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Residency training exposes medical trainees to prolonged work hours, academic pressure and emotionally demanding clinical situations. These stressors contribute to psychological distress, potentially affecting patient safety and long-term workforce sustainability. This cross-sectional study assessed the prevalence of psychological distress among postgraduate (PG) medical students using the Depression Anxiety Stress Scale (DASS-21), evaluated coping strategies using the Brief COPE questionnaire and examined associations between stress and coping patterns from a psychiatric rehabilitation perspective. Methods: A total of 430 PG medical trainees from three medical colleges of India completed a structured online questionnaire including demographic details, DASS-21 and Brief COPE questionnaire. Scores were computed as per standardized guidelines. Subgroup differences across specialty (clinical vs non-clinical), year of training and institutional site were evaluated. Correlations between stress and coping patterns were analyzed to explore adaptive and maladaptive psychological responses. Results: Clinical specialties demonstrated significantly higher stress scores compared to non-clinical specialties (Mean=29.8 vs 21.4). First-year residents reported the highest distress, primarily associated with long duty hours (75–100 hours/week) and reduced autonomy. Active and support-seeking coping strategies predominated, while religious coping showed modest positive correlation with stress (r=.15). Avoidant coping remained low. Minimal institutional variation suggested systemic stressors across training environments. Conclusions: PG trainees experience considerable distress, most evident during early residency and across high-intensity clinical specialties. While adaptive coping is prevalent, elevated stress highlights the need for structured mental health rehabilitation strategies, duty-hour reforms and resilience-building interventions. Findings emphasize occupational mental health as a critical component of healthcare workforce sustainability.