Document Type : Original Article
Authors
1 Department of Educational Management, Isfahan University, Isfahan, Iran
2 Department Educational Management, Kharazmi University, Tehran, Iran
Abstract
BACKGROUND: There is growing acknowledgment that medical education can be a stressful
experience for students and may have a devastating effect on their psychological well‑being. The
present article, therefore, aimed at investigating students’ academic resilience as a mediating variable
in self‑efficacy‑test anxiety relation.
MATERIALS AND METHODS: In this cross‑sectional correlational study, a convenience sample
of 243 medical students was selected and participated, three prevalidated questionnaires were
applied, that is, general self‑efficacy questionnaire, academic resilience questionnaire, and test
anxiety questionnaire. To analyze the data, Pearson’s correlation coefficient as well as structural
equation modeling (SEM) were used.
RESULTS: According to Pearson’s coefficients, self‑efficacy was found to be positively correlated
with academic resilience (r = 0.437, P ≤ 0.01) and negatively with test anxiety (r = −0.475, P ≤ 0.01).
SEM results also indicated that self‑efficacy positively impacts on academic resilience (β = 0.43,
P < 0.001) and negatively on test anxiety (β = −0.37, P < 0.001). In addition, results demonstrated the
mediating role of academic resilience in self‑efficacy‑test anxiety relationship (β = −0.108, P < 0.001).
CONCLUSION: This study showed that academic resilience could play a mediating role in students’
self‑efficacy‑test anxiety relationship.
Keywords
1. Radcliffe C, Lester H. Perceived stress during undergraduate
medical training: A qualitative study. Med Educ 2003;37:32‑8.
2. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review
of depression, anxiety, and other indicators of psychological
distress among U.S. and Canadian medical students. Acad Med
2006;81:354‑73.
3. Ahmady S, Khajeali N, Kalantarion M, Sharifi F, Yaseri M.
Relation between stress, time management, and academic
achievement in preclinical medical education: A systematic
review and meta‑analysis. J Educ Health Promot 2021;10:32.
4. Hahn H, Kropp P, Kirschstein T, Rücker G, Müller‑Hilke B. Test
anxiety in medical school is unrelated to academic performance
but correlates with an effort/reward imbalance. PLoS One
2017;12:e0171220.
5. Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of
depression amongst medical students: A meta‑analysis. Med
Educ 2016;50:456‑68.
6. Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D,
Chiang VW, et al. Rates of medication errors among depressed
and burnt out residents: Prospective cohort study. BMJ
2008;336:488‑91.
7. Rab F, Mamdou R, Nasir S. Rates of depression and anxiety
among female medical students in Pakistan. East Mediterr Health
J 2008;14:126‑33.
8. Yusoff MS, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN,
Esa AR. Prevalence and associated factors of stress, anxiety and
depression among prospective medical students. Asian J Psychiatr
2013;6:128‑33.
9. Shao R, He P, Ling B, Tan L, Xu L, Hou Y, et al. Prevalence of
depression and anxiety and correlations between depression,
anxiety, family functioning, social support and coping styles
among Chinese medical students. BMC Psychol 2020;8:38.
10. Khorvash F, Vesal S, Yamani N, Hadadgar A, Mehrbod N. The
relationship between residents’ interest to their specialty field and
their level of anxiety. J Educ Health Promot 2014;3:33.
11. Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, et al. The global prevalence of anxiety among medical students:
A meta‑analysis. Int J Environ Res Public Health 2019;16:2735.
12. Haldorsen H, Bak NH, Dissing A, Petersson B. Stress and
symptoms of depression among medical students at the
University of Copenhagen. Scand J Public Health 2014;42:89‑95.
13. Asayesh H, Hosseini MA, Sharififard F, Kharameh ZT. The
relationship between self‑efficacy and test anxiety among the
paramedical students of Qom university of medical sciences.
J Adv Med Educ 2016;1:14‑21.
14. Gao YQ, Pan BC, Sun W, Wu H, Wang JN, Wang L. Anxiety
symptoms among Chinese nurses and the associated factors:
A cross sectional study. BMC Psychiatry 2012;12:141.
15. Singh I, Jha A. Anxiety, optimism and academic achievement
among students of private medical and engineering colleges:
A comparative study. J Educ Dev Psychol 2013;3:222.
16. Sareen J, Cox BJ, Afifi TO, de GraafR, Asmundson GJ, ten Have M,
et al. Anxiety disorders and risk for suicidal ideation and suicide
attempts: A population‑based longitudinal study of adults. Arch
Gen Psychiatry 2005;62:1249‑57.
17. Nakhostin‑Ansari A, Sherafati A, Aghajani F, Khonji MS,
Aghajani R, Shahmansouri N. Depression and anxiety among
Iranian Medical Students during COVID‑19 pandemic. Iranian
journal of psychiatry. 2020;15(3):228‑35.
18. Van Eerde W. A meta‑analytically derived nomological network
of procrastination. Pers Individ Differ 2003;35:1401‑18.
19. Senaratne R, Van Ameringen M, Mancini C, Patterson B. The
burden of anxiety disorders on the family. J Nerv Ment Dis
2010;198:876‑80.
20. Wittchen HU. Generalized anxiety disorder: Prevalence, burden,
and cost to society. Depress Anxiety 2002;16:162‑71.
21. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M,
et al. Years lived with disability (YLDs) for 1160 sequelae of 289
diseases and injuries 1990‑2010: A systematic analysis for the
Global Burden of Disease Study 2010. Lancet 2012;380:2163‑96.
22. Dahlin M, Joneborg N, Runeson B. Stress and depression
among medical students: A cross‑sectional study. Med Educ
2005;39:594‑604.
23. Cassidy S. Resilience building in students: The role of academic
self‑efficacy. Front Psychol 2015;6:1781.
24. Ozen NS, Ercan I, Irgil E, Sigirli D. Anxiety prevalence and
affecting factors among university students. Asia Pac J Public
Health 2010;22:127‑33.
25. Bandura A, Adams NE. Analysis of self‑efficacy theory of
behavioral change. Cogn Ther Res 1977;1:287‑310.
26. Pekrun R. The control‑value theory of achievement emotions:
Assumptions, corollaries, and implications for educational
research and practice. Educ Psychol Rev 2006;18:315‑41.
27. PekrunR, Frenzel AC, Goetz T, PerryRP. The control‑value theory
of achievement emotions: An integrative approach to emotions in
education. In: Emotion in Education. Amsterdam, Netherlands:
Elsevier; 2007. p. 13‑36.
28. Bandura A. Self‑efficacy: Toward a unifying theory of behavioral
change. Psychol Rev 1977;84:191‑215.
29. Hayat AA, Shateri K, Amini M, Shokrpour N. Relationships
between academic self‑efficacy, learning‑related emotions, and
metacognitive learning strategies with academic performance
in medical students: A structural equation model. BMC Med
Educ 2020;20:76.
30. Kurbanoglu NI, Akim A. The relationships between university
students’ chemistry laboratory anxiety, attitudes, and self‑efficacy
beliefs. Aust J Teacher Educ 2010;35:4.
31. Schunk DH, Ertmer PA. Self‑regulation and academic learning:
Self‑efficacy enhancing interventions. In: Handbook of
Self‑regulation. Amsterdam, Netherlands: Elsevier; 2000.
p. 631‑49.
32. Krispenz A, Gort C, Schültke L, Dickhäuser O. How to reduce
test anxiety and academic procrastination through inquiry of
cognitive appraisals: A pilot study investigating the role of
academic self‑efficacy. Front Psychol 2019;10:1917.
33. Mao Y, Yang R, Bonaiuto M, Ma J, Harmat L. Can flow alleviate
anxiety? The roles of academic self‑efficacy and self‑esteem in
building psychological sustainability and resilience. Sustainability
2020;12:2987.
34. Shi M, Liu L, Wang ZY, Wang L. The mediating role of resilience
in the relationship between big five personality and anxiety
among Chinese medical students: A cross‑sectional study. PLoS
One 2015;10:e0119916.
35. Russo SJ, Murrough JW, Han MH, Charney DS, Nestler EJ.
Neurobiology of resilience. Nat Neurosci 2012;15:1475‑84.
36. Campbell‑Sills L, Stein MB. Psychometric analysis and refinement
of the Connor‑davidson Resilience Scale (CD‑RISC): Validation of
a 10‑item measure of resilience. J Trauma Stress 2007;20:1019‑28.
37. Neufeld A, Malin G. Exploring the relationship between medical
student basic psychological need satisfaction, resilience, and
well‑being: A quantitative study. BMC Med Educ 2019;19:405.
38. Wang MC, Gordon EW. Educational Resilience in Inner‑city
America: Challenges and Prospects. Milton Park: Routledge; 1994.
39. Abiola T, Udofia O. Psychometric assessment of the Wagnild
and young’s resilience scale in Kano, Nigeria. BMC Res Notes
2011;4:509.
40. Waxman HC, Gray JP, Padron YN. Review of Research on
Educational Resilience. Washington, DC: Institute of Education
Sciences; 2003.
41. Martin AJ, Marsh HW. Academic resilience and its psychological
and educational correlates: A construct validity approach. Psychol
Sch 2006;43:267‑81.
42. Hamill SK. Resilience and self‑efficacy: The importance of efficacy
beliefs and coping mechanisms in resilient adolescents. Colgate
Univ J Sci 2003;35:115‑46.
43. Putwain DW, Nicholson LJ, Connors L, Woods K. Resilient
children are less test anxious and perform better in tests at the end
of primary schooling. Learn Individ Differ 2013;28:41‑6.
44. Cooke GP, Doust JA, Steele MC. A survey of resilience, burnout,
and tolerance of uncertainty in Australian general practice
registrars. BMC Med Educ 2013;13:2.
45. Hair JF Jr., Hult GT, Ringle C, Sarstedt M. A primer on partial
least squares structural equation modeling (PLS‑SEM). Thousand
Oaks: Sage Publications; 2016.
46. Chen G, Gully SM, Eden D. Validation of a new general
self‑efficacy scale. Organ Res Methods 2001;4:62‑83.
47. Chegini Z, Janati A, Asghari‑Jafarabadi M, Khosravizadeh O.
Organizational commitment, job satisfaction, organizational
justice and self‑efficacy among nurses. Nurs Pract Today
2019;6(2):86‑93.
48. Pintrich PR, Smith DA, Garcia T, McKeachie WJ. Reliability
and predictive validity of the motivated strategies for learning
questionnaire (MSLQ). Educ Psychol Measur 1993;53:801‑13.
49. Roick J, Ringeisen T. Self‑efficacy, test anxiety, and academic
success: A longitudinal validation. Int J Educ Res 2017;83:84‑93.
50. Yerdelen S, McCaffrey A, Klassen RM. Longitudinal examination
of procrastination and anxiety, and their relation to self‑efficacy
for self‑regulated learning: Latent growth curve modeling. Educ
Sci 2016;16(1):5‑22.
51. Titrek O, Çetin C, Kaymak E, Kaşikçi MM. Academic motivation
and academic self‑efficacy of prospective teachers. J Educ Train
Stud 2018;6:77‑87.
52. Sagone E, de Caroli ME. “Yes I can”: Psychological resilience and
self‑efficacy in adolescents. Int J Dev Educ Psychol 2016;1:141‑8.
53. Galindo‑Domínguez H, Pegalajar M. Mediator and moderator
effect of resilience between self‑efficacy and burnout amongst
social and legal sciences faculty members. Rev Psicodidáctica
(English ed). 2020;25(2):127‑35.
54. Schwarzer R, Warner LM. Perceived self‑efficacy and its relationship to resilience. In: Resilience in Children, Adolescents,
and Adults. Berlin, Germany: Springer; 2013. p. 139‑50.
55. Herrman H, Stewart DE, Diaz‑Granados N, Berger EL, Jackson B,
Yuen T. What is resilience? Can J Psychiatry 2011;56:258‑65.
56. Masten AS. Regulatory processes, risk, and resilience in adolescent
development. Ann N Y Acad Sci 2004;1021:310‑9.
57. Maddi SR, Khoshaba DM. Resilience at Work: How to Succeed no
Matter what Life Throws at You. New York: Amacom Books; 2005.
58. Cassen R, Feinstein L, Graham P. Educational outcomes:
Adversity and resilience. Soc Pol Soc 2009;8:73‑85.
59. Wu G, Feder A, Cohen H, Kim JJ, Calderon S, Charney DS, et al.
Understanding resilience. Front Behav Neurosci 2013;7:10.
60. Slavin RE. Educational Psychology: Theory and Practice. Boston:
Pearson Education; 2019 Apr.
medical training: A qualitative study. Med Educ 2003;37:32‑8.
2. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review
of depression, anxiety, and other indicators of psychological
distress among U.S. and Canadian medical students. Acad Med
2006;81:354‑73.
3. Ahmady S, Khajeali N, Kalantarion M, Sharifi F, Yaseri M.
Relation between stress, time management, and academic
achievement in preclinical medical education: A systematic
review and meta‑analysis. J Educ Health Promot 2021;10:32.
4. Hahn H, Kropp P, Kirschstein T, Rücker G, Müller‑Hilke B. Test
anxiety in medical school is unrelated to academic performance
but correlates with an effort/reward imbalance. PLoS One
2017;12:e0171220.
5. Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of
depression amongst medical students: A meta‑analysis. Med
Educ 2016;50:456‑68.
6. Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D,
Chiang VW, et al. Rates of medication errors among depressed
and burnt out residents: Prospective cohort study. BMJ
2008;336:488‑91.
7. Rab F, Mamdou R, Nasir S. Rates of depression and anxiety
among female medical students in Pakistan. East Mediterr Health
J 2008;14:126‑33.
8. Yusoff MS, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN,
Esa AR. Prevalence and associated factors of stress, anxiety and
depression among prospective medical students. Asian J Psychiatr
2013;6:128‑33.
9. Shao R, He P, Ling B, Tan L, Xu L, Hou Y, et al. Prevalence of
depression and anxiety and correlations between depression,
anxiety, family functioning, social support and coping styles
among Chinese medical students. BMC Psychol 2020;8:38.
10. Khorvash F, Vesal S, Yamani N, Hadadgar A, Mehrbod N. The
relationship between residents’ interest to their specialty field and
their level of anxiety. J Educ Health Promot 2014;3:33.
11. Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, et al. The global prevalence of anxiety among medical students:
A meta‑analysis. Int J Environ Res Public Health 2019;16:2735.
12. Haldorsen H, Bak NH, Dissing A, Petersson B. Stress and
symptoms of depression among medical students at the
University of Copenhagen. Scand J Public Health 2014;42:89‑95.
13. Asayesh H, Hosseini MA, Sharififard F, Kharameh ZT. The
relationship between self‑efficacy and test anxiety among the
paramedical students of Qom university of medical sciences.
J Adv Med Educ 2016;1:14‑21.
14. Gao YQ, Pan BC, Sun W, Wu H, Wang JN, Wang L. Anxiety
symptoms among Chinese nurses and the associated factors:
A cross sectional study. BMC Psychiatry 2012;12:141.
15. Singh I, Jha A. Anxiety, optimism and academic achievement
among students of private medical and engineering colleges:
A comparative study. J Educ Dev Psychol 2013;3:222.
16. Sareen J, Cox BJ, Afifi TO, de GraafR, Asmundson GJ, ten Have M,
et al. Anxiety disorders and risk for suicidal ideation and suicide
attempts: A population‑based longitudinal study of adults. Arch
Gen Psychiatry 2005;62:1249‑57.
17. Nakhostin‑Ansari A, Sherafati A, Aghajani F, Khonji MS,
Aghajani R, Shahmansouri N. Depression and anxiety among
Iranian Medical Students during COVID‑19 pandemic. Iranian
journal of psychiatry. 2020;15(3):228‑35.
18. Van Eerde W. A meta‑analytically derived nomological network
of procrastination. Pers Individ Differ 2003;35:1401‑18.
19. Senaratne R, Van Ameringen M, Mancini C, Patterson B. The
burden of anxiety disorders on the family. J Nerv Ment Dis
2010;198:876‑80.
20. Wittchen HU. Generalized anxiety disorder: Prevalence, burden,
and cost to society. Depress Anxiety 2002;16:162‑71.
21. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M,
et al. Years lived with disability (YLDs) for 1160 sequelae of 289
diseases and injuries 1990‑2010: A systematic analysis for the
Global Burden of Disease Study 2010. Lancet 2012;380:2163‑96.
22. Dahlin M, Joneborg N, Runeson B. Stress and depression
among medical students: A cross‑sectional study. Med Educ
2005;39:594‑604.
23. Cassidy S. Resilience building in students: The role of academic
self‑efficacy. Front Psychol 2015;6:1781.
24. Ozen NS, Ercan I, Irgil E, Sigirli D. Anxiety prevalence and
affecting factors among university students. Asia Pac J Public
Health 2010;22:127‑33.
25. Bandura A, Adams NE. Analysis of self‑efficacy theory of
behavioral change. Cogn Ther Res 1977;1:287‑310.
26. Pekrun R. The control‑value theory of achievement emotions:
Assumptions, corollaries, and implications for educational
research and practice. Educ Psychol Rev 2006;18:315‑41.
27. PekrunR, Frenzel AC, Goetz T, PerryRP. The control‑value theory
of achievement emotions: An integrative approach to emotions in
education. In: Emotion in Education. Amsterdam, Netherlands:
Elsevier; 2007. p. 13‑36.
28. Bandura A. Self‑efficacy: Toward a unifying theory of behavioral
change. Psychol Rev 1977;84:191‑215.
29. Hayat AA, Shateri K, Amini M, Shokrpour N. Relationships
between academic self‑efficacy, learning‑related emotions, and
metacognitive learning strategies with academic performance
in medical students: A structural equation model. BMC Med
Educ 2020;20:76.
30. Kurbanoglu NI, Akim A. The relationships between university
students’ chemistry laboratory anxiety, attitudes, and self‑efficacy
beliefs. Aust J Teacher Educ 2010;35:4.
31. Schunk DH, Ertmer PA. Self‑regulation and academic learning:
Self‑efficacy enhancing interventions. In: Handbook of
Self‑regulation. Amsterdam, Netherlands: Elsevier; 2000.
p. 631‑49.
32. Krispenz A, Gort C, Schültke L, Dickhäuser O. How to reduce
test anxiety and academic procrastination through inquiry of
cognitive appraisals: A pilot study investigating the role of
academic self‑efficacy. Front Psychol 2019;10:1917.
33. Mao Y, Yang R, Bonaiuto M, Ma J, Harmat L. Can flow alleviate
anxiety? The roles of academic self‑efficacy and self‑esteem in
building psychological sustainability and resilience. Sustainability
2020;12:2987.
34. Shi M, Liu L, Wang ZY, Wang L. The mediating role of resilience
in the relationship between big five personality and anxiety
among Chinese medical students: A cross‑sectional study. PLoS
One 2015;10:e0119916.
35. Russo SJ, Murrough JW, Han MH, Charney DS, Nestler EJ.
Neurobiology of resilience. Nat Neurosci 2012;15:1475‑84.
36. Campbell‑Sills L, Stein MB. Psychometric analysis and refinement
of the Connor‑davidson Resilience Scale (CD‑RISC): Validation of
a 10‑item measure of resilience. J Trauma Stress 2007;20:1019‑28.
37. Neufeld A, Malin G. Exploring the relationship between medical
student basic psychological need satisfaction, resilience, and
well‑being: A quantitative study. BMC Med Educ 2019;19:405.
38. Wang MC, Gordon EW. Educational Resilience in Inner‑city
America: Challenges and Prospects. Milton Park: Routledge; 1994.
39. Abiola T, Udofia O. Psychometric assessment of the Wagnild
and young’s resilience scale in Kano, Nigeria. BMC Res Notes
2011;4:509.
40. Waxman HC, Gray JP, Padron YN. Review of Research on
Educational Resilience. Washington, DC: Institute of Education
Sciences; 2003.
41. Martin AJ, Marsh HW. Academic resilience and its psychological
and educational correlates: A construct validity approach. Psychol
Sch 2006;43:267‑81.
42. Hamill SK. Resilience and self‑efficacy: The importance of efficacy
beliefs and coping mechanisms in resilient adolescents. Colgate
Univ J Sci 2003;35:115‑46.
43. Putwain DW, Nicholson LJ, Connors L, Woods K. Resilient
children are less test anxious and perform better in tests at the end
of primary schooling. Learn Individ Differ 2013;28:41‑6.
44. Cooke GP, Doust JA, Steele MC. A survey of resilience, burnout,
and tolerance of uncertainty in Australian general practice
registrars. BMC Med Educ 2013;13:2.
45. Hair JF Jr., Hult GT, Ringle C, Sarstedt M. A primer on partial
least squares structural equation modeling (PLS‑SEM). Thousand
Oaks: Sage Publications; 2016.
46. Chen G, Gully SM, Eden D. Validation of a new general
self‑efficacy scale. Organ Res Methods 2001;4:62‑83.
47. Chegini Z, Janati A, Asghari‑Jafarabadi M, Khosravizadeh O.
Organizational commitment, job satisfaction, organizational
justice and self‑efficacy among nurses. Nurs Pract Today
2019;6(2):86‑93.
48. Pintrich PR, Smith DA, Garcia T, McKeachie WJ. Reliability
and predictive validity of the motivated strategies for learning
questionnaire (MSLQ). Educ Psychol Measur 1993;53:801‑13.
49. Roick J, Ringeisen T. Self‑efficacy, test anxiety, and academic
success: A longitudinal validation. Int J Educ Res 2017;83:84‑93.
50. Yerdelen S, McCaffrey A, Klassen RM. Longitudinal examination
of procrastination and anxiety, and their relation to self‑efficacy
for self‑regulated learning: Latent growth curve modeling. Educ
Sci 2016;16(1):5‑22.
51. Titrek O, Çetin C, Kaymak E, Kaşikçi MM. Academic motivation
and academic self‑efficacy of prospective teachers. J Educ Train
Stud 2018;6:77‑87.
52. Sagone E, de Caroli ME. “Yes I can”: Psychological resilience and
self‑efficacy in adolescents. Int J Dev Educ Psychol 2016;1:141‑8.
53. Galindo‑Domínguez H, Pegalajar M. Mediator and moderator
effect of resilience between self‑efficacy and burnout amongst
social and legal sciences faculty members. Rev Psicodidáctica
(English ed). 2020;25(2):127‑35.
54. Schwarzer R, Warner LM. Perceived self‑efficacy and its relationship to resilience. In: Resilience in Children, Adolescents,
and Adults. Berlin, Germany: Springer; 2013. p. 139‑50.
55. Herrman H, Stewart DE, Diaz‑Granados N, Berger EL, Jackson B,
Yuen T. What is resilience? Can J Psychiatry 2011;56:258‑65.
56. Masten AS. Regulatory processes, risk, and resilience in adolescent
development. Ann N Y Acad Sci 2004;1021:310‑9.
57. Maddi SR, Khoshaba DM. Resilience at Work: How to Succeed no
Matter what Life Throws at You. New York: Amacom Books; 2005.
58. Cassen R, Feinstein L, Graham P. Educational outcomes:
Adversity and resilience. Soc Pol Soc 2009;8:73‑85.
59. Wu G, Feder A, Cohen H, Kim JJ, Calderon S, Charney DS, et al.
Understanding resilience. Front Behav Neurosci 2013;7:10.
60. Slavin RE. Educational Psychology: Theory and Practice. Boston:
Pearson Education; 2019 Apr.
)