Existential distress in medical students matters: An exploratory pilot study of the occurrence of the existential distress phenomenon in Czech medical students
Authors: Světlák Miroslav , Sláma Ondřej 
Published: January 2023

Background
Existential distress (ED) is a multi-dimensional construct used to describe the mental turbulence experienced by a person who has been exposed to the idea or personal experience of impending death. Existential distress is an experience not only of terminally ill people; it is a universal feeling for most human beings in some specific situations and life periods. Studying medicine and other health disciplines exposes students from the beginning to the topic of death and dying. This exposure increases the risk of the development of existential distress and may affect their mental health and professional identity. Reflecting on this and working on the topic during medical and nursing studies may foster resilience and may help the students to be better prepared for those highly emotionally charged situations in clinical practice. Conditions for including the systematic reflection of existential distress into medical education must be explored, as should the prevalence and other characteristics of the phenomenon in medical students. In 2022, we organized an electronic questionnaire survey among students of the Faculty of Medicine in Brno, Czech Republic, on their perception of the severity of the topic of existential distress and several related topics.
Methods
Altogether, 622 students were surveyed (a total response rate of 19.41%; mean age 22.3 ± 2.1; general medicine = 394; 63.3%; 228 other health disciplines). The survey included questions on the prevalence and severity of existential distress among students and their attitudes and opinions on the issue of integrating the reflection of this topic into the educational curriculum at their faculties.
Results
The results showed that existential distress was present in 47.9% of medical faculty students above the group average. No difference was found between general medicine students and students of other medical faculty study disciplines (p < 0.001). The findings further revealed the student estimation that 87.5% ± 6.1 of patients do not openly discuss existential distress in conversations with medical professionals in outpatient clinics or hospitals. In this context, 96% of students agreed or strongly agreed that healthcare professionals should have the skills to address existential distress in patients, and 86% of students agreed or strongly agreed that the management of their own existential distress should be one of the core topics of the psychology course at the medical faculty. Students identified several challenges and concerns they had in communicating about existential distress with patients, the most common being the fear that they would not t find the right words (57.4%), fears and worries about their own emotional reactions (52.6%), and concerns about the emotional reactions of patients (48.1%).
Conclusions
The current pilot study showed that fear and anxiety associated with death and dying were highly prevalent in medical faculty students. The study raises the argument that existential distress is a significant topic that needs to be addressed theoretically and practically during medical and health education. The similar prevalence of this type of distress and perceived demand in medical and nursing students proves the need for psychological support in this area for all healthcare students.