Stress Levels and Coping Strategies Among First-Year and Final-Year Medical Students in Public and Private Medical Colleges: A Comparative Cross-Sectional Study

Abstract

Background: Medical education is highly demanding and exposes students to considerable psychological stress. First-year students often struggle with academic adjustment, whereas final-year students face clinical responsibilities, career uncertainty, and professional pressures. Objective: To compare stress levels and coping strategies between first-year and final-year medical students enrolled in public and private medical colleges in District Swat, Khyber Pakhtunkhwa, Pakistan. Methodology: A comparative cross-sectional study was conducted among 248 MBBS students from Saidu Medical College (public sector) and Swat Medical College (private sector). Participants were recruited using a non-probability convenience sampling technique. Data were collected using a structured 38-item questionnaire assessing demographic characteristics, perceived stress, stress-related factors, and coping strategies. Stress scores were categorized into predefined levels ranging from low to extreme stress. Coping mechanisms were classified as problem-focused, non-problem-focused, and maladaptive. Results: Overall stress levels were higher among final-year students, particularly those enrolled in the private medical college, who demonstrated the highest mean stress score (46.7; 62.3%). Academic stressors constituted the most prominent source of stress (68%), followed by family-related (65%), personal (60.4%), and social stressors (60.2%). Major stressors included curriculum management, excessive academic workload, prolonged class duration, perceived poor educational quality, parental expectations, financial concerns, and uncertainty regarding future career opportunities. Problem-focused coping strategies were the most frequently adopted approaches (71.2%), with studying from the beginning of the academic year, effective schedule management, and seeking guidance from teachers or senior students being the most common adaptive behaviors. Religious activities and physical exercise were also frequently reported, whereas maladaptive coping strategies were comparatively less common. Conclusion: Medical students experience substantial stress, with final-year students carrying a greater burden. Medical colleges should strengthen academic support, counseling, stress-management programs, and healthy coping practices. Keywords: Coping Strategies, Medical Students, Psychological Stress, Stress, Undergraduate Medical Education.