The relationship between educational environment, coping strategies, and perceived stress among prosthodontic residents in Thailand: A national cross-sectional study

The path to becoming a specialist in dentistry is a marathon of intense learning, where students must master complex procedures while managing the weight of patient care and academic expectations. For those training in prosthodontics, the field dedicated to restoring teeth and jaws, the pressure is often felt more acutely than in other areas. This pressure manifests as stress, a state where the demands of the environment feel heavier than the resources a person has to handle them. When stress becomes chronic, it can erode a person's well-being, disrupt sleep, and even cloud the judgment needed for delicate clinical work. Researchers have long known that the way students cope with these pressures matters, but a critical question remains: is the stress coming from the individual's internal reactions, or is it driven by the structure of the training program itself? Understanding the source of this strain is essential for creating a system that supports the mental health of future doctors without compromising the quality of their education.

In a national study conducted across Thailand, researchers set out to map the landscape of stress among prosthodontic residents. They focused on sixty-nine trainees from six different universities, ranging from their first year of training to their third. The team asked these residents to fill out a detailed survey that measured three specific things: how stressed they felt in general, how stressful their specific educational environment was, and what methods they used to handle that pressure. The survey asked about everything from the fear of failing a complex case to the lack of time for personal life, and it also asked residents to identify whether they tended to use helpful strategies, like taking a break or solving a problem, or unhelpful ones, like avoiding the issue or drinking more alcohol. By gathering this data from a wide network of schools rather than just one, the researchers aimed to see if the patterns held true across the entire country.

The results painted a clear picture of where the pressure originates. The average stress level reported by these residents was notably high, but the study found that the most powerful driver of that stress was not the resident's gender, their year of training, or their personal coping style. Instead, the single strongest predictor of how stressed a resident felt was the quality of their educational environment. Residents who perceived their training program as stressful—citing issues like rigid policies, lack of support staff, or difficult assessments—reported significantly higher levels of overall stress. This finding suggests that the environment itself acts as a heavy load, one that no amount of individual resilience can easily lift if the system remains unchanged.

When the researchers looked at how stress changed over time, they noticed a distinct pattern. First-year residents reported the highest levels of stress related to their educational environment, often feeling overwhelmed by the sheer volume of new information and the pressure to prove themselves. As residents moved into their second and third years, this environmental stress dropped significantly. By the final year, trainees seemed to have adapted, feeling more confident in their skills and more familiar with the expectations of their program. However, this relief was not universal; even in the later years, specific frustrations remained, such as the lack of adequate support staff in clinics and the challenges of working with part-time faculty. The study also found that while female residents reported feeling more stressed by their educational environment than their male or LGBTQ+ counterparts, their overall sense of stress was similar across all groups, suggesting that different factors might be weighing on different people.

Perhaps the most surprising aspect of the findings was the role of coping strategies. The residents generally relied on positive methods to manage their days, such as focusing on what they could control or engaging in hobbies. Yet, the data showed that these positive habits did not significantly lower their overall stress scores. While using negative strategies, like avoidance or substance use, was linked to slightly higher stress, the study concluded that positive coping alone was not enough to counteract a difficult training environment. It appears that when the system itself is the source of the problem, individual efforts to stay calm or solve problems have limited power. The researchers noted that negative coping behaviors were only marginally associated with higher stress, suggesting that while these habits are not ideal, they are not the primary cause of the distress either.

The study identified the most common triggers for anxiety among these specialists. The top stressors were not just about clinical skill, but about the performance of the training system itself. Residents were most worried about giving presentations in seminars, the fear of failing when treating complex cases, and the pressure to meet research requirements. These are tasks that require high levels of precision and public scrutiny. In contrast, the least stressful aspects of their training were things like the availability of holidays and the ability to collaborate with part-time faculty, areas where the system seemed to function adequately. The data revealed that while the residents were capable of finding ways to unwind, the structural demands of their education created a baseline of tension that persisted regardless of their personal efforts.

Ultimately, this research points to a straightforward conclusion: to improve the well-being of prosthodontic residents, the focus must shift from trying to make the students tougher to making the training environment less demanding. The study suggests that programs should intervene at the institutional level by clarifying expectations, ensuring adequate staffing, and providing early psychological support, particularly for those in their first year who are most vulnerable to the shock of the transition. While teaching students how to cope is valuable, the evidence indicates that the most effective way to reduce stress is to fix the environment that creates it. By addressing the structural stressors that the residents face daily, dental schools can foster a healthier learning atmosphere where future specialists can thrive without sacrificing their mental health.