PURPOSE
Medical students undergo training that demands high academic performance,
emotional perseverance, and personal sacrifice. McClusky’s margin theory
defines the margin for learning as what remains after subtracting the
draining aspects of life (load) from the available sources of cognitive
strength (power). Although medical school stress is well recognized, few
studies examine how students themselves conceptualize the forces that
diminish their margin. This study explores the perceived sources of load
among preclinical osteopathic medical students and their effect on available
margin.
METHODS
Focus groups were held with second-year osteopathic medical students.
Transcripts were anonymized and analyzed using two cycles of qualitative
coding followed by thematic analysis to identify the sources of load that
reduce their margin during training. Participants were asked to discuss areas
such as health, self-confidence, family relationships, religion/spirituality,
interpersonal relationships, and open discussion for additional factors.
RESULTS
Five major categories of load became prominent: (1) Academic and
professional pressure, including impostor syndrome, fear of failure, and
professional prejudice against osteopathic physicians; (2) mental and
physical health strains, including anxiety, sleep disruption, and negative
projection into relationships; (3) institutional and systemic deficiencies,
such as financial burden, lack of institutional compassion, and negative
faculty feedback; (4) time and work-life imbalance, including guilt around
rest, eroding boundaries, poor nutrition, and sacrifice of personal
milestones; and (5) relational and social conflict, including religious
guilt, strained relationships, and sociopolitical concerns.
CONCLUSION
Medical students experience sources of load that extend beyond what has
been traditionally defined by McClusky and the margin in life scale,
reflecting an interconnected mix of academic pressure, personal strain, and
social conflict. Understanding these sources of load provides a critical foundation
for targeted institutional and curricular reforms that are essential not only
for preserving students’ learning capacity but also for cultivating a more
resilient and sustainable medical education system.