Sources of stress in Canadian dental students: a prospective mixed methods study

The objectives of this study were to describe sources of stress in predoctoral dental students and first-year residents at one dental school and to understand how these sources evolved during the four-year curriculum and in the first year after graduation. The study used a mixed methods design. Quantitative data were collected from subjects in each of the five cohorts of students and residents, every month for a period of one year (other than the summer holiday period; N varied each month from 77 to 127). Sources of stress were measured using the Dental Environment Stress questionnaire (DES). The investigators administered the DES twice, once at the end of each academic semester, and used DES categories that emerged from factor analysis to assess monthly sources of stress. Qualitative data collected through individual interviews (N=6) were aimed at understanding the main sources of stress in each year of the curriculum. Results from both quantitative and qualitative phases demonstrated that the main stressors for all dental students throughout the year were examinations and grades as well as workload. Students in the clinical years were also concerned about patient treatment. The residents and final-year students reported future plans as an additional stressor. Over the year, there was a significant increase for workload stress in the fourth year (p<0.05); in the third year there was a significant increase in patient treatment stress (p<0.05) with a significant decrease for personal factors (p<0.05). The study demonstrated that sources of stress in these students and first-year residents varied according to their stage in the program and the period of the year.