Comparative Analysis of Stress, Coping Strategies, and Psychological Flexibility Among Postgraduate Medical Students

Postgraduate medical students face a unique combination of academic, clinical, and personal challenges that expose them to heightened psychological stress. Understanding how stress interacts with coping strategies, self-compassion, emotional regulation, and psychological flexibility is crucial for designing interventions that promote resilience and well-being.

A cross-sectional study was conducted among postgraduate medical trainees in a tertiary care institution in India. Participants completed validated tools including the Postgraduate Stressor Questionnaire (PSQ), Self-Compassion Scale (SCS), Brief COPE Inventory, Difficulties in Emotion Regulation Scale (DERS), and the Acceptance and Action Questionnaire-II (AAQ-II). Data were analyzed using descriptive statistics, independent t-tests, and chi-square tests to compare domains across groups. Between‑group differences on AAQ‑II were trivial in magnitude (Cohen's d ≈ 0.10) with overlapping 95% CIs. Given the sample (N=80), post‑hoc sensitivity suggests limited power to detect effects smaller than d≈0.45; thus, the null may reflect true similarity or insufficient power. Nearly half exceeded the >25 cut‑off, indicating a cohort‑level challenge rather than group‑specific differences.

The majority of participants were below 27 years of age, with balanced gender distribution and a predominance of unmarried students. Performance pressure emerged as the most significant stressor (p=0.003). Group A demonstrated significantly higher self-kindness and overall self-compassion, while Group B showed higher self-judgement and maladaptive coping, including substance use (p=0.004). Emotion regulation difficulties were more pronounced in Group B, particularly in emotional awareness and clarity (p=0.025). Psychological flexibility, as measured by AAQ-II, was comparable between groups with no significant difference.

Postgraduate medical students experience high stress levels, predominantly due to performance pressure. Self-compassion appears to be a protective factor, enhancing adaptive coping and emotional regulation, whereas maladaptive coping strategies exacerbate stress-related difficulties. Institutional support combined with self-compassion-based interventions may strengthen resilience and safeguard mental health in this vulnerable group.