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Med Educ. 2016 Jun;50(6):646-56. doi: 10.1111/medu.12987.

Health-promoting factors in the freshman year of medical school: a longitudinal study.

Author information

Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Department of Health Sciences, Friedensau Adventist University, Möckern, Germany.



The freshman year of medical school is a stressful period in the lives of future doctors. Resilience to this stress differs greatly, leading to different health outcomes. Less resilient students, whose health may deteriorate early in their education, are at greater risk for developing stress-related diseases. Early identification of individuals at risk and the provision of tailored health-promoting interventions might prevent this.


This study was designed to investigate: (i) how the health of medical students develops over the freshman year, and (ii) whether certain protective factors can predict general and mental health status after 1 year of medical education.


A prospective, longitudinal, observational study was conducted at one medical school. Self-rated general and mental health status before and after the freshman year were used as outcomes. In addition to socio-demographic variables and leisure activities, personality and study-related behaviour and experience were surveyed as potential predictors. Both descriptive techniques and logistic regression analyses were employed to identify predictors for general and mental health separately.


At baseline, 93% of medical students rated their general health and 88% rated their mental health as good. These frequencies declined over the first year to 76% and 84%, respectively. For general health, regular physical activity was the strongest predictor (odds ratio [OR] 4.58). Satisfaction with life (OR 1.18) and balance and mental stability (OR 1.20) emerged as positive predictors, and age (OR 0.85) and striving for perfection (OR 0.76) as negative predictors. Mental health status was predicted by emotional distancing (OR 1.25), experience of social support (OR 0.73), neuroticism (OR 0.89) and age (OR 0.85).


Self-rated general and mental health declined throughout the first year of medical education. Physical activity proved to be a strong predictor for the maintenance of good general health. This finding may represent a starting point for health-promoting interventions, such as the provision of time slots for physical activity.

[Indexed for MEDLINE]

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