Stressful incidents, stress and coping strategies in the pre-registration house of®cer year Elisabeth Paice, 1 Harry Rutter, 1 Mike Wetherell, 1 Belinda Winder 2 & I C McManus 2 Context Previous studies have drawn attention to the stresses experienced by doctors in their ®rst year. Objectives To gain a deeper understanding of the causes of stress in newly quali®ed doctors, how they cope, and what interventions might make the year less traumatic. Design Postal questionnaire. This study focused on an open question asking about a stressful incident, the coping strategy used to deal with it, stressors in general and current levels of stress using the General Health Questionnaire. Setting 336 hospitals throughout the United Kingdom. Subjects A cohort of doctors followed from the time of their application to medical school, studied towards the end of their pre-registration year (n  2456). Results The response rate to the questionnaire was 58á4%. The incidents were categorised into the major groups Responsibility (33á6%), Interpersonal (29á7%), Overwork (17á0%), Death and disease (13á0%), and Self (6á7%). GHQ revealed psychological morbidity in 31% of respondents. Stress levels were highest in those reporting an incident about Responsibility or Self, lowest in those describing Death or disease. Stressors in general and preferred coping strategies differed between the groups. Conclusion The incidents suggested the following interventions to reduce stress: better supervision in the ®rst few weeks in post, at night, and for medical problems on surgical wards; more attention to avoiding sleep deprivation; more time for discussion with col- leagues at work; more personal time with friends and family. The choice of incident described was in¯uenced by the personal characteristics of the respondent. Keywords Adaptation, psychological; cohort studies; education, medical, postgraduate/*psychology; Great Britain; interpersonal relations; medical staff, hospital; questionnaires; stress/*psychology. Medical Education 2002;36:56±65 Introduction Doctors are among the most stressed professionals, and their ®rst year is especially stressful. 1±4 A study of pre- registration house of®cers in 1987 demonstrated depressive illness in 28% of those tested. Factors associated with stress were overwork, with its impact on sleep and personal life; talking to distressed relatives; and serious treatment failures. 5 Since then, steps have been taken to reduce working hours and improve educational and clinical supervision. 6,7 Despite these measures, a recent study showed that the incidence of psychological morbidity among house of®cers remains high. 8,9 We attempted to gain a deeper understanding of the factors associated with stress in a recent cohort of pre-registration house of®cers by asking them to describe an incident that they had found particularly troubling, dif®cult or distressing during the year. We also explored how stressed they were at present, what aspects of their jobs they found stressful, and how they coped with stressful events. Our aim was to gain a deeper understanding of stress in newly quali®ed doc- tors and generate ideas about interventions that might make the year less traumatic. Methods The study began as a prospective cohort study of medical student selection, looking at 6901 applicants to UK medical schools in Autumn 1990 for admission in October 1991. 10 Three thousand, three hundred and thirty-three applicants entered medical school, 2961 in 1 London Postgraduate Medical and Dental Education, UK, 2 CHIME, UCL Medical School, London, UK Correspondence: Elisabeth Paice, London Postgraduate Medical and Dental Education, 20 Guilford Street, London, WC1N 1DZ, UK. Tel.: 020 76923355; Fax: 020 76923396; E-mail: epaice@london deanery.ac.uk Stress 56 Ó Blackwell Science Ltd MEDICAL EDUCATION 2002;36:56±65