Changes in wellbeing and professional values among medical undergraduate students: a narrative review of the literature

Background Educators are concerned by the high prevalence of emotional distress among medical students, and by the alleged decline in their humanitarian values. Objective To re-examine these concerns by reviewing studies of medical students' wellbeing and development. Method Narrative review of the literature. Main findings (a) Medical students' emotional distress increases during their undergraduate training. However, although higher than in the general population, the prevalence of distress among medical students is similar to that among other university students. (b) Medical students' distress is independently related to endogenous factors (personality traits and life events) and to their perception of the medical learning environment. (c) Medical students do not display a measurable increase in moral reasoning, empathy and tolerance of uncertainty. (d) Students' wellbeing, moral development, reflectivity and tolerance of uncertainty have been shown to be interrelated, and associated with clinical performance. Conclusions The findings of this review endorse the concerns about the wellbeing and development of undergraduate medical students. The design of the reviewed studies does not permit inferences about causality. Yet, these findings are consistent with the hypothesis that medical training causes emotional distress that delays students' development and affects their clinical performance.