Since 2020, involution has suddenly become a popular online term from an academic term to a popular one in China. Educational involution generally refers to a relatively closed teaching environment. In the field of education, education stakeholders continuously increase their time, energy, capital, and other investments in order to achieve their expected goals. Finally, it leads to leading to a decrease in the overall input-output ratio. The education involution has also become one of the most frequently mentioned "pain points", and people's intuitive feelings about it are parents' anxiety, students' hard work, teachers' fatigue, and all education stakeholders are increasing their investment. In this context, a general consensus is that involution as a kind of irrational competition is highly related to mental health, based on more than 100 million quotations on the internet pertaining to both involution and mental health 1.
The negative impact of involution on higher education in universities deserves the attention of educators, as it brings new academic pressure and further threatens the mental health of college students, especially medical students who already face heavy academic pressure. In higher education, medical students deal with many more types of challenging stressors than most students with other majors, including curricular aspects, learning environments, intense academic demands and workloads, personal life events, and psychological pressures that are difficult to cope with 2,3. Medical students’ academic and emotional demands are more prominent than those of any other profession 4. Research has shown that stress is a double-edged sword for medical students that can either increase their chances of success or prevent them from enhancing their performance 5.
To medical students, stress provides motivation that, to some extent, can be considered an academic stimulation. However, prolonged stress can lower academic performance and lead to health problems 6. A study in China indicated that, to a certain extent, stress scores might negatively correlate with academic performance among medical students 5. In addition, many studies have shown evidence of a link between stressful events and physical health in all college students, including medical students 7,8. For example, among several psychosocial factors, emotional stress has been recognized as a modifiable risk factor for cardiovascular disease 9–11 and could cause cardiovascular consequences for medical students when long-term stressors are placed on them 7. Continuous stress further impacts students by negatively affecting their self-concept, such as self-worth, general health, and immune functions 12. Therefore, researchers have explored factors such as anxiety and depression, which are associated with stress 13,14. The negative emotions caused by these pressures reduce life satisfaction 15, threaten the mental health of medical students, hinder their self-development 16, and cause serious socioeconomic burdens 17.
Despite the growing evidence for a positive relationship between involution behavior and stress level among college students, the debate over whether involution causes mental health problem has persisted. A survey by da found that involution does not always have a positive correlation with anxiety among college students in different contexts. No previous studies have considered the psychological adjustment among medical students in coping with stress under Chinese academic involution. Under academic involution, exploring the process of coping with stress and psychological adjustment from medical students’ perspectives can be targeted to identify the adverse consequence caused by stress, and provide a basis for appropriate internal and external interventions to address the mental health problem and stress response for medical students in the future. Hence, this study aims to explore the experiences of medical students coping with stress under academic involution and construct an interpretive understanding from the medical students’ perspective by using constructivist grounded theory.