Stressing the journey: using life stories to study medical student wellbeing

Tania M. Jenkins, Jenny Kim, Chelsea Hu, John C. Hickernell, Sarah Watanaskul, John D. Yoon

While previous studies have considered medical student burnout and resilience at discrete points in students' training, few studies examine how stressors and resilience-building factors can emerge before, and during, medical school. Our study focuses on students' life stories to comprehensively identify factors contributing to student wellbeing. We performed a secondary analysis of life-story interviews with graduating fourth year medical students. These interviews were originally conducted in 2012 as part of the Project on the Good Physician, and then re-analyzed, focusing on student wellbeing. Respondents were encouraged to identify turning points in their life stories. De-identified transcripts were then coded using a consensus-based iterative process. 17 of 21 respondents reported feeling burned out at least once during medical school. Students identified three major stressors: negative role models, difficult rotations, and the United States Medical Licensing Examination Step 1. Two "motivational stressors"-financial concerns and personal life events-emerged as sources of stress that also motivated students to persevere. Finally, students identified four factors-positive role models, support networks, faith and spirituality, and passion-that helped them reframe stressors, making the struggle seem more worthwhile. These findings suggest that a life-story approach can add granularity to current understandings of medical student wellbeing. Initiatives to reduce stress and burnout should extend beyond the immediate medical school context and consider how past challenges might become future sources of resilience. This study also provides an example of secondary analysis of qualitative data, an approach which could be useful to future research in medical education.