title: Stressors and starting points for health-promoting interventions in medical school from the students' perspective: a qualitative study.
abstract: BACKGROUND
  Medical education is considered very challenging and connected with high levels of psychosocial stress for students. The aim of this study was to identify stressors and possible starting points for health-promoting interventions from the perspective of the students themselves.
  
  
  METHODS
  We conducted two focus groups with medical students from pre-clinical and clinical semesters. We analyzed the data using content analysis following Mayring's approach.
  
  
  RESULTS
  The stressors in the pre-clinical stage of medical education were more diverse and perceived as more intense than those in the clinical stage. They comprised contextual factors and individual behaviour. Participants mentioned the weekly examinations as a specific stressor. The existing absence regulations gave the participants the impression that they should not be absent through illness at any point during the course, and this idea further promoted presenteeism. Peer groups and mentoring programmes were perceived as helpful.
  
  
  CONCLUSIONS
  Stressors and starting points for health-promoting interventions are closely related to the medical curriculum and its organization. As such, the curriculum itself-in addition to programmes aimed at improving stress management-should primarily stand at the centre of activities for enhancing students' health.
authors.affiliation: Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23552, Lübeck, Germany, thomas.koetter@uksh.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kötter
authors.forename: Nadine J
authors.initials: NJ
authors.lastname: Pohontsch
authors.forename: Edgar
authors.initials: E
authors.lastname: Voltmer