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Background  Residents face demanding situations on the job and have been found to perceive high levels of strain. Medical students also reported a high degree of strain and even depressive tendencies when entering their clinical rotations. The aim of this study was to explore the perceived strain of medical students from different undergraduate curricula and at different stages of academic advancement during different phases of an assessment simulating a resident’s first day in hospital.    Methods  Sixty-seven undergraduate medical students participated in the following three phases of the assessment in the role of a resident: a consultation hour with five simulated patients, a management phase with interprofessional contact, and a patient handover with a colleague. They completed the Strain Perception Questionnaire (STRAIPER) after each phase. Students from different undergraduate curricula (VI: vertically integrated,  n  = 35 versus non-VI: not vertically integrated,  n  = 26) and different academic advancement (semester 10,  n  = 26 versus final year,  n  = 41) were compared.    Results  All students showed the highest strain level after the management phase compared to the consultation hour and the handover. Medical students from a non-VI curriculum felt significantly more strain in the dimension of agitation ( p  < .05) after the consultation hour compared to students from a VI curriculum and compared to the management phase and the handover. No significant difference in perceived strain was found between students from semester 10 compared to final year students.    Conclusions  During the consultation hour and the handover with a colleague medical students faced tasks which are familiar to them from undergraduate education. Their higher strain levels during the management phase might occur because they are confronted with unfamiliar tasks and decisions. Feeling responsible for the right actions in this phase of multitasking and professional interaction might have added to the strain students perceived during this phase. Patient management should be emphasized more in any type of undergraduate medical curriculum.

Perceived strain of undergraduate medical students during a simulated first day of residency