The relative importance of resilience factors prior, during, and after stress-inducing exams in medical students

Resilience is a dynamic process of adapting to stress. Identifying modifiable resilience factors (RFs) remains challenging due to the difficulty of studying individuals before, during, and after a stressor in real time. We addressed this by investigating modifiable protective factors in the context of university exams, a predictable and impactful stressor, and focused on medical students to examine RFs in a vulnerable cohort under standardized conditions. In this exploratory study, we used data from the three-wave 'RESIST' Study involving 451 medical students from the UK. Our investigation covered three timepoints with differing levels of stress (1) a non-exam period, (2) an exam period, and (3) post-exams at the end of the term. We examined the distinct impact of 13 modifiable RFs at individual, family, and community levels. Specifically, we investigated their relative importance and their cumulative impact with regard to self-reported mental health symptoms at three timepoints. We found the highest relative importance rankings for self-esteem, brooding, and distress tolerance. While most individual resilience factors had negligible-to-small effects, the sum of all 13 effects was similar to the effects of self-reported mental health symptoms at the previous timepoint on themselves. Our findings shed light on the role of RFs, and their cumulative and timing effects, and their associations with exam-related self-reported mental health problems among medical students.