Transitioning to medical school: The intersection of mental health and time management

INTRODUCTION

Time management involves structuring, protecting, and adapting one’s use of time to meet evolving circumstances.^[1] It becomes especially critical during periods of significant life change, such as the transition from secondary school to the rigorous environment of medical education. Medical students often face a heightened academic workload, unfamiliar surroundings, and peer pressures, all of which can make effective time management and successful adaptation essential.^[2-4]

Studies have consistently shown a strong positive correlation between time management and academic success. For instance, well-planned effort management, strategic learning approaches, and organized study routines have been linked to better academic outcomes, whereas poor habits – such as last-minute cramming, overuse of social media, and disorganized study methods – have been associated with weaker performance.^[5,6] In addition, time management and self-assessment strategies have been found to enhance academic performance among 1^st-year students in health-related fields, underscoring the importance of organizational and synthesizing skills over raw aptitude.^[7,8]

Different learning styles also play a critical role. Tools that help students understand their individual learning preferences can guide them toward more effective study techniques. Among these styles, surface learning – where students memorize material solely for examinations – tends to result in superficial understanding and is more common during undergraduate years. In contrast, deep learning, which emphasizes conceptual understanding, becomes more prevalent in postgraduate settings.^[9] For example, research from the United Kingdom found that 1^st-year medical students who employed deep learning approaches achieved higher scores than those who relied on superficial strategies.^[10] Similarly, a Turkish study highlighted the popularity of multimodal learning among 1^st-year medical students, with a preference for read/write methods.^[11] Motivational strategies such as peer learning, seeking help when needed, and creating a well-organized study environment have also been shown to improve learning outcomes and time management practices.^[12,13]

This study aims to contribute to a deeper understanding of how medical students in their 1^st year manage their time and adapt to their demanding academic environments. The findings are intended not only to help these students develop better time management strategies, thereby improving their academic performance, but also to inform guidelines set forth by the National Medical Commission.^[14] By addressing these challenges and offering evidence-based recommendations, this research seeks to support medical undergraduates in their academic journey and provide a foundation for future educational frameworks.

MATERIALS AND METHODS

The present observational study received approval from the institutional research and ethics committee (approval code: GMCH/IEC/2023/1117R) and was conducted in accordance with the ethical principles established in the 1964 Declaration of Helsinki and its subsequent amendments or comparable standards. The present study adheres to the STROBE guidelines for observational studies.

The present study is a single-center study. A total of 157 1^st-year undergraduate medical students enrolled in the Bachelor of Medicine and Bachelor of Surgery (MBBS) program participated in this study. Informed consent was obtained from all participants before enrollment. Subjects were divided into two cohorts: The first cohort (pre-group; n = 77) completed a time management assessment questionnaire before the commencement of their initial professional MBBS classes and the second cohort (post-group; n = 80) completed the same questionnaire following their first mid-term examinations during the 1^st year of the MBBS curriculum.

The assessment instrument was distributed electronically as a Google Form. To preserve participant confidentiality and autonomy, individual identities were concealed from peers throughout the process.

The following domains of time management were evaluated:

1. Time management mechanisms: Questions in this section examined various methods of time allocation, including micro- and macro-level planning approaches

2. Coping with the flow of academics: This domain explored strategies employed to manage time in accordance with the pace of the academic schedule.

3. Organization of time and meeting deadlines: Participants were queried on their use of structured methods and guidance to efficiently organize time to meet academic deadlines

4. Outcomes of time management: This domain assessed the perceived effectiveness of time management in achieving academic goals, maintaining confidence, and supporting mental well-being

5. Sense of purpose: Included only in the post-group survey, this domain addressed participants’ underlying motivations and intentions behind implementing time management strategies.

At the conclusion of the survey, an open-ended question invited participants to describe potential causes of time management imbalance in their academic routines.

Data collection was managed through Google Forms. Given the categorical nature of the data, Chi-square tests were employed to compare responses between the pre- and post-groups. Pearson correlation tests were used to identify relationships among the different domains of time management.

RESULTS

The present investigation was conducted among 1^st-year MBBS undergraduates, focusing on the assessment of various time management domains using a Google-based questionnaire. In total, 77 students constituted the pre-group, responding before the commencement of their first professional MBBS classes, while 80 students formed the post-group, responding after their initial mid-term examination. Tables 1 and 2 present a comparative analysis of time management domains between these two groups.

Regarding the domain “mechanism of time management,” significant differences were observed in microplanning (P = 0.0059) and macroplanning (P = 0.0255) [Figure 1], the utilization of applications for time management (P = 0.0026), checking email (P = 0.0053), and daily digital screen time (P = 0.0043) [Figure 2]. Within the “coping with temporal flow” domain, significant differences emerged in daily and weekly target setting (P = 0.0113 and P = 0.0332, respectively).

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Figure 1:

Comparing the queries of domain (a) “macroplanning” and (b) “microplanning.” The comparison of responses among the macroplanning and microplanning domain. Group 1 comprises the medical students after entering the medical college and before starting of their Bachelor of Medicine and Bachelor of Surgery classes. Group 2 comprises of the medical students after completing their first-time mid-term examination.

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Figure 2:

Comparing the queries of the domain “digital screen time per day.” Comparison of responses among different time periods of the “digital screen time per day” domain. Group 1 comprises the medical students after entering the medical college and before starting their Bachelor of Medicine and Bachelor of Surgery classes. Group 2 comprises the medical students after completing their first time mid-term examination.

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In the “organization to meet deadlines” domain, significant differences were observed in students’ responses to statements such as “I have said no to my friends to organize my work and meet deadlines” and “how do you organize/prioritize your work” (P < 0.0001 for both). Conversely, no significant difference was identified in the “propensity of plan” domain (P = 0.1574).

For the “outcome” domain, several items exhibited significant differences between groups, including self-assessment of being a smart and hard worker (P = 0.0026), the relationship between time management and target achievement (P = 0.0450), time management’s impact on mental health (P = 0.0018), its influence on goal attainment (P = 0.0009), and rewarding oneself after reaching goals (P < 0.0001).

Further analysis revealed significant correlations among the different time management domains, as depicted in Figure 3. Responses to the open-ended question on time mismanagement highlighted common challenges such as social media distractions, syllabus pressure, a competitive academic environment, and insufficient self-study time due to extended college hours.

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Figure 3:

The correlation matrix among the responses of the queries in post-group. The numerical values in the boxes are showing the Pearson correlation coefficient (r value) for the correlation among the respective pair of queries. The boxes marked in gray are showing the significant correlation (P < 0.05). The coded queries are as follows. A: Make a list of work to be done daily, B: Target work for a week and then for a month (macroplanning), C: Use an application for time management, D: Screen time per day, E: Need to make a list of “to do” work, F: Targets set/day, G: Targets set/week, H: Number of times did microplanning, I: Microplanning did >50% of time, J: Could weigh burden of my syllabus and plan my test preparation, K: How do you organize/priorities your work, L: Keep reserve day with some amount of work shift, M: Scheduled preparation of my semester examination, N: Time management and achievement of my targets, O: Time management and my confidence level, P: Time management and my goals, Q: Time management and my mental health, R: Time management of National Eligibility-cum-Entrance Test examination (entrance examination for the undergraduate course) and its application to Bachelor of Medicine and Bachelor of Surgery (MBBS) 1^st-year midsemester examinations, S: Surface learning will help in covering syllabus and get marks too, T: Deep learning will help in covering syllabus and get marks too, U: Blend of surface and deep learning will help in covering syllabus and get marks too, V: MBBS course every year ends up with 20–25% of supplementary examination and I am not an exception.

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DISCUSSION

Effective time management is recognized as a fundamental component of medical education, influencing both academic performance and overall well-being. The present study sought to examine changes in various time management domains among 1^st-year MBBS students, noting substantial shifts in micro- and macroplanning, the use of time management applications, deep- and surface-learning, email-checking habits, daily and weekly target setting, and digital screen time. These findings suggest that the transition into medical school – marked by a more demanding curriculum and new academic pressures – has a significant impact on students’ time management strategies.

A notable decrease in daily and weekly planning was observed in the post-group, potentially reflecting the intensification of their schedules and the pressures of covering the voluminous medical syllabus. The increase in digital screen time, coupled with frequent mention of social media as a distractor, aligns with findings by Voltmer et al., who reported that medical students in the early years of training face elevated stress, anxiety, and depression.^[2] Similarly, Afshar et al. highlighted the role of self-perceived stress levels as critical predictors of work-related behaviors and coping patterns.^[3] Other studies, such as those by Kilic et al., further corroborate the link between academic burnout – manifesting as emotional exhaustion and cynicism – and the stressors inherent in early medical training.^[15]

Within the domain of “coping with temporal flow,” fewer daily and weekly targets were set in the post-group, which may reflect the constraints of lengthy college hours and reduced time for self-directed study. Barbosa et al. identified burnout in 12% of freshman medical students, emphasizing that self-regulated learning skills are essential in mitigating such outcomes.^[16] Similarly, Wang and Zheng found that learning-related boredom and impaired self-regulation heightened the risk of burnout, underscoring the importance of adaptive strategies in sustaining academic performance.^[17]

Regarding “organization to meet deadlines” and “propensity of plan,” the post-group demonstrated a more practical approach to task completion, although without increased reliance on senior or mentor guidance for time management. These findings align with those of Bin Abdulrahman et al.,^[8] who identified effective time management, interruption control, and prioritization as hallmarks of highly successful medical students. Furthermore, Sisa et al.^[18] suggested that by emphasizing deliberate planning and time management, a tailored interventional program can improve learning and study skills.

The domain of “outcome” revealed a complex pattern: Although the post-group reported achieving more of their targets (up to 75%), they also experienced greater stress related to time management, likely due to the increased workload and academic demands. Ibrahim et al.^[19] reported that nearly a third of medical students exhibited a high probability of generalized anxiety disorder, highlighting the mental health challenges associated with intensive training. Barbosa et al.^[16] similarly found that successful performance during the 1^st year of medical school depended heavily on self-directed study, sufficient study time, and sustained motivation.

Exploration of correlations among time management domains revealed significant associations between macroplanning and task prioritization, confidence, goal achievement, and mental health. Effective microplanning was linked to better examination preparation, target achievement, and increased confidence, reinforcing findings from meta-analyses such as Claessens et al.,^[20] which demonstrated that robust time management correlates with improved academic performance and psychological well-being. In addition, prior studies have shown that anxiety can exacerbate academic procrastination,^[21] further underscoring the importance of structured time management strategies for medical students.

Interestingly, this study observed that deep learning was helping the students in covering the academic syllabus and achieving the target than superficial learning, likely because it facilitates a deeper understanding and better interpretation of the subject matter. Deep learning was linked to the use of time management tools and more strategic scheduling, and prior research by Dolmans et al.^[22] noted that problem-based learning environments can foster deeper learning approaches while still accommodating certain surface learning strategies. These nuanced findings suggest that while deep learning remains the ideal, surface learning may have situational utility in the demanding context of medical education.

CONCLUSION

In summary, this study illuminates the significant shifts in time management practices among 1^st-year MBBS students as they adapt to the demands of medical school. The results highlight the critical role of well-structured time management in reducing stress, improving academic outcomes, and enhancing overall well-being. However, the study also acknowledges key limitations, including the use of distinct pre- and post-groups and the potential confounding effects of students’ diverse educational backgrounds. The future research should aim to longitudinally assess the same cohort of students, consider controlling for these variables, and explore targeted interventions to further optimize time management strategies and support medical students’ academic journeys.