Perceived medical school stress and the development of behavior and experience patterns in German medical students

Background: Longitudinal data about the development of health risks and resources in relation to the performance of medical students are limited. Aims: To evaluate the development of study-related experience and the correlation to performance. Method: Medical students in the first (2006), second (2008), and fifth years (2011) of their studies were surveyed with standard instruments for quality of life, study-related behavior and experience, perceived medical school stress, anxiety and depression, and grades in their first major exam. Results: The proportion of students with a healthy behavior and experience pattern decreased from 47.3 in the first year to 36.9 in the second year and 17.6 in the fifth year. This corresponded to an increase in the proportion of students at risk for burnout (7.1 first, 20 second, 19 fifth year). Students with a healthy behavior and experience pattern scored higher in self-perceived performance (p<0.05) and objective grades. Stress and risk for burnout were important predictors for anxiety and depression. Conclusions: The decrease in health and the increase in risk patterns indicate a need for prevention and health promotion that should not only focus on individual behavior but also address the contextual factor of study organization within medical school.