research paper on medical students

• Open access
• Published: 30 April 2024

From corners to community: exploring medical students’ sense of belonging through co-creation in clinical learning

• Valerie Isobel Rae 1 ,
• Samantha Eve Smith 2 ,
• Samantha Rae Hopkins 1 &
• Victoria Ruth Tallentire 1  

BMC Medical Education volume  24 , Article number:  474 ( 2024 ) Cite this article

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Belonging is critical for the development and wellbeing of medical students. Belonging, particularly within a ‘relational being’ paradigm, presents a significant challenge for students, especially within clinical learning environments. Co-creation is a learning relationship in which students are actively involved in the education process. It is inherently relational and promotes belonging within higher education environments. Little is known about utilising co-creation in the curriculum, within medical education. The aim of this study was to explore medical students’ experience of co-creation of learning resources within the clinical learning environment.

Following ethical approval, medical students were invited to become co-creators of a learning bulletin resource, within the paediatric acute receiving unit, at a paediatric teaching hospital. Interpretative phenomenological analysis (IPA) was used to enable an in-depth exploration of how medical students experienced co-creation within the clinical learning environment. Medical students participated in semi-structured interviews about their experience, which were transcribed verbatim and analysed using IPA. The analysis integrated individual lived experiences into an analytic summary.

Nine medical students participated. Three group experiential themes were identified: identity maturation; learning community and workplace integration. The support found within this co-created learning community, along with maturation of their identity, allowed the participants to experience a challenge to their existing worldview. This shift in perspective resulted in them responding and behaving in the workplace in new ways, which enabled them to belong as themselves in the clinical learning environment. These findings were situated within the developmental concept of self-authorship, as well as contributing to a new understanding of how co-creation promoted social integration.

Conclusions

Co-creation enabled students to learn in a meaningful way. The relational power of co-creation, can be harnessed to deliver participatory learning experiences, within our increasingly complex healthcare environment, to support the learning, development and integration of doctors of the future.

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In the melee of modern clinical environments, medical students often struggle to belong [ 1 ]. The student experience is rotational and transitory, and students are frequently anonymous within clinical teams. Medical students endure more psychological distress than matched peers, which is intensified when entering the clinical learning environment [ 2 , 3 ]. Belonging is a fundamental pre-requisite of human development and wellbeing [ 4 ]. Educator responsibility to nurture learning environments that promote belonging has amassed increasing attention in the post-pandemic world. Conceptions of belonging incorporate feelings of acceptance, being valued and ‘fitting in’ [ 5 ]. A recent alternative paradigm of belonging, referred to as relational being, offers a challenge to the dominant understanding of students belonging to and ‘fitting in’ with the university [ 6 ]. Instead, it encourages a relational view of students as, “being within an ecology” which “explicitly values what they bring”, as well as their diversity [ 6 ]. In response, attention to learning structures and processes that promote students’ being within this paradigm, is of interest, as a previously unexplored solution.

Co-creation is a close collegiate relationship between students and teachers that welcomes students’ perspectives and actively involves them in the teaching and learning process [ 7 ]. Co-creation gifts a potential solution to students’ challenges with belonging in the clinical learning environment because it is inherently relational. Within higher education environments, co-creation enables students to become valued partners, and promotes creativity and critical thinking skills [ 7 , 8 ].

Through a mutualistic symbiotic learning relationship, co-creation aims to enrich teaching and learning, via a social, dialogic and creative process, resulting in something new [ 8 , 9 ]. Co-creation is often situated alongside ‘students as partners’ and ‘student engagement’ strategies [ 10 ]. However, during co-created learning and teaching there is an expectation that students will share responsibility, decision-making and embrace enhanced agency within meaningful relationships with teachers, recently described as ‘agentic engagement’ [ 11 , 12 ]. In relation to higher education courses that have adopted co-created learning and teaching, students describe the experiences as relationship-enhancing, grounded in trust, and immensely rewarding [ 8 ]. Meaningful learning is defined as the interaction between existing knowledge and that which is newly acquired [ 13 ]. Co-creation may introduce students to meaningful participatory learning relationships, with consequential learning benefits as they negoitate between existing and new knowledge.

Co-created learning relationships within higher education benefit students, as a result of them becoming valued partners [ 14 , 15 , 16 , 17 ]. Key features of co-creation include student empowerment, reciprocity in the learning relationship with teachers and flattening of hierarchy. Within this context, education becomes a shared endeavour of constructing and negotiating understanding with , rather than to , the student [ 8 , 18 , 19 ]. Successful co-created learning and teaching experiences are generated by ensuring reciprocal respect and distributed ownership, enabled by explicit communication relating to the intention of the experience [ 20 ]. Failure to enact these attributes has negative consequences [ 14 ]. The bidirectional relationship within co-creation is empowering for basic psychological needs, defined by self-determination theory; autonomy, belonging and competence [ 21 ]. These needs must be met to drive and promote intrinsic motivation [ 21 ]. Co-creation offers a new space for students to add their value to learning and teaching.

In addition to offering a new form of learning relationship, co-creation also enables new roles. Hence, this becomes an opportunity for transformation, and may inspire critical examination of pervasive norms [ 22 , 23 ]. Re-examination is essential within our increasingly complex modern healthcare environments, and assists in attending to concerns about sustainability of education [ 24 ]. Co-creating with students promotes critical thinking and creative skills [ 8 ], which are areas that the educational research community has identified to be of key importance for future research [ 25 ]. In sum, the values of co-creation enable students to explore new ways of thinking and being, which may help to create learning environments in which students can flourish whilst navigating the complexity of the healthcare setting.

Despite copious evidence of co-creation’s benefits within higher education, its relational pedagogy (underpinned by social constructivism), has yet to be fully harnessed within medical education [ 26 , 27 ].

Co-creation can take multiple forms both in and of the curriculum. Co-creation of the curriculum is an activity that informs educational design (e.g., curricular re-design or module re-design), usually prior to learning and teaching taking place. Whereas, co-creation in the curriculum is an activity that creates learning and teaching during a programme or course. For example, students and teachers jointly determining a title and topic for an essay or creating a newsletter together [ 11 ]. A co-creation typology helps teachers to reflect on what type they are engaging in and communicate this to others [ 11 ]. Co-creation in medical education has predominantly been situated as a design activity of curricula and modules [ 28 , 29 , 30 , 31 ]. Little is known about the process of implementing co-creation in the clinical learning environment, as a learning and teaching activity in the curriculum, or about the medical student experience of co-creation in this context [ 11 , 32 ]. Understanding more about how co-created learning and teaching experiences affects medical students during clinical placements might help us to better understand the value of incorporating this pedagogy into medical curricula, in the hope that this could enhance medical student belonging during clinical placements.

The aim of this study was to explore medical students’ experience of co-creation of learning resources within the clinical environment.

We received ethical approval from the University of Edinburgh Medical Education Ethics Committee – reference number 2022/27. All participants gave written consent for data collection, data analysis and the publication of anonymised results. Participants were able to leave the study at any time without giving a reason.

Study design

This constructivist study used interpretative phenomenology, which is a methodology devoted to understanding how people make sense of experiences within their lives [ 33 , 34 ]. It is committed to detailed inquiry of each case, in its own right, in a particular context, which forms a thorough and systematic analysis [ 35 ]. The data is considered at multiple levels and stages, within an interpretative ebb and flow, in interaction with the researcher [ 36 ]. Interpretative phenomenology has particular utility when the topic in question is relatively under-researched and is related to self, identity and meaning-making [ 37 ].

Inherent in this methodology is the belief that to gain an understanding of the participants’ lived experience, rigorous interpretative work is required by the researcher. It requires the researcher to become aware of their pre-conceptions, born of their own experience, to prioritise the participants’ being-in-the world. However, there is acceptance that these pre-conceptions cannot be bracketed and hence the researcher takes a dynamic and active role [ 35 ]. We employed reflexive notes throughout the process, to continuously and cyclically re-examine the interpretation of the data to ensure the participant voice was prioritized throughout the hermeneutic cycle.

We conducted this study in the context of the primary medical degree at the University of Edinburgh in Scotland, United Kingdom. During their penultimate year, medical students undertake five-week long placements within varied clinical areas, including paediatrics. Within the tertiary paediatric hospital in Edinburgh, a monthly learning bulletin in the Acute Receiving Unit is curated by a group of paediatric trainees (residents). This resource includes key contemporaneous and condensed ‘learning points’, and signposting to further resources. It is shared via email with the entire medical paediatric team, from medical students to consultants (attendings). Paediatric trainees volunteer to be part of the five-member education team collating the learning bulletin resource. Student numbers were approximately matched to that of the paediatric trainees, by hosting two groups, asynchronously in order to provide a balance of voices from each group i.e. five specialist trainees, five students and author VIR. Further details are contained within [Additional File S1 ].

Participant recruitment

Between November 2022 and January 2023, we used a purposive sampling strategy to recruit a homogenous participant group (in keeping with interpretative phenomenology methodology), all of whom were fifth-year University of Edinburgh medical students. Students were approached by author VIR during an introductory session to their paediatric clinical placement. The entire cohort, of 50 students, was informed about the study and, after having the opportunity to reflect on written information, those who wished to join the team as co-creators indicated their interest. Students were not expected to immediately indicate their interest, but were asked to contact the author via email, if they wished to participate. At the introductory session, the cohort was reassured that not participating in the study was equally acceptable, and were also informed that any co-created learning resources would be shared with the entire cohort.

Data collection

Following their five-week placement, author VIR conducted individual semi-structured interviews regarding participants’ experiences of co-creation in the clinical learning environment. Interviews were informed by the interview guide [Additional File S2 ], but participants were able to talk in detail about their experiences and what was pertinent to them. Participants were encouraged to keep reflective diaries, which were informed by a set of co-created reflective questions [Additional File S3 ] and some participants referred to these during their interviews. Interviews were audio recorded, transcribed verbatim and data was kept confidential.

Data analysis

We employed interpretative phenomenological analysis (IPA) of the transcribed interview data, following a four-stage process [ 35 ] [Fig. 1 ].

Following stage four [Fig.  1 ], author VIR developed the GETs into an analytic summary which was supported by quotes from each participant. VIR conducted this process with all participants, whilst VRT, SES, and SRH reviewed and audited the themes to ensure that they were grounded in the transcripts and accurately represented an interpretation of the participants’ experiences. All authors were involved in data interpretation and analysis.

Four stage process of interpretative phenomenological analysis [ 35 ]. Table adapted from prose in Interpretative Phenomenological Analysis: Theory, Method and Research (Smith, Flowers, Larkin (2022))

Personal and interpersonal reflexivity

Reflexive processes enabled the authors to be mindful of their worldviews and their influence on the research process. The authors hope that this reflexivity statement will enable the reader to understand how this work may align (or not) with their own beliefs, and hence the utility of the work to them. All team members are educators and researchers, and our prior research regarding identity formation [ 38 ], social relationships and integration [ 39 , 40 ] are likely to have influenced themes felt to be most pertinent. Author VIR is employed as a medical education fellow by the National Health Service in Lothian (Edinburgh). A part of her job role is to support education within clinical learning environments but she does not hold responsibility for any University of Edinburgh assessment processes. VIR has the personal belief that exclusively hierarchical clinical learning environments hamper students belonging and hence learning experiences. Therefore, she believes she has a responsibility to create learning spaces for all voices to be valued [ 41 ] Additionally, she believes a competency based primary medical degree encourages enculturation of students and consequentially creates limited space for students’ own values and beliefs to be expressed. Furthermore, she believes this stifles creativity, and has a negative impact on wellbeing. Ultimately, she believes in the inherent power of personal and collective learning, which may be unlocked within a co-created learning relationship, and this has been further enhanced by becoming a co-creator of this work.

Nine students agreed to participate. The sample size is normative for IPA, where emphasis is placed on the detailed analysis of each case and not the total case number [ 35 , 42 ]. IPA studies commonly have fewer than 10 participants, in order to enable researchers to undertake the detailed analysis required and uphold the idiographic focus [ 43 , 44 ]. Participants were aged between 21 and 24; six identified as female, two as male and one declined to categorise their gender identity. They had no prior experience of co-creation in the clinical learning environment. Interviews were approximately half an hour in length.

We identified three major themes: identity maturation; learning community; and workplace integration. The major themes, their associated sub-themes, and the relevant interconnections are depicted in Fig.  2 .

Themes and sub-themes connected across three spheres; self, co-created learning community and workplace. Interconnections between self (purple), a newly co-created learning community (blue), and the workplace (orange) are depicted within and between three spheres. Identity maturation as a professional, teacher and lifelong learner spanned all three spheres, as illustrated by the arrow moving out from the self sphere into the learning community and workplace. Interdependent learning occurred between individuals in the newly co-created learning community, represented as connecting the self sphere to the learning community sphere. Vicarious learning involved bi-directional interaction between the learning community and workplace and is hence situated between those two spheres. Behavioural congruence and attitudinal shift were found within the workplace, and are represented on the border of the workplace sphere

Identity maturation

Co-creation moulded how students perceived themselves in the world. Maturation was observed across a variety of their identities. Within the group experiential theme of identity maturation, we describe how the students’ views of themselves evolved as professionals; as teachers; and as lifelong learners.

Self as a professional

Co-creation acted as a gateway to identifying as a professional. Participants felt that they were not yet professionals, but actively sought opportunities to act in a professional role, and were grateful for the chance to do so:

“I’ve learned a lot. Not just in terms of academic content but more as in how you work in a group as a professional…that I probably haven’t done at university yet. [To] get a feel of how you work in a team or something creative as a professional was really good.” (Student 3)

They were motivated to become co-creators by “ trying to get somewhere now.” (Student 5) Students felt they hadn’t experienced working authentically in a professional team and they were palpably relieved to have this opportunity:

“ To collaborate …and know that …when you put your minds together you can get things done … is reassuring.” (Student 8)

The experience was analogous to working as a doctor, due to the development of the professional skills of negotiation, uncertainty tolerance and critical thinking:

“ Navigating through it [uncertainty], is one of the biggest challenges for new doctors. [The] co-creation project might be [a] nice segue in to this space [first-year doctor]. I will be better prepared thanks to this project.” (Student 1)

Self as a teacher

Students were able to participate by becoming a teacher of the teachers, which represented a new role within the clinical learning environment. It encouraged deep engagement and was described as a “ really good way to enhance your learning even more .” (Student 2) They also articulated that becoming a teacher of teachers felt like a courageous act, stepping away from the expected norms of a medical student:

“[This was an] opportunity to teach against the gradient of the traditional hierarchy of seniority and step outside of the comfort zone.” (Student 9)

They described the process of embodying the duality of being a learner, as well as a teacher:

“[To know] what people might like to know about or what are interesting things we’re learning and what knowledge you’d like to share with other people, thinking about that whilst on placement was a good thing.” (Student 4)

Self as a lifelong learner

Students’ relationships with medical knowledge were changed by the experience. They moved from seeing knowledge as an entity passed from teacher to learner – a rejection of the knower and the known. Knowledge could now be viewed as, “ communal learning, and recognising that everyone’s got knowledge that other people don’t have or might not have.” ( Student 3)

Empathy for doctors, who were now also recognised as situated on the continuum of a learning journey, was developed:

“ You’re both learners and you both are wanting to learn more about certain things. And even though one might be further along than the other, you’re both still on that continuous journey of learning.” (Student 7)

In summary, participants were no longer solely learners. They identified with new and multiple identities of professional, teacher and lifelong learner.

Learning community

Students experienced a new collaborative learning community where they could support, create and learn with each other. Sub-themes included interdependence and vicarious learning.

Interdependence

All participants experienced becoming part of a new collegiate community, which was separate to, but deeply intertwined with, the clinical learning environment. This was an opportunity to connect with others, which contrasted with participants’ usual experience of isolated working during placement. This new learning space bolstered and grounded Student 1. This was a shared experience of the group, but Student 1went on to relate it to personal wellbeing:

“It was therapeutic. I was having ups and downs every day and the meeting actually helped me. It does encourage people to…come to others…rather than being in [their] own thoughts.” (Student 1)

The group unified around their shared purpose of co-creating the resource and this enhanced social cohesion:

“It feels really rewarding when you’ve all put work into something together and it comes together really nicely, that’s a nice bonding experience that you have.” (Student 7)

This type of collaboration had previously only been experienced with trusted friends, but co-creation built trust within and beyond the co-creation group:

“I think if you learn something interesting it’s nice to be able to share it with people. And usually… with my friend, if you learn something and you’re like, oh that was really cool and we’ll tell each other… But to… then be asked to tell more people .” (Student 4)

Participants had an interdependent learning experience which was born from trust and generated collaborative purpose.

Vicarious learning

Students recognised the importance of social learning during the process of creating a new resource together. Enhanced equity of exposure to learning was possible by making visible individual clinical experiences, which were transmitted via the group:

“ I felt like I was able to…get a broader experience…that I wouldn’t have necessarily got.” (Student 6)

Vicarious learning was a reciprocal process with new insights also taken back out into the clinical learning environment:

“ In the first couple of weeks it just made me a bit more alert and then the weeks after that, I just found it really interesting to see the themes, that we as a group, had thought would be useful, to see how they were visible. Even though it’s someone else that had observed them, once they’d started looking for them, I could also see them [in the clinical learning environment].” (Student 3)

“Open conversations” (Student 5) were central to the process of vicarious learning. The conversations created a stimulus for individual reflection:

“Thinking about those things that other people had said, those concepts, I’ve definitely reflected on those things a lot more whilst I was on placement.” (Student 4)

Via these tools, the group came to find coherence by working through the creative process together:

“I think if we’d known from the beginning exactly what we were doing, that would have made it easier. But then I also think that… no-one know[s] what we were doing right at the beginning and that’s part of it, isn’t it, figuring out what it is we want… how we want to be involved and what it is that we can do.” (Student 4)

In summary, a supportive and interdependent learning community was established through multiple interrelated social and creative processes, where students worked out how they could best contribute. A sense of belonging was nurtured, as students felt they mattered, were seen and were respected within a community they were equally responsible for building.

Workplace integration

The support found within the third space learning community, as well as the maturation of their identities, allowed the participants to experience a challenge to their existing worldview. Consequently, integration into the workplace occurred in a new way which was enacted by participants in two ways: behavioural congruence and attitudinal shift.

Behavioural congruence

Student’s behaviours found more alignment with their personal values. They felt more able to “speak back and share” (Student 6) with consultants (attendings) and paediatric trainees. There was a growing reciprocity with these staff groups as a result:

“ It’s just a bit of a snowball, I think. Once you start asking people questions and speaking to them, they’ll respond better to you. ” (Student 3)

Listening more, driven by the responsibility to co-create the learning bulletin, also contributed to this reciprocity:

“I think having two-way conversations … when things are less clear it’s interesting to have your ear to the ground, about those kinds of conversations.” (Student 5)

Speaking up was mediated by the social capital garnered by being part of the co-creation project:

“[ Co-creation] gave me something to talk about which can …be really helpful…, when you feel like you might not have a lot of common ground with someone.” (Student 6)

Consultants (attendings) and paediatric trainees could not always be relied upon to support learning processes due to clinical workloads, which left students feeling lost and consequentially unproductive, which was incongruent with their values:

“Especially at the beginning of the block, you do feel a bit purposeless. You are very much just standing in a corner waiting for someone to look out for you.” (Student 3)

Co-creation changed this feeling of being lost and they took initiative:

“ I wondered, does it happen often [a clinical event], even though I wasn’t directly involved, [co-creating] made me feel like I was getting something out of being at placement. Whereas, before [co-creation], I would have just been like, oh I’ve sat for an hour and no one’s looked at me.” (Student 3)

Attitudinal shift

Participants’ attitudes towards the clinical learning environment became more positive as result of co-creation. This mentality shift resulted in enhanced motivation, driven by increased agency. Medical student positionality and associated value was changed:

“ I think with co-creation, because it makes you, as a medical student feel valued and feel like the work that you do and the input that you have does make a difference, and people are willing to listen to you, and you do have something to offer to the team.” (Student 7)

Students conceptualised the inclusivity of co-created learning as representative of the values of the workplace:

“ It made me feel more positively about the kind of people that I was going to be around signall[ing] to me that it wasn’t going to be a horribly hierarchical five weeks ” and, “ [it] was just a signifier that it was a more open and responsive department.” (Student 3)

However, it was perhaps only an adjunct, reinforcing those values, when teams were already inclusive:

“ It felt like a really inclusive team, which was a lot nicer than some of my past experiences, so I think the co-creation made it feel even more inclusive and made it feel like I’m more part of the team.” (Student 7)

Co-creation was also related to the experience of users interacting with the health service:

“Lots of negative experiences [of patients] are borne out of feeling misunderstood or not respected, [co-creation] seems like a good way of starting to dismantle that because you are breaking down barriers and hierarchies that can feel really trapping.” (Student 6)

In summary, the medical students experienced co-creation as a tool to support them to belong as themselves in the workplace. Across all themes, participants felt empowered by new, freeing and useful ways of being, with novel roles and symbiotic ways of connecting with others. Within this theme, participants shared how co-creation explicitly signalled to them the value they could bring, which was interpretated as them developing a sense of relational belonging.

This study explored participating medical students’ experiences of co-creating a learning bulletin, as an activity involving authentic professional team working. The co-created learning and teaching activity in the curriculum created a platform for a co-created learning community and shaped identity maturation along with new workplace behaviours and attitudes.

Within the self-sphere, students were given an invitation to embody a powerful new identity as a teacher of teachers (providing learning to those who also teach the students). Identity maturation is related to the developmental concept of self-authorship. Self-authorship is “the capacity of an individual to define a coherent internal belief system” and utilise this within relationships, decisions and actions [ 45 ]. Self-authorship is defined in three dimensions: cognitive, intrapersonal and interpersonal [ 46 ]. It applies to the co-creation experience because we observed students developing self-authorship in the cognitive dimension (adjustment of their epistemic expectations) [ 47 ], the intrapersonal dimension (different ways of being a medical student which were congruent with their personal values) and the interpersonal dimension (relationships with peers and staff were constructed and perceived differently). The self-authoring process was a vehicle for them to be empowered to belong as themselves, known as ‘relational being’ [ 6 ]. The ability of co-creation experiences to aid self-authorship has been observed in higher education students’ co-creation of curriculum [ 48 ], but has not previously been described in medical students engaged in a short co-creation learning and teaching activity. Becoming self-authored, via a crossroad experience such as this, is important for future healthcare professionals who will be navigating a progressively complex healthcare landscape [ 46 ].

As newly valued, increasingly self-authored beings, students were able to build social connections within the learning community and workplace spheres. Previous work on social integration divides such connections into bonds (those with shared identities) and bridges (those with different identities) [ 49 ]. Participants in our study formed bonds within the co-created learning group. As a result, they then formed bridges out into the workplace [ 49 , 50 ]. This new learning network was co-regulatory and vicarious [ 51 , 52 ] in nature and responds to the need to re-examine how we support student connection, which is critical to wellbeing [ 53 ]. Within this exploration, interconnectivity across the three spheres (self, learning community and workplace), showcased how social integration and belonging intersect. Hence, promotion of a post-humanism view, which considers students within a learning ecology, in contrast to prevailing transactional competitive individualism is encouraged [ 6 ]. Integration between internal and external influences has been related to professional identity formation via social cognitive theory [ 54 ]. Co-created bidirectional learning relationships and new networks are waiting to be utilised by medical educators, to encourage all students to integrate, and hence foster a learning ecology where everyone can ‘ be’ and participate meaningfully.

Strengths and limitations

IPA offered a unique opportunity for an in-depth examination of how medical students learn whilst participating in co-creating a learning resource [ 55 ]. As with other constructivist methodologies, findings may be transferable (to some contexts), but are not generalizable (to all contexts) [ 56 , 57 ]. The use of reflective diaries alongside interviews was beneficial as it encouraged participants to reflect prior to sharing their experiences. VIR was the interviewer, as well as a co-creator, which built relational trust with the participants prior to interview and gave her an ‘insider’ view. Given this, authors VRT, SES, SRH, who did not have a learning relationship with the participants, were utilised to independently verify the findings. However, the learning relationship with author VIR may have influenced what the participants chose to share about their experience, as they may have wished to express gratitude for their inclusion and VIR’s time and effort. This may have resulted in negative facets of their experience remaining undisclosed. Perceptions of existing power relations, in the clinical learning environment may have also been a mediating influence both on student experience, as well as how they felt able to share their experiences.

Further research

It would be beneficial to understand the experience of medical students, within the cohort, who did not participate. Specifically, it would be important to understand whether the results of this study were transferable to non-participating students, who were aware of co-creation occurring in their learning environment. We would be interested to understand what factors determine students’ decisions to become co-creators, as well as directing further research towards developing our understanding of how co-creation can be inclusive for all, not just some learners. Furthermore, we are interested to understand whether there was sustained impact on identity maturation, behaviours and attitudes via self-authoring and social integration bond and bridge-building. Co-production of research with medical students is likely to be a powerful tool to develop a more nuanced understanding.

Medical students in this study described experiences of identity maturation as professionals, teachers and as lifelong learners. They also co-created a new learning community, involving internal bonds and bridges out into workplace. This study lends support to the notion that co-creation may have the power to transform medical students’ experience of belonging, and may deliver meaningful learning experiences. Medical educators should consider enabling co-creation opportunities within their curricula, to promote students’ self-authorship and embodiment of helpful new professional identities.

Data availability

The datasets used and/or analysed during the current study are not publicly available, as participants did not consent to this, but are available from the corresponding author on reasonable request, if additional consent sought and gained from participants.

Abbreviations

Interpretative phenomenological analysis

Personal Experiential Themes

Group Experiential Themes

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Acknowledgements

We are grateful for the contribution of participating medical students in this study, who became co-creators. We would sincerely like to thank them. We would also like to acknowledge the paediatric trainees who were co-creators alongside our students. We would like to thank Dr Jay Shetty for his support of this work, via his role as Child Life and Health module organiser for The University of Edinburgh.

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VIR conceptualised and designed the study; acquired, analysed and interpreted data, and wrote the original draft of the manuscript, including preparing Figs.  1 and 2 . SRH analysed and interpreted data and substantively revised the manuscript. SES conceptualised and designed the study; analysed and interpreted data, and substantively revised the manuscript. VRT conceptualised and designed the study; analysed and interpreted data, and substantively revised the manuscript. All authors read and approved the final manuscript.

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Rae, V.I., Smith, S.E., Hopkins, S.R. et al. From corners to community: exploring medical students’ sense of belonging through co-creation in clinical learning. BMC Med Educ 24 , 474 (2024). https://doi.org/10.1186/s12909-024-05413-2

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Academic stress is the most common mental state that medical students experience during their training period. To assess academic stress, to find out its determinants, to assess other sources of stress and to explore the various coping styles against academic stress adopted by students. Methods: It was a cross sectional study done among medical students from first to fourth year. Standard self-administered questionnaires were used to assess academic stress and coping behaviour. Mean age of the 400 participants was 20.3 ± 1.5 years. 166(41.5%) of them were males. The academic stress was found to be of mild, moderate and severe level among 68(17%), 309(77.3%) and 23(5.7%) participants respectively. Overall coping with stress was found to be poor, average and good among 15(3.8%), 380(95%) and 5(1.2%) participants respectively. Passive emotional ( p  = 0.054) and passive problem ( p  = 0.001) coping behaviours were significantly better among males. Active problem coping behaviour ( p  = 0.007) was significantly better among females. Active emotional coping behaviour did not vary significantly between genders ( p  = 0.54). Majority of the students preferred sharing their personal problems with parents 211(52.7%) followed by friends 202(50.5%). Binary logistic regression analysis found worrying about future ( p  = 0.023) and poor self-esteem ( p  = 0.026) to be independently associated with academic stress. Academic stress although a common finding among students, the coping style to deal with it, was good only in a few. The coping behaviours were not satisfactory particularly among male participants. This along with other determinants of academic stress identified in this study need to be addressed during counselling sessions.

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Introduction

Academic stress has been reported to be the most common mental state that medical students experience during their training period (Ramli et al. 2018 ). It is on the rise among them probably due to increasing course requirements (Ramli et al. 2018 ; Drolet and Rodgers 2010 ). Kumaraswamy ( 2013 ) observed that the issues known to precipitate academic stress were excessive assignments, peer competition, examinations and problems related to time management. University students, for the life phase they are going through, also have to deal with many other stresses such as detachment from the family, building of self-identity and issues concerning adolescence period and those in relation to student-workers. The stress of the medical student is also connected to the relationship with the patient in the clinical period.

Some amount of academic stress is beneficial as it brings about healthy competition with peer group, promotes learning and helps to excel in academics (Malathi and Damodaran 1999 ; Afolayan et al. 2013 ). Lumley and Provenzano ( 2003 ) however reported that, excess of academic stress adversely affects academic performance, class attendance and psychological well-being of students. If it is not identified early and managed, it can cause depression, anxiety, behavioural problems, irritability, social withdrawal and physical illnesses (Adiele et al. 2018 ; Deb et al. 2015 ; Verma et al. 2002 ; Chen et al. 2013 ).

In addition to assessment of academic stress among under graduate medical students, it is also essential to analyze the various stress coping mechanisms adopted by them. This will help researchers in suggesting appropriate intervention strategies for the benefit of the students. Students in turn can educate their patients in future to identify stress and suggest measures to deal with it.

Previous studies have reported that medical students used active coping mechanisms (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ; Gade et al. 2014 ; Abouammoh et al. 2020 ), positive reframing (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ), planning (Chawla and Sachdeva 2018 ; Wu et al. 2018 ), positive reappraisal (Wu et al. 2018 ), emotional support (Chawla and Sachdeva 2018 ; Gade et al. 2014 ), peer discussions (Oku et al. 2015 ) and acceptance (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ) as means for coping stress. There were minimal reports of usage of avoidance strategies for coping stress among medical students (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ).

Royal College of Psychiatrists ( 2011 ) reported that students with secure attachments to family and those residing in a supportive community are in a better position to handle stress. Therefore assessment of various determinants of academic stress is essential to frame most suitable remedial measures for the benefit of the affected. This study was hence done to assess academic stress, to find out its determinants, to assess other sources of stress and to explore the various coping styles adopted by medical students to deal with academic stress in a coastal city in south India.

Materials and Methods

This cross sectional study was conducted in the month of March 2018 at a private medical college in Mangalore. The institutional ethics committee approval was taken before the commencement of the study. Permission to conduct the study was taken from the Dean. Sample size of 364 participants was calculated at 95% confidence intervals (CI), 90% power and the proportion of medical students with average level of academic stress taken as 51.4% based on the findings of Mostafavian et al. ( 2018 ). A non-response rate of 10% was added to arrive at the final sample size which was calculated as 400 participants. A total of 100 students of Bachelor of Medicine and Bachelor of Surgery course from first year to fourth year were therefore chosen to participate in this study using simple random sampling method.

The students were briefed about academic stress and the objectives of this study, in the classroom setting, and written informed consent was taken for their participation. In order to maintain anonymity, the filled in consent form were first collected back from the participants. Later the questionnaires were distributed by the investigators. It was a semi-structured questionnaire containing both closed and open ended questions. It was pre-tested in a group of ten students before its use in the current study. No changes in the questionnaire resulted following the pre-testing and the data collected in this phase were not included in the final study.

Data Collection Tools

Academic stress was assessed using the academic stress inventory tool for university students prepared by Lin and Chen ( 2009 ). They had reported the alpha value of Cronbach’s reliability test for this questionnaire as 0.90. The questionnaire was slightly modified during the content validation phase in this study to incorporate questions on career related issues along with few other minor changes. This questionnaire contained 35 items which were designed in a five point Likert scale. The responses in the scale were “completely disagree,” “disagree,” “neutral,” “agree,” and “completely agree”, with scores ranging from one to five points respectively. Cumulative scores ranging from 35 to 81, 82 to 128 and 129 to 175 were considered as mild, moderate and severe levels of academic stress respectively.

The coping techniques employed by the respondents was assessed using the academic stress coping style inventory developed by Lin and Chen ( 2010 ). The Cronbach’s alpha value of internal consistency for the stress coping style questionnaires was reported by them to be 0.83. It was shortened during the content validation phase to result in 25 questions designed again in Likert’s five-point scale. Scores were ranging from 5 for “completely agree” to 1 for “completely disagree”. Overall coping with stress was rated as poorly adoptive when cumulative score of the participant ranged from 25 to 58, average when it was 59 to 92 and good when it was 93 to 125.

Coping behaviour were grouped as active emotional coping, active problem coping, passive emotional coping and passive problem coping behaviours. Active emotional coping behaviour involved individuals adopting the attitude of emotional adjustment like positive thinking emotions and self-encouragement, when faced with academic stress. Active problem coping behaviour involved dealing academic stress by focussing at the centre of the problem and finding a solution themselves by being calm and optimistic or by searching assistance from external sources. Passive emotional coping behaviour involved constraining emotions, self-accusation, getting angry, blaming others or God or by giving up. Passive problem coping behaviour involved procrastinations, evasive behaviours or going into alcohol or drug abuse while facing academic stress (Lin and Chen 2010 ).

The overall alpha value of Cronbach’s reliability test for the academic stress and coping style inventory questionnaire used in this study was calculated to be 0.901, indicating excellent reliability.

Statistical Analysis

The data entry and analysis were done using IBM SPSS for Windows version 25.0, Armonk, New York. Statistical tests like Chi square test, Fisher’s exact test, Student’s unpaired t test and Karl Pearson’s coefficient of correlation were used for analysis. All the determinants of academic stress significant at 0.15 level were placed in the multivariable model. Backward stepwise elimination procedure was done to identify the independent determinants of academic stress in the model at the last step. p value 0.05 or less was used as the criterion for significance.

A total of 400 students participated in this study and all of them gave satisfactorily filled forms. Their mean age was 20.3 ± 1.5 years and median age was 20 years with an Inter Quartile Range (19, 22) years. As many as 166(41.5%) of them were males. Out of the total participants, 45(11.2%) were local residents, 51(12.8%) were outsiders but within the same state, 262(65.5%) were from other states within India, 35(8.8%) were non-residential Indians and the rest 7(1.7%) were foreigners. Medium of schooling among 388(97%) students was English.

Among the participants, 67(16.7%) were currently staying at their home or rented apartment while the rest 333(83.3%) were staying in the hostels or were staying as paying guests. Majority of them [228(57%)] were staying with their friends. Among others, 118(29.5%) were staying alone, 46(11.5%) with their parents, 7(1.8%) with their relatives and one with her elder sibling.

With respect to lifestyle habits, majority of the participants [249(62.2%)] went to college by walk, and majority [339(84.7%)] slept for 6 to 8 h on an average per day. (Table 1 ).

Sources of Stress among Participants

Majority of students either agreed or strongly agreed that some teachers provided so much of academic information, making it difficult for students to assimilate knowledge [177(44.2%)]. Fear of failure in the exams was the other major cause of academic stress [206(51.5%)]. (Table 2 ).

Majority of students either agreed or strongly agreed that by missing few lectures, they felt anxious about falling short of attendance towards the end [204(51%)]. They also regretted having wasted time set apart for studies [240(60%)]. (Table 3 ).

Overall the level of academic stress was found to be mild among 68(17%), moderate among 309(77.3%) and severe among 23(5.7%) participants. The mean academic stress score was found to be 100.6 ± 19.7. Gender wise variation in academic stress levels was noticed. It was of mild, moderate and severe level among 29(17.5%), 129(77.7%) and 8(4.8%) males and among 39(16.7%), 180(76.9%) and 15(6.4%) females respectively (X 2  = 0.472, p  = 0.79).

The other non-academic sources of stress reported by participants were lack of sufficient vacations [130(32.5%)], staying away from family [103(25.7%)], worrying about future [70(17.5%)], low self-esteem [52(13%)], having trouble with friends 39(9.7%)], facing financial difficulties [33(8.2%)], interpersonal conflicts [28(16.7%)], conflicts with roommates [26(6.5%)], issues with partners [23(5.8%)], sleeping disorders [21(5.2%)], transportation problems [20(5%)], problems in the family [18(4.5%)], searching a partner [17(4.2%)] and lack of parental support [5(1.2%)].

14(3.5%) participants had underlying chronic morbidities. These morbidities were allergic rhinitis among 3, migraine among 3, polycystic ovarian disease among 3, menorrhagia among 2 and allergy, peptic ulcer, hypothyroidism, and impaired glucose tolerance in one student each.

Coping Strategies Adopted by Participants

Majority of the participants [294(73.5%)] either agreed or strongly agreed that they tried to think or do something, that would make them feel happier and relaxed when they were stressed. (Table 4 ).

Overall coping with stress was found to be poor among 15(3.8%), average among 380(95%) and good among 5(1.2%) participants.

The mean coping with stress score was 75.2 ± 9.2. The mean score of various coping behaviours like active emotional coping (items 1 to 6), active problem coping (items 14 to 18), passive emotional coping (items 7 to 13) and passive problem coping (items 19 to 25) were found to be 21.7 ± 3.4, 13.2 ± 2.7, 18.6 ± 4.6 and 18.3 ± 4.2 respectively. (Table 4 ).

Mean active emotional coping score among males ( n  = 166) was 21.5 ± 3.5 and among females ( n  = 234) was 21.8 ± 3.3 (t = 0.613, p  = 0.54). Mean passive emotional coping score among males (n = 166) was 19.1 ± 5.0 and among females (n = 234) was 18.2 ± 4.1 (t = 1.933, p  = 0.054). Mean active problem coping score among males (n = 166) was 12.8 ± 2.8 and among females (n = 234) was 13.5 ± 2.5 (t = 2.711, p  = 0.007). Mean passive problem coping score among males (n = 166) was 19.1 ± 4.4 and among females (n = 234) was 17.7 ± 3.9 (t = 3.412, p  = 0.001).

The various measures adopted by participants to deal with stress were sharing problems with others [223(56.2%)], meditation [132(56.8%)], performing yoga [50(12.8%)], sleeping [29(7.5%)], practicing Tai Chi [13(3.5%)] and listening to music [11(3%)]. Other methods like watching television and exercising were reported by 8(2.2%) participants each, aromatherapy and sports by 5(1.3%) each, eating favourite food and consuming alcohol by two each and browsing through the internet by one participant.

Majority of the students preferred sharing their personal problems with parents 211(52.7%), followed by friends 202(50.5%), siblings 71(17.7%) and others 26(6.5%).

Eight(2%) participants reported using medications for the management of stress. One of them had taken Lorazepam tablets while another Sertraline tablets. The rest of them did not specify the medications.

Reasons like lack of sufficient vacations and worrying about future were found to have highly significant association with academic stress among participants ( p  ≤ 0.001). (Table 5 ).

Coping with stress was average/good among 328(98.8%) participants with moderate/severe levels of academic stress in comparison to 57(83.8%) with mild level of academic stress ( p  < 0.00001).

Similarly correlation of academic stress scores with stress coping scores was found to be significant (r = 0.467, p  < 0.001). Also correlation between academic stress scores with passive emotional (r = 0.513, p < 0.001) and passive problem (r = 0.401, p < 0.001) coping behaviours were found to be significant. However academic stress was not significantly correlated with active emotional (r = − 0.036, p  = 0.468) and active problem (r = 0.072, p  = 0.149) coping behaviours.

Binary logistic regression analysis found worrying about future ( p  = 0.023) and poor self-esteem ( p  = 0.026) among participants to be significantly associated with academic stress after adjusting the confounding effect of other variables in the model. (Table 6 ).

For calculating unadjusted Odds Ratio and 95% CI, participants staying with friends/alone were compared with those staying with parents/siblings/relatives (reference value), participants reporting speed of internet connection at place of stay as average/poor were compared with those reporting good connectivity (reference value).

An interesting fact about this study was that the response rate was total. This supports the importance of this study which addresses a felt need of every medical student.

Academic stress of moderate to severe level were reported among 83% participants in this study. In other studies done among medical students, academic stress was reported among 50% (Dyrbye et al. 2008 ), 53% (Bamuhair et al. 2015 ), 61% (Zamroni et al. 2018 ) and 74.6% (Mostafavian et al. 2018 ) participants. Academic stress among university students of other courses were reported among 48.8% (Reddy et al. 2018 ), 70.7% (Sharififard et al. 2014 ) and 73% (Adiele et al. 2018 ) participants. From these comparisons, it was obvious that academic stress was high among the participants in this study probably because of cultural factors.

There was no association between academic stress and gender of participants in this study as also reported by Mostafavian et al. ( 2018 ) and Zamroni et al. ( 2018 ). However several other studies done among university students reported females to have significantly greater academic stress than males (Adiele et al. 2018 ; Bamuhair et al. 2015 ; Reddy et al. 2018 ; Al-Sowygh et al. 2013 ).

Academic stress was found to be more among medical students in the first year (Nakalema and Ssenyonga 2014 ; Abdulghani 2008 ) or in the final year (Bamuhair et al. 2015 ). This was in contrast to the findings in this study were no such association was observed.

Place of residence was not associated with academic stress in this study and also in the study done among medical students in Iran by Mostafavian et al. ( 2018 ).

Academic stress in the present study was found to be least among participants who were staying with their parents, siblings or relatives. This may be because, number of students at this setting are outsiders. Studying over here, might also be their first occasion of moving out of their home environment. They therefore may be lacking their previously learnt support system such as banking on their family members and childhood friends during difficult times, as also observed by Kumar and Nancy ( 2011 ). They now have to find solutions to various problems by themselves, or by being dependent looking out for newer social contacts. If they were staying with their family members, perhaps they might have received the necessary emotional support during examinations and other stressful situations. The other benefits like getting hygienic food, good living conditions and people to take care of one’s health would have been best when family members were around. The observations in this study were however contradicting the observation of Mostafavian et al. ( 2018 ) who observed that the academic stress was significantly more among those living at their houses compared to those at dormitories.

As many as 60% participants regretted having wasted time set apart for their studies. Poor time management was found to be associated with academic stress by other researchers too (Misra and McKean 2000 ; Macan et al. 1990 ). Good time management skills involves prioritization of activities and judicious usage of time available for organization of the tasks to be completed. Time management was found to determine academic performance by Misra and McKean ( 2000 ). Moreover those with sound time management behaviour were found to have fewer psychological and physical symptoms related to stress (Misra and McKean 2000 ; Macan et al. 1990 ). Lammers et al. ( 2001 ) reported that close to half of the students had notable weaknesses in their time management skills.

Fear of failure in exams and falling short of attendance towards the end were the reasons for academic stress among more than half the participants in this study. Teachers can play an important role in alleviating examination related fears and anxieties by conducting frequent mock examinations (Sharma et al. 2011 ). Meeting individual students’ needs (Aherne et al. 2016 ), to find out the reason for missing classes, time scheduling of activities and providing constructive feedback to students (Sharma et al. 2016 ) are the other recommended strategies advised by previous researchers. Abouserie ( 1994 ) stated that the amount of guidance and support offered by teachers would be a key factor in determining the stress levels of students in any institution. Students themselves have opined that social support from teachers and peer groups, consulting services, and various extracurricular activities are the most useful strategies to deal with stress (Chang et al. 2012 ). As opined by the student community themselves, every institution need to offer them psychotherapy sessions, trainings for reducing emotional tension and opportunities to improve social intelligence (Ruzhenkov et al. 2016 ).

Issues like worrying about future and poor self-esteem among participants in this study were significantly associated with academic stress in the multivariable analysis model. These problems may be related to issues like concern about clearing the increasingly competitive entrance exams and also about the fear of them not being able to pursue the specialty of their choice in future. To address such sensitive problems, there is a need of the placement of a professional counsellor at various professional colleges. Pressley and McCormick ( 1995 ) also suggested that the learning environment within classrooms should be non-competitive, collaborative and task-oriented and not performance oriented, so as to create a stress free learning environment.

Having said this, the course work at medical schools should not be too light either. Kanter ( 2008 ) suggested that this approach can affect the quality of education. Rather students need to be trained in the right way to directly solve the problems related to academic stress by themselves being a part of a self-help program (Chen et al. 2013 ; Aherne et al. 2016 ).

The various sources of academic stress among medical students listed in other studies were, vastness of curriculum as reported by 61.6% (Anuradha et al. 2017 ), 82.2% (Bamuhair et al. 2015 ), and 82.3% (Oku et al. 2015 ), fear of failure in examination by 61.8% (Anuradha et al. 2017 ), frequency of examination by 52.2% (Anuradha et al. 2017 ), lack of recreation and inadequate holidays by 51.8% (Anuradha et al. 2017 ) and by 76.4% (Oku et al. 2015 ), sleep related problems by 64.3% (Bamuhair et al. 2015 ), worrying about future by 78.2% (Bamuhair et al. 2015 ), family problems by 54% (Bamuhair et al. 2015 ), interpersonal conflicts by 57.1% (Bamuhair et al. 2015 ), low self-esteem by 51.7% (Bamuhair et al. 2015 ) and transportation problems by 56.2% participants (Bamuhair et al. 2015 ).

Coping with stress was found to be average among 95% participants in the present study. Almost three-fourth of the participants in the present study tried to think or do something that would make them feel happier and relaxed when they were stressed. Coping methods commonly used by students in previous studies were effective time management, sharing of problems, planned problem solving, going out with friends, social support, meditation and getting adequate sleep. Even emotion-based strategies to cope stress like self-blaming and taking self-responsibility have been reported (Wolf 1994 ; Supe 1998 ; Stern et al. 1993 ; Redhwan et al. 2009 ).

Coping with stress in this study was better among participants with higher levels of academic stress which was similarly observed among Saudi Arabian medical students by Bamuhair et al. ( 2015 ). This suggests that students who perceived greater academic stress where in a position to apply coping strategies against it in a much better way. However the significant correlation between academic stress scores and passive emotional and passive problem scores indicates that the coping behaviour adopted by participants to deal with stress was not satisfactory. Therefore counselling the participants to adopt active coping behaviours is very essential at this setting. In a study done in Ghana by Atindanbila and Abasimi ( 2011 ), wrong or inadequate coping strategies were practiced by university students resulting in reduction of academic stress by mere 4%. Bamuhair et al. ( 2015 ) observed that 32.1% medical students felt too often that, they could not cope with stress. Therefore coping strategies against academic stress among university students in other parts of the world was not satisfactory either. The coping strategies adopted are generally found to vary depending on socio-cultural factors like region, social group, gender, age, and by individuals’ previous experiences as per the WHO/EHA ( 1998 ).

Passive emotional and problem coping behaviours were significantly more among males. This meant that males adopted a number of unhealthy behaviours to deal with academic stress. Unpleasant social coping behaviour was found to reduce social support and increase loneliness by Kato ( 2002 ). Felsten ( 1998 ) observed that specifically procrastination as a coping behaviour was found to result in depression in both men and women.

Female students on the other hand had significantly better active problem scores under coping behaviour. They were hence more mature and composed than the male participants in analysing the centre of the problem in a calm and optimistic manner, and in finding solutions for the same. Bamuhair et al. ( 2015 ) observed that the mean of coping strategies score was significantly higher among females. Females were also found to be better at time management compared to their male counterparts (Misra and McKean 2000 ; Khatib 2014 ). Males therefore need to be counselled about healthy coping behaviours in dealing with academic stress.

Al-Sowygh et al. ( 2013 ) observed that the denial and behaviour disengagement as stress coping strategies were reported to be significantly more among females while self-blame was reported to be more among males. Bang ( 2009 ) reported that the coping mechanism of choice is related to the differences in the roles expected from gender. Males are expected to deal stressful situations by their outward actions while females are expected to focus on emotions and seek social support. Soffer ( 2010 ) stated that women usually choose health-promoting behaviours while men prefer health-risky behaviours.

There was no association between age of participants with the perceived level of academic stress or with the level of adaptability to cope with it in this study supporting the observations of Bamuhair et al. ( 2015 ).

Limitations

This was a cross-sectional study conducted in a single medical college. Therefore the findings of this study cannot be generalized to all medical students across India.

The results of the study reflect important insights into the nature of stress faced by the medical students and the ways they deal with the same. Academic stress was found to be common and was of moderate level in more than three-fourth of the participants. Level of coping with stress was found to be average among 95% of them. Worrying about future and poor self-esteem were independently associated with academic stress among students. Male participants adopted more of unhealthy means of coping with academic stress. Therefore they need to be educated regarding the healthy coping methods. Counselling sessions and other students’ support systems need to be more organized to cater to the issues like career guidance, healthy coping behaviours, time management and to improve the self-esteem among the affected. Attention should also be paid to make the study environment in the classrooms more stress free without excessive academic load. Educating students about unpleasant consequences of stress is equally important. Teachers can also play a constructive role in mentoring and guiding students regarding choosing the right measures to cope with stress. Interactive academic sessions on stress control can further encourage medical students to single out each and every problematic issue. This would accomplish the aim of reducing the academic stress, adopting healthy academic stress coping behaviours, improving academic performance and minimizing anxiety among those with forethoughts about their future professional careers.

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Acknowledgements

We authors thank all the medical students of who took part in this study.

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This manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work.

Nitin Joseph: guarantor of this research work, design, literature search, tool preparation, manuscript preparation, revising the work critically for important intellectual content.

Aneesha Nallapati: data collection, data analysis, statistical analysis, interpretation of data, revising the work critically for important intellectual content.

Mitchelle Xavier Machado: data collection, data entry, literature search, manuscript preparation, manuscript editing, revising the work critically for important intellectual content.

Varsha Nair: concept of this study, data collection, data entry, manuscript editing, revising the work critically for important intellectual content.

Shreya Matele: data collection, literature search, manuscript editing, revising the work critically for important intellectual content.

Navya Muthusamy: data collection, literature search, manuscript editing, revising the work critically for important intellectual content.

Aditi Sinha: data collection, literature search, manuscript editing, revising the work critically for important intellectual content.

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Joseph, N., Nallapati, A., Machado, M.X. et al. Assessment of academic stress and its coping mechanisms among medical undergraduate students in a large Midwestern university. Curr Psychol 40 , 2599–2609 (2021). https://doi.org/10.1007/s12144-020-00963-2

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Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
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• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Tops & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

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15 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

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[The use of medical journals by medical students. Which medical journals are read?]

Affiliation.

• 1 Leids Universitair Medisch Centrum, afd. Klinische Epidemiologie, Leiden.
• PMID: 25970674

Objective: To investigate the role of scientific medical journals in Dutch medical curricula.

Design: Descriptive questionnaire study.

Method: In 2013, medical students (from year 3 onwards) at the Leiden University Medical Centre (LUMC), were invited to respond to an online questionnaire. They were presented with 28 multiple-choice questions and 11 statements about the use of scientific medical journals in the medical curriculum. We calculated the frequencies of the answers per question and analysed differences between medical students using two-by-two tables.

Results: The questionnaire was completed by 680 (53.0%) of 1277 invited medical students enrolled at the LUMC. Most of the respondents were those doing clinical rotations (56.6%) and 60.1% had research experience. More than half of the students read at least one scientific journal a few times per month; this percentage was 38.8% among third-year students, 49.3% among fourth-year students, 60.0% among those on clinical rotation, and was higher among students with research experience (63.3%) than among those without research experience (44.1%). Nearly 90% of students agreed with the statement that the development of academic and scientific education should take place in the bachelor's phase of medical school.

Conclusion: Medical students start to read scientific medical journals at an early phase in the medical curriculum and this increases further when students start to undertake research projects or go on clinical rotation. Medical curricula should be constructed in such a way that medical students learn to select and interpret research findings adequately for themselves before they turn to articles from scientific medical journals.

• Education, Medical, Undergraduate
• Periodicals as Topic / statistics & numerical data*
• Schools, Medical
• Students, Medical / psychology
• Students, Medical / statistics & numerical data*
• Surveys and Questionnaires

Peer support

How medical students are using social media in 2024, today, social media networks offer valuable opportunities for med students to enhance their education, writes margo winter, oms iii. she also shares some of the challenges and risks of using social media as a medical student., what's trending, margo winter, oms iii.

Student Doctor Winter is an OMS III at Midwestern University/Chicago College of Osteopathic Medicine.

In an era when social media has become an integral part of daily life for many people, the influence of social networks extends beyond sharing memes and updates on personal adventures. Particularly in the medical field, social media has emerged as a dynamic tool for medical students, offering avenues for learning, networking and professional development.

Social media platforms provide spaces for students to engage in discussions, share resources and access educational content. Hashtags like #MedEd (medical education) and #FOAMed (free open access medical education) facilitate the dissemination of journal articles, podcasts and case studies, enriching students’ learning experiences.

Below is a breakdown of how medical students are using social media to enhance their education.

Benefits and challenges

The use of social media in medical education offers numerous benefits, including learning opportunities, expanded professional networks and increased visibility within the medical community. Social media enables students to stay updated on the latest developments in health care, collaborate with peers and experts and showcase their work to potential employers. 

However, using social media also poses challenges and risks for medical students. When using social media, medical students must be mindful of privacy concerns and take care to be professional. They also need to avoid spreading and/or being taken in by misinformation. Medical students are often cautioned about the content they post online, as it can have professional implications and impact their future careers.

Many students opt to maintain separate personal and professional accounts to mitigate these risks and ensure clarity regarding their professional status. Additionally, disclosures in bios and disclaimers about the nature of their expertise help mitigate confusion among patients and followers.

Day-to-day documentation

Beyond academia, sites like Instagram provide a platform for students to document a behind-the-scenes journey through medical school, sharing insights into their experiences, challenges and triumphs. For instance, students might share details about their clinical experiences, such as struggling through a first day in a surgical operating room (OR) or navigating a challenging specialty. These posts foster a sense of community and camaraderie among medical students across the country.

Furthermore, they give premeds a window into real medical students’ lives and foster the opportunity for premeds to interact directly with current medical students.

In the same vein, mentoring is another significant aspect of medical students’ presence on social media. By offering advice on navigating the application process, preparing for exams and exploring different specialties, they play a crucial role in guiding aspiring physicians on their journey to medical school.

Especially for students with a nontraditional experience or a unique journey to medical school, these student accounts can offer valuable inspiration and advice to premeds from all over. 

Professional networking

Social media also serves as a platform where medical students can showcase their work and connect with residency programs. By sharing research projects, clinical experiences and professional achievements, they enhance their visibility and demonstrate their commitment to their chosen field. For example, students will often share photos from conferences and poster presentations using hashtags or tag industry leaders to call attention to that field of research.

Additionally, social media facilitates communication with residency programs, providing students with opportunities to explore different specialties, connect with program directors, attend virtual open houses and gain insights into the residency application process. 

Earning potential

In recent years, social media has emerged as a way for medical students to earn income through endorsements and sponsored content. Students with significant followings can leverage their platforms to promote products, events or health care initiatives, earning money in the process. Popular accounts like this include MD medical student Joel Bervell’s Instagram page. Bervell calls himself a “Medical Mythbuster” and has been featured on TV shows such as the Today Show.

While this can be a lucrative opportunity for students, it also comes with ethical considerations and the need to maintain professionalism and transparency in sponsored posts.

Opportunities abound

Social media has revolutionized the way medical students learn, collaborate and engage with the broader health care community. By leveraging these platforms responsibly and ethically, students can enhance their education, expand their professional networks and contribute meaningfully to the advancement of medicine. As the digital landscape continues to evolve, medical education must embrace the opportunities afforded by social media while addressing its inherent challenges.

Through mindful and responsible use, social media can empower the next generation of health care professionals to make a positive impact on patient care and medical practice.

Related reading:

Reflections on the ‘Barbie’ movie and its impact on women in medicine

Social media usage and depression in adolescents and young adults: Examining the connection

An ounce of prevention

Preventing illness and injury: is it ever too late to adopt a healthy lifestyle, double or nothing, a winning pair: this brother do duo went from wrestling to wellness, thinking outside the box, 6 ways to be a physician without practicing clinical medicine, a life in medicine, in memoriam: may 2024, more in lifestyle.

Confronting burnout and moral injury in medicine

Regarding burnout in medicine, “I knew there was more to the story than the frustration of dealing with administrative obstacles,” writes Jerry Balentine, DO.

Nearly 70% of doctors in their 40s want to retire in their 50s or early 60s, survey reveals

Medscape report finds that physicians, on average, would like to save $3.9 million to feel comfortable retiring from medicine.

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