Psychological Impact of Medical Education: Stress, Anxiety, Burnout, and the Mediating Role of Coping Mechanisms Among Medical Students

Abstract

Medical education is widely recognized as one of the most psychologically demanding academic fields, exposing students to heavy workloads, frequent examinations, and clinical responsibilities. This study examined the relationships among stress, anxiety, burnout, and coping mechanisms among undergraduate medical students, and tested coping mechanisms as a mediator of the stress–anxiety relationship. A quantitative, cross-sectional survey was administered to 300 undergraduate medical students (46.0% male, 54.0% female) across academic years at medical colleges in Khyber Pakhtunkhwa, Pakistan, recruited via purposive sampling. Stress and anxiety were assessed with the Depression Anxiety Stress Scale-21, burnout with the Maslach Burnout Inventory, and coping mechanisms with the Brief COPE Scale. Stress was significantly positively correlated with anxiety (r = .49, p < .001) and burnout (r = .48, p < .001), and significantly positively correlated with coping mechanisms (r = .33, p < .001), while coping mechanisms were significantly negatively correlated with anxiety (r = –.18, p = .002). Regression analysis showed stress significantly predicted anxiety (β = .49, R² = .24, p < .001) and burnout (β = .48, R² = .23, p < .001). Mediation analysis (Hayes' PROCESS Model 4) confirmed that coping mechanisms partially mediated the relationship between stress and anxiety (indirect effect B = –0.11, 95% CI [–0.17, –0.07]), with a significant direct effect remaining (B = 0.57, p < .001). Findings underscore the considerable psychological burden of medical education and support the integration of early mental health screening, stress management programs, coping-skills training, and institutional counseling services in medical colleges.