On the Importance of Resilience Factors Prior, During, and After Stress-Inducing Exams in Medical Students

Resilience can be defined as a dynamic process of adapting and bouncing back in the face of significant stressors, adversity, or trauma. Identifying factors that contribute to resilience and are modifiable prior to, during or after times of significant stress is thus crucial – yet still poorly understood. To this end, we here study potentially modifiable resilience factors among medical students, who usually report elevated mental health problems during stress-inducing exam periods. We used data from the three-wave Resilience Study (RESIST) involving 451 medical students of the University of Cambridge. Our investigation covered three timepoints with differing levels of mental health and perceived stress: (1) a non-exam period, (2) the exam period, and (3) post-exams. We examined the distinct impact of 13 resilience factors at individual, family, and community levels. Specifically, we investigated their relative importance on mental health and perceived stress, at subsequent timepoints. Our findings underscore the crucial role of (pre-exam) resilience factors for mitigating exam-related perceived stress and mental health problems. Effects were strongest for self-esteem, brooding and distress tolerance. Crucially, while most individual resilience factors had small effects, the sum of all 13 effects was higher than the autoregressive effects of mental health and perceived stress for explaining themselves (at a subsequent timepoint). Future studies should test the effects of resilience-enhancing interventions, which should consider the broad-ranging effects across individual-, family- and community-level resilience factors.