Perceived Stress, Stressors, and Recommendations Suggested by Medical Students: A Convergent Mixed-Methods Study

Introduction: Stress among medical students is a global concern that affects their well-being, learning, and future professional performance. Although Bangladeshi studies have quantified stress prevalence and stressors, evidence on students' lived experiences, coping responses, and recommendations for well-being is limited. This study aimed to assess stress and stressors among medical undergraduates; explore stress experiences, contextual stressors, coping, and recommendations; and integrate quantitative and qualitative findings for institutional stress-reduction strategies. Methods A convergent mixed-methods study was conducted on medical students from one private (PrMC) and one public (PbMC) college in Dhaka, Bangladesh. The quantitative survey included 201 participants using proportionate stratified random sampling. Perceived stress and stressors were assessed using the Perceived Stress Scale-10 (PSS-10) and Medical Student Stressor Questionnaire (MSSQ-40). The qualitative component comprised six focus groups with 53 students from various academic phases. Quantitative data were analyzed using descriptive statistics, non-parametric tests, and multivariable regression, and qualitative data using reflexive thematic analysis. The findings were integrated using joint display and meta-inference. Results The mean PSS-10 score was 22.23 ± 6.19, with 70.6% and 24.4% of participants reporting moderate and high stress, respectively. Academic-related (mean = 2.252) and teaching- and learning-related stressors (mean = 2.024) were the highest-rated MSSQ-40 domains. Female sex and private medical college enrolment were independently associated with lower stress, whereas academic-related stressors were associated with higher stress (all p < 0.01). Qualitative analysis showed stress stemmed from interconnected academic, institutional, and social contexts, including workload, assessment pressure, unsupportive institutional practices, limited recreational and social infrastructure, and inadequate mental health services. Students described informal peer support as a lifeline. Although students employed both problem- and emotion-focused coping strategies, many perceived these responses as insufficient because organizational constraints limited their effectiveness. Students often see stress as inevitable in academia and endure it. Participants suggested refining curriculum, supportive faculty interactions, a better learning environment, and trustworthy mental health resources. Conclusion Medical students in Bangladesh experience moderate-to-high stress driven by academic, institutional and social contexts. Improving medical student well-being requires system-level reforms that address academic structures, institutional support, and learning environments rather than relying solely on individual resilience-focused approaches.