Medical trainee attrition: The link between training stress, coping and thoughts of dropping out

Dr Mary Rogers

Five hundred and five (505) medical students and 349 junior doctors are the subject of an Australian study conducted by Griffith University researchers to identify the coping mechanisms used to deal with training stress, and whether a link exists between these strategies and their thoughts about dropping out of medicine.

“Even though there is some recognition of the lack of work-life balance in the field of medicine, little is known about how workload stressors and coping strategies are associated with contemplating dropping out of medicine,” says co-investigator and Centre for Work, Organisation and Wellbeing researcher, Dr Mary Rogers.

Categorised as having either ‘serious’ or ‘not serious’ thoughts about doing so, factors which informed the likelihood of dropping out included professional fit (most important for student respondents), workload (most important for junior doctor respondents), work-life balance (female trainees commented more), and the field’s training and education systems.

Differences between medical students and junior doctors

Mary and the research team tested differences between the two groups’ stress and the coping mechanisms they employed to manage it. Such mechanisms included problem solving, risky behaviour, avoidance and support-seeking coping strategies. Analysis of the data revealed 635 participants to be ‘not serious’ about dropping out, with the remaining 219 having ‘serious’ thoughts about doing so. Significant links existed between the level of trainee and the seriousness of their intentions to drop out, as did the seriousness-gender interaction. Seriousness was associated with higher training stress (with students recording higher levels than their junior doctor counterparts), and avoidance and risky behaviour coping strategies. Junior doctors were found to have a higher tendency to seek support from others, as were females in both groups. Males in both however, reported higher levels of risky behaviour coping, while problem-solving efforts and support-seeking strategies helped change respondents’ minds (regardless of gender) about dropping out.

Career satisfaction

Previous research has shown the complexities of a satisfying occupational life and personal lifestyle for those working in medicine. Control of one’s schedule and hours of work, their marital status, gender, and caring responsibilities mediate this relationship, while the multifaceted nature of workload demands including the volume of material to be learned, exams, and clinical training add to this mix.

In concluding, Dr Rogers highlights the benefits of this study and a way forward:

“Identification of at-risk groups can inform efforts to design and deliver wellness interventions for medical trainees, assisting with the prevention of burnout and risk-taking behaviours, empowering individuals, reducing adverse reactions to training demands, and improving mental wellbeing. The career satisfaction of medical students and junior doctors has flow on benefits to their patients and the community as a whole.”

The findings of this study are published in an article authored by Mary, Peter Creed, Judy Searle and Serena Nicholls entitled, ‘Coping with medical training demands: thinking of dropping out, or in it for the long haul’ (2015, Studies in Higher Education, doi: 10.1080/03075079.2014.999318). The study was funded by the Australian Research Council (grant number DP1094066).