Academic stress and sleep among first year and preclinical medical students: a qualitative evidence synthesis

Abstract Background The first year of medical school combines a heavy academic load with a major life transition, and poor sleep is common from the earliest weeks of training. Survey research shows that stress and poor sleep occur together but says little about how students experience the relationship. This rapid qualitative evidence synthesis examined recent qualitative evidence on how first year and preclinical medical students experience academic stress and sleep. Methods Ten searches of open access sources identified qualitative and mixed methods studies published from 2021 onward. Selection, appraisal with the Critical Appraisal Skills Programme checklist, and thematic synthesis were carried out by one reviewer. Reporting followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. The protocol was not registered. Results The searches returned 95 records, of which 66 were screened after removal of duplicates and 14 were assessed in full. Seven studies from the United Kingdom, the United States, India, Brazil and Malaysia were included. Only one study sampled first year students exclusively, and sleep was the main focus of two. Four analytical themes were developed: entering a layered transition; sleep as the negotiable resource; a mind that will not switch off; and coping, culture and connection. Students described sleep as the first resource surrendered to academic demand, and one study described peer norms that framed early rest as weak commitment. Worry about examinations carried into the night, and poor sleep in turn eroded concentration and emotional control, a cycle that students felt powerless to interrupt. Relationships and flexible support were described as buffers, whereas caffeine, late screen use and mandated wellness activities offered little relief. Conclusions In a small evidence base, academic stress and sleep loss were described as one entangled problem rooted in academic culture rather than individual weakness. The findings are tentative because the search was limited to open access sources and one reviewer carried out selection, appraisal and synthesis. Medical schools may wish to consider pacing first year assessment, keeping timetables predictable, discussing late night study norms openly and offering flexible support. Studies that follow first year cohorts are needed to test these findings.