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Stress Management in Medical Education: A Review of the Literature

Shapiro, Shauna L. MA; Shapiro, Daniel E. PhD; Schwartz, Gary E. R. PhD

Educating Physicians: Research Reports

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. Studies were included if they evaluated stress-management programs for medical trainees (medical students, interns, or residents); reported empirical data; and had been conducted at allopathic medical schools.

Results: Although the search yielded over 600 articles discussing the importance of addressing the stress of medical education, only 24 studies reported intervention programs, 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 in depression and anxiety, (3) increased spirituality and empathy, (4) enhanced knowledge of alternative therapies for future referrals, (5) improved knowledge of the effects of stress, (6) greater use of positive coping skills, and (7) the ability to resolve role conflicts. Despite these promising results, 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 which intervention works best for whom, (3) specificity of outcome measures, and (4) follow-up assessment, including effectiveness of future patient care.

Ms. Shapiro is a doctoral student in clinical psychology, University of Arizona, Tucson. Dr. Shapiro is assistant professor, Departments of Psychiatry and Integrative Medicine, University of Arizona College of Medicine. Dr. Schwartz is professor of psychology, neurology, psychiatry, and medicine, University of Arizona.

Correspondence and requests for reprints should be addressed to Ms. Shapiro, University of Arizona Department of Psychology, Tucson, AZ 85721; e-mail: 〈〉.

The authors acknowledge and thank all of the pioneering researchers who have contributed to the field of stress management in medical education. They also thank Benedict Freedman for his insightful editorial comments and Heather Rist for her help in creating Table 1.

© 2000 Association of American Medical Colleges