Work

Examining the multidimensional structure of stress among international medical students: a construct-based approach

Year: 2026

Type: article

Abstract: BACKGROUND: International medical students experience diverse stressors that extend beyond academic demands to include challenges of cultural adaptation, institutional management, and experiences of discrimination. Understanding the structure of these interrelated stress domains is essential for developing effective educational and support strategies. This study examined the multidimensional structure of stress among international medical students using a construct-based analytical approach grounded in the Transactional Model of Stress and Coping. METHODS: A cross-sectional survey was conducted with 322 international students enrolled in the English-language medical program at the Medical University of Varna, Bulgaria. Participants completed a self-report questionnaire informed by standardized instruments, including the University Stress Scale and the Academic Stress Scale. Confirmatory factor analysis (CFA) was used to test a four-factor model comprising academic, adaptation, management, and discrimination-related stress. RESULTS: (48) = 70.08, p = .020; CFI = 0.941; TLI = 0.918; RMSEA = 0.047; SRMR = 0.060), supporting the conceptualization of stress among international medical students as a multidimensional construct. Academic stress emerged as the strongest factor, while strong correlations were observed among the stress domains, particularly between adaptation and management stress, indicating that adjustment difficulties and institutional challenges are closely interconnected. CONCLUSIONS: The findings underscore the need for comprehensive institutional strategies that address multiple dimensions of student well-being. Implementing culturally responsive counseling, peer mentoring, and transparent administrative communication may reduce overall stress and enhance adaptation and resilience among international medical students.

Source: BMC Medical Education

DOI: 10.1186/s12909-026-08667-0

Authors: Silviya Pavlova Nikolova, Eusebius Small, Margarita Stefanova Velikova, Mariya Aleksandrova Ivanova, Saltanat Childress, Krasimira Svetoslavova Laleva

Institutions: Medical University of Varna, The University of Texas at Arlington

Language: English

Topic: Healthcare professionals’ stress and burnout

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Quality education

Open Access status: gold

Estimated APC paid: $2,990