The assessment and remediation of dysfunctional stress in medical school.

This paper describes an ecosystem approach to the management of dysfunctional stress in a medical education setting. An assessment of the student-perceived environment was conducted in three phases: (a) brainstorming to identify potential sources of stress; (b) design and use of the Medical School Environmental Stress Inventory (MSESI) to measure student-reported stress; and (c) follow-up interviews to validate these findings and to identify specific factors contributing to the stressful situations, consequences resulting from the stress, coping strategies used, potential solutions to the stressful situations, and aspects of the environment perceived as supportive. Students described the major stressors as information-input overload, short-age of time, inadequate feedback regarding performance, and poor quality of interpersonal relationships. The authors, committed to an action-research model, used the results to design appropriate interventions.