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

ABSTRACT

CONTEXT 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. METHODS: 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). RESULTS: 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 (ß=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (ß=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (ß=-6.48; 95%CI=-10.01 to -2.95), psychological (ß=-22.89; 95%CI=-25.70 to -20.07), social relationships (ß=-14.28; 95%CI=-19.07 to -9.49), and physical health (ß=-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 (ß=-31.42; 95%CI=-37.86 to -24.98), learning (ß=-7.32; 95%CI=-9.23 to -5.41), teachers (ß=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (ß=-7.33; 95%CI=-8.53 to -6.12), atmosphere (ß=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (ß=-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. CONCLUSIONS: 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.