EMPIRICAL REPORT Understanding Medical Students’ Experience with Stress and Its Related Constructs: A Focus Group Study from Singapore Julia Farquhar 1 & Desiree Lie 2 & Angelique Chan 2 & Mandy Ow 2 & Arpana Vidyarthi 3 Received: 24 September 2016 /Accepted: 1 March 2017 # Academic Psychiatry 2017 Abstract Objective In order to protect medical students from burnout and its untoward psychiatric effects, it is imperative to under- stand their stress, burnout, coping, and resilience experiences. This study aimed to derive collective definitions from the medical student perspective, to identify common themes of students’ experiences, and to distinguish pre-clinical and clin- ical year students ’ experiences relating to these four constructs. Methods The authors conducted focus groups of medical stu- dents in Singapore across 4 years using a semi-structured question guide. Participants shared their understanding, expe- riences, and the relationships between stress, burnout, coping, and resilience. Coders independently evaluated construct def- initions and derived common themes through an iterative pro- cess, and compared transcripts of pre-clinical and clinical year students to determine differences in experience over time. Results Nine focus groups (54 students, 28 females, mean age 24.3) were conducted. Students identified common definitions for each construct. Nine themes emerged within three domains: (1) relating constructs to personal experience, (2) interrelating stress, burnout, coping, and resilience, and (3) understanding the necessity of stress. Compared to clinical students, pre- clinical students reported theory-based rather than reality-based experiences and exam-induced stress, defined constructs using present rather than future situations, and described constructs as independent rather than interrelated. Conclusions This sample of medical students in Singapore shares a common understanding of stress, burnout, coping, and resilience, but experiences these uniquely. They perceive a positive role for stress. These findings build upon prior lit- erature, suggesting an interrelationship between stress and its related constructs and adding the novel perspective of students from an Asian country. Keywords Medical students: behavioral sciences . Medical students: emotional problems . Medical students: support Burnout has been described as a worldwide epidemic, afflicting almost half of doctors in training in the USA and Asia [1, 2]. Burnout is characterized by emotional exhaustion, depersonalization, and a diminished sense of accomplishment [3]. For medical students and professionals, burnout is asso- ciated with a less professional learning environment, and later, with attrition from practice, increased medical system costs, and perceived medical errors [4–8]. Given its magnitude and impacts, it is essential to understand and mitigate stress, a precursor of burnout [9]. Stress, a physical and psychological reaction to a deviation from the norm [10], is an inevitable facet of medical training, which leaves medical students prone to its effects. As medical students’ experiences with and re- sponses to stress are established early [11], understanding these is paramount to mitigating the negative impacts of stress during training and beyond. Medical students have higher stress levels than their peers [12]. Known medical student stressors include academic load, limited leisure time, perceived mistreatment in clinical settings, worries about residency and hospital performance, and repeated transitions in medical school [ 13]. Theoretically, certain levels of * Julia Farquhar Farquhar.julia@gmail.com 1 Duke University School of Medicine, Durham, NC, USA 2 Duke-NUS Medical School, Singapore City, Singapore 3 National University Health System, Singapore City, Singapore Acad Psychiatry DOI 10.1007/s40596-017-0703-7