Beyond the curriculum: a cross-sectional study of medical student psychological distress, and health care needs, practices and barriers



Medical students report significant levels of distress, and are reluctant to seek help despite health care needs, often citing factors associated with the medical school environment beyond training, generally termed the ‘hidden curriculum’.


The primary objectives of the current study were to establish the level of psychological distress in a sample of medical students enrolled in an Atlantic Canadian medical school, explore factors that predict the psychological distress, examine health care needs, concerns, and practices, and consider potential barriers to care.


Instruments assessing distress (i.e., the Kessler Psychological Distress scale), predictors of distress (i.e., the Perceived Medical School Stress scale), and health care needs and practices (i.e., the Medical Student Health Survey) were administered to 180 medical students. Distress was also compared to three age, sex, and frequency matched Canadian Community Health Survey (CCHS) samples representing the general Canadian population, full time university/college students, and those reporting Anxiety Disorder diagnosed by a healthcare provider.


Medical students reported significantly higher levels of psychological distress than each comparison group, which was significantly predicted by training year, and three PMSS subscales, i.e., “Medical school controls my life”, “Is more a threat than a challenge”, and “Long hours and responsibilities associated with clinical training”. Eighty-six percent of students reported health care needs ranging from common complaints to mental illness, with many either seeking services outside their training institution, consulting with peers, or not attaining care, primarily for reasons of confidentiality and/or non-permissive training schedules.


Medical student psychological distress is significant, and while it may reflect rigors of training, it is also linked with stigma, perceptions that the curriculum is controlling and can often be considerably overwhelming. As a function of this environment, students may not be adequately attending to their own health issues.

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Correspondence to Ken Fowler.

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Bartlett, J., Fowler, K. Beyond the curriculum: a cross-sectional study of medical student psychological distress, and health care needs, practices and barriers. Soc Psychiatry Psychiatr Epidemiol 55, 1215–1221 (2020).

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  • Medical students
  • Psychological distress
  • Hidden curriculum
  • Barriers to care
  • Health care needs