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Abstract Introduction Medical residents (MR) are an important pillar for a future effective health system. As such, it is important to study all the factors throughout their training that may influence their professional development, like gender-based violence (GV). Objetive To design and evaluate the psychometric proprieties of subtle GV among medical residents' assessment scale (SGEVRA). Method The design was carried out in two phases: (1) in the qualitative phase, three focus groups were interviewed to obtain information about GV during medical training; and (2) in the quantitative phase, the information was incorporated into the instrument and the psychometric properties were tested. Results A total of 1,645 medical residents (MRs) completed the instrument. Exploratory factor analysis led to a final two factor model comprised of 31 items that explained 74.9% of the variance. The factors were labelled as gender discrimination (factor 1) and sexual violence (factor 2); both demonstrated high internal consistency using Cronbach's alpha (factor 1: .987; factor 2: .935). Discussion and conclusion The SGEVRA is a brief, valid, and reliable instrument for assessing subtle GV among MR.
Resumen Introducción Los residentes médicos (MR) son un pilar importante para un futuro sistema de salud efectivo. Por ello, es importante estudiar todos los factores a lo largo de su capacitación que puedan influir en su desarrollo profesional, como la violencia de género (GV). Objetivo Diseñar y evaluar las propiedades psicométricas de la Escala de Violencia Sutil de Género en médicos residentes (SGEVRA, por sus siglas en inglés). Método El diseño se realizó en dos fases: (1) cualitativa: se entrevistó a tres grupos focales para obtener información sobre la VG durante la capacitación médica; y (2) cuantitativa, donde la información se incorporó al instrumento y se evaluaron las propiedades psicométricas. Resultados 1,645 residentes médicos (MR) completaron el instrumento. El análisis factorial exploratorio condujo a un modelo final de dos factores compuesto por 31 reactivos que explicaron el 74.9% de la varianza. Los factores fueron etiquetados como discriminación de género (factor 1) y violencia sexual (factor 2); ambos demostraron una alta consistencia interna con el alfa de Cronbach (factor 1: .987; factor 2: .935). Discusión y conclusión SGEVRA es un instrumento breve, válido y confiable para evaluar GV en MR.
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RESUMEN: Introducción: En el año de 2011 había en México 3 823 psiquiatras, con una tasa estimada de 3.4 por cada 100 mil habitantes. Es necesario mantener actualizada esta información para alcanzar los objetivos globales de atención a la salud mental. Objetivo: Estimar el número total de psiquiatras en México en 2016; determinar su distribución geográfica y comparar los resultados con los obtenidos en el año 2011. Método: Estudio comparativo y longitudinal. Se consultaron diversas fuentes para actualizar el número de psiquiatras en 2016 y conocer sus características sociodemográficas. Se compararon estas características con las encontradas en 2011. Resultados: Un total de 4 393 psiquiatras ejercen su especialidad en México en 2016. Sobre una población de 119 530 753 habitantes, se obtuvo una tasa de 3.68 psiquiatras por cada 100 000 habitantes. Existe una pobre distribución de estos especialistas en el país. Alrededor del 60% de todos los psiquiatras ejercen en las tres mayores ciudades de México. Discusión y conclusión: La tasa nacional de psiquiatras se incrementó en comparación con la obtenida en 2011, sigue siendo inferior a la recomendada por la Organización Mundial de la Salud (OMS). La distribución geográfica de los psiquiatras es inequitativa debido a la centralización y a factores económicos.
ABSTRACT: Introduction: In 2011 we had 3823 psychiatrists in Mexico, with an estimated rate of 3.4 per 100 000 inhabitants. In order to achieve the global targets of mental health attention, it is important to update this information. Objetive: To estimate the total number of psychiatrists in Mexico in 2016; detemine their geographic distribution and compare the results with the ones obtained in 2011. Method: Longitudinal and comparative study. Diverse sources of information were consulted in order to update the number of psychiatrists in 2016 and to know their sociodemographic characteristics, that were compared with the ones obtained in 2011. Results: 4 393 psychiatrists practiced their specialty in Mexico in 2016. With a population of 119 530 753 inhabitants, we obtained a rate of 3.68 psychiatrists per 100 000 inhabitants. There's a poor distribution of theese specialists in the country. Around 60% of all psychiatrists practice in the tree major cities of Mexico. Discussion and conclusion: The national rate of psychiatrists increase in comparisson with the one we found in 2011, it remains lower that the one recommended by the World Health Organization (WHO). Geographic distribution of the psychiatrists is inequitative because of centralization and economic factors.
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The prevalence of depression in Medical Students (MS) is higher than in the general population and changes with time. It is not known whether the prevalence of depression is higher and the associated factors different between students that initiate the last and first academic years in Medical School. Objective To compare the prevalence of depression and the associated factors in MS that start their academic courses in the first and the last academic years. Methods This is a cross sectional, observational and analytical study. A total of 1871 MS participated: 1240 were in the initiation of the first academic year, and 631 in the initiation of the last academic year. Participants answered a written survey conformed by a questionnaire about risk factors for depression and assessed for current depression with the Patients Health Questionnaire-9 (PHQ-9). Results The prevalence of depression (PHQ-9>10) was significantly higher in last year MS compared to first year MS (5.7 vs. 3.5%). The percentage of MS with a personal history of depression was higher in last year compared to first year MS (12.1% vs. 7.1%), as was the mean for previous depressive episodes (3.2 vs. 1.6). The age of onset for depressive episodes was higher in the last year group. Conclussions The prevalence of depression in MS that initiated the academic year is higher in the last year than at the beginning of the first year of the career, and could be attributed, among other factors, to a cumulative phenomenon resulting from the allostatic load that this academic process currently generates. A personal history of depression and other situational factors are associated to the presence of depression in a differential manner according to the academic year and should be considered in future studies.
La prevalencia de depresión en estudiantes de la Facultad de Medicina (EM) es mayor que en la población general y cambia a lo largo del tiempo. No se conoce si la prevalencia de depresión es mayor y los factores asociados son diferentes en estudiantes que inician el último y el primer año académico de la carrera de Medicina. Objetivo Comparar la prevalencia de Depresión y los factores asociados en EM que inician el año académico en primer año y aquellos que realizan el año de internado. Método Este es un estudio observacional, transversal y analítico. Participaron un total de 1871 EM: 1240 que iniciaban el primer año de la carrera y 631 que iniciaban el año de internado. Los alumnos contestaron una encuesta en papel compuesta por el Cuestionario sobre Factores de riesgo para Depresión y el Cuestionario sobre la Salud del Paciente (PHQ-9, por sus siglas en inglés) para evaluar la presencia actual de depresión. Resultados La prevalencia de Depresión (PHQ-9>10) resultó significativamente mayor en los estudiantes de internado comparados con los de primer año (5.7 vs. 3.5%). El porcentaje de alumnos con antecedente personal de depresión fue mayor en los alumnos de internado con respecto a los de primer año (12.1% vs. 7.1%), como lo fue el promedio de episodios depresivos previos (3.2 vs. 1.6). La edad de inicio del primer episodio depresivo fue significativamente mayor para los del quinto año. Conclusiones La prevalencia de Depresión en EM que inician el año académico es mayor en la etapa final de la carrera y puede ser atribuible, entre otros factores, a un fenómeno acumulativo de carga alostática que actualmente genera este proceso educativo. Los antecedentes personales para depresión y los factores situacionales se asocian a la presencia de depresión de una forma diferente de acuerdo al año académico y deben de ser considerados en futuros estudios.
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Introduction In several countries, the number of candidates to enter Psychiatry is diminishing. In Mexico, the kind of factors that influence the preference for a medical specialty and the way the selection tendencies change across the years of the medical career is not well known. In this study we analyzed the specialty preferences in a representative sample of students from different years of Medicine School at the National Autonomous University of Mexico (UNAM). Material and methods Descriptive cross-sectional study. Specialty preferences were assessed in students enrolled in the 2009-2010 school year of the Medicine School through a questionnaire designed expressly for this research. Data were analyzed quantitatively and qualitatively. Results A total of 2737 students participated. Most of the students (n = 2634) had already considered a specialty. Preferred specialties were General surgery (n=403, 14.72%), followed by Internal medicine (n=382, 13.96%) and Pediatrics (n=261, 9.54%). On the other hand, Radiology (n=314, 11.47%), Pediatrics (n=280, 10.23%) and Family medicine (n=263, 9.61%) were all specialties that students would not choose. For Psychiatry, there was a greater tendency only among first year students to see it as a choice of specialty. Compared with men (n=114, 11.53%), the percentage of women (n=259, 14.81%) who considered Psychiatry as an option of medical residency was higher. Discussion We could see that Psychiatry is neither the most preferred nor the most rejected specialty among medical students. Unfortunately, misconceptions still prevail around it and they do not favor its selection as a potential option of residency. It would be necessary to strengthen the knowledge about mental health and psychiatry, and to have the teachers promoting it in order to change the trends of selection.
Introducción En diversos países el número de candidatos para ingresar a la especialidad de Psiquiatría es cada vez menor. En México desconocemos a detalle los factores que inciden en la preferencia por una especialidad médica y la forma en que esa tendencia se va modificando a través de los años de la carrera de Medicina. En este estudio analizamos las preferencias de especialidad en una muestra representativa de estudiantes de los diferentes años de la carrera de Medicina en la Universidad Nacional Autónoma de México (UNAM). Material y métodos Estudio transversal descriptivo. Por medio de un cuestionario diseñado ex profeso para la indagación de las preferencias de especialidad, se evaluaron a los alumnos inscritos en el ciclo escolar 2009-2010 de la carrera de Medicina que aceptaron participar. Los datos se analizaron cuanti y cualitativamente. Resultados Participaron 2737 estudiantes. La mayor parte de los alumnos (n=2634) ya tenía considerada una opción de especialidad. Con una p<0.001, las especialidades preferidas fueron: Cirugía general (n=403, 14.72%), seguida de Medicina interna (n=382, 13.96%) y Pediatría (n=261, 9.54%). Mientras que Radiología (n=314, 11.47%), Pediatría (n=280, 10.23%) y Medicina familiar (n=263, 9.61%) se mencionaron como las especialidades que no elegirían. En cuanto a la Psiquiatría, sólo entre los alumnos de primer año se observó una mayor tendencia a considerarla como una opción de especialidad. En comparación con los hombres (n=114, 11.53%), fueron más las mujeres (n=259, 14.81%) que la consideraron como una alternativa para cursar una residencia. Discusión Si bien la Psiquiatría no se encuentra entre las especialidades más rechazadas por los alumnos participantes, tampoco figura dentro de las preferidas. Desafortunadamente siguen prevaleciendo concepciones erróneas a su alrededor que no favorecen su selección como una potencial especialidad a cursar. Sería necesario reforzar el conocimiento sobre la salud mental y la psiquiatría y su promoción por parte de los docentes en la búsqueda de un cambio en las tendencias.
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There are few available and reliable data regarding the number and geographic location of psychiatrists in Mexico. It is important to have these data in order to know if the mental health needs of the country are being met. This study is an attempt to update both the current data on this subject by locating the most psychiatrists possible, and also to learn more about how they manage their medical practice. Methods Descriptive and cross-sectional study. Several sources available in Mexico were consulted such as Mexican Psychiatry Associations, health care institutions, universities, telephone directories among several others, to locate psychiatrists and to identify where and what kind of practice they have. Results According to our several data bases, 3823 psychiatrists were counted in Mexico, 225 of these being child and adolescent psychiatrists. The rate of psychiatrists obtained was 3.47 psychiatrists per 100 000 inhabitants and 0.69 child and adolescent psychiatrists per 100 000 inhabitants under 15 years. 56% of psychiatrists practiced in the Federal District. There are 1.8 male psychiatrists for every female psychiatrist. Discussion The number of psychiatrists in Mexico is still below the rate that the World Health Organization recomends. The distribution by gender is shifting towards more equality. Psychiatrists were found to be grouped in urban areas of the country. The number of psychiatrists and child and adolescent psychiatrists seems to be insufficient to cover the needs of the country.
Existe poca información disponible y actualizada acerca del número de psiquiatras en México y sobre su localización geográfica. Es importante conocer estos datos para saber si se cubren las necesidades de salud mental del país. Este estudio busca actualizar tanto los datos disponibles sobre este tema al localizar el mayor número de psiquiatras posibles, como el tipo de práctica en su especialidad y si cuentan con la certificación correspondiente. Metodología Se trata de un estudio descriptivo y transversal. Se consultaron múltiples fuentes disponibles en México, como las asociaciones psiquiátricas mexicanas, las instituciones hospitalarias, las universidades, los directorios telefónicos y otros, para localizar a los psiquiatras, identificar dónde ejercen y conocer el tipo de su práctica profesional. Resultados Considerando nuestras diversas fuentes de búsqueda, se contabilizó un total de 3 823 psiquiatras para una población total de 112 000 000 de habitantes. Del número total de psiquiatras, 225 tienen la subespecialidad de paidopsiquiatría. Se obtuvo una tasa de 3.47 psiquiatras por cada 100 000 habitantes y de 0.69 paidopsiquiatras sobre una población de 100 000 habitantes menores de 15 años. El 56% se encuentra en el Distrito Federal. Hay 1.8 psiquiatras varones por cada mujer en esa especialidad. Discusión El número de psiquiatras en México aún está por debajo de la tasa recomendada por la Organización Mundial de la Salud. La distribución por género está cambiando hacia una más equitativa. Se encontró que los psiquiatras están agrupados en las zonas urbanas del país. El número de psiquiatras y paidopsiquiatras es insuficiente para cubrir las necesidades de salud mental del país.
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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.
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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.
ABSTRACT
Introduction Recent studies have shown an increase in psychiatric symptomatology in medical students and physicians during their professional practice. Some studies show that these professionals have a higher prevalence of psychiatric symptoms than the general population. This phenomenon is a consequence of the particular conditions of this professional activity, and, in the case of students, of high academic demands that lead to stressful situations that interfere with their academic performance and the development of clinical skills, which may have repercussions on their relationship with their patients. The predominant symptoms are anxiety, depression and stress, as well as substance use; there has also been an increase in the number of students with suicide attempts. Most of these problems occur during the first two years of the degree course as well as the internship year. Depression is masked by anger, by virtue of the fact that it is an internalized form of anger. It has also been documented that there is a significant link between certain personality traits and the presence or absence of mental symptoms, regardless of the situations to which people are exposed. The feature with the highest association with the presence of symptomatology is neuroticism, while the personality traits that are most conducive to the achievement of academic success and better adaptation and, therefore, a lower number of symptoms are empathy and kindness. The purpose of this study was to establish a diagnosis of the mental health and personality traits of medical students in the high performance groups and compare them with those of the groups of students that performed poorly during the first two years of the degree course. This transversal, exploratory study involved the participation of 370 students from the UNAM Medical School: 220 belonged to the high performance groups, called educational quality nuclei (NUCE), while 1 50 were repeat students. The variables considered were: age, sex, type of group (NUCE or repeat), academic year (first or second year of the degree), place of origin and type of high school from which they had graduated (public or private). Two instruments were used to measure personality traits and psychiatric symptomatology: the Big Five Personality Traits and the Symptom Check List-90. The results of the study show that in both groups (repeat students and NUCE) over 85% were from the Federal District. Repeat students were mainly women (85.3%) and students from public schools (93.6%). As for the high performance group (NUCE), 83.1 % were from private schools and just 1 6.9% from public schools. Repeat students showed personality traits that included neuroticism and very little openness compared with the high performance groups, which displayed traits of greater openness and less neuroticism, with p<0.01. In general, students from NUCE groups showed traits of greater extraversion, empathy and diligence compared with repeaters. Psychiatric symptomatology was more severe among the repeat group than the NUCE group (p<0.05). The psychiatric symptomatology displayed by both groups included: obsession-compulsion, depression and anxiety. In the comparisons, the two groups showed significant differences in total symptomatology. There were also differences in the following symptomatology, by order of importance: phobia, interpersonal sensitivity, somatization, anxiety, obsessive-compulsive disorder and psychoticism (p<0.05). Differences were found between academic years, with second-year students showing greater symptomatology; women displayed the greatest symptomatology. No differences were found for the interaction between sex and academic year. The analysis of structural models was used to determine the relationship between the variables being studied, with significant correlation coefficients with p<.05 being found between personality and sex, personality and type of high school, as well as type of group and suicidal ideation, academic year and psychiatric symptomatology, personality and suicidal ideation and personality and psychiatric symptomatology. The results of the study coincided with those in the literature, although there were some differences between the two groups of students. Repeat students displayed greater levels of psychiatric symptomatology compared with students in the high performance groups. This suggests that students who perform less well in their degree courses also report higher mean responses in psychiatric symptomatology, mainly on scales of somatization, anxiety, phobia and interpersonal sensitivity. As for type of personality, students in the high performance group reported higher average scores on the scales of extraversion, empathy and openness, with the exception of the neuroticism scale. This suggests that personality features may be predictors of better academic performance as well as greater intellectual skill. This finding is reinforced by the repeater group's results, since they report higher scores in the personality trait of neuroticism. The diligence scale was the same for both groups. The study corroborated the fact that second-year students display the greatest symptomatology, with women reporting higher averages in psychiatric symptomatology scores (mean = 7.3). Sex is associated with greater empathy and solidarity, with women achieving higher scores in both personality traits. Although the neuroticism trait is also associated with the female sex and suicidal ideation, scores for this trait were higher for men. This trait can be considered a predictor for both suicidal ideation and the presence of a higher number of psychiatric symptoms. Lastly, the symptomatology in which these students obtained the highest scores is related to the obsessive-compulsive disorder, a situation which we consider may be due to the type of screening test used. It is a fact that studying medicine involves continuously stressful conditions. For these students, however, seeking help to cope with the presence of psychiatric symptomatology is extremely complicated since they regard it as a form of weakness. This raises the need to develop large-scale programs to orient students in order to enable them to identify symptoms at an early stage, which in turn will permit timely treatment.
En estudios recientes se ha demostrado un incremento en la sintomatología psiquiátrica que presentan los estudiantes de medicina, así como los médicos durante su ejercicio profesional. En algunos estudios se señala que estos profesionistas tienen una prevalencia de síntomas psiquiátricos por arriba de los de la población general. Este fenómeno es una consecuencia de las condiciones propias de la actividad profesional y, en el caso de los alumnos, por situaciones que demandan una mayor exigencia académica, que conlleva a su vez situaciones estresantes que interfieren en su desempeño académico, así como en el desarrollo de habilidades clínicas que pueden repercutir en su relación con los pacientes. Los síntomas que predominan son la ansiedad, la depresión y el estrés, así como el consumo de sustancias; también se ha incrementado el número de estudiantes con intentos de suicidio. Se observa que la mayoría de estos problemas tipo se presentan en los dos primeros años de la carrera, así como en el año de internado. La depresión se encuentra enmascarada por enojo, en virtud de que ésta representa un enojo internalizado. Asimismo se ha documentado que existe una relación importante entre la presencia de ciertos rasgos de personalidad y la presencia o ausencia de síntomas mentales, independientemente de las situaciones a las que se expongan las personas. El rasgo que presenta una mayor asociación con la presencia de sintomatología es el neuroticismo, así como también los rasgos de personalidad que influyen con un mejor cumplimiento de logros académicos y una mejor adaptación. El objetivo de este trabajo fue establecer un diagnóstico de la salud mental y los rasgos de personalidad de los estudiantes de medicina que se encuentran en los grupos de alto rendimiento y compararlo con los grupos de alumnos que presentan bajo rendimiento académico durante los dos primeros años de la carrera. En este estudio exploratorio, de tipo transversal, participaron 370 estudiantes de la Facultad de Medicina de la UNAM: 220 correspondían a los grupos de alto rendimiento, llamados núcleos de calidad educativa (NUCE), y 150 eran alumnos repetidores. De entre los resultados que arrojó el estudio, se encontró que para ambos grupos (repetidores y NUCE) más de 85% provenía del Distrito Federal. En el grupo de repetidores predominaron las mujeres (85.3%) y los alumnos procedentes de escuelas públicas (93.6%). En relación con el grupo de alto rendimiento (NUCE), 83.1% procedía de escuelas privadas y sólo 16.9% de escuelas públicas. Los alumnos repetidores mostraron rasgos de personalidad de neuroticismo y de poca apertura en comparación con los grupos de alto rendimiento, quienes mostraron rasgos de mayor apertura y menor neuroticismo, con una p<0.01. En general, los alumnos de los grupos NUCE mostraron rasgos de mayor extroversión, mayor empatía y diligencia en comparación con los repetidores. La sintomatología psiquiátrica mostró mayor gravedad en el grupo repetidor con respecto al grupo NUCE (p<0.05). La sintomatología psiquiátrica que presentaron ambos grupos fue: obsesión-compulsión, depresión y ansiedad. Entre las comparaciones resultaron diferencias significativas en ambos grupos en el total de sintomatologías. También hubo diferencias en las siguientes sintomatologías por orden de importancia: fobia, sensibilidad interpersonal, somatización, ansiedad, trastorno obsesivo-compulsivo y psicoticismo (p<0.05). Los resultados del estudio presentan coincidencias con lo publicado por la bibliografía; sin embargo, hay diferencias entre ambos grupos de estudiantes. En los alumnos repetidores se observó mayor sintomatología psiquiátrica en comparación con los alumnos de los grupos de alto rendimiento. Por lo anterior, se concluye que los alumnos que presentan menores niveles de logro en la carrera también presentan medias de respuestas mayores en sintomatología psiquiátrica, principalmente en las escalas de somatización, ansiedad, fobia y sensibilidad interpersonal.