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APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v6.i1.2019.30-34 

ISSN 2412 - 3188 

Original Article                                                                                  

Comparative analysis of perceived medical 
school stress among freshman & graduate year 
senior students 
Farhat Minhas1, Muhammad Mujtaba2, Sohail Jamil2, Unaiza Javed3,  
Muhammad Waqas Rabbani4 & Iftikhar Minhas5 
1Department of Behavior Sciences, Avicenna Medical & Dental College, Lahore 
2Department of Psychiatry – Gulab Devi Hospital, Lahore 
3Department of Behavioral Sciences, Rashid Latif Medical College, Lahore 
4Human Development Research Foundation, Islamabad 
5Department of Psychiatry, Shalamar Medical & Dental College, Lahore  

 

Abstract 
Background: Research indicates that medical students are exposed to higher stress 
levels due to the extensive academic programs and intense workload. In order to 
control this public health issue, it is important to understand the significance and 
impact of stress on the personal as well as professional life of the medical school 
students. To compare the perceived medical school stress (PMSS) among freshman 
and graduate year students of medical school. 
Methodology: This cross-sectional study was conducted on a sample of 200 
medical students from three different private medical colleges at Lahore. No 
gender or age-related biasness was considered, subjects details including 
sociodemographic characteristics and PMSS scores were recorded using a 
structured questionnaire. The data was analyzed using SPSS version 21 & 
Microsoft Excel 2017. 
Results: Out of the 200 students, 100 were freshman with a mean age of 19 ± 0.5 
years and 100 were graduate year students with a mean age of 22.9 ± 0.8 years. 
There were 29.5% males while the remaining 70.5% were females. The mean 
difference between the two groups of students in the PMSS academic domain was 
- 0.59 (p = 0.587) and the mean difference in the psychosocial domain was 0.54 (p 
= 0.788). The mean difference in the total PMSS score was 0.05 (p = 0.999). 
Conclusion: After careful consideration, it is concluded that the mean PMSS score 
among medical students does not differ much between freshman and graduate 
year students. 
 

Keywords 
Medical School Stress, Medical Students, Perceived Stress, Medical Education. 

Citation: Minhas F, Mujtaba M, Jamil 
S, Javed U, Rabbani MW, Minhas I. 
Comparative analysis of perceived 
medical school stress among freshman 
& graduate year senior students. APP. 
2019; 6(1):30-34 
 
Corresponding Author Email: 
farhat.minhas26@gmail.com 
 
DOI: 10.29052/2412-3188.v6.i1.2019.30-34 

 
Received 11/03/2019 
 
Accepted 03/06/2019 
 
Published 12/10/2019 
 
Copyright © The Author(s). 2019 This  
is an open access article distributed 
under the terms of the Creative 
Commons Attribution 4.0 International 
License, which permits unrestricted 
use, distribution, and reproduction in 
any medium, provided the original 
author and source are credited.  
 

 

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The author(s) 
declare that there is no conflict of 
interest in the preparation of this 
manuscript. 
 

https://doi.org/10.29052/2412-3188.v6.i1.2019.
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Introduction  
Medical education is deemed to be among the 
most demanding and challenging profession 
not only physically in terms of long and 
strenuous workhours but also mentally. 
During the course of the training, medical 
students undergo many psychological 
changes1. Thus, the metamorphosis from an 
undergraduate student to a full-fledged 
physician is laced with several strains and 
pressures1. Competitive environment, 
human suffering and exposure to death are 
some of the recognized academic medical 
school stressors2. These stressors negatively 
affect the health and quality of life of the 
students and the physicians leading to 
decreased performances which itself 
contributes to stress2,3. Therefore, to break 
this vicious cycle it is important to 
understand the association between stress 
and performance during medical education.  
There is ample evidence supporting the belief 
that a high level of psychological distress is 
experienced during the difficult training 
leading to adverse consequences on student’s 
performance. Stress is prevalent in as much 
as 90% of the medical students worldwide 
and the statistics indicate that doctors mostly 
suffering from stress are in early 
undergraduate years4-6. It is worth noting 
that stress, under normal circumstances and 
in controlled levels, is a beneficial aspect of 
human behaviour. It may help students learn 
more in shorter spans of time and to get more 
work done and succeed against odds. Thus 
stress, in an optimal level, is beneficial but the 
acute burst of energy and the enhanced 
performance comes with a physical and 
psychological cost. Moreover, over-
experiencing stress can lead to physical and 
mental health problems and impairing 
cognitive functioning and learning abilities of 
medical students7,8. 
 
It may not be just a coincidence that student’s 
mental health progressively deteriorates as 
they move through their educational and 
training years. Reviewing evidence from 
different studies leads us to believe that 
studies conducted on medical students in 

their later years of education and training 
reported the worst levels of stress, however, 
owing to the different study settings and 
varied educational environments, the results 
cannot be generalized and thus direct 
comparative evidence is much needed9,10. 
Perceived Medical School Stress (PMSS) 
Instrument is the most validated stress tools 
for medical school students11, addressing 
stress induced by workload, competition and 
financial uncertainties. It mainly focuses and 
predicts the problems associated with mental 
health of the medical students12. The aim of 
this study was to examine the perceived 
stress among freshman and graduate year 
medical School students measured using the 
PMSS scores.  

 

Methodology 
A cross-sectional multicenter study was 
conducted upon a sample of 200 medical 
students from three different private medical 
colleges at Lahore including Lahore Medical 
and Dental College, Avicenna Medical and 
Dental College & Shalamar Institute of 
Health Sciences. These students were then 
divided based on their academic 
performances as freshman and graduate year 
students including 100 students in each 
group. Data like sociodemographic details 
and score of the PMSS were recorded. 
 
The PMSS is a 13-item questionnaire, 
responses are recorded on a 5-point Likert 
scale (ranging from 1 = I strongly disagree; 
5=I strongly agree). This questionnaire has a 
good reliability with Cronbach's alpha value 
of 0.81. The recorded data was analyzed 
using SPSS version 21 & Microsoft Excel 2017. 
Where all continuous variables were 
presented using mean and standard 
deviation. For association the chi-square test 
was applied used and p-value<0.05 was 
considered significant. 
 

Result 
A total of 200 medical school students were 
selected for the study with 100 students in 
each group i.e. freshman and graduate year, 
with a mean age of 19±0.5 years and 22.9±0.8 



 

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years respectively. Out of the total, there 
were 29.5% males while the remaining 70.5% 
were females. 
 

The mean difference between the two groups 
of students in the PMSS academic domain 

was - 0.59 (p = 0.587) and the mean difference 
in the psychosocial domain was 0.54 (p = 
0.788). The mean difference in the total PMSS 
score was 0.05 (p = 0.999).    

 

Table 1: Comparative analysis of perceived stress among freshman and graduate  

year students of medical schools  
Freshman  Graduate year students p-value  

Psycho-Social Domain 25±3.1 24.4±3.4 0.788 
Academic Domain 22±2.8 22.6±3.1 0.587 
PMSS Score 47.1±4.9 47±5.3 0.999 

*PMSS-Perceived Medical School Stress. 

*Values are given as mean ± SD. 

*P-value<0.05 is considered significant. 

 

Discussion 
It is evident from previous literature that 

stress is prevalent among medical students, a 

national study in support concluded that 

around 90% of the enrolled medical students 

experienced stress at one or more points 

during their educational and training years13. 

Another study from Thailand showed high 

stress level among 61.4% of the medical 

students14. Based on our results there was no 

significant difference in the mean PMSS score 

among freshman and graduate year students.   

The studies mentioned above used different 

stress scales and students of different 

academic professions were selected, having 

different curricula and catered to different 

responsibilities. Which might be the reasons 

behind variations in the levels of stress 

however, one thing is certain that the level of 

stress was high than levels that may be 

deemed healthy among the students enrolled 

in all of these studies13-15. The literature 

reports abundantly that female medical 

students suffer from stress more often than 

their male counterparts. In our research, the 

mean PMSS scores reported by female 

medical students were significantly higher 

than the mean PMSS scores reported by male 

medical students. One of the reasons for this 

may be the cultural constraints faced by 

females16. 

The study also strengthens the fact that 

academic and training related stressors are 

the main reasons for the aggravated stress 

levels among medical students. As reported 

in our study, academic factors had a stronger 

role to play than other psychosocial factors 

promoting stress among enrolled students. 

The stress, once it sets-in, then spills over to 

other aspects of a student’s life and manifest 

several adverse effects17. It is interesting to 

note that not only does stress from one source 

affect others but relief acquired from one 

aspect of the life helps alleviate stress from 

other aspects, and this is documented by a 

research from the United States that suggests 

that physical exercise, healthy lifestyle and a 

positive social environment reduce the 

cumulative stress level among students, thus 

highlighting opportunities for better health 

and highlighting the need of active 

incorporation of healthy co-curricular and 

extra-curricular activities in a medical 

students life18. 

The study had several limitations including 

sample size and population diversity. 

Moreover, many of the potential cofounders 

were not observed. The students mental and 



 

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physical health and the previous academic 

records would also be helpful if assessed. No 

correlations were observed with respect to 

age and gender. The study was limited to 

three centers of Lahore only which provides 

the diversity but the results are not sufficient 

enough to provide generalized view 

nationally. Our study adds up to the need for 

highlighting these mental health issues 

existing among medical students and 

physicians which is mostly associated with 

their workload. Therefore, PMSS is a 

beneficial tool that should be used to identify 

stress initially and to cope with it 

accordingly.  

Conclusion  
It is concluded from the study results that the 

mean PMSS among medical students does 

not differ much between the different years 

i.e. similar findings were observed among 

freshman and graduate year students. 

However, despite not being much different, 

both are higher than what may be considered 

healthy for medical students. Thus factors, 

other than increasing educational years and 

the resultant increase in difficulty of the 

course may be explored. 

Acknowledgement  
We would like to thank our respective 

institutes for facilitating this research and Dr. 

Shazia Jamil for her kind help. 

References  
1. Daya Z, Hearn JH. Mindfulness 

interventions in medical education: A 

systematic review of their impact on 

medical student stress, depression, 

fatigue and burnout. Med Teach. 

2018;40(2):146-153. 

2. Dyrbye LN, Thomas MR, Shanafelt TD. 

Medical student distress: causes, 

consequences, and proposed solutions. 

Mayo Clin Proc. 2005;80(12):1613–1622. 

3. Wallace JE, Lemaire JB, Ghali WA. 

Physician wellness: a missing quality 

indicator. The Lancet. 

2009;374(9702):1714-1721. 

4. Fares J, Al Tabosh H, Saadeddin Z, El 

Mouhayyar C, Aridi H. Stress, burnout 

and coping strategies in preclinical 

medical students. North Am J Med Sci. 

2016;8(2):75-81. 

5. Ludwig AB, Burton W, Weingarten J, 

Milan F, Myers DC, Kligler B. 

Depression and stress amongst 

undergraduate medical students. BMC 

Med Educ. 2015;15(1): Article 141. 

6. Heinen I, Bullinger M, Kocalevent RD. 

Perceived stress in first year medical 

students-associations with personal 

resources and emotional distress. BMC 

Med Educ. 2017;17(1): Article 4. 

7. Paudel S, Subedi N, Shrestha A. Stress 

and its relief among undergraduate 

dental students in a tertiary health care 

centre in eastern Nepal. Dentistry. 

2013;3(157):2161-1122. 

8. Cool J, Zappetti D. The physiology of 

stress. In Medical Student Well-Being 

2019 (pp. 1-15). Springer, Cham. 

9. Dyrbye LN, Sciolla AF, Dekhtyar M, 

Rajasekaran S, Allgood JA, Rea M, 

Knight AP, Haywood A, Smith S, 

Stephens MB. Medical School 

Strategies to Address Student Well-

Being: A National Survey. Acad Med. 

2019;94(6):861-868. 

10. Worly B, Verbeck N, Walker C, 

Clinchot DM. Burnout, perceived 

stress, and empathic concern: 

differences in female and male 

Millennial medical students. Psychol 

Health Med. 2019;24(4):429-438. 

11. Vitaliano PP, Maiuro R, Mitchell E, 

Russo J. Perceived stress in medical 

school: resistors, persistors, adaptors 

and maladaptors. Soc Sci Med. 

1989;28(12):1321–1329.  

12. Tyssen R, Vaglum P, Grønvold NT, 

Ekeberg O. Factors in medical school 

that predict postgraduate mental 

health problems in need of treatment. A 



 

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APP| Published By AEIRC| Volume 6 Issue 1  

 

nationwide longitudinal study. Med 

Educ. 2001;35(2):110–120.  

13. Shaikh BT, Kahloon A, Kazmi M, 

Khalid H, Nawaz K, Khan N, Khan S. 

Students, stress and coping strategies: a 

case of Pakistani medical school. 

Education For Health-Abingdon-

Carfax Publishing Limited-. 

2004;17(3):346-353. 

14. Saipanish R. Stress among medical 

students in a Thai medical school. Med 

Teac. 2003;25(5):502-506. 

15. Morrison R, O'Connor RC. Predicting 

psychological distress in college 

students: The role of rumination and 

stress. J Clin Psychol. 2005;61(4):447-

460. 

16. Matheny KB, Curlette WL, Aysan F, 

Herrington A, Gfroerer CA, Thompson 

D, Hamarat E. Coping resources, 

perceived stress, and life satisfaction 

among Turkish and American 

university students. Int J Stress Manag. 

2002;9(2):81-97. 

17. Cohen JS, Patten S. Well-being in 

residency training: a survey examining 

resident physician satisfaction both 

within and outside of residency 

training and mental health in Alberta. 

BMC Med Educ. 2005;5(1): Article 21. 

18. Shah M, Hasan S, Malik S, 

Sreeramareddy CT. Perceived stress, 

sources and severity of stress among 

medical undergraduates in a Pakistani 

medical school. BMC Med Educ. 

2010;10(1): Article 2.  

 

 

 

 

  

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