Stress management in medical education: A review of the literature

Purpose. To review systematically clinical studies providing empirical data on stress-management programs in medical training. Method. The authors searched Medline and PSYCHINFO from 1966 to 1999. Studi es were included if they evaluated stress-management programs for medical t rainees (medical students, interns, or residents); reported empirical data; and had been conducted at allopathic medical schools. Results. Although th e search yielded over 600 articles discussing the importance of addressing the stress of medical education, only 24 studies reported intervention prog rams, and only six of those used rigorous scientific method. Results revealed that: medical trainees participating in stress-management programs demonstrated (1) improved immunologic functioning, (2) decreases i n depression and anxiety, (3) increased spirituality and empathy, (4) enhan ced knowledge of alternative therapies for future referrals, (5) improved k nowledge of the effects of stress, (6) greater use of positive coping skill s, and (7) the ability to resolve role conflicts. Despite these promising r esults, the studies had many limitations. Conclusion. The following considerations should be incorporated into future research: (1) rigorous study design, including randomization and control ( comparison) groups, (2) measurement of moderator variables to determine whi ch intervention works best for wham, (3) specificity of outcome measures, a nd (4) follow up assessment, including effectiveness of future patient care .