Depression and factors associated with psychological well-being in medical students

INTRODUCTION

Medical training is characterized by high academic, emotional, and physical demands, especially in the final years of the program. During the rotating internship, students face a crucial transition to professional practice, marked by increasing clinical responsibilities, intensive hospital rotations, and a challenging hierarchical environment [1,2]. This stage, which represents the culmination of undergraduate studies, involves almost exclusive immersion in healthcare institutions, with long workdays, clinical decision-making, and constant exposure to human suffering—factors that significantly increase the risk of psychoemotional disturbances [3].

International scientific evidence shows that medical students are more vulnerable to affective disorders and psychological distress compared to the general population. A meta-analysis published in JAMA, involving more than 122,000 students from 43 countries, found a prevalence of depression of 27.2%, far exceeding rates among the general young population [4].

The situation worsened during the COVID-19 pandemic, with a recent meta-analysis examining 130 studies involving more than 132,000 students reporting a significant increase in anxiety and depression disorders among this population [5]. Countries such as India, Colombia, Mexico, Nicaragua, Peru, and Venezuela have also documented high levels of psychological distress among medical interns, with varying prevalences of depressive symptoms [6–9].

At the national level, empirical data on the mental health of medical students in Argentina remain limited. In the province of San Luis, a prevalence of burnout syndrome of 89% was reported among senior-year students, a condition closely linked to depressive symptoms [10]. In the Autonomous City of Buenos Aires, the University of Buenos Aires has implemented the CALMA app as a suicide prevention tool based on dialectical behavior therapy. However, no published studies have yet evaluated its impact on the medical student population [11].

Despite the magnitude of the problem, most affected students do not seek professional treatment, whether due to lack of awareness, stigma, or a lack of adequate institutional resources [4]. This situation poses an urgent challenge for universities and health systems, which must implement effective strategies for early detection, psychological support, and suicide prevention.

This research asks: What are the experiences and perceptions that students attribute to depression and psychological distress during their clinical rotations? The hypothesis is that there are significant levels of psycho-emotional distress linked to academic stress, isolation, and lack of support.

Given this situation, this study aims to analyze levels of depression and factors associated with psychological well-being among senior medical students at the Inter-American Open University (UAI) in the Autonomous City of Buenos Aires. The study seeks to provide up-to-date, locally relevant scientific evidence to assess the scope of the problem in the Argentine context and to inform the design of early intervention and prevention programs in the university setting.

Elements of the Problem

- Current situation of students facing high levels of stress, academic overload, exposure to human suffering, and long workdays, especially during clinical rotations. These conditions may affect their psychological well-being.

- Scope of the study: This study is limited to final-year medical students at the Inter-American Open University (UAI), at its campus in the Autonomous City of Buenos Aires, during the 2024–2025 academic year.

- Relevance of the problem: depression and suicidal ideation are significant risk factors for the health and academic performance of future physicians.

- Accessibility to data or empirical evidence, if available nationally or internationally.

- Accessibility and awareness of the consequences of the problem if timely intervention is not provided.

- Impact on knowledge gaps in public or private institutions or among interested individuals who can contribute to reducing factors predisposing to depression.

- Impact of the level of depressive symptoms on senior medical students at the Inter-American Open University (UAI).

- Accessibility to the possibility of an approach that respects methodological justification and feasibility.

Various international studies have documented that medical students exhibit a higher prevalence of depressive symptoms and other indicators of psychological distress compared to other university students and to the general population of the same age [3,19]. According to a systematic review published in JAMA, approximately 27% of medical students experience depressive symptoms at some point during their training [3].

In Latin America, research conducted in Mexico, Peru, Colombia, and Brazil points to a similar trend, with figures ranging from 25% to 40% for depressive symptoms, especially during the final years of medical school [6–9,20]. In Argentina, data remain scarce and heterogeneous, although isolated studies have reported an increase in psychological distress during advanced stages of medical training [10,15,21].

From a theoretical perspective, the stress-diathesis model posits that certain individuals are more vulnerable to depression due to genetic, psychological, or environmental factors [22]. In the medical context, high academic demands, exposure to death, performance pressure, and a lack of support networks can act as triggering stressors [1,12,22].

Meanwhile, various theoretical approaches have sought to explain the psychological and social factors contributing to emotional distress and the onset of depressive symptoms. The interpersonal theory of suicidal behavior, for example, has been used in some studies to understand the role of the perception of being a burden, social isolation, and habituation to emotional suffering as potential determinants of psychological distress [23]. These elements can be observed to varying degrees in medical students, especially during the final rotation, when emotional exhaustion and feelings of loneliness often intensify [2,6,23].

Depression is one of the leading mental health disorders affecting college students, with a particularly high incidence among those pursuing a medical degree [3,25]. This population faces unique academic and emotional demands, making it particularly vulnerable [1,12]. Various international studies have reported high prevalences of depressive symptoms among medical students, ranging from 20% to 40%, especially in advanced stages of training [3,25].

The final year of the program, which includes the rotating internship, represents a critical period in which an overload of clinical responsibilities, evaluative pressure, direct exposure to situations of human suffering, and the progressive transition to professional practice converge [2,13,26]. This stage also involves a marked reduction in time allocated to rest, leisure, and social connections, which can contribute to isolation, emotional exhaustion, and the onset or worsening of mood disorders [12,26].

Risk factors associated with this issue include, among others, constant academic demands, sleep deprivation, perfectionism, fear of medical error, peer competitiveness, and the absence of institutional frameworks for the preventive management of psychological distress [4,14,22,27]. Added to this is the limited implementation of active emotional support policies by universities, which leaves many students without adequate support during times of high subjective stress [15,21,27].

Although the international literature has extensively documented this phenomenon [3,5,9], in the Argentine context—and particularly in educational institutions in the Autonomous City of Buenos Aires—there remains a marked lack of systematic studies that would allow for a precise assessment of the problem's magnitude and local characteristics [10,11,21]. This lack of data limits the development of prevention, early detection, and psychosocial intervention strategies adapted to the country’s cultural and educational context [18,28].

From a bioethical and public health perspective, addressing this issue is not only relevant but urgent. Future health professionals must be supported throughout their comprehensive training, which should encompass not only academic and technical development but also emotional and mental well-being, as the impact of depression on this population extends beyond the individual, potentially compromising the quality of medical care, empathy with patients, clinical decision-making, and the safety of the healthcare system as a whole [8,29].

Therefore, research into this phenomenon is justified not only in scientific terms but also in light of the ethical commitment of educational institutions to the health and dignity of their students [17,29].

MATERIALS AND METHODS

This study employs a qualitative approach with a descriptive and exploratory orientation. The qualitative approach is considered the most appropriate for an in-depth exploration of the experiences, perceptions, emotions, and meanings attributed by final-year medical students at the Inter-American Open University (UAI) to their experiences with depression and to factors associated with psychological well-being. This type of study allows access to individual and collective subjectivities and provides an understanding of the phenomena from the perspective of the actors involved.

In terms of the research level, it is descriptive, as it seeks to characterize the psycho-emotional experiences of students within their academic and social context, and at the same time, exploratory, given that there is little local research that specifically addresses this phenomenon from a qualitative approach, particularly within the context of the final stage of medical school.

This design does not aim to establish causal relationships or generalize results to the entire student population, but rather to gain an in-depth understanding of the factors underlying psychological distress and the subjective processes that may promote or mitigate self-destructive behaviors. In turn, it allows the construction of a theoretical and empirical foundation that serves as a starting point for broader future research or targeted institutional interventions.

The design adopted for this research is qualitative and descriptive. A non-experimental strategy is employed since independent variables will not be manipulated; rather, phenomena will be described and analyzed as they occur in the natural environment of the study subjects.

The descriptive approach aims to characterize students’ experiences and perceptions regarding depression and factors associated with psychological well-being, without seeking to establish causal relationships, but rather to highlight the frequency, manifestations, and contextual aspects associated with this issue in the academic setting.

Through semi-structured interviews and focus groups, we will explore the discourses, emotions, coping resources, and social representations surrounding the mental health of future physicians. This design facilitates the production of situated, humanized knowledge relevant to the institutional context of medical education and promotes the development of proposals sensitive to students’ real needs.

Population

The population of this study consists of final-year medical students completing their rotating internship at the Inter-American Open University (UAI) during the 2025 academic year. This group is considered because it is in a particularly demanding academic stage, marked by high levels of stress, vocational uncertainty, work overload, exposure to illness and death, and limited institutional support for emotional and psychological well-being.

This population group shares operationally defined common characteristics: they are full-time students in their final year of medical school, with at least six months of experience in the rotating internship, residing in the Autonomous City of Buenos Aires or attending classes in person at campuses within this jurisdiction. This definition establishes a clear framework for analyzing the experiences, perceptions, and emotional states that shape the internship experience and its effects on mental health.

Sample

The sample selected for this research will consist of a representative portion of the population.

Since this is a qualitative study, a non-probabilistic, purposive sampling method will be applied, based on criteria of accessibility, willingness to participate, and informational richness. Priority will be given to the diversity of trajectories, personal experiences, and institutional contexts to obtain a broad and nuanced understanding of the phenomenon under study.

The sample will consist of 16 participants, a sufficient number to achieve theoretical saturation of the collected information.

This implies that data collection will continue until new interviews no longer provide substantially new information regarding the defined thematic axes.

The units of analysis in this research are the narratives, perceptions, emotions, and experiences reported by students regarding their emotional state, levels of depression, coping strategies, institutional ties, and, especially, the presence or absence of depression. The focus is on a deep understanding of these experiences, their contextualization, and their interpretation from a critical and integrative perspective.

Since this study adopts a qualitative approach, the primary data collection instrument will be a semi-structured interview, specifically designed to explore in depth the perceptions, experiences, and reflections of final-year medical students regarding levels of depression and factors associated with psychological well-being during their clinical rotations.

The interview will consist of an open-ended thematic guide, developed based on the theoretical framework and research objectives, which will allow for the exploration of aspects such as:

- The emotional and cognitive burden experienced during the internship.

- Perceptions of institutional, faculty, and peer support.

- The coping strategies used.

- The impact of academic, family, and social expectations.

The instrument will be reviewed and validated by the researcher under the supervision of their advisor and with the approval of the academic committee, to ensure the relevance, clarity, and consistency of the items with the study’s objectives. Pilot interviews will be conducted with two participants outside the sample to verify understanding of the questions and the appropriateness of the language.

The interviews will be individual, in-person or virtual, with an estimated duration of 40 to 60 minutes, following the signing of the informed consent form. They will be audio-recorded with the participant’s authorization and then transcribed verbatim for subsequent analysis.

The final instrument will be included in the thesis appendices, along with the informed consent form and the institutional authorization letter.

Within the framework of qualitative research, the operationalization of variables does not follow the traditional quantitative logic of variables, indicators, and numerical scales, but rather is based on the identification of thematic categories emerging from the study objectives and the theoretical framework.

For this research, we will use analytical categories to guide data collection and analysis, without limiting the possibility of new categories emerging from participants’ discourse (inductive analysis). The main dimensions and subdimensions planned are described below:

These categories will serve as the basis for the coding and content analysis of the discourses, using techniques such as open, axial, and selective coding, which are characteristic of grounded theory.

The flexibility of this framework will allow for the incorporation of new codes that emerge during the course of the research, while maintaining methodological rigor and respect for the participants’ voices.

This research complies with the ethical principles established in the Declaration of Helsinki, which guides medical research involving human subjects and encompasses the fundamental principles of respect for persons, beneficence, non-maleficence, and justice. Furthermore, the guidelines established by the Ethics Committee of the Inter-American Open University (UAI) will be followed, and the necessary approvals will be sought from the institutions involved.

Since the study employs a qualitative approach involving in-depth interviews with senior medical students, absolute respect for participants’ autonomy, privacy, confidentiality, and psychological well-being will be guaranteed. Each participant will receive a written informed consent form detailing the purpose of the study, the voluntary nature of their participation, the option to withdraw at any time, and the confidential use of the information provided.

The interviews will be anonymous, with no recording of names or direct identifying information, and the information obtained will be used exclusively for academic and scientific purposes. The transcripts of the accounts will be coded with pseudonyms to protect participants’ identities.

Furthermore, measures to ensure emotional support will be prioritized during the interviews, given that the research topic—depression and factors associated with psychological well-being—may cause distress. Therefore, strategies for psychological support and professional referral will be available if any participant experiences significant distress during the process.

Finally, all relevant ethical documents (informed consent, institutional endorsement, and protocols for addressing psychosocial risks) will be available in the thesis appendices, ensuring transparency and integrity in the research.

RESULTS

The sample consisted of sixteen students (E1–E16) in their final year of the medical program at the Inter-American Open University (UAI), who were completing their rotating internship during the 2025 academic year. This group represented a diverse sample across gender, age, and personal experiences within the various hospital rotations, providing a broad, contextualized view of the phenomenon under study.

Participants were selected through purposive sampling, prioritizing voluntariness, accessibility, and willingness to share their experiences, in line with the study’s qualitative approach. All interviewees signed an informed consent form, ensuring respect for the ethical principles of autonomy, confidentiality, and non-maleficence.

The interviews were individual and semi-structured, conducted in a trusting environment that encouraged the free expression of emotions, perceptions, and experiences. They were conducted both in person at university campuses or hospital facilities where the students were completing their rotations, and virtually via video calls, adapting to each participant’s circumstances. The average duration was 45 minutes, although some interviews lasted up to an hour when the interviewees spontaneously delved into personal or reflective aspects of their experience.

In all cases, the interviews were recorded with the participants’ consent and subsequently transcribed verbatim, preserving the narrative richness and authenticity of the discourse. This procedure enabled us to identify common patterns, individual nuances, and significant differences in emotional well-being and in factors associated with academic stress.

The following table summarizes the general characteristics of the participants, identified by alphanumeric pseudonyms (E1–E16) to ensure anonymity and protect their identities:

Table 3. General characteristics of the interviewed students (E1–E16) in their final year of the medical program at the Inter-American Open University, academic year 2025.

Emotional experience during the internship

The emotional experiences described by the participants revealed a wide spectrum of feelings, with distress, anxiety, and emotional exhaustion predominating. Most stated that the internship was a period of intense emotional strain and responsibility, a challenging transition to professional life.

Several interviewees reported experiencing intense pressure and vulnerability. “At first I was excited, but over time I began to feel exhausted, drained of energy, and afraid of making mistakes” (E4). Others expressed ambivalent emotions: “It was a beautiful experience; I learned so much, but I also felt alone and sometimes overwhelmed by so many demands” (E7).

Long workdays, lack of rest, and constant exposure to patients’ suffering were factors mentioned repeatedly. “Seeing patients die every day leaves a mark on you. You try not to think about it, but you get home, and it keeps going round and round in your head” (E13).

Likewise, a sense of emotional overwhelm emerged, especially among those without strong support networks. “I felt like everything was overwhelming me, as if I didn’t have any time for myself” (E2). Even so, some students highlighted the personal satisfaction derived from clinical learning and supporting patients: “Despite the exhaustion, seeing a patient improve brings you immense joy” (E10).

In summary, the internship experience was deeply ambivalent, marked by conflicting feelings of professional enthusiasm and psychological exhaustion. On the one hand, the students highlighted the satisfaction derived from hands-on learning, the opportunity to apply the knowledge they had acquired, and direct patient contact—aspects that strengthened their medical calling and sense of purpose. However, this positive experience was continually strained by emotional overload, accumulated fatigue, and a sense of vulnerability amid clinical and academic demands.

Many described the internship as a stage of personal growth and professional maturity, but also as a period in which their physical and emotional limits were tested. The initial enthusiasm for providing patient care turned, in some cases, into exhaustion, insecurity, and feelings of inadequacy, especially when the demands exceeded their coping capacity. Overall, the accounts show that the rotating internship is a complex formative experience, in which pride in advancing toward the medical profession coexists with a marked psychological impact stemming from stress and the responsibilities assumed.

Academic Stress and Performance Pressure

All interviewees agreed that academic demands and constant evaluation generated high levels of stress. The need to “always perform at one’s best” and comparisons with peers were cited as sources of pressure.

“I feel like I have to prove what I know all the time, because if I make a mistake, they’ll call me out in front of everyone” (E6). In other cases, the fear of failure was a central concern: “I was afraid of not measuring up, of doing poorly in the rotation, or of the faculty thinking I’m not cut out for this” (E5).

Several participants mentioned that excessive workload prevented a balance between their academic and personal lives. “There’s no time for anything, not even to eat properly or rest. It’s all hospital and studying” (E9).

Assessment pressure was also linked to a perception of unfairness or arbitrariness in clinical evaluations. Some described how performance depended more on the instructor’s mood than on their own effort. “You can do everything perfectly and still get a bad grade. That frustrates you and makes you doubt yourself” (E12).

The internship was perceived as a decisive and challenging stage, where practical learning was intertwined with a constant fear of error, intense self-demand, and pressure to achieve academic and clinical performance. Participants reported that every procedure, observation, or decision felt like a constant evaluative moment, creating a continuous sense of being watched and judged. This perception fostered a state of sustained psychological alertness, which, while driving professional commitment and responsibility, also led to high levels of anxiety and emotional tension.

Many students expressed that, although they understood the importance of rigor in medical practice, the lack of room for error or reflection without punishment made learning a distressing experience. The fear of making mistakes in front of faculty or patients, coupled with the need to meet high personal and external standards, led to an excessive self-demand that limited their enjoyment of the educational process. In some cases, interviewees reported that the feeling of “not being able to fail” persisted even outside the hospital, affecting their sleep and overall well-being.

Overall, the testimonies reveal that the internship was experienced as an intense but emotionally draining training phase, in which the desire to learn and excel coexisted with constant internal and external pressure, resulting in persistent, prolonged, and difficult-to-manage stress throughout the academic year.

Signs of psychological distress and depressive symptoms

During the interviews, multiple manifestations consistent with mild to moderate depressive symptoms emerged, such as sadness, demotivation, sleep disturbances, and thoughts of hopelessness.

“There were days when I didn’t want to get out of bed; I felt like nothing made sense” (E4). “I slept poorly, ate out of anxiety, and was tense all the time” (E3). In some cases, indicators of profound emotional exhaustion were observed: “I would cry in the hospital bathroom without really knowing why” (E7).

Although most did not report explicit suicidal ideation, they did mention thoughts of wanting to disappear or not continue: “Sometimes I thought that if I could leave everything behind and start something new, I would. It’s not that I wanted to die, but I didn’t want to go on like that” (E9).

Social isolation was another frequent manifestation. “I stopped seeing my friends; I had no energy or desire to do so. I just wanted to sleep when I got home” (E14).

Overall, the participants’ accounts revealed accumulated emotional fatigue throughout their residency, with clear signs of psychological distress and anhedonia, consistent with depressive states linked to the academic and clinical environment.

Protective Factors and Coping Strategies

Despite the distress, most interviewees identified both personal and external resources that helped them cope. Among the most frequently mentioned were family support, friendships with peers, spirituality, and engaging in recreational activities.

“My family was my support; they always reminded me that this was just a phase and that it would pass” (E15). “Going for a walk or listening to music helped me disconnect from the hospital” (E16).

Some turned to psychological therapy as a coping tool. “I started seeing a psychologist because I couldn’t handle the anxiety anymore, and it did me a world of good to be able to talk about all of this” (E1). Others highlighted the importance of peers as a source of emotional support: “We listen to one another; sometimes a chat with a colleague is worth more than any advice” (E10).

Coping strategies ranged from humor and resilience to setting personal boundaries. “I learned not to be so hard on myself, to accept that not everything depends on me” (E8).

These findings reflect that, although the educational environment proved highly demanding and emotionally taxing, students managed to mobilize various personal and social resources that acted as protective mechanisms against psychological burnout. The coping strategies identified were numerous and diverse, ranging from recreational or sports activities and seeking spaces for emotional disconnection to strengthening meaningful bonds with family members, friends, or classmates.

The presence of close support networks—especially family support and peer solidarity—emerged as a central factor in cushioning the effects of stress and preventing emotional breakdown. Likewise, some participants noted that psychological therapy, spiritual practice, or dialogue with trusted individuals were key tools for maintaining emotional stability during times of greatest pressure.

Although not all interviewees had access to the same resources, most demonstrated a conscious effort to preserve their mental well-being, showing resilience and adaptability in the face of the adversities inherent to boarding school life. In this regard, students not only weathered the impact of academic and care-related demands but also learned to identify their limits, prioritize self-care, and recognize the importance of emotional balance as part of the educational process.

Overall, the results suggest that, despite the adverse context, participants employed active coping strategies, enabling them to maintain an acceptable level of psychological well-being and continue their academic journey without significant interruptions.

Institutional support and support networks

Perceptions of institutional support varied widely. Most felt that the university lacks systematic opportunities for emotional support. “They never asked us how we were doing. All that matters is completing the rotations” (E2).

Some acknowledged the willingness of certain faculty members, but noted that support depended more on individual initiative than on institutional policy. “I had a very compassionate professor, but she was an exception. In general, there’s no place to talk about how we feel” (E12).

The interviewees expressed a desire for the university to implement mental health programs and ongoing psychological counseling: “It would be important to have a space to talk, without fear of being judged or that it will affect our grades” (E11).

Despite the lack of formalized institutional support, students highlighted the value of peer support as their primary safety net: “We understand each other because we’re going through the same thing. We support each other a lot” (E14).

In conclusion, institutional support was perceived as insufficient, disorganized, and inaccessible, leaving students emotionally helpless in the face of the internship's demands. While some mentioned the goodwill of certain professors or tutors, most agreed that there were no formal or sustained mechanisms for psychological or academic support. This lack led students themselves to build informal peer support networks based on empathy, active listening, and mutual understanding, serving as an alternative source of emotional support in the absence of institutional structures. Although valuable, these networks formed spontaneously and without professional support, highlighting the need for universities to promote permanent spaces for mental health and student support that acknowledge the emotional impact of the educational process and provide preventive and ongoing support to future physicians.

Final reflections from the participants

At the conclusion of the interviews, the students shared personal reflections on the internship's meaning and the lessons they learned. Many reported developing greater emotional resilience and empathy, though they acknowledged periods of doubt and exhaustion.

“I learned to recognize my limits, to ask for help when I need it” (E3). “This year changed me as a person; it made me more empathetic toward patients and also toward myself” (E10).

Several emphasized the need for institutional reforms focused on student well-being: “The system should take better care of students. You can’t learn well if you’re emotionally drained” (E5).

Overall, the final accounts reflected a positive assessment of the personal and professional growth achieved during the internship, accompanied by a recognition of the effort and emotional maturity gained in the face of the challenges experienced. Many participants expressed pride in having overcome such a demanding phase, noting that the experience strengthened their medical vocation, fostered resilience, and deepened their empathy toward patients and themselves. However, this positive assessment coexisted with constructive criticism of the academic and organizational structure of medical training, perceived as rigid, hierarchical, and insensitive to students’ emotional needs. Several interviewees stated that, although they value the demands as an inherent part of the training process, they consider it necessary to incorporate spaces for listening, mentoring, and institutional psychological support that promote a healthier balance between academic excellence and holistic well-being. In summary, the final testimonies reveal a mature and reflective perspective, in which students acknowledge both the educational value of the internship and its structural limitations, proposing changes aimed at a more humane and empathetic medical education.

General Summary of Findings

The results show that final-year medical students experienced the rotating internship as a formative yet emotionally demanding process, marked by high levels of stress, self-imposed pressure, and symptoms of psychological distress. At the same time, they identified sources of resilience, including interpersonal support, family, and personal coping strategies.

The body of testimonies allows us to conclude that students’ psychological well-being is compromised by structural factors in the educational and healthcare environment, and that the implementation of institutional spaces for emotional support is an urgent necessity to promote a more humane and comprehensive medical education.

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DISCUSSION

The results obtained in this study provide a deeper understanding of the emotional experiences and factors associated with psychological well-being among final-year medical students. The findings align with the international literature, which indicates that the rotating internship is one of the most stressful and emotionally demanding stages of medical training [3,5,9]. As noted by Rotenstein et al. (2016) and Benjet et al. (2021), the prevalence of depressive symptoms and psychological distress among medical students far exceeds that of the general population, a fact clearly reflected in the accounts analyzed.

In this study, students describe the internship as an ambivalent process, where satisfaction with clinical learning coexists with feelings of anxiety, sadness, and emotional exhaustion. This phenomenon has also been documented by Fernández and García (2023), who note that continuous exposure to illness and death, coupled with high academic demands, can lead to emotional burnout, demotivation, and symptoms consistent with depression. The local findings thus reinforce previous evidence that medical training represents not only a cognitive challenge but also a significant emotional challenge.

Likewise, pressure to perform and fear of making mistakes emerge as central elements in the participants’ experience. The feeling of being constantly evaluated, along with self-imposed demands and peer competition, constitutes a constant source of stress. Previous studies conducted in Chile and Brazil have described similar dynamics, where the culture of medical perfectionism and the lack of room for error generate anxiety and frustration [7,19]. In this regard, the results reaffirm the need to rethink pedagogical models that are based solely on demands and evaluation, and to incorporate strategies that promote emotional safety and reflective learning.

Furthermore, the accounts reveal depressive symptoms of varying intensity, expressed as sadness, fatigue, sleep disturbances, and loss of interest, without necessarily progressing to major clinical conditions. This finding aligns with the report by Campo-Arias and Oviedo (2020), who argue that subclinical symptoms of depression are highly prevalent among university students and frequently underestimated. The fact that several participants acknowledged thoughts of hopelessness or a desire to drop out reinforces the importance of implementing early detection protocols and psychological support within educational institutions.

In contrast to risk factors, the study also identifies coping strategies and protective resources that promote adaptation and well-being. The presence of family support, peer support, seeking professional help, and participation in recreational activities emerges as key elements for maintaining emotional balance. These strategies align with the stress-coping model proposed by Lazarus and Folkman (1984), which holds that personal and social resources can moderate the impact of environmental demands. Resilience, in this context, becomes an essential component of psychological well-being, reinforcing the findings of Barraza et al. (2023), who highlight the influence of perceived emotional intelligence on reducing stress and anxiety among medical students.

A relevant aspect of the present study is the widespread perception of a lack of institutional support, which participants describe as a structural gap in medical education. This absence of formal psychological support mechanisms aligns with the findings of Gómez and Martínez (2022), who note that the stigma associated with seeking help and the lack of institutional policies exacerbate students’ emotional vulnerability. The replacement of these spaces with informal peer support networks demonstrates students’ ability to create spontaneous support mechanisms. However, it also highlights universities’ ethical responsibility to offer systematic mental health programs.

From a theoretical perspective, the findings can be interpreted in light of the stress-diathesis model, which posits that the emergence of depressive symptoms depends on the interaction between personal vulnerabilities and contextual stressors [22]. In this case, academic workload, exposure to human suffering, and the lack of institutional support act as precipitating factors, while resilience, spirituality, and support networks operate as protective factors. This dynamic balance explains why, despite high demands, many students manage to maintain an acceptable level of emotional well-being.

Regarding methodological limitations, it should be noted that, as this is a qualitative study with a purposive sample of sixteen participants, the results cannot be generalized to the entire medical student population. However, its strength lies in the depth and richness of the narratives, which allow for an understanding of subjective dimensions that quantitative studies rarely capture. Another potential limitation relates to social desirability bias, as some students may have moderated their responses when discussing sensitive topics such as depression or suicidal ideation.

Despite these limitations, this research provides new insights into the emotional reality of medical students in the Argentine context, an area where systematic scientific research remains scarce [10,21]. The novelty of this study lies in its qualitative, exploratory approach, centered on participants' voices, which helps highlight specific needs and institutional priorities.

In conclusion, the findings suggest that medical students’ psychological well-being depends not only on their personal resources but also on the structural conditions of the educational system. Universities must implement preventive strategies and permanent psychological support spaces to promote mental health, empathy, and self-care during the most critical stages of medical training. Future studies should delve deeper into evaluating the impact of these programs, incorporate mixed-methods approaches, and comparatively explore differences between public and private institutions to build healthier, more humanized, and sustainable academic environments.

CONCLUSION

This research enabled an in-depth exploration of the emotional experiences, risk factors, and coping resources associated with the psychological well-being of senior medical students at the Inter-American Open University (UAI). Through the qualitative analysis of sixteen semi-structured interviews, it was evident that the rotating internship constitutes a decisive yet highly demanding stage of training, characterized by a constant tension between clinical learning and emotional exhaustion.

The findings show that most students navigate this period with significant levels of stress, anxiety, and mild or moderate depressive symptoms, associated with academic overload, fear of making mistakes, and constant self-demand. However, relevant protective factors were also identified, such as personal resilience, family support, and peer support, which enabled participants to maintain their emotional balance and continue their academic trajectories.

Furthermore, a widespread perception of insufficient institutional support was observed, underscoring the urgent need for universities to implement psychological support programs, personalized mentoring, and active-listening spaces to promote the mental well-being of future healthcare professionals. The absence of systematic policies for emotional support not only increases individual vulnerability but can also negatively impact the quality of learning and, in the long term, the empathetic and safe practice of the medical profession.

From a holistic perspective, this study reaffirms that medical education should not focus exclusively on technical and scientific development but also on the human, emotional, and ethical dimensions of the student, recognizing that psychological well-being is an essential component of professional competence.

In terms of future implications, the results of this research allow for a rethinking of the pedagogical and organizational strategies of training institutions, promoting a more humane, participatory, and self-care-oriented educational model. Future studies could expand this line of research through mixed-methods approaches, inter-institutional comparisons, or longitudinal analyses that allow for the evaluation of the evolution of psychological well-being throughout the medical career.

In summary, it is concluded that the emotional well-being of medical students depends on both the personal resources they develop to cope with academic demands and the institutional conditions that facilitate or hinder this process. Addressing this issue with a preventive, empathetic, and structural approach represents not only an ethical obligation for universities but also an investment in the mental health and human well-being of future physicians.

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