Using convenience sampling, 233 full-time professional master’s students in clinical medicine enrolled in the dual-track integrated program at a medical university in the Guangxi Zhuang Autonomous Region were recruited ([6]). Anonymous questionnaires were distributed and collected online. Of the 233 questionnaires distributed, all 233 were returned. Each was fully completed without omissions or logical inconsistencies; thus, all were considered valid. Inclusion criteria were as follows: full-time professional master’s students in clinical medicine currently enrolled and having provided informed consent. Exclusion criteria were: not enrolled in the dual-track integrated program or incomplete questionnaire responses. The sample comprised 116 males (49.79%) and 117 females (50.21%); 96 first-year students (41.20%), 69 second-year students (29.61%), and 68 third-year students (29.18%); 136 students from rural backgrounds (58.37%) and 97 from urban backgrounds (41.63%).

A self-developed “Psychological Stress Sources Questionnaire for Professional Master’s Students in Clinical Medicine” was used. The questionnaire development process was as follows: first, semi-structured interviews were conducted with 10 professional master’s students in clinical medicine. The interview results were organized and combined with a review of existing research findings to form preliminary items. Subsequently, following the research framework of [8], the original items were screened, and ambiguous, repetitive, or otherwise poor-quality items were removed. This process ultimately resulted in a formal questionnaire containing 20 pressure measurement items. Items 1 - 3 collected demographic information (gender, grade, and place of origin), while items 4 - 23 formed a 20-item stress scale employing a 5-point Likert format (1 = no stress, 5 = extreme stress), with higher scores indicating greater psychological stress. The design of the questionnaire and the division of its dimensions were guided by established frameworks for psychological stressor questionnaires intended for professional master’s students in clinical medicine ([8]). The items were classified into five core stress dimensions:

1) Further education and employment stress (items 4 - 9): including employment anxiety and decisions about pursuing further studies.

2) Financial stress (items 10 - 13): including low residency training stipends and financial dependence.

3) Interpersonal relationship stress (items 14 - 17): including problems arising from family communication, relationships with department colleagues and supervisors, and interactions with classmates and roommates.

4) Academic stress (items 18 - 20): including the inability to balance clinical work and research, heavy academic workload, and graduation pressure.

5) Emotional stress (items 21 - 23): including romantic conflicts, difficulties in finding a partner, and clinical work encroaching on time for emotional life.

Table 1. Cronbach’s α coefficients of the psychological stress scale.

Reliability was assessed by computing Cronbach’s α coefficients using SPSS 26.0. The total scale α was 0.918, and the coefficients for the five dimensions were all above 0.80, ranging from 0.809 to 0.872. These values meet psychometric requirements and are consistent with the reliability levels of similar stress scales developed for medical postgraduates ([12]; [11]), as shown in Table 1.

Data were analyzed using SPSS 26.0. Continuous variables are presented as means and standard deviations, and categorical variables as frequencies and percentages. The Mann–Whitney U test was used for comparisons between two independent samples, and the Kruskal–Wallis H test for multiple-group comparisons. The significance level was set at α = 0.05. The score for each dimension was calculated as the arithmetic mean of all item scores within that dimension, and the total stress score was calculated as the arithmetic mean of all 20 item scores. The classification of stress levels was determined based on the midpoint and distribution characteristics of the 5-point Likert scale: a mean score ≥ 4.0 was defined as “high level,” 3.0 ≤ mean score < 4.0 as “medium-high level,” and mean score < 3.0 as “low level.”

As presented in Table 2, the participants’ total mean stress score was 3.82 (SD = 0.76), indicating a moderate-to-high level of stress. The dimension scores, in descending order, were as follows: further education and employment stress (4.01, SD = 0.82), academic stress (3.95, SD = 0.79), financial stress (3.87, SD = 0.81), emotional stress (3.76, SD = 0.83), and interpersonal relationship stress (2.68, SD = 0.91). This stress profile aligns with findings from previous Chinese studies on psychological stress among medical professional masters and with the dimensional structure of the stressor questionnaire referenced in this study ([8]; [3]).

Table 2. Scores on each dimension of psychological stress.

With regard to further education and employment stress, the highest-scoring items were “worry about not graduating smoothly” (4.12, SD = 0.94) and “worry about not finding a satisfactory job” (4.08, SD = 0.91). Employment market saturation and career uncertainty were the main triggers ([13]). For academic stress, the most prominent item was “difficulty balancing clinical work and research” (4.03, SD = 0.87), illustrating a core conflict in time allocation between clinical duties and research ([10]). In terms of financial stress, most students rated the residency training stipend as excessively low (4.02, SD = 0.89); the inability to be financially independent—while their non-medical peers had already started working—significantly affected their mental state (3.96, SD = 0.86) ([14]). Concerning emotional stress, the item “being too busy with clinical work to attend to emotional life” received the highest rating (3.89, SD = 0.92), indicating that clinical demands encroach on personal life ([2]). Interpersonal relationship stress was generally low; only “poor family communication” scored slightly higher (3.12, SD = 1.03). High-quality interpersonal support from supervisors, colleagues, and peers can alleviate perceived stress ([1]).

1) Gender differences: Female students scored significantly higher than male students on further education and employment stress (Z = −2.864, p < 0.01), emotional stress (Z = −3.127, p < 0.01), and financial stress (Z = −2.153, p < 0.05). No statistically significant differences were observed for academic or interpersonal relationship stress (p > 0.05). Higher stress sensitivity among female students is a common characteristic in medical student populations.

2) Grade differences: Third-year students demonstrated significantly higher further education and employment stress (H = 12.568, p < 0.001) and academic stress (H = 9.874, p < 0.01) compared with first- and second-year students. First-year students primarily experienced adaptation stress. Second-year students gradually assumed greater clinical responsibilities while preparing for the medical licensing examination, completing the experimental part of their thesis, and collecting data; their stress centered mainly on balancing clinical and research demands. Third-year students faced peak pressures related to graduation, residency completion, and employment.

3) Origin differences: Students from rural backgrounds reported significantly higher financial stress than those from urban backgrounds (Z = −4.217, p < 0.001). Conversely, urban students exhibited significantly higher further education and employment stress than rural students (Z = −2.365, p < 0.05). No significant differences emerged in the other dimensions (p > 0.05). Variations in available resources and family expectations linked to place of origin influenced stress perception ([5]).

Under the dual-track integrated model, professional master’s students in clinical medicine experience moderate-to-high levels of stress, with further education and employment stress and academic stress as the primary sources. The fundamental cause of excessive stress is the superimposition of multiple training tasks aimed at developing both clinical competence and research ability. The instrument employed in this study was designed with reference to professional frameworks for stressor questionnaires, and its excellent reliability guarantees stable and reliable measurement, lending scientific credibility to the conclusions ([12]). These results also corroborate the widespread high-stress state among medical postgraduates. Multiple domestic surveys have likewise shown that psychological stress among professional master’s students in clinical medicine is significantly higher than that among postgraduates in other disciplines, and that prolonged high stress increases the risk of psychological problems such as anxiety and depression ([9]; [4]).

1) Further education and employment stress: This dimension had the highest score among all dimensions (4.01 ± 0.82), with “worry about not being able to graduate smoothly” (4.12 ± 0.94) and “worry about not finding a satisfactory job” (4.08 ± 0.91) being the two highest-scoring items among all items. The residency completion assessment, medical licensing examination, and graduation defense create a triple barrier; failure to pass any of them hinders normal graduation and employment. Moreover, intensified competition in the healthcare job market and the far-reaching impact of healthcare reform amplify anxiety about career prospects, while insufficient public support for the medical profession further heightens perceived stress.

2) Academic stress: This dimension scored 3.95 ± 0.79, with “difficulty balancing clinical work and research” (4.03 ± 0.87) being the key item. Clinical rotations consume a substantial amount of time, compressing the time available for research training and thesis writing. This structural imbalance between clinical work and research can exacerbate academic burnout.

3) Financial stress: This dimension scored 3.87 ± 0.81, with “excessively low residency training allowance” (4.02 ± 0.89) and “financial dependence on family” (3.96 ± 0.86) being the most prominent items, particularly significantly affecting students from rural backgrounds (Z = −4.217, p < 0.001), and financial dependence directly affects their quality of life, emotional well-being, and academic development.

4) Emotional stress: Excessive clinical working hours and irregular schedules constrain opportunities for emotional and social engagement. The narrowed social circles resulting from academic and financial pressures further intensify emotional distress, a phenomenon closely related to the dual student–physician identity of these students.

5) Interpersonal relationship stress: Support from supervisors and clinical departments can reduce interpersonal stress. Poor family communication appears to be the main source of interpersonal stress for most students, whereas strong social support can buffer stress responses.

Women’s more sensitive perception of emotional, employment, and financial stress is associated with gender-related psychological traits and social role expectations. Third-year students face multiple critical junctures—graduation, employment, and residency completion—and reach peak stress levels, a pattern consistent with the psychological development trajectory of medical postgraduates. Students from rural backgrounds encounter prominent financial stress, while those from urban backgrounds experience greater further education and employment stress partly due to higher family expectations. Resource disparities linked to students’ backgrounds significantly shape stress perception.

This study has a single-center cross-sectional design, which limits the generalizability of the findings. Mediating variables such as anxiety levels, psychological resilience, and coping styles were not included. Only a cross-sectional investigation was performed, without verification of intervention effects. Future research should adopt multi-center sampling and longitudinal tracking designs, and undertake empirical studies incorporating positive psychology interventions to refine the research framework.

Optimize the dual-track integrated training program by rationally allocating clinical and research time, and by reducing unnecessary rotations and assessment loads. Introduce structured psychological stress regulation courses that integrate growth mindset and mindfulness training into the mental health curriculum; such courses can significantly reduce levels of depression, anxiety, and perceived stress. Establish a grade-specific mental health early-warning mechanism to provide targeted counseling—addressing employment and graduation concerns for third-year students and adaptation challenges for first-year students.

Supervisors should fulfill dual responsibilities in academic guidance and psychological care, and reduce unreasonable research demands. Departments should cultivate an inclusive clinical atmosphere to mitigate workplace interpersonal stress and, where feasible, provide financial subsidies to rotating professional master’s students. Drawing on the Transactional Theory of Stress and Coping, supervisors can guide students to reinterpret clinical stress as motivation for competence building, thereby optimizing their stress response patterns.

Raise the residency training stipend standard and improve employment security policies for professional master’s students in clinical medicine. Families should strengthen emotional communication and reduce financial, psychological, and emotional pressure. Society should enhance its understanding and support of the medical profession, thereby constructing a comprehensive social support system that alleviates external stressors.

Students should acquire time management skills to balance clinical work, academics, and personal life. They are encouraged to adopt positive coping strategies such as mindfulness training and emotional regulation, and to cultivate a growth mindset. Actively seeking social support and enhancing psychological resilience and stress regulation capacity can mitigate stress-induced harm at the individual level.