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BMJ Open. 2017 Sep 11;7(9):e016837. doi: 10.1136/bmjopen-2017-016837.

The health and well-being of Australia's future medical doctors: protocol for a 5-year observational cohort study of medical trainees.

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School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
The University of Sydney, School of Public Health, Sydney, New South Wales, Australia.
Black Dog Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia.
St. George Hospital, Kogarah, New South Wales, Australia.
Richmond Hospital, St. John of God Health Care, North Richmond, New South Wales, Australia.



Clinical training in the undergraduate medical course places multiple stressors on trainees, which have been held to lead to heightened distress, depression, suicide, substance misuse/abuse and poor mental health outcomes. To date, evidence for morbidity in trainees is largely derived from cross-sectional survey-based research. This limits the accuracy of estimates and the extent to which predispositional vulnerabilities (biological and/or psychological), contextual triggers and longer-term consequences can be validly identified. Longitudinal clinical assessments embedded within a biopsychosocial framework are needed before effective preventative and treatment strategies can be put in place.


This study is an observational longitudinal cohort study of 330 students enrolled in the undergraduate medicine course at the University of New South Wales (UNSW) Sydney, Australia. Students will be recruited in their fourth year of study and undergo annual assessments for 4 consecutive years as they progress through increasingly demanding clinical training, including internship. Assessments will include clinical interviews for psychiatric morbidity, and self-report questionnaires to obtain health, psychosocial, performance and functioning information. Objective measures of cognitive performance, sleep/activity patterns as well as autonomic and immune function (via peripheral blood samples) will be obtained. These data will be used to determine the prevalence, incidence and severity of mental disorder, elucidate contextual and biological triggers and mechanisms underpinning psychopathology and examine the impact of psychopathology on performance and professional functioning.


Ethics approval has been granted by the UNSW human research ethics committee (reference HC16340). The findings will be disseminated through peer-reviewed publications and conference presentations, and distributed to key stakeholders within the medical education sector. The outcomes will also inform targeted preventative and treatment strategies to enhance stress resilience in trainee doctors.


anxiety disorders; eating disorders; mental health

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Competing interests: None declared.

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