns and Implications

The hierarchical distribution of stressors in our study suggests a pyramidal stress model—with the base formed by academic overload, rising to peak stress due to emotional and interpersonal pressures.

Effects of Stress on Academic Performance:

Academic Decline: High stress is associated with reduced performance, absenteeism, and decreased academic engagement (Yusoff et al., 2013) ⁽¹⁶⁾. Ours study also reflect similar findings as as stress factors adversely affects their academics in form of 77.4% (graph no: 2) agreed with effect on performance and 59.8 (graph no: 3) agreed with effect on attendance.

Graph no: 2 Effect of stress on performance

Graph no: 3 Effect of stress on attendance

The high burden of stress among first-year MBBS students mainly caused by academic stress , time management & self-expectations related issues. It necessitates early identification, supportive interventions, and curriculum reforms. Stress not only affects mental well-being but directly hampers academic performance and professional development.

Recommendations:

We need larger sample size which includes multiple medical colleges of government and private set ups to get more accurate picture about factors causing stress among 1st year UG medical students.

The dominance of cognitive and structural academic burdens underscores the urgent need for: Curricular reforms to allow self-paced learning, Time-management workshops for medical students, Mentoring programs to address psychological and adjustment issues, Integration of extracurricular time within the weekly academic calendar. Institutional support systems, need for counselling, peer support groups, stress management workshops are also needed to identify stress and enhance coping mechanisms against it among students.

These interventions can enhance student resilience and academic satisfaction.

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