Secondary Traumatic Stress in Medical Students During Clinical Clerkships

Health care workers exposed to traumatic events while working with patients are at risk for secondary traumatic stress (STS). Data on this phenomenon in medical students are limited. This prospective study examines the trajectory and prevalence of STS among medical students during clinical clerkships.

The study at The University of Colorado School of Medicine was conducted in 2 phases: the first evaluated STS across multiple time points in a single year (n = 187); the second assessed STS prevalence at the end of the clerkship year in 3 cohorts (2020-2023) (n = 482). The study used a validated Secondary Traumatic Stress Scale (STSS). Multilevel growth curve modeling was used to explore the change trajectory of STSS scores across the year after controlling for covariates.

In phase 1, the quadratic trend coefficient was negative (-1.56), indicating a predicted trajectory in STSS total scores that started lower at clerkship year start, reached an apex during the year, and decreased by year end ( P < .001). The intercept (32.73) and linear (5.17) coefficient estimates together (37.90) predicted a total score increase indicating mild STS to a total score at the cutoff for moderate STS between July-October ( P < .001). The only statistically significant covariate was reporting an influential psychiatric condition (4.86, P < .001). Phase 2 revealed an end-of-year prevalence of moderate to severe STS of 35.7%, stable across all 3 cohorts. In phase 2, STS categories were significantly different for those reporting a psychiatric condition ( P = .007).

Medical student STS symptoms increase during the clerkship year and do not return to baseline for many by the end. More research is warranted to understand risk and protective factors for STS, strategies to mitigate symptom development, and how much of the observed STS is attributable to the COVID-19 pandemic.