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Personal Development and Growth in First Year Medical Students and Their Academic Performance

Maria Teresa Cortes, Eduardo Acosta-Arreguín, Mariana Fouilloux, Rocío García, Ileana Petra*

Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University, Mexico (UNAM)

Abstract: Introduction. The Development and Personal Growth competency of medical students is relevant for their integral formation, so it has been important to include it in the curriculum. The purpose of this research is to describe the characteristics of this competency in students from the first year of the career of medicine in the middle of the school year and identify if any of the components of this factor influence his/her performance in school. Methodology. It is a descriptive and comparative study carried out with students from the first year medical school. Using a Likert type eleven-scale questionnaire (self-esteem, self-awareness, commitment, creativity, resilience and coping, self-criticisms and, optimism, empathy, commitment, assertiveness and leadership, Teamwork, social and interpersonal skills). Main findings. Less than a third of the students reported "always" or "usually" behaviors that account for a proper development in all of the eleven scales. Women obtained better scores than men in most of the scales of personal growth and development. Students from private educational institutions obtained higher scores self-awareness and emotional expression, on this scale than from public schools, and they obtained higher academic results. Conclusions and its significance. Taking into consideration the above, the purpose of this study is to associate these studied factors with one of the competencies “Development and Personal Growth”. It is very important that students who are going through this period receive support by not only Mental Health Programs, but by their teachers, that can participate by understanding and helping their students in these situations. So getting to know these weak links in the growth and development of our students may help us to develop strategies to improve cognitive, procedural skills and attitudes necessary for their professional life.

Keywords: personal development, first year medical students

Citation: Maria Teresa Cortes, Eduardo Acosta-Arreguín, Mariana Fouilloux, Rocío García, Ileana Petra, Personal Development and Growth in First Year Medical Students and Their Academic Performance. American Journal of Educational Research, 5 (8). 871-878. January 2017. doi:10.12691/education-5-8-6

1. Introduction

The Development and Personal Growth of medical students is relevant for their integral formation, so it has been important to include it in the curriculum. At the Faculty of Medicine of the National Autonomous University of Mexico “Personal Growth and Development” has included it as one of their main competencies and therefore an important factor to study. Authors like Gordon [1] agree with this idea, noting that attitudes and self-consciousness of students vary between the start and finish of school, and not only the acquisition of facts or reasoning skills.

This has generated a series of studies interested in observing different areas related to the personal development of students; such is the case of a medical research in which Williams and Deci [2] found that those who had behavioral and positive learning attitudes had greater autonomy in their learning and development, than those controlled by his environment.

On the other hand, in studies conducted with students of nursing in the United Kingdom (3), noted that their levels of stress and self-esteem changed during their training. In addition, students under a tutorial support program had a high self-esteem, low levels of stress and a more effective coping of their academic demands than those who did not have such support. For this remedy allowed, them to develop skills and knowledge that positively affected their acceptance, confidence in themselves and control academic demands [4].

We also noted that in education, relevance to include programs that provide student strategies that enable them to develop their capacity for self-criticism, but being aware, that continuous severe criticism in itself may constitute a statistically significant predictor of depression [5].

Fitzgerald and cols. [6], carried out an investigation at the Johns Hopkins University School of Medicine, in Baltimore, and found that students considered leadership a feature of great importance in the practice of medicine, so a curriculum with a training program on leadership and negotiation skills in teamwork and interdisciplinary would be well received by them.

In a study with young people from the academic programs of medicine, psychology, nursing, and dentistry at the University of Colombia, found that those who showed higher self-esteem, showed a higher level of development in its assertiveness [7].

On the other hand, Casey and cols, [8] conducted a research with students of the School of Nursing and Midwifery, National University of Ireland, promoting collaborative learning activities. This showed that this was an effective strategy to develop in the students a greater participation in their learning process and, thus, reflected on their performance, with a more critical thinking, as well as the capacity to regulate their own learning.

Elmore and col, [9] carried out a research project with students of the McWhorter School of Pharmacy, Stanford University, in Alabama, where it was found that the implementation of the team-based learning strategy favored the development of communication skills, teamwork, professionalism, and application of knowledge as well as the commitment of the students in a more active learning.

As attitudes and moral-ethical values, students valued the absence of discriminatory listening attitude and empathy. Among job related issues, they valued responsibility and punctuality. Legal and emotional self-care were valued as self-related attitudes. Among aptitudes, skills and capacities, and communicational skills, teamwork and professional attitudes was relevant [10].

Also considered in the development and personal growth of students, is its relationship with the academic performance. There are studies, where there has been a positive association between school performance and commitment to their studies. In Spain [11], commitment appears as a learning facilitator. In Colombia [12], dedication and commitment dimensions relate positively with a good academic performance; and in Baja California, Mexico [13], there is a statistically significant correlation between students working, when comes the dimensions associated with the commitment, "vigor" and "dedication" and students who do not work, when it involves the "absorption" dimension.

A relationship between the commitment of these students and their academic performance was found at a University in Chile [14], where commitment serves as a variable in the predictive relationship between positive emotions experienced by the student in class and the support offered by the teacher to promote their autonomy in the learning process, and their school performance.

In a qualitative research conducted with medical students in London [15], commitment to learning affected the academic performance throughout their studies.

On the other hand, the association between academic achievement and resilience has been investigated in different countries. Comparing the factors of resiliency among college students of Colombia with high and low academic performance, found that the first had more resilient factors than the second did [16]. By contrast, in a study conducted at another University also of Colombia [17], the correlation between academic performance and resiliency was low. While, in a research conducted specifically with students of medicine, in no association between the extent of resilience of these students and their academic performance was found at University of New Zealand. [18]

Studies that allow observing specifically how the self-esteem and self-criticism, among others, are associated with low ratings were not found.

Other studies reported correlations between the sources of stress in students of the Faculty of Medicine of the UNAM, and his inability to retain study materials and their bad grades. All this led them to develop feelings of frustration, inefficiency and impotence that was also associated with depression [19,20] and hence recognized as symptoms of these problems a decline in self-esteem and alterations in their capacity of self-criticism. Another study indicates that about eighty percent of the students of the same school showed stress and other emotional factors such as depression [21].

2. Methods

It is a descriptive and comparative study carried out with students from the first year medical school of the Faculty of Medicine of the Universidad Nacional Autonomous of Mexico (UNAM). From 1217 registered students, 1024 were present at the time of the investigation and agreed to participate, after having explained the nature of the study and the confidential handling of information.

In order to evaluate the variables that account for the competency "Development and personal growth" provided in the curriculum [22], eleven scale Likert, designed and validated by Cortés and col, [23], with an alpha of Cronbach fluctuating between 0.617 and 0.786, was applied. These scales were:

1. Self-esteem. Defined, as the trust that you have in your thinking ability and the basic challenges of living with other people and how they are considered.

2. Self-awareness and emotional expression. Refers to, the self-awareness that the person has of their own emotions and how they are affected in a given situation. While emotional expression refers to the ability of the individual to show their affections and feelings.

3. Commitment. Capacity of the individual to consistency handle their personal and professional activities and lead them to improve. Related to attitudes and behaviors reflected in the achievement of his/her schedule.

4. Creativity. Ability to seek new solutions and manage them with practical and useful spontaneity in all situations.

5. Resilience and coping. Individual's ability to address problems that affect personally and to be able recover from emotional conflicts.

6. Critic and self-criticism. Flexibility in assessing perspectives, activities and to handle emotions objectively, and if necessary to consider opinions of others.

7. Positive perspective (optimism). Capacity of showing a favorable attitude in diverse situations of life and act accordingly.

8. Self-confidence. Belief that one is able successfully perform a task or choose the right approach to solve a problem.

9. Assertive-Leadership. Assertive behavior expresses the feelings, attitudes, desires, opinions or rights of a person in a direct, firm and honest way, respecting at the same time the feelings, attitudes, desires, opinions and rights of other individuals, as part of the show of characteristics of leadership.

10. Empathy. Ability to recognize and understand the needs and desires of others.

11. Teamwork, social and interpersonal skills. Individual's ability to interact harmoniously with others on productive activities.

Each of these scales includes five answer options: "always" (5 points), "usually" (4 points), "occasionally" (3 points), "rarely" (2 points) and "never" (1 point).

Once the 11 scales were applied, the following statistical analysis was performed:

a) A descriptive Table of sociodemographic variables, academic performance, as well as scales of growth and development staff (for each scale item), through frequencies and percentages.

b) A comparative analysis of the development and personal growth and academic performance of the study population, by sex, age and school of origin, using the Mann-Whitney U test statistic for sex and Kruskal-Wallis for age and school of origin. (This last one, when there were statistically significant differences. The Mann-Whitney U test between groups to observe these differences was applied to observe these differences.

The variables of this study were grouped as follows to perform some of the statistical analysis.

1) The scores of each scale of personal growth and development were divided into three levels (low, medium, high), as illustrated below:

Table

2) Assessment was made of the school performance by calculating the combined averages of eight subjects (Anatomy, Embryology, Biochemistry, and Molecular Biology, Basic-clinical Integration, Biomedical informatics I, Mental Health, Public Health). According to the following ranges, the grades were divided into students with an average of less than six, considered as a level of underperformance. If the average was of six or seven then the level was regular; and, if his overall rating was between eight and ten, that qualified as good. The highest grade possible being ten.

3) Students placed according to age, into three groups: seventeen to nineteen-year-olds, from twenty to twenty-two and twenty-three years or more.

4) According to high school background, students placed into three of the following groups: those that came from UNAM’s prep schools (ENP); those studied Sciences and Humanities schools (CCH), also of the UNAM; and those graduates from private high schools.

NOTE: students from the ENP follow a traditional teaching system. While from the CCH a collaborative work-oriented system is used. Finally, students from private schools have a traditional system but the studies are more in depth.

Most of the students 1350 (80-85%) enter the UNAM from the ENP and CCH, and if they had high enough grades and didn´t fail any course, they were entitled to an automatic pass for being part of the UNAM. Only approximately 15 percent of the total tuition is offered to young people from private schools if they pass an exam and report prep school grades of more than 8.5 to 10.

2.1. Ethics

The Research and Ethics commission’ from the Faculty of Medicine of the UNAM approved this research.

3. Results

Since they were not complete 76 questionnaires were excluded remaining 948 students in the study; 600 were women (63.3%) and 348 men (36.7%), with an average age of 19 years (standard deviation = 1.4; Median [Me] = 18; the minimum [Min] age of 17, while the maximum [Max] was 32. In addition, according to the prep school, 49.9% came from ENP; 340 (35.9%), from CCH; and 135 (14.2%) came from private schools.

At the end of the school year, close to half (47.7%) presented a regular academic performance, slightly more than one-third (36%) showed a good performance, while the rest of them (16.4%) did not pass.

For the descriptive analysis of the items (Table 2, Table 3 and Table 4), the Response alternatives were: 1) "always" and "usually" considering that the student who chose either shows an adequate level in their personal development. 2) "Occasionally" may involve some level of insecurity and lack of consolidation in the assessed skills; and 3) "rarely" and "never" may show little progress in the assessed areas of growth and personal development.

Seventy per cent of the students or more answered items in a specific scale with "always" or "usually" leads us to believe that they have an adequate level of group management skill concerned by the scale.

Based on the results, in each of the scales the following results were:

The level of development and personal growth achieved by the student, based on the score obtained in each scale.

1. Self-esteem (nine items, α =. 734). Less than a third of the students reported "always" or "usually" behaviors that account for a proper development in this area (Table 2); in fact, slightly more than half of the students had low self-esteem (Table 1).

2. Self-awareness and emotional expression (four items, α =. 723). Less than 13 percent of the students said "always" or "usually" to be aware of their emotions and feelings, as well as to express what they feel (Table 2). In addition, a high number of them presented a low level of development in this area (Table 1).

3. Commitment (six items, α =. 776). Less than twenty-two per cent of young people reported to present "always" or "usually" behaviors that reflect the degree of commitment with school activities (Table 2); and around seventy per cent of them showed low commitment. (Table 1).

4. Creativity (five items, α =. 621). Less than twenty percent of the students said "always" or "usually" they showed behaviors that account for its development (Table 2), and a low level of creativity was observed in approximately seventy-six percent of them (Table 1).

5. Resilience and coping (three items, α =. 736). Just eleven percent of the students said to react adequately "always" or "usually" in difficult situations (Table 3); while close to seventy per cent of them presented a low response in its ability to confront and overcome obstacles (Table 1).

6. Critic and self-criticism (seven items, α =. 624). Less than twenty percent of the students said to present "always" or "usually" behaviors that handle the criticism of others; while slightly less than half reported "always" or "usually" had a proper management of self-criticism (Table 3). Close to half of the population had low level of development in this area (Table 1).

7. Positive perspective on life - optimism (seven items, α =. 760). Less than 18 percent of students said to present "always" or "usually" optimistic behavior in different situations in their personal or academic life (Table 3). This gives way to a high number of students with low optimism (Table 1).

8. Self-confidence (a) (eight items, α =. 794). Less than twenty-three percent of students reported having "always" or "usually" confidence in their ability to make decisions or to perform (Table 3), while nearly three-fourths demonstrated a low level of development in this area (Table 1).

9. Assertiveness-leadership (nine items, α =. 684). Less than twenty percent of the students responded "always" or "usually" to assertive behaviors that account for their ability to interact appropriately with others and lead them, if necessary (Table 4). This coincides with the low level of development in this area reported by approximately seventy-eight percent. (Table 1).

10. Empathy (six items, α =. 573). Less than fourteen percent of students reported "always" or "usually" behaviors that reflect his/her ability to consider the feelings and views of others (Table 4); while little more than sixty-five percent reported a low level of empathy (Table 1).

11.Work and support teamwork, social and interpersonal skills (eleven items, α =. 772). Less than thirty-three percent of students said "always" or "usually" to behaviors that account for the ability to work team and interact with other people (Table 4). Around eighty percent showed a low level of development in this area (Table 1).

Table 1. Development and personal growth of medical students according to each scale (n = 948)

Table 2. Self-esteem, emotions, commitment and creativity of the students of medicine per item (n = 948)

Table 3. Resilience, self-assessment, optimism and self-confidence in medical students, per item (n = 948)

Table 4. Assertiveness, leadership, empathy, and collaborative work of medical students per item

In summary, the majority of the population studied did not report behaviors that reflect a proper development and personal growth.

As a result of the comparative analysis of sex on the scales of personal growth and development, as well as the academic performance of students; we find that statistically significant differences exists between men and women in the creativity scales (Z =-2.223; p =. 026), resiliency and coping (Z =-3,335; p =. 001). Also with optimism (Z = - 3.071, p =. 002), Self-confidence (Z =-2.721; p =. 007), empathy (Z =-4.791; p =. 001) and work and support team (Z =-2.326; p =. 020); as well as in the overall average of the eight subjects studied during the first year of the career (Z =-4.308; p =. 001). Women obtained better scores than men in most of the scales of personal growth and development, except in the two last mentioned. On the other hand, in terms of academic performance, the men reached best averages at the end of the first school year ( = 7.5, SD = 1.4) Me = 7.8, Min = 0, Max = 9. 8) than women ( = 7, SD = 1.7) Me = 7.4, Min = 0, Max = 9 5).

Comparing age groups, development and personal growth scales and the average grade scores obtained at the end of the first year; we found that there were only statistically significant differences between scores on the scale of empathy (χ²= 9.079; p =. 011). This observed specifically between the age of 22 years and older students and those aged 17 to 19 years (Z =-2.818; p =. 005). The first obtained higher scores (= 13.2, SD = 2.3) Me = 14, Min = 9 Max = 18) than the second (= 11.3, SD = 3; Me = 11, Min = 5 Max = 22).

On the other hand, as a result of the comparative analysis according to the student’s prep school, the only statistically significant differences was between the scales of self-awareness and emotional expression (χ²= 10.409; p =. 005) and commitment (χ²= 7.084; p =. 029), as well as in academic performance (χ²= 158.7; p =. 001).

With regard to the foregoing, self-awareness and emotional expression, students from private educational institutions obtained higher scores on this scale (= 7.4, SD = 3; Me = 7 Min = 4, Max = 18) than those from ENP (= 6.9; SD = 2.3; Me = 6, Min = 4, Max = 17). And these, in turn, reached scores higher than those who had studied his prep in the CCH ( = 6.5; SD = 2.3; Me = 6, Min = 4, Max = 14). By comparing each group with the other two, there were statistically significant differences among students from ENP and CCH (Z =-2337; p =. 019), as well as between those who come from private schools and those from CCH (Z =-2.890; p =. 004), in both cases the first got higher scores on this scale than the later.

In terms of the level of commitment observed in students, there was statistical significance obtained when comparing the three groups according to their prep school, that occurs only between those who come from private schools ( = 13.6; SD = 3.9; Me = 13, Min = 7 Max = 28) and the CCH ( = 12.6; SD = 3.5; Me = 12, Min = 6 Max = 25) (Z =-2.599; p =. 009).

According to academic performance, students who achieved a higher overall average, at the end of the first year, were those who came from private schools ( = 7.9; SD = 1.3; Me = 8.1, Min = 1. 8, Max = 9. 8). While those from ENP ( = 7.5; SD = 1.4; Me = 7.8, Min = 0, Max = 9 4) scored higher than those from CCH ( = 6.5; SD= 1.7; Me = 6.8, Min = 0, Max = 9.1).

4. Discussion

The study of the various aspects of the development and Personal growth of students involved in their training and skills to advance their career, has gained increasing interest in recent years. Universities have been working on some factors that have called their attention as commitment, empathy, group work, etc. The present study developed a questionnaire consisting of eleven scales to analyze several of this considered dimensions as a way to integrate a more complete panorama, recognizing that there are a host of variables and that it is not to cover all of them. On the other hand, there are not only these factors but also some clinical pictures such as anxiety, depression, and other emotions that influence the abilities of students during their career [19].

Taking into consideration the above, the purpose of this study is to associate these studied factors with one of the competency’s “Development and Personal Growth” included in the curricula of the Faculty of Medicine of the UNAM, to better understand its influence in first year medical students.

We must take into consideration that the results listed here were obtained when the student had already completed approximately half of the school year. And already faced tests of great difficulty (Anatomy, Histology, Embryology and Biochemistry), as well as a heavy workload that has led them to change many of their customs, and to redistribute their free time, their relationship with their families and friends, etc.

In Table 1, generally less than 2.3% of students were within the range of high level of positive attitudes at the time of the study.

Camargo & cols. [7], point out in their study that a positive correlation between self-esteem and assertiveness shows that a student had a good level of personal development. This was present in our study but we consider that if other variables are present, it can better explain what the student is facing. Showing a strong interaction between the scales and how more than one dimension affects the other dimensions.

When self-esteem is low, they feel they are not acceptable and do not give importance to what they do (self-expression). Thus, there is little satisfaction with their career and therefore little effort is put in commitment. As expected, their active participation and their creativity cannot flourish and the confidence in them-selves is altered by not being able to take responsibility for their decisions and believe that they do things well. Casey & cols. [8], who found that students with a greater commitment in their studies tend to further develop their critical thinking and their ability to regulate their own learning process, which is reflected in a better performance in their studies, have commented this. Results of this study, leads us to consider the importance that students maintain their commitment and their confidence in them-selves.

With this said, self-esteem is considered an important aspect of all psychological research that must be promoted during educational. Because of the influence, that it has on the development of other skills that favor personal and professional growth, as it was observed in other research projects, where students with high self-esteem tend to face more effectively the academic demands [3,4].

In scales such as assertiveness and leadership, empathy and teamwork, we see that, not being able to mediate in a conflict or not being able to comment when there has been an injustice, leads to difficulties in their social skills. Showing a type of shy student, unable to say 'no', as well as a person with poor group participation and therefore difficulty in understanding others.

Garcia & cols. [10] found out that student’s value the skills of communication and empathy, which now are low in the students in our study.

Elmore & cols, [9] indicate the importance of students working as a team because among other things it helps them in the acquisition of knowledge and commitment, and agree that the lack of these abilities, can be another factor that hinders their good personal development.

It is very important that students who are going through this moment receive support by not only Mental Health Programs, but by their teachers, that can participate by understanding and stimulating their students in these situations. So getting to know these weak links in the growth and development of our students may help us to develop strategies to improve cognitive, procedural skills and attitude necessary for their professional life.

Acknowledgments

We thank Aurora Farfán, Guadalupe Sánchez, Esperanza Nápoles and Primo Sandoval for their participation in the application of the questionnaire as well as in sending the results to the students.

References

[1]   | Gordon, J. “Fostering students’ personal and professional development in medicine: a new framework for PPD”, Med Educ, 37 (4), 341-349, 2003.
[2]   | Williams, G.C. and Deci, E.L. “Internalization of biopsychosocial values by medical students: a test of self-determination theory”, J Pers Soc Psychol, 70 (4), 767-779, April 1996.
[3]   | Edwards, D., Burnard, P., Bennett, K. and Hebden, U. “A longitudinal study of stress and self-esteem in student nurses”, Nurse Educ Today, 30 (1), 78-84, January 2010.
[4]   | Gammon, J. and Morgan, H. “A study to ascertain the effect of structured student tutorial support on student stress, self-esteem and coping”, Nurse Educ Pract, 5 (3), 161-171, May 2005.
[5]   | Gilbert, P., McEwan, K., Matos, M. and Rivis, A. “Fears of compassion: development of three self-report measures”, Psychol Psychother Theory, Res Pract, 84 (3), 239-255, 2011.
[6]   | Fitzgerald, A.S., Miller, R.G., Levine, D.M, Beach MC and Ashar, B. “Assessing student needs for leadership skills training in medical school. Abstracts from the 36th Annual Meeting of the Society of General Internal Medicine”, J Gen Intern Med, 28 (Suppl 1), S25, June 2013.
[7]   | Camargo, A.L., Rodríguez, C., Ferrel, F.R. and Ceballos, G.A. “Asertividad y autoestima en estudiantes de primer semestre de la Facultad de Ciencias de la Salud de una universidad pública de la ciudad de Santa Marta (Colombia), Psicología desde el Caribe, 24, 91-105, Agosto-Diciembre 2009.
[8]   | Casey, D., Burke, E., Houghton, C., Mee, L., Smith, R., Van Der Putten, D., Bradley, H. and Folan, M. “Use of peer assessment as a student engagement strategy in nurse education”, Nurs Health Sci, 13 (4), 514-520, December 2011.
[9]   | Elmore, L., Skelley, J. and Woolley, T. “Impact of adapted team-based learning methods on student self-assessment of professionalism, teamwork and skills in a self-care course”, Currents Pharm Teach Learn, 6 (4), 488-493, July-August 2014.
[10]   | García, D., Núñez, F., Vargas, P., Astudillo, S., Hitschfeld, M., Gennero, R., Salvatierra, L. and Benavente, A. “Expectativas de estudiantes de medicina de pregrado en relación al perfil de médico esperado”, Rev Méd Chile, 134, 947-954, 2006.
[11]   | Salanova, M., Martínez, I.M., Bresó, E., Llorens, S. and Grau, R. “Bienestar psicológico en estudiantes universitarios: Facilitadores y obstaculizadores del desempeño académico”, An Psicol, 21 (1), 170-180, 2005.
[12]   | Caballero, C.C., Abello, R. and Palacios, J. “Relación del burnout y el rendimiento académico con la satisfacción frente a los estudios en estudiantes universitarios”, Av Psicol Latinoam, 25 (2), 98-111, 2007.
[13]   | Salgado, M.C., Sevilla, M. and Berelleza, M. “El rendimiento académico y el compromiso de los alumnos que trabajan de la licenciatura en Informática de la FCA de la UABC”, Rev Iberoam Invest Desarro Educ, 11, July-December 2013.
[14]   | Oriol, X., Mendoza, M., Covarrubias, C.G. and Molina, V. “Emociones positivas, apoyo a la autonomía y rendimiento de estudiantes universitarios: el papel mediador del compromiso académico y la autoeficacia”, Rev Psicodidáctica, 21 (2), 2016.
[15]   | Todres, M., Tsimtsiou, Z., Sidhu, K., Stephenson, A. and Jones, R. “Medical student’s perceptions of the factors influencing their academic performance: An exploratory interview study with high-achieving and re-sitting medical students”, Med Teach, 34 (5), e325-e331, 2012.
[16]   | Peralta, S.C., Ramírez, A.F. and Castaño, H. “Factores resilientes asociados al rendimiento académico en estudiantes pertenecientes a la Universidad de Sucre (Colombia)”, Psicol Caribe, 17, 196-219, July 2006.
[17]   | Álvarez, L.Y. and Cáceres, L. “Resiliencia, rendimiento académico y variables sociodemográficas en estudiantes universitarios de Bucaramanga (Colombia)”, Psicol Iberoam, 18 (2), 37-46, July-December 2010.
[18]   | Wilkinson, T.J., McKenzie, J.M., Ali, A.N., Rudland, J., Carter, F.A. and Bell, C.J. “Identifying medical students at risk of underperformance from significant stressors”, BMC Med Educ, 16, 43, 2016.
[19]   | Fouilloux, C., Petra, I., Romero, M. and González, L. “Fuentes de estrés en estudiantes de medicina. Un estudio piloto”, Rev Fac Med UNAM, 37 (3), 132-136, 1994.
[20]   | Guerrero, J.B., Heinze, G., Ortíz, S., Cortés, J., Barragán, V. and Flores, M. “Factores que predicen depresión en estudiantes de medicina”, Gac Méd México, 149, 598-604, 2013.
[21]   | Romo, F., Tafoya, S.A. and Heinze, G. “Estudio comparativo sobre depresión y los factores asociados en alumnos del primer año de la Faculta de Medicina y del Internado”, Salud Ment, 36 (5), 375-379, Septiembre-Octubre 2013.
[22]   | Facultad de Medicina, UNAM. Plan de estudios 2010 y programas académicos de la licenciatura de médico cirujano. The Institution, México, 2010.
[23]   | Cortés, M.T., Petra, I., Acosta, E., Reynaga, J., Fouilloux, M., García, R. and Piedra, E. “Desarrollo y crecimiento personal. Construcción y validación de un instrumento para evaluar esta competencia en alumnos de Medicina”, FEM, 20 (2), 65-73, 2017.