Council on Medical Student Education in Pediatrics


Search This Site

Journal Club

Answers: exercise, think happy thoughts, be young

Health-promoting factors in the freshman year of medical school: A longitudinal study. Kotter T. et al.  Medical Education 2016; 50: 646-656


Reviewed by Srividya Naganathan

Tags: Preclerkship, self-assessment, survey

What was the study question?

How does health of medical students change over the freshman year? Which factors predict general and mental health status after one year of medical school?

How was the study done?

In this prospective longitudinal study, students at a single German medical school completed general health and mental health related questionnaires before and after the freshman year of medical school. Other data such as socio-demographic, leisure activities, personality and study related behaviors were also included. Descriptive techniques and logistic regression analysis were used to analyze the data.

What were the results?

Out of a total of 376 students, 225 data sets were included in the analysis. At baseline, 93% of students rated their general health and 88% their mental health as good. These percentages declined to 76% and 84% respectively at the end of the 1st year of medical school. The decline in general health was statistically significant for female students (93% versus 72%). Regular physical activity (odds ratio [OR] 4.58), satisfaction with life (OR 1.18) and balance and mental stability (OR 1.20) were positive predictors while age (OR 0.85) and striving for perfection (OR 0.76) were negative predictors of general health. For mental health, neuroticism (OR 0.89), experience of social support (OR 0.73), practice of relaxation techniques (OR 0.26) and age (OR 0.85) were inversely related while high levels of emotional distancing was predictive of good mental health.

What are the implications of these findings?

The freshman year of medical school can be a stressful time due to transitions in life. This study showed decline in general health over the course of the 1st year. Physical activity was the strongest predictor of maintenance of good health and younger students were more resilient than their older counterparts. Surprisingly, experience of social support and regular practice of relaxation techniques were associated with poor mental health! The authors’ explanation was that higher social support before beginning medical school may lead to perceived loss of support during the 1st year causing mental strain while regular practice of relaxation may be an indicator of pre-existing mental distress.

Editor’s Note:  As we learn more about the effects of toxic stress in our patients and how to build resilience to mitigate those effects, it is fitting that we do the same for our students. (JG)

Return to Journal Club