Learning Environment and Mental Health Among Medical Students in Teaching Hospitals a Systematic Review of Organizational Determinants and Evidence Based Interventions
DOI:
https://doi.org/10.59890/ijnhs.v4i4.1Keywords:
Learning Environment, Medical Students, Mental Health, Teaching Hospitals, Organizational DeterminantsAbstract
Medical students in teaching hospitals face a complex learning environment that has the potential to affect mental health and academic functioning. This study aims to analyze the relationship between organizational determinants in the learning environment and mental health outcomes and identify evidence-based interventions. Systematic review was conducted following PRISMA 2020 through a search of scientific databases, with 18 studies meeting the inclusion criteria and analyzed using narrative and thematic synthesis. Results show that high workload, inadequate supervision, mistreatment, competitive climate, and low institutional support are associated with stress, anxiety, depression, and burnout. Interventions in the form of mentoring, peer support, workload modification, supportive supervision, and psychological services showed benefits. The findings confirm the importance of organizational strategies to create a healthier clinical learning environment
References
Benamer, H. T. S., Alsuwaidi, L., Khan, N., Jackson, L., Lakshmanan, J., Ho, S. B., Kellett, C., Alsheikh-Ali, A., & Stanley, A. G. (2023). Clinical learning environments across two different healthcare settings using the undergraduate clinical education environment measure. BMC Medical Education, 23, 495. https://doi.org/10.1186/s12909-023-04467-y
Boyd, N., & Alexander, D. G. (2022). An online mindfulness intervention for medical students in South Africa: A randomised controlled trial. South African Journal of Psychiatry, 28, 1840. https://doi.org/10.4102/sajpsychiatry.v28i0.1840
Chisholm, L. P., Jackson, K. R., Davidson, H. A., Churchwell, A. L., Fleming, A. E., & Drolet, B. C. (2021). Evaluation of racial microaggressions experienced during medical school training and the effect on medical student education and burnout: A validation study. Journal of the National Medical Association, 113(3), 310–314. https://doi.org/10.1016/j.jnma.2020.11.009
Cipta, D. A., Wijovi, F., Melisa, L., Lili, R., Marcella, E., Tancherla, A., Siswanto, F. G., Adiya, D. A. K. L., Chen, S., Dermawan, G. J. C. I., Louis, M. I., Citraningtyas, T., & Molodynski, A. (2022). Burnout prevalence and degree among undergraduate medical students in Indonesia during 1 month of the COVID-19 pandemic: A cross-sectional descriptive survey. International Journal of Social Psychiatry, 68(6), 1232–1237. https://doi.org/10.1177/00207640221116812
Collins, C., Pichan, C., McGee, L., Siden, J. Y., & Brower, K. (2023). Assessing student burnout, treatment acquisition, and barriers to care to prompt changes in a student mental healthcare program. Academic Psychiatry, 47(2), 164–168. https://doi.org/10.1007/s40596-022-01685-2
De Cassai, A., Dost, B., Tulgar, S., & Boscolo, A. (2025). Methodological standards for conducting high-quality systematic reviews. Biology, 14(8), 973. https://doi.org/10.3390/biology14080973
Ditton, E., Knott, B., Hodyl, N., Horton, G., Oldmeadow, C., Walker, F. R., & Nilsson, M. (2023). Evaluation of an app-delivered psychological flexibility skill training intervention for medical student burnout and well-being: Randomized controlled trial. JMIR Mental Health, 10, e42566. https://doi.org/10.2196/42566
Dyrbye, L. N., Satele, D., & West, C. P. (2021). Association of characteristics of the learning environment and US medical student burnout, empathy, and career regret. JAMA Network Open, 4(8), e2119110. https://doi.org/10.1001/jamanetworkopen.2021.19110
Fazia, T., Bubbico, F., Nova, A., Buizza, C., Cela, H., Iozzi, D., Calgan, B., Maggi, F., Floris, V., Sutti, I., Bruno, S., Ghilardi, A., & Bernardinelli, L. (2023). Improving stress management, anxiety, and mental well-being in medical students through an online mindfulness-based intervention: A randomized study. Scientific Reports, 13, 8214. https://doi.org/10.1038/s41598-023-35483-z
Graves, J., Flynn, E., Woodward-Kron, R., & Hu, W. C. Y. (2022). Supporting medical students to support peers: A qualitative interview study. BMC Medical Education, 22, 300. https://doi.org/10.1186/s12909-022-03368-w
Hathaisaard, C., Wannarit, K., & Pattanaseri, K. (2022). Mindfulness-based interventions reducing and preventing stress and burnout in medical students: A systematic review and meta-analysis. Asian Journal of Psychiatry, 69, 102997. https://doi.org/10.1016/j.ajp.2021.102997
Himmelberger, Z. M., Tibbetts, Y., Barron, K. E., Hulleman, C. S., Harootunian, G., & Speicher, M. R. (2024). How can a growth mindset-supportive learning environment in medical school promote student well-being? Families, Systems, & Health, 42(3), 343–354. https://doi.org/10.1037/fsh0000915
Jahrami, H., AlKaabi, J., Trabelsi, K., Pandi-Perumal, S. R., Saif, Z., Seeman, M. V., & Vitiello, M. V. (2023). The worldwide prevalence of self-reported psychological and behavioral symptoms in medical students: An umbrella review and meta-analysis of meta-analyses. Journal of Psychosomatic Research, 173, 111479. https://doi.org/10.1016/j.jpsychores.2023.111479
Klein, H. J., & McCarthy, S. M. (2022). Student wellness trends and interventions in medical education: A narrative review. Humanities and Social Sciences Communications, 9, 92. https://doi.org/10.1057/s41599-022-01105-8
Kloos, J., Simon, E., Sammarco, A., El-Nashar, S., & Bazella, C. (2023). Neglect as an undefined and overlooked aspect of medical student mistreatment: A systematic review of the literature. Medical Teacher, 45(12), 1395–1403. https://doi.org/10.1080/0142159X.2023.2218982
Leep Hunderfund, A. N., Saberzadeh Ardestani, B., Laughlin-Tommaso, S. K., Jordan, B. L., Melson, V. A., Montenegro, M. M., Brushaber, D. E., West, C. P., & Dyrbye, L. N. (2025). Sense of belonging among medical students, residents, and fellows: Associations with burnout, recruitment retention, and learning environment. Academic Medicine, 100(2), 191–202. https://doi.org/10.1097/ACM.0000000000005892
Lili, R., Molodynski, A., Farrell, S. M., Citraningtyas, T., & Kloping, N. A. (2022). Wellbeing and mental health among medical students in Indonesia: A descriptive study. International Journal of Social Psychiatry, 68(6), 1277–1282. https://doi.org/10.1177/00207640211057709
Liu, Y., & Cao, Z. (2022). The impact of social support and stress on academic burnout among medical students in online learning: The mediating role of resilience. Frontiers in Public Health, 10, 938132. https://doi.org/10.3389/fpubh.2022.938132
Lu, C.-P., Dijk, S. W., Pandit, A., Kranenburg, L., Luik, A. I., & Hunink, M. G. M. (2024). The effect of mindfulness-based interventions on reducing stress in future health professionals: A systematic review and meta-analysis of randomized controlled trials. Applied Psychology: Health and Well-Being, 16(2), 765–792. https://doi.org/10.1111/aphw.12472
Martinussen, M., Jain, N. R., Tai, J., Bearman, M., & Ajjawi, R. (2025). A critical review of psychological safety in clinical learning environments. Medical Teacher, 47(12), 1884–1894. https://doi.org/10.1080/0142159X.2025.2551255
McClintock, A. H., Fainstad, T. L., & Jauregui, J. (2022). Clinician teacher as leader: Creating psychological safety in the clinical learning environment for medical students. Academic Medicine, 97(11S), S46–S53. https://doi.org/10.1097/ACM.0000000000004913
McClintock, A. H., Fainstad, T., Blau, K., & Jauregui, J. (2023). Psychological safety in medical education: A scoping review and synthesis of the literature. Medical Teacher, 45(11), 1290–1299. https://doi.org/10.1080/0142159X.2023.2216863
Moran, A., Shanahan, A., Tomlin, A., Ivers, R., & Thomas, S. J. (2023). Pilot study of a group clinical supervision model for medical students. Australasian Psychiatry, 31(5), 694–699. https://doi.org/10.1177/10398562231186238
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021a). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … McKenzie, J. E. (2021b). PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ, 372, n160. https://doi.org/10.1136/bmj.n160
Prendergast, M., Cardoso Pinto, A. M., Harvey, C.-J., & Muir, E. (2024). Burnout in early year medical students: Experiences, drivers and the perceived value of a reflection-based intervention. BMC Medical Education, 24, 7. https://doi.org/10.1186/s12909-023-04948-0
Preovolos, C., Grant, A., Rayner, M., Fitzgerald, K., & Ng, L. (2024). Peer mentoring by medical students for medical students: A scoping review. Medical Science Educator, 34(6), 1577–1602. https://doi.org/10.1007/s40670-024-02108-7
Puranitee, P., Kaewpila, W., Heeneman, S., van Mook, W. N. K. A., & Busari, J. O. (2022). Promoting a sense of belonging, engagement, and collegiality to reduce burnout: A mixed methods study among undergraduate medical students in a non-Western, Asian context. BMC Medical Education, 22, 327. https://doi.org/10.1186/s12909-022-03380-0
Till, B., Hofhansl, A., & Niederkrotenthaler, T. (2024). Effects of the mental health promotion seminar ‘Coping with stress’ in the undergraduate medical curriculum of the Medical University of Vienna. BMC Medical Education, 24, 41. https://doi.org/10.1186/s12909-023-05019-0
Yu, W., Yang, S., Chen, M., Zhu, Y., Meng, Q., Yao, W., & Bu, J. (2022). School psychological environment and learning burnout in medical students: Mediating roles of school identity and collective self-esteem. Frontiers in Psychology, 13, 851912. https://doi.org/10.3389/fpsyg.2022.851912
Yu, W., Yao, W., Chen, M., Zhu, H., & Yan, J. (2023). School climate and academic burnout in medical students: A moderated mediation model of collective self-esteem and psychological capital. BMC Psychology, 11, 77. https://doi.org/10.1186/s40359-023-01121-6
