The practical year: a qualitative study on stressors, resources and proposed improvements among medical students

The last academic year in medical faculties in Germany is the so-called practical year (PY), which is a combination of studying and on-the-job clinical training. Based on research documenting considerable stress among both medical students and resident physicians it can be assumed that PY students likewise experience high levels of stress. However, evidence remains sparse for medical students in the practical year in Germany and elsewhere.

PY students at a German medical school were recruited via purposeful and snowball sampling and semi-structured qualitative interviews were conducted by telephone. Data collection was carried out until data saturation was reached. The interviews were voice-recorded, transcribed verbatim and content-analyzed using MAXQDA software (2020).

Eighteen female and seven male participants (n = 25; mean age: 26.6 years; standard deviation (SD = 3.7)) were interviewed (mean duration = 36 min with SD = 7.6). Mentioned stressors included a lack of skills and knowledge, poor supervision, routine tasks (i.e., lack of learning experiences due to repetitive work), lack of appreciation (mainly on the part of superiors) and a heavy workload. Resources included working with patients and their appreciation, a positive learning and working atmosphere on the wards, learning and knowledge acquisition, one-on-one supervision by a medical colleague, clinical-practical training as well as a positive work-life balance with sufficient leisure time. Among other things, the PY students suggested a better pay and a change in absence regulations as well as the opportunity to take care of their own patients and to have structured PY teaching.

PY students perceived multiple stressors, but also resources and suggested potential improvements. There is a subjective need for improvements of the working and training conditions in the PY. However, further studies are required to quantify and prioritize those needs and to explore the feasibility of the suggested interventions.