ABSTRACT
Vincular las fuentes de estrés, el afrontamiento y el desempeño académico en los estudiantes de medicina. Para ésto se llevó a cabo un estudio longitudinal en el que participaron 93 estudiantes en el primer año y 80 estudiantes de segundo año en el seguimiento, pertenecientes a un programa de alto desempeño académico de la carrera de medicina. Se aplicó el Cuestionario de Fuentes de Estrés en Estudiantes de Medicina y el Cuestionario de Estrategias de Afrontamiento en cuatro momentos (al inicio y al final del primero y segundo años). Se observó que el nivel de estrés se mantuvo sin cambios significativos para primero y segundo años, tanto en la primera como segunda evaluación (F=2.18, p=0.09). Sin embargo, sólo el puntaje de estrés detectado en la primera medición del primer año se relacionó de forma significativa con el promedio final de este año escolar (r=-0.33, p≤0.05). El afrontamiento predominante en ambos años de la carrera de medicina fue la estrategia de "Solución de problemas" y la menos utilizada fue el "Distanciamiento". Al comparar las estrategias de afrontamiento entre los estudiantes de primero y segundo años, se observaron diferencias en el uso del "distanciamiento", que fue más utilizado por los alumnos en segundo año y el "apoyo social" por los alumnos en primero. A pesar de que las calificaciones fueron menores en los estudiantes cuya estrategia de afrontamiento predominante fue el "pensamiento mágico" y los niveles de estrés más altos, no hubo diferencias significativas con respecto a las otras estrategias. Se concluyó, que los niveles de estrés permanecen constantes en los alumnos de primero y segundo años de la carrera de medicina, pero las fuentes que lo generan y el modo de afrontarlas, se modifican conforme transcurre el ciclo escolar y parecen asociarse al desempeño académico de esta población.
To link the sources of stress, coping strategies and academic performance among medical students. For this we conducted a longitudinal study involving 93 first-year undergraduates and with 80 second-year undergraduates in the follow up, enrolled on the Faculty of Medicine's high academic performance program. Two surveys-Sources of Stress among Medical Students and Coping Strategies-were carried out at four stages (at the start and end of the first and second years). It was observed that the stress level was maintained without significant changes to the first and second year, both at the first and at the second evaluation (F=2.18, p=0.09). However, only the stress scores detected at the initial measurement of the first year was related significantly to the final average of that year (r=-0.33, p≤0.05). In both year groups of medical students, "Problem Solving" was revealed as the main coping strategy, while "Distancing" was the strategy least used. By comparing the coping strategies between first and second-year students, differences were detected in the use of "Distancing," which was more prevalent among second-year students while "Social Support" was used more among first-year students. Although students whose coping strategy was mainly "Wishful Thinking" scored lower and experienced higher stress levels, no significant differences were found compared to other strategies. Was concluded that stress levels remained constant among first and second-year medical students but the sources that create them and the coping strategies change over the school year and appear linked to this population's academic performance.
Vincular as fontes de estresse, o afrontamento e o desempenho acadêmico nos estudantes de medicina. Para isto levou-se a cabo um estudo longitudinal no qual participaram 93 estudantes no primeiro ano e 80 estudantes de segundo ano no seguimento, pertencentes a um programa de alto desempenho acadêmico do curso de medicina. Aplicou-se o Questionário de Fontes de Estresse em Estudantes de Medicina e o Questionário de Estratégias de Afrontamento em quatro momentos (ao início e ao final do primeiro e segundo anos). Observou-se que o nível de estresse se manteve sem câmbios significativos para o primeiro e segundo anos, tanto na primeira quanto segunda avaliação (F=2.18, p=0.09). Porém, só a contagem de estresse detectada na primeira medição do primeiro ano se relacionou de forma significativa com a média final deste ano escolar (r=-0.33, p≤0.05). O afrontamento predominante nos dois anos do curso de medicina foi a estratégia de "Solução de problemas" e a menos utilizada foi o "Distanciamento". Ao comparar as estratégias de afrontamento entre os estudantes de primeiro e segundo anos, se observaram diferenças no uso do "distanciamento", que foi mais utilizado pelos alunos em segundo ano e o "apoio social" pelos alunos em primeiro. A pesar de que as qualificações foram menores nos estudantes cuja estratégia de afrontamento predominante foi o "pensamento mágico" e os níveis de estresse mais altos, não houve diferenças significativas com respeito às outras estratégias. Concluiu-se, que os níveis de estresse permanecem constantes nos alunos de primeiro e segundo anos do curso de medicina, mas as fontes que o geram e o modo de afrontá-las, modificam-se conforme transcorre o ciclo escolar e parecem associar-se ao desempenho acadêmico desta população.
Subject(s)
Humans , Adaptation, Psychological , Stress, Psychological , Students , Education, MedicalABSTRACT
The study and analysis of different factors related to the academic performance of medical students remains a topic of interest, either for selection processes or for the establishment of strategies and interventions to support students who may need it. It is said that there are two groups of features associated with academic performance: the academic (high school grades, scores on entrance exams) and non-academic (personality traits, presence or absence of psychopathology, sociodemographic aspects) characteristics. The purpose of this study was to identify the influence that different features of a group of medical students from the High Academic Performance Program (HAPP) at Universidad Nacional Autonoma de Mexico (UNAM) had on their school performance. Materials and methods This paper presents the one year follow up of a cohort of students initially studied during the selection process to entry the HAPP of Medicine School at UNAM. We evaluated all first-year medical students of UNAM who, during 2009-2010, continued to be part of the HAPP and who agreed to participate in this research. At the end we studied 94 students (48 men, 46 women) with a mean age of 18.3 years. The analyzed variables were: academic performance, demographic factors, academic background, personality, abstract thinking, creative thinking, mental disorder. For the initial evaluation at the entrance to University we used the Minnesota Multiphasic Personality Inventory -2 (MMPI-2), the sub-scale of abstract reasoning from the Differential Aptitude Test (DAT), a semi-structured interview to investigate demographic and academic characteristics, and the figural test from the Torrance Test of Creative Thinking. In a second assessment (at the end of the first year), we applied the MMPI-2 (for a second time with the intention to avoid the pressure that students could have during the selection process to enter the HAPP) and Mini-International Neuropsychiatric Interview (MINI) to assess the presence of psychopathology. Also, final grades were collected from the academic file of each student. For statistical analysis we used ANOVA, multiple linear regression models, bivariate correlations and cluster analysis. Results The general knowledge test was presented as the only significant predictor for both the final average for all subjects separately, and for the final general average. Results: The general knowledge test was the only significant predictor for both the final average and the final grades for each subject. Characteristics of creative thinking (e.g fluency) or personality traits (such as MMPI-2 Mania scale) were significant predictors for the final average for most of the subjects, however they were not consistent at all. Anatomy (r= 859), developmental biology (r=852), biochemistry (r=. 893) and cell biology and tissue (r=.889) were subjects whose average had a high correlation with the global final average, while public health (r=.696) and medical psychology (r=.670) showed a moderate correlation. The score of abstract thinking (r=.029) had not any correlation with the final average that these students got at the end of the year. A comparison between the two measurements (one at the entrance to Medicine School and the other one year later) of the MMPI-2 was made and we found that there was a pattern of consistency between measurements and all correlations among the different scales that shape the inventory were significant (p<.001). Hypochondriasis, Depression, Hysteria and Psychasthenia scales, tended to rise significantly. In order to evaluate the presence of psychopathology in these students at the end of the first year of Medicine School, the MINI it was used. Of the 96 students, it was found that 77 (80.20%) had no psychopathology, and that 19 (19.79%) had one or more mental disorders at the moment of the interview. The disorders that presented the participants were: major depressive disorder (n=15), generalized anxiety disorder (n=7), bipolar disorder (n=1) and anorexia nervosa (n=1). To determine the influence of the presence of psychopathology on the students final grades, we analyzed the differences between the group of students without any mental disorder and the group with psychopathology. There was no statistically significant difference in the general final average (U=678 500, Z0-.503, p=0.615), and it was a characteristic that only made a difference for the final grades of Anatomy (U=475, Z=-2.50, p=0.012) and Public Health (U=544, Z=-2.007, p=0.045). None of the socioeconomic aspects influenced the students' academic performance. Discussion For the group of the evaluated students, we only found that the general test scores of knowledge is a significant and consistent predictor for average subjects in the first year and the final general average. Conclusions The general knowledge test was a useful predictor for final grades because it seems to summarize many of the skills and habits related to student academic success.
Antecedentes El estudio y análisis de los factores relacionados con el desempeño escolar de los estudiantes de Medicina continúa siendo un tema de interés, ya sea con fines de selección o para el establecimiento de estrategias o intervenciones de apoyo para los alumnos. El propósito de este estudio fue identificar la influencia que tenían las diferentes características de un grupo de estudiantes del Programa de Alta Exigencia Académica (PAEA) al finalizar el primer año de la carrera de Medicina en la Universidad Nacional Autónoma de México (UNAM) en su rendimiento escolar. Material y métodos En este artículo se presenta el seguimiento a un año de una cohorte de alumnos del PAEA inicialmente estudiada a su ingreso a la Facultad de Medicina de la UNAM. En total se estudiaron 94 alumnos (48 hombres, 46 mujeres), con una media de edad de 18.3 años. Las variables evaluadas fueron: desempeño académico, factores sociodemográficos, trayectoria académica, rasgos de personalidad, pensamiento abstracto, pensamiento creativo, trastorno mental. Estas se midieron a través del Inventario Multifásico de la Personalidad Minnesota-2 (MMPI-2), la sub-escala de razonamiento abstracto del Test de Aptitudes Diferenciales (DAT); una entrevista semi-estructurada, la prueba figural del test de Pensamiento Creativo de Torrance, y la Mini-entrevista Neuropsiquiátrica Internacional (MINI). Para el análisis estadístico se emplearon ANOVA, modelos de regresión lineal múltiple por pasos hacia atrás, correlaciones bivariadas y análisis de clusters. Resultados El Examen General de Conocimientos se presentó como el único predictor significativo tanto para el promedio final de todas las asignaturas por separado, como para el promedio final general. Características del pensamiento creativo (como la fluidez) o de los rasgos de personalidad (como la escala de Manía del MMPI-2) se mostraron como predictores significativos para el promedio final de la mayoría de las materias, sin embargo no fueron constantes en todas. Anatomía (r=859), biología del desarrollo (r=852), bioquímica (r=.893) y biología celular y tisular (r=.889) fueron asignaturas cuyo promedio tuvo una correlación elevada con el promedio final general; mientras que salud pública (r=.696) y psicología médica (r=.670) presentaron una correlación moderada, y el puntaje de pensamiento abstracto (r=.029) no tuvo ninguna correlación con el mismo. Se realizó una comparación entre las mediciones (inicial y un año después) del MMPI-2 y se observó que existía un patrón de constancia entre las mediciones y todas las correlaciones resultaron significativas (p<.001). De los 96 alumnos evaluados un 19.79% resultó positivo para algún trastorno mental (el depresivo mayor fue el más frecuente). Sin embargo esto sólo afectó en el promedio de Anatomía (U=475, Z=-2.50, p=0.012) y en el de Salud Pública (U=544, Z=-2.007, p=0.045). Ninguno de los aspectos socioeconómicos influyó en el desempeño académico de los estudiantes. Discusión Para el grupo de alumnos evaluados, sólo se encontró al puntaje del examen general de conocimientos como un predictor significativo y constante para el promedio de las asignaturas del primer año y el promedio final general. Conclusiones El examen general de conocimientos se mostró como una evaluación de utilidad pues parece resumir muchas de las habilidades y hábitos del estudiante que se relacionan con un buen desempeño académico.
ABSTRACT
The importance to assess in a comprehensive way the cognitive, emotional, personal and social features of the students entering medical school is recognized nowadays in order to select from the candidates, not just those with high cognitive abilities, but also the ones with a vocation and interest in the study of this science. These are characteristics that should be specially sought among the students of high performance academic groups. In the Department of Medicine, as it is in some other departments at the Universidad Nacional Autónoma de México (UNAM), there is a special plan called High Academic Performance Program (PAEA), which aims to test innovative teaching models to generate health resources able to operate in special working conditions. Medicine students enrolled at the PAEA have a particular schedule which includes, in addition to the program established at the regular curriculum, some other specific activities, meaning greater demand for them. These special training includes activities such as: early introduction to research labs, based-problem learning, methodology workshops, introductory course in computing, and personalized assistance from academic tutors. It is because of these peculiar features, that, with this study, we aim to determine the profile of the students of the PAEA from the analysis and comparison of the candidates' characteristics. Materials and methods This was a comparative cross-sectional study that included all the first entry students at the Department of Medicine who applied to enter the selection process of the PAEA at the 2009-2010 period. These candidates were required to ask voluntarily to be included in the selection process to be part of PAEA, and to demonstrate at least a high school grade of 8.5, and to complete the assessment instruments. For this study, the assessment instruments used were: Minnesota Multiphasic Personality Inventory (MMPI-2), Differential Aptitude Test (DAT) sub-scale of abstract reasoning, and a semi-structured interview designed specifically for this evaluation. The variables considered for this research were: • Sociodemographic characteristics: All those features that define the economical, social and demographic situation of a person or population. • Academic background: All the information of studies and activities that the student has done throughout his/her school years. • Vocational features: Preferences, perceptions and attitudes of the student for his/her own autonomous choice of career or profession. • Personality traits: Generalized and focused mental systems that have the ability to convert external stimuli to guide different forms of behaviors. • Abstract reasoning: Mental process that allows people to solve logic problems, forecasting and planning. Data obtained from the instruments were analyzed with descriptive statistics, multiple linear regression, logistic regression, cluster analysis and factor analysis. Results The study included 194 candidates (100 of them were accepted to be included at the PAEA). In general, the studied population had a greater percentage of women (61.86%) and a mean age of 18.35 + 1.5 years old. Around a quarter of this population studied high school at Escuela Nacional Preparatoria (National High School), but it was observed that the highest percentage (20.1%) of students accepted to enter PAEA had the antecedent of being graduate from private high schools with high academic standards. This last finding is important since the candidates from these private schools are students who not only have access to a history of multiple academic and extracurricular activities, but they also come with certain academic stimulation, and so, it is expected that they have developed strategies to contend in competitive environments. The average grade of high school was lightly higher for the group of accepted students (9.27+0.41) than for those not accepted (9.13+0.47). Compared to those who were not accepted, more students in the group of accepted candidates were fluent in English (46.91%), French (1 4.43%) or other foreign language (3.61 %) besides Spanish. The personality profile obtained from the MMPI-2 was similar for both groups of candidates, accepted and not accepted. It was determined that accepted students were characterized by: having high energy and strength to achieve their goals, being sociable but with little commitment to the others, questioning the statu quo, being creative. However, within this group it was also observed that there was a tendency to manipulate other people to get what they wanted and that some of their behaviors may be governed by impulsivity. The group of candidates not accepted to the Program seemed to have the same personality features with greater energy, which could lead them into disarray. Characteristics such as social introversion and hypochondriasis have been aspects of interest in some previous studies. Both personality features have revealed significant long-term predictors, whether to have an adequate academic performance (associated to low levels of both social introversion and hypochondriasis) or to develop any psychopathology (related to high levels of social introversion and hypochondriasis). For this population, professional interests were directed towards the medical practice, while teaching was not considered as a priority interest (but it prevailed in the group of not accepted). Promotion of humanitarian aid discriminated those accepted candidates. At least 10% of the students in the group of accepted candidates said that they could see themselves having a successful future. The difference in interests within these students reflects distinct experiences in each group, and therefore dissimilar life projects that make them having diverse perspectives of present and future circumstances. The fact that the group of approved candidates has high motivation for success is consistent with their acceptance to be part of a group of high performance. However, it may be advisable to promote a training throughout their social awareness in order to enable them to have an overall performance of their profession. The best predictors of acceptance were: the rating of the overall review of knowledge (an exam that every first entry student does at the beginning of Medicine School) and the score of DAT's abstract reasoning, which correlated with r = 0.485. It is important to say that neither the grade of high school nor the age were good predictors to be accepted to PAEA. Conclusions Since PAEA seeks to select students with characteristics and skills that enable them to function in the field of medicine under a high rate of academic achievement, it is expected that, as it was confirmed in this research, accepted students where those who had greater cognitive abilities, who were fluent in other languages, with interest focused on successful clinical practice and research, and with less concern about socio-economical aspects of their environment. However, there are still many questions regarding the defining characteristics of this population and the way these features will impact their education. It is necessary to continue characterizing and studying the groups of students entering PAEA, and follow up their outcome in order to determine if the evaluated aspects have an influence on their academic performance during medical school.
En la Facultad de Medicina, como en algunas otras de la Universidad Nacional Autónoma de México, existe un Programa de Alta Exigencia Académica (PAEA), el cual busca probar métodos de enseñanza novedosos para formar recursos capaces de desarrollarse en condiciones especiales de trabajo. Esto se lleva a cabo por medio de un programa en que el alumno lleva, además de las actividades regulares establecidas en el currículum de la carrera, algunas otras planeadas específicamente para estos grupos y que demandan mayores exigencias para los estudiantes que forman parte de ellos. Dadas estas características del PAEA en la Facultad de Medicina, es prioritaria una evaluación integral de los candidatos que formarán parte del programa, la cual debe incluir aspectos cognoscitivos, emocionales, personales y sociales. Por ello, el objetivo de este estudio fue establecer el perfil de los alumnos del PAEA a partir del análisis y la comparación de las características de la población de candidatos que se postularon para ingresar a este programa durante la promoción 2009-2010. Material y métodos Estudio transversal comparativo en el cual se incluyó a todos aquellos estudiantes de primer ingreso (ciclo 2009-2010) que solicitaron de manera voluntaria ingresar al proceso de selección del PAEA, que tuvieron por lo menos 8.5 de promedio en el bachillerato y que completaron los instrumentos de evaluación. Se aplicaron: el Inventario Multifásico de la Personalidad Minnesota-2 (MMPI-2), la subescala de razonamiento abstracto del Test de Aptitudes Diferenciales (DAT), y una entrevista semiestructurada diseñada expresamente para esta evaluación. Los datos obtenidos se manejaron con estadísticos descriptivos, regresión lineal múltiple, regresión logística, análisis de clusters y análisis factorial. Resultados Se incluyó a 194 aspirantes, de los cuales fueron aceptados 100, con un predominio en la población femenina (61.86%) y una media de edad de 1 8.35 ± 1.5. Una cuarta parte de la población estudiada provenía de las Escuelas Nacionales Preparatorias, pero el mayor porcentaje de aceptación (20.1%) para ingresar al PAEA se observó entre los alumnos egresados de escuelas preparatorias privadas de alto nivel académico. El perfil de personalidad obtenido por medio del MMPI-2 fue similar para los candidatos aceptados y los no aceptados. Los alumnos aceptados para ingresar al PAEA se caracterizaron por: presentar una gran energía y consolidar sus metas, ser sociables pero con poco compromiso con los demás, cuestionar el status quo y ser creativos; no obstante, se observó una tendencia a manipular a los demás para conseguir sus fines. Algunas de sus conductas pueden estar regidas por impulsividad. Los alumnos no aceptados presentaron estas características con una mayor energía que pudiera llevarlos a la desorganización. Los intereses profesionales se dirigieron hacia la práctica médica. Aunque la docencia no fue considerada como un interés, predominó entre los no aceptados, mientras que la promoción de ayuda humanitaria discriminó a los aceptados. Los mejores predictores de la aceptación fueron la calificación del examen general de conocimientos y el razonamiento abstracto, los cuales se correlacionaron con r=0.485. Ni la edad, ni el promedio de bachillerato fueron buenos predictores en cuanto a la aceptación para entrar al PAEA. Conclusiones Dado que el PAEA busca seleccionar alumnos con características y habilidades que les permitan desempeñarse en el campo de la Medicina con un ritmo de alto rendimiento académico, resulta esperable que, tal como se corroboró en esta investigación, se aceptaran alumnos con una mayor competencia cognoscitiva, con dominio de otras lenguas, con intereses centrados en la práctica clínica exitosa y en la investigación, y con menor preocupación por aspectos socioeconómicos de su entorno. Sin embargo, será preciso continuar perfilando y estudiando a los estudiantes de este programa con el fin de determinar aquellos rasgos que influyen en su desempeño durante la licenciatura.