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      Relationship among Medical Student Resilience, Educational Environment and Quality of Life

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          Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students.


          We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young’s resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire – short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI).


          Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (β=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (β=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (β=-6.48; 95%CI=-10.01 to -2.95), psychological (β=-22.89; 95%CI=-25.70 to -20.07), social relationships (β=-14.28; 95%CI=-19.07 to -9.49), and physical health (β=-10.74; 95%CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (β=-31.42; 95%CI=-37.86 to -24.98), learning (β=-7.32; 95%CI=-9.23 to -5.41), teachers (β=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (β=-7.33; 95%CI=-8.53 to -6.12), atmosphere (β=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (β=-3.12; 95%CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements.


          Medical students with higher resilience levels had a better quality of life and a better perception of educational environment. Developing resilience may become an important strategy to minimize emotional distress and enhance medical training.

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          Most cited references 19

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          Positive psychology. An introduction.

          A science of positive subjective experience, positive individual traits, and positive institutions promises to improve quality of life and prevent the pathologies that arise when life is barren and meaningless. The exclusive focus on pathology that has dominated so much of our discipline results in a model of the human being lacking the positive features that make life worth living. Hope, wisdom, creativity, future mindedness, courage, spirituality, responsibility, and perseverance are ignored or explained as transformations of more authentic negative impulses. The 15 articles in this millennial issue of the American Psychologist discuss such issues as what enables happiness, the effects of autonomy and self-regulation, how optimism and hope affect health, what constitutes wisdom, and how talent and creativity come to fruition. The authors outline a framework for a science of positive psychology, point to gaps in our knowledge, and predict that the next century will see a science and profession that will come to understand and build the factors that allow individuals, communities, and societies to flourish.
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            Towards an understanding of resilience and its relevance to medical training.

            This article explores the concept of resilience and its potential relevance to medicine. It also looks at the dimensions of resilience and its ethical importance for effective professional practice, and considers whether a focus on resilience might be useful in medical training. An applied literature search was conducted across the domains of education, ethics, psychology and sociology to answer the research question: 'What is resilience and what might it mean for professional development in medical education?' This article predominantly considers the findings in relation to training in undergraduate and postgraduate settings, although the literature is wide-ranging and findings may be applicable elsewhere.   Resilience is a dynamic capability which can allow people to thrive on challenges given appropriate social and personal contexts. The dimensions of resilience (which include self-efficacy, self-control, ability to engage support and help, learning from difficulties, and persistence despite blocks to progress) are all recognised as qualities that are important in clinical leaders. Much of what is deemed good practice in modern pedagogical approaches to medical training may support the development of resilience in adulthood, but this concept has rarely been used as a goal of professional development. More research is needed on the ways in which resilience can be recognised, developed and supported during and after clinical training.   Resilience is a useful and interesting construct which should be further explored in medical education practice and research. © Blackwell Publishing Ltd 2012.
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              Validation of a Portuguese version of the Beck Depression Inventory and the State-Trait Anxiety Inventory in Brazilian subjects.

              We have validated a Portuguese version of the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) tests by obtaining profiles for three Brazilian samples: 270 university students, 117 panic patients and 30 depressed patients. The mean BDI scores were higher for depressed patients (25.2 +/- 12.6), intermediate for anxious patients (15.8 +/- 10.3) and lower for students (8.5 +/- 7.0). Mean STAI scores for anxious (52.8 +/- 11.4) and depressed patients (56.4 +/- 10.5) were higher than for the student sample (40.7 +/- 8.6). BDI and STAI scores were correlated significantly in all samples. The internal consistency of the Portuguese version of BDI is in agreement with the literature (0.81 for students and 0.88 for depressed patients). The present data demonstrate that the psychometric properties of the Portuguese versions of the BDI and STAI are comparable to the original English language versions of these questionnaires, thereby indicating their use in clinical situations.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                29 June 2015
                : 10
                : 6
                [1 ]Center for Development of Medical Education, School of Medicine of the University of São Paulo, Sao Paulo, Brazil
                [2 ]Evangelical Medical School of Parana, Curitiba, Brazil
                [3 ]Department of Medicine, School of Medicine of the University of Sao Paulo, Sao Paulo, Brazil
                [4 ]Department of Obstetrics and Gynecology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
                [5 ]State University of São Paulo, Botucatu, Brazil
                [6 ]ABC Foundation Medical School, Santo Andre, Brazil
                [7 ]School of Medicine of Marilia, Marilia, Brazil
                [8 ]School of Medicine of Rio Preto, Rio Preto, Brazil
                [9 ]Department of Psychiatry, School of Medicine, State University of Campinas, Campinas, Brazil
                [10 ]Department of Pathology, School of Medicine of the University of Sao Paulo, Sao Paulo, Brazil
                Sickle Cell Unit, JAMAICA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: MAM PT PSPS SG SCE HBMSP VLG KBG EMTNC BP LFT SB NRS. Performed the experiments: PT PSPS SCE SG HBMSP MAM VLG KBG BP SB NRS EMTNC LFT. Analyzed the data: PT ISS PSPS FBM MP SCE BP MAM. Wrote the paper: PT ISS PSPS FBM MAM. Created the eletronic platform used in data collection: PSPS.


                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                Page count
                Figures: 1, Tables: 3, Pages: 13
                This study was supported by CAPES (Brazilian Federal Agency for the Support and Evaluation of Graduate Education) and CNPq (National Council for Scientific Development), Brazil.
                Research Article
                Custom metadata
                Data used in the paper have been deposited in DRYAD public respository (doi: 10.5061/dryad.63r07).



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