Survey finds high levels of distress among Czech medical students

Building of the 1st Faculty of Medicine in Prague

Czech medical students are under excessive amounts of stress – leading to the majority suffering from mental and physical health problems themselves. That’s according to a survey by a group of recent medical graduates.

Dr. Martin Palička, lead author of the study, says that he and his group Po medině were not surprised by the survey’s finding that around 95% of all Czech medical students experience excessive stress, as medicine is a famously demanding and difficult field of study.

“However, what did surprise us were the consequences of excessive stress – approximately 70% of all Czech medical students admitted to somatic problems like vomiting, diarrhoea, skin rash and insomnia, in connection with excessive stress.”

The results of the survey are pretty damning – almost all medical students experience excessive stress and roughly 30% reported using alcohol to reduce stress rather than to have fun. Some 19% reported using medication like antidepressants and anxiolytics and 21% have sought professional psychological help, which Dr. Palička considers “an alarming number.”

The study also found that students who report higher levels of stress are four times more likely to drop out. This is a problem for Czech society at large, which has been struggling with a shortage of doctors for a long time, and may also be the area where Czechia loses out in comparison with other countries, says Dr. Palička.

Photo illustrative: Charles University

“It is interesting to compare the overall dropout rate for any reason between different countries, which is, for example, 0.5% in Canada and 3% in the USA per year. And here in the Czech Republic, we are talking about an average of 20% of students dropping out during their medical studies, and excessive stress may be one of the causes of this stark difference.”

However, Dr. Palička also stressed that the authors hadn’t been able to find a survey with a similarly large national scope in the literature. Their study had an incredibly large sample size, with almost a third of all medical students in Czechia participating. The 3,183 students and recent graduates who took part represent eight different faculties drawn roughly equally from each of the six years of study. The distribution of male and female survey participants roughly corresponds to the gender makeup of medical faculties in Czechia (roughly three-quarters female and one-quarter male).

One thing worth mentioning is that although the proportion of students studying at medical faculties is overwhelmingly female, many of the survey participants reported sexism and discrimination as a contributing factor to stress.

 “Humiliation at internships and exams with comments about how we should rather cook and take care of our husbands at home,” reports one survey respondent in the open-ended answers to the question about which specific situations cause excessive stress. In contrast to the rest of the survey, which was mostly multiple choice, this section allowed participants to respond in their own words, and a selection of their answers are faithfully recorded on the Po medině website.

Photo illustrative: Filip Jandourek,  Czech Radio

“Sometimes I have trouble even coming to classes and exams when I know that it is not what I can do that will decide my result, but my gender and the mood of the professor,” says another student in this section.

However, sexism aside – isn’t stress a normal part of being a doctor? Doctors are responsible for people’s lives, surely something that is innately stressful? And don’t medical studies play a part in “separating the wheat from the chaff”? After all, people who can’t handle the stress of studying medicine surely won’t be able to handle the stress of an operating theatre. Dr. Palička offers this response to these assertions.

“This argument is common and we as authors agree that being a doctor is demanding and studying medicine should also be demanding. We are by no means calling for a reduction in the necessary demands on student readiness for working in medicine. We are simply saying that stress can be divided into necessary stress, which relates to the difficulty and duration of the study programme, and unnecessary stress, which can be eliminated with goodwill and targeted interventions.”

Dr. Palička also points out that medicine is an extremely broad field which encompasses not only high-stress specialisations such as obstetrics and surgery, but also areas which do not involve dealing with life and death on a day-to-day basis, such as dermatology and general medicine.

Photo illustrative: jarmoluk,  Pixabay,  CC0 1.0 DEED

“Yes, if you want to be an obstetrician or interventional cardiologist, you have to be able to cope with stress. But the same does not apply to fields such as dermatology, genetics, and general medicine, just to name a few. So when our medical students fail to finish their studies due to excessive stress we are potentially losing excellent specialists.”

Professor Martin Vokurka, dean of Charles University’s 1st Faculty of Medicine – one of the faculties surveyed by Dr. Palička’s team – says the study was well-executed but that it was missing a comparison with other areas of study or the wider population at large.

“It compares only medical students, so we don’t know how it compares with students of other technical disciplines or law studies and so on, or even with other parts of the population.”

However, Professor Vokurka acknowledges that the level of stress present at medical faculties is very high and that some of this stress could be reduced or avoided altogether, adding that he appreciates that an empirical study has been carried out that documents this concretely.

“I think it’s very important that we know about it now and that we have some data which are not abstract but have some support from the research by the Po medině group, so we can work with it.”

Professor Vokurka says that an advisory service for the faculties’ international students has already been running for the last two years and has been very successful. However, he acknowledges that these students have a different set of problems to the Czech students.

“The English-speaking students are in a very different situation from the Czech-speaking students – they are thousands of kilometres from their families and they are sometimes in a very different environment culturally.”

To help address the problems thrown up by the survey, Professor Vokurka says the faculty will soon be appointing a new representative of the Dean’s Board who will be in charge of dealing with student feedback and complaints, as well as providing more psychological help and monitoring their overall satisfaction with the aim of improving it.

“But of course there will always be a certain level of stress present – when I was a student the sources of stress were different, but they were still there. One thing is to help the students to deal with it, but not to completely eliminate it, which is not possible.”

The full results of the survey can be found here: