Investigating the Relationship Between Resilience, Stress-Coping Strategies, and Learning Approaches to Predict Academic Performance in Undergraduate Medical Students: Protocol for a Proof-of-Concept Study

A cross-sectional study of academic success measures, grit, and resilience among US dental students

PURPOSE

This study explored themes previously identified as central to holistic professional school success, as related to traditional academic achievement, resilience, and grit measures.

METHODS

This cross-sectional study surveyed third- and fourth-year US dental students. Items addressed themes previously identified as central to professional school success, including need for cognition, patient ownership, collective orientation, grit, and resilience. Traditional academic metrics were also included. Statistical analyses comprised one-way analysis of variance (ANOVA), simple linear regression, and stepwise multiple regression procedures.

RESULTS

A total of 126 students participated (81% response rate). Collective orientation, need for cognition, patient ownership, and resilience did not significantly correlate with grade point average (GPA), whereas grit did, r = 0.29. Need for cognition and patient ownership combined significantly predicted grit with approximately 35% of variance explained. Approximately 25% of variance in resilience scores was accounted for by need for cognition, coupled with collective orientation. Grit and resilience significantly correlated, r = 0.59.

CONCLUSIONS

Grit significantly predicted both traditional and alternative metrics of success among dental students, particularly need for cognition and patient ownership. A high need for cognition is consistent among students who display both grit and resilience. Neither resilience nor the alternative measures of success predicted traditional academic metrics.

Conceptual Utility Model for the Management of Stress and Psychological Wellbeing, CMMSPW™ in a university environment: theoretical basis, structure and functionality

This article describes and introduces the Conceptual Utility Model for the Management of Stress and Psychological Wellbeing, CMMSPW™ Its purpose is to assess, evaluate and treat stress and psychological wellbeing. First, the theoretical assumptions of the model are presented. This model is an application of the 3P Model, Theory of Internal vs. External Behavioral Regulation and the Model of Competency for the Management of Stress and Psychological Wellbeing. Second, the conceptual structure of the model is presented. This model allows the structural and functional determination of the variables and predictive, mediating and final factors for stress and psychological wellbeing. Third, the functional structure is presented. For predictive factors, the internal and external self-regulation theoretical model allows us to assess levels of internal and external regulation of the individual and their context, as well as other personal and contextual factors involved in self-regulation. For mediating factors, the model of competence for the management of stress and wellbeing allows us to analyze conceptual (concept and principles), mediating (skills and metaskills) and attitudinal (attitudes, values and habits) variables. Finally, in relation to factors that condition outcomes, we can determine levels of response to stress and psychological wellbeing. Finally, limitations and conclusions are presented. The model also allows us to determine predictive relationships between those three types of variables and is functionally transferable to other contexts, including contexts proper to the psychology of education, clinical practice and healthcare, and psychosocial, organizational and technological contexts.

Emotional intelligence weakly predicts academic success in medical programs: a multilevel meta-analysis and systematic review

BACKGROUND

Emotional intelligence (EI) is a predictive factor of academic success in undergraduate Doctor of Medicine (MD) programs. Although some research suggests a positive association between EI and academic success in MD programs, other research reports neither an association nor a negative correlation between the two variables. The current study aimed to resolve these contradictory findings by conducting a systematic review and a meta-analysis using research from 2005 to 2022.

METHODS

Data were analyzed using a multilevel modeling approach to (a) estimate the overall relationship between EI and academic success in MD programs and (b) determine whether the mean effect size varies according to country (United States vs. non-United States countries), age, EI test, EI task nature (ability-based vs. trait-based), EI subscales, and academic performance criteria (grade point average vs. examinations).

RESULTS

Findings from 20 studies (m = 105; N = 4,227) indicated a positive correlation between EI and academic success (r = .13, 95% CI [.08, - .27], p < .01). Moderator analyses indicated that the mean effect size significantly varied according to EI tests and EI subscales. Moreover, three-level multiple regression analyses showed that between-study variance explained 29.5% of the variability in the mean effect size, whereas within-study variance explained 33.5% of the variability in the mean effect.

CONCLUSIONS

Overall, the current findings show that EI is significantly, albeit weakly, related to academic success in MD programs. Medical researchers and practitioners can therefore focus on integrating EI-related skills into the MD curriculum or target them through professional development training and programs.

Different Effects of Perceived Social Support on the Relationship between Perceived Stress and Depression among University Students with Borderline Personality Disorder Symptoms: A Multigroup Mediation Analysis

Background: While perceived social support can mediate the relationship between perceived stress and depression, little is known about the differences between individuals with high and low borderline personality disorder symptoms (BPDS). This study aimed to investigate the associations among perceived stress, perceived social support, and depression, and compare low and high levels of BPDS. Methods. This cross-sectional analysis was a secondary analysis of data from the SI-Bord study. University students across Thailand completed a screening instrument for borderline personality disorder, the Perceived Stress Scale (PSS), the Revised Thai Multi-dimensional Scales of Perceived Social Support (MSPSS), and the Patient-Health Questionnaire (PHQ)-9. Mediation analysis using PROCESS was applied to test the direct and indirect effects of perceived stress on depression. Multigroup mediational analysis was adopted to compare low and high levels of BPDS. Results. The mean age of the 330 participants was 20.27 (SD, 1.4) and 80% were female. Significant correlations were observed between the PSS, MSPSS, and PHQ scores, with greater magnitude among the high-level BPDS group (p < 0.001). A significant direct effect on perceived stress and a significant indirect effect on depression through perceived social support were noted. Of all the sources of social support, only the significant others variable significantly differed between the two groups (p < 0.05). Conclusion. Perception of social support had a significant mediating role in perceived stress and depression. The magnitude of associations was remarkably high for individuals with high BPDS compared to those with low BPDS. Unlike those with low BPDS, all sources of social support were significant mediators between the two groups.

Effects of resilience on impulsivity, cognition and depression during protracted withdrawal among Chinese male methamphetamine users

BACKGROUND

Methamphetamine (METH) dependence is a complex and dynamic public health problem. Long-term abuse of METH can increase numerous risks of mental and physical problems. Currently, the methods to reduce METH dependence and improve the withdrawal symptoms are limited and ineffective. Resilience is seen as a multidimensional and dynamic capability to recover or bounce back from stressful events and is also generally considered as a protective factor against mental dysfunction.

METHODS

One hundred thirty-four males with METH dependence were consecutively recruited from Huanglong Compulsory Isolated Detoxification Center between 2019 and 2021, of whom 112 were into the group. The Connor-Davidson Resilience Scale (CD-RISC), Self-rating depression scale (SDS), Self-rating anxiety scale (SAS), Barratt Impulsiveness Scale-11(BIS-11), and the Repeatable Battery for the Assessment of Neuropsychological Status (Rbans) were used to evaluate resilience, depression, anxiety, impulsivity, and cognition respectively.

RESULTS

The results mainly indicated that high resilience group showed lower SDS, SAS and BIS-11 scores than low resilience group (all p < 0.05). Besides, the total scores of Rbans were higher in high resilience groups than low resilience group (both p < 0.05). Moreover, linear regression results showed that resilience may be influenced by the scores of SDS and SAS.

CONCLUSIONS

Resilience is negatively correlated with impulsivity and depression. Besides, it is also positively associated with cognitive function. Drug users with higher resilience may have a strong ability to mobilize psychological resources to create a good psychological environment, which may have a positive effect on the relief or improvement of symptoms.

Zimbabwean PreClinical Medical Students Use of Deep and Strategic Study Approaches to Learn Anatomy at Two New Medical Schools

Anatomy is a challenging preclinical subject owing to the vast amount of information that students need to master. The adoption of relevant study approaches is key to the development of a long-lasting understanding of anatomical subject matter. Phenomenographic educational research describes the medical students as using a variable mix of deep, strategic, and surface approaches to study. Continually assessing students' learning preferences and approaches is crucial for achieving the desired learning outcomes. The approaches to studying anatomy in two groups of first-year Zimbabwean medical students from two newly established medical schools were collected using the Approaches and Study Skills Inventory for Students (ASSIST) instrument and than analyzed. At least 90% of the students believed that anatomy involved reproducing knowledge or personal understanding and development. Overall, the majority of the students adopted deep and strategic approaches, while a distant minority used the surface approach. There was no significant correlation between either the students' sex or age and their preference for a specific approach to studying. The mean anatomy grades for students using a strategic approach were significantly higher than those using deep or surface approaches. The number of strategic learners was double that of deep learners among the high achievers subgroup. The strategic approach positively correlated with performance in examinations. Generally, the students shared a common understanding of the concept of anatomy learning. Studies such as this can assist with the identification of students at risk of failure and empower lecturers to recommend the adoption of more beneficial strategic and deep learner traits.

Design, Implementation, and Evaluation of a Distance Learning Framework to Adapt to the Changing Landscape of Anatomy Instruction in Medical Education During COVID-19 Pandemic: A Proof-of-Concept Study

This study presents the design of a DL-framework to deliver anatomy teaching that provides a microfiche of the onsite anatomy learning experience during the mandated COVID-19 lockdown. First, using nominal-group technique, we identified the DL learning theories to be employed in blueprinting the DL-framework. Effectiveness of the designed DL-framework in anatomy teaching was demonstrated using the exemplar of the Head and Neck (H&N) course during COVID-19 lockdown, in the pre-clerkship curriculum at our medical school. The dissemination of the DL-framework in the anatomy course was informed by the Analyse, Design, Develop, Implement, and Evaluate (ADDIE) model. The efficiency of the DL-framework was evaluated using the first two levels of Kirkpatrick's model. Versatility of the DL-framework was demonstrated by aligning its precepts with individual domains of key learning outcomes framework. The framework's blueprint was designed amalgamating principles of: Garrison's community inquiry, Siemens' connectivism and Harasim's online-collaborative-learning; and improved using Anderson's DL-model. Following the implementation of the DL-framework in the H&N course informed by ADDIE, the framework's efficiency was evaluated. In total, 70% students responded to the survey assessing perception toward DL (Kirkpatrick's Level: 1). Descriptive analysis of the survey results showed that the DL-framework was positively received by students and attested that students had an enriched learning experience, which promoted collaborative-learning and student-autonomy. For, Kirkpatrick's Level: 2 i.e., cognitive development, we compared the summative assessment performance in the H&N course across three cohort of students. The results show that the scores of the cohort, which experienced the course entirely through DL modality was statistically higher (P < 0.01) than both the other cohorts, indicating that shift to DL did not have an adverse effect on students' learning. Using Bourdieu's Theory of Practice, we showed that the DL-framework is an efficient pedagogical approach, pertinent for medical schools to adopt; and is versatile as it attests to the key domains of students' learning outcomes in the different learning outcomes framework. To our knowledge this is the first-study of its kind where a rationale and theory-guided approach has been availed not only to blueprint a DL framework, but also to implement it in the MBBS curriculum.

A Path Analysis Model of Protection and Risk Factors for University Academic Stress: Analysis and Psychoeducational Implications for the COVID-19 Emergency

The aim of this research was to empirically validate hypothesized predictive relationships of protection and risk factors for experiencing academic stress. A synthesis of models-the presage-process-product model; the studying, learning and performing under stress competency model; and self- vs. external-regulatory theory-underlies the investigation and is important for assessment and guidance in stress situations within the university context. Over the course of an academic year, a sample of 564 Spanish university students voluntarily completed validated questionnaires, in an online format, on several psychological variables connected to academic stress. Correlational analysis and the path analysis model, within an ex post facto design, were used to build empirical models of the presage-process-product factors that constitute protection or risk factors in academic stress. Two statistically acceptable models appeared: one with protection factors and another with risk factors in predicting and preventing academic stress at a university. These results support the need for psychology units at university that have a preventive, health and education focus, going beyond the merely clinical. Focus on an individual is insufficient, given that there are also contextual factors that predispose academic stress. Discussion, conclusions, and implications for assessment and intervention in academic stress in university students and teachers, within the present COVID-19 crisis, are offered.

Relationship between Emotional Intelligence, Educational Achievement and Academic Stress of Pre-Service Teachers

Emotional intelligence (EI) and stress are constructs that often characterize the teaching profession and are inversely related. There is evidence in the literature that suggests the importance of teachers working on EI in order to learn coping strategies and improve their teaching practices. This descriptive and correlational study had the purpose of examining the social-emotional profile of future teachers based on their EI and academic stress levels in order to provide guidance for future stressful situations that will affect their future professional development. For this purpose, we used a random sampling for convenience in a university population enrolled in degrees of education at Andalusian universities (Spain), getting a sample of 1020 pre-service teachers. The results pointed to a superiority in EI, academic stress, and academic achievement in favor of females compared to males. The relationship among EI, academic stress, and student teachers' achievement was demonstrated. Furthermore, some components of EI were positioned as important factors to improve student achievement and reduce academic stress. Once the high incidence of these constructs on academic achievement was confirmed, the importance of developing EI and coping and stress skills training programs, aimed at improving academic success and their subsequent professional development, was demonstrated.

The relationships between resilience and student personal factors in an undergraduate medical program

BACKGROUND

Resilience is an essential aspect of wellbeing that plays a major role in undergraduate medical education. Various personal and social factors are known to affect resilience. Empirical evidence remains limited regarding resilience and the personal factors that affect it among undergraduate medical students in an Asian setting. Therefore, this study aims to identify undergraduate medical students' level of resilience and its relationships to personal factors in Indonesia.

METHODS

This cross-sectional study was conducted among undergraduate medical students in years 1-6. Respondents were asked to complete three validated questionnaires: the Connor-Davidson Resilience Scale (CD-RISC) to measure resilience, the Brief-COPE to assess coping mechanisms, and the Big Five Personality Test to measure five personality dimensions. Descriptive and Pearson's correlation analyses were completed to explore relationships between each variable. Regression analysis was completed to analyze the extent to which coping mechanisms, personality, and academic achievement explained the variation in resilience scores.

RESULTS

A total of 1040 respondents completed the questionnaires (a 75.42% response rate). Students in both preclinical and clinical stages had quite good levels of resilience and higher scores on adaptive coping mechanisms than on maladaptive coping mechanisms. Adaptive and maladaptive coping mechanisms, Big Five Personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness), and students' academic achievement explained 46.9% of students' resilience scores.

CONCLUSIONS

Although the resilience scores in this study were comparable to resilience scores among undergraduate medical students in other settings, we found that coping mechanisms, personality traits, and academic performance may predict resilience among medical students.

Design, Implementation and Evaluation of a Distance Learning Framework to Expedite Medical Education during COVID-19 pandemic: A Proof-of-Concept Study

BACKGROUND

The COVID-19 pandemic has forced medical schools to suspend on-campus live-sessions and shift to distance-learning (DL). This precipitous shift presented medical educators with a challenge, 'to create a "simulacrum" of the learning environment that students experience in classroom, in DL'. This requires the design of an adaptable and versatile DL-framework bearing in mind the theoretical underpinnings associated with DL. Additionally, effectiveness of such a DL-framework in content-delivery followed by its evaluation at the user-level, and in cognitive development needs to be pursued such that medical educators can be convinced to effectively adopt the framework in a competency-based medical programme.

MAIN

In this study, we define a DL-framework that provides a 'simulacrum' of classroom experience. The framework's blueprint was designed amalgamating principles of: Garrison's community inquiry, Siemens' connectivism and Harasim's online-collaborative-learning; and improved using Anderson's DL-model. Effectiveness of the DL-framework in course delivery was demonstrated using the exemplar of fundamentals in epidemiology and biostatistics (FEB) course during COVID-19 lockdown. Virtual live-sessions integrated in the framework employed a blended-approach informed by instructional-design strategies of Gagne and Peyton. The efficiency of the framework was evaluated using first 2 levels of Kirkpatrick's framework. Of 60 students, 51 (85%) responded to the survey assessing perception towards DL (Kirkpatrick's Level 1). The survey-items, validated using exploratory factor analysis, were classified into 4-categories: computer expertise; DL-flexibility; DL-usefulness; and DL-satisfaction. The overall perception for the 4 categories, highlighted respondents' overall satisfaction with the framework. Scores for specific survey-items attested that the framework promoted collaborative-learning and student-autonomy. For, Kirkpatrick's Level 2 that is, cognitive-development, performance in FEB's summative-assessment of students experiencing DL was compared with students taught using traditional methods. Similar, mean-scores for both groups indicated that shift to DL didn't have an adverse effect on students' learning.

CONCLUSION

In conclusion, we present here the design, implementation and evaluation of a DL-framework, which is an efficient pedagogical approach, pertinent for medical schools to adopt (elaborated using Bourdieu's Theory of Practice) to address students' learning trajectories during unprecedented times such as that during the COVID-19 pandemia.

Confronting the Challenges of Anatomy Education in a Competency-Based Medical Curriculum During Normal and Unprecedented Times (COVID-19 Pandemic): Pedagogical Framework Development and Implementation

BACKGROUND

Anatomy is considered to be one of the keystones of undergraduate medical education. However, recently, there has been drastic reduction, both in gross anatomy teaching hours and its context. Additionally, a decrease in the number of trained anatomists and an increase in the costs associated with procuring human cadavers have been noted, causing a diminution of cadaveric dissections in anatomy education.

OBJECTIVE

To address these challenges, there is an ardent need for a pedagogical framework such that anatomy education can be disseminated through active learning principles, within a fixed time frame, using a small team of anatomists and a small number of cadaveric specimens (for live on-site sessions) as well as collaborative learning principles. The latter is particularly important when anatomy education is delivered through distance learning, as is the case currently during the COVID-19 pandemic.

METHODS

Here, we have blueprinted a pedagogical framework blending the instructional design models of Gagne's 9 events of instruction with Peyton's 4-step approach. The framework's applicability was validated through the delivery of anatomical concepts, using an exemplar from the structure-function course Head and Neck during the normal and COVID-19-mandated lockdown periods, employing the archetype of Frey syndrome. Preliminary evaluation of the framework was pursued using student feedback and end-of-course feedback responses. The efficiency of the framework in knowledge transfer was also appraised.

RESULTS

The blueprinted instructional plan designed to implement the pedagogical framework was successfully executed in the dissemination of anatomy education, employing a limited number of cadaveric specimens (during normal times) and a social media application (SMA)-integrated "interactome" strategy (during the COVID-19 lockdown). Students' response to the framework was positive. However, reluctance was expressed by a majority of the faculty in adopting the framework for anatomy education. To address this aspect, a strategy has been designed using Mento's 12-step change management model. The long-term benefits for any medical school to adopt the blended pedagogical framework have also been explicated by applying Bourdieu's Theory of Practice. Additionally, through the design of an SMA interactome model, the framework's applicability to the delivery of anatomy education and content during the ongoing COVID-19 pandemic was realized.

CONCLUSIONS

In conclusion, the study effectively tackles some of the contemporary key challenges associated with the delivery of anatomy content in medical education during normal and unprecedented times.