A cross-sectional study of distress, coping, resilience, and academic performance in medical students

Introduction: Medical students often face psychological distress affecting their academic performance and well-being. While coping and resilience may buffer this stress, their roles in academic outcomes across different training stages are poorly understood. This study explored how distress, coping, resilience, and learning perception relate to academic performance across semesters. Methods: A cross-sectional study of 677 pre-clinical medical students was conducted in 2024 across Semesters 1, 3, 5, and 7. Standardised instruments measured psychological distress, burnout, resilience, coping, and perceptions of the learning environment. Data were analysed using ANCOVA to compare constructs across semesters. Principal Component Analysis (PCA) and Structural Equation Modeling (SEM) assessed the direct and indirect pathways linking distress to Grade Point Average (GPA). Results: Psychological distress and burnout increased during mid-training while resilience traits such as perseverance and help-seeking consistently decreased. Coping styles remained stable. PCA identified three latent constructs: distress, coping, and resilience. SEM revealed that distress negatively predicted GPA both directly (β = –0.186, p < .001) and indirectly via resilience (β = 0.052, p = .003). Coping was positively associated with resilience (β = 0.412, p < .001), but its effect on GPA was marginal. A multi-group SEM confirmed a consistent relationship across academic semesters. Conclusion: Although the effects were small, psychological distress significantly influenced academic performance, partially mediated by resilience. While coping remained stable, resilience declined and did not recover, highlighting the need for support. Interventions to enhance coping may bolster resilience and improve academic outcomes.