From risk to resilience? Longitudinal transitions in coping patterns and burnout risk among medical students

INTRODUCTION: This study investigates the longitudinal development of stress-related coping patterns in medical students using the validated 'Work-related Behaviour and Experience Patterns' instrument, which categorises individuals into four typologies: healthy (H) and protective (P) patterns, reflecting adaptive coping and resilience, and the risk patterns overexertion (O) and burnout tendency (B), reflecting maladaptive stress-related coping and reduced recovery capacity. This study aims to (1) assess the prevalence of these patterns over the course of medical training, (2) explore transitions between patterns, and (3) evaluate the influence of socio-demographic predictors. METHOD: We analysed panel data from over 1,400 medical students across six survey waves between 2019 and 2024 to model within- and between-person variation across study years. We applied descriptive transition matrices and random-effects logistic panel regressions to examine pattern persistence and the likelihood of shifts over time. RESULTS: Regression analyses indicate an increase in healthy and protective patterns due to a decline in overexertion over time, while burnout tendency remains largely stable. Transition matrices and lagged-variable approaches reveal considerable temporal persistence of individual patterns. Female students and those reporting substance use are more likely to exhibit unfavourable patterns. High learning strain and exam anxiety significantly increases the risk of overexertion and burnout patterns. DISCUSSION: These findings highlight both dynamic and stable components of stress patterns among medical students. Individual predispositions and coping abilities appear to play a larger role than structural and curricular factors. The results suggest that early detection and longitudinal support programs, both integrated within medical training and offered as extracurricular options, might help promote resilience and prevent persistent overexertion and a tendency toward burnout.