title: How does the quality of life and the underlying biochemical indicators correlate with the performance in academic examinations in a group of medical students of Sri Lanka?
abstract: BACKGROUND
  Individual variation of examination performance depends on many modifiable and non-modifiable factors, including pre-examination anxiety. Medical students' quality of life (QoL) and certain biochemical changes occurring while they are preparing for examinations has not been explored.
  
  
  OBJECTIVE
  We hypothesize that these parameters would determine the examination performance among medical students.
  
  
  METHODS
  Fourth-year medical students (n=78) from the University of Ruhuna, Sri Lanka, were invited. Their pre- and post-exam status of QoL, using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, and the level of biochemical marker levels (i.e., serum levels of thyroid profile including thyroglobulin, cortisol and ferritin) were assessed. Differences between the scores of QoL and serum parameters were compared with their performance at the examination.
  
  
  RESULTS
  The mean QoL score was significantly lower at pre-exam (56.19±8.1) when compared with post-exam (61.7±7.1) levels (p<0.001). The median serum TSH level prior to the exam (0.9 mIU/L; interquartile range 0.74-1.4 mIU/L) was significantly lower (p=0.001) when compared with the level after the exam (median of 2.7 mIU/L; IQR 1.90-3.60). The mean±SD fT4 level was significantly higher before the exam (19.48±0.4 pmol/L at study entry vs. 17.43±0.3 pmol/L after the exam; p<0.001). Median serum ferritin (SF) level prior to the exam (43.15 (23.5-63.3) µg/L) was significantly lower (p≤0.001) when compared with after-exam status (72.36 (49.9-94.9) µg/L). However, there was no difference in mean serum cortisol levels (16.51±0.7 at pre-exam and 15.88±0.7 at post-exam, respectively; p=0.41).
  
  
  CONCLUSIONS
  Students had higher fT4 and low ferritin levels on pre-exam biochemical assessment. It was evident that students who perform better at the examination had significantly higher QoL scores at each domain tested through the questionnaire (Physical health, Psychological, Social interaction and Environment). The higher the QoL scores, the better the grades were. It was also found that students who failed exhibited profound differences in the QoL score.
authors.affiliation: Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka; manjula.hettiarachchi@gmail.com.
authors.forename: Manjula
authors.initials: M
authors.lastname: Hettiarachchi
authors.affiliation: Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
authors.forename: Chathuranga Lakmal
authors.initials: CL
authors.lastname: Fonseka
authors.affiliation: Coronary Care Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Gunasekara
authors.affiliation: Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
authors.forename: Prasanjanie
authors.initials: P
authors.lastname: Jayasinghe
authors.affiliation: Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
authors.forename: Dasun
authors.initials: D
authors.lastname: Maduranga
mesh_terms: D000328:Adult; D015415:Biomarkers; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007398:Interpersonal Relations; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D013188:Sri Lanka; D013337:Students, Medical / Q000523:psychology*; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000097:blood
chemical_list: D015415:Biomarkers; D013963:Thyroid Hormones; D013972:Thyrotropin; D005293:Ferritins; D006854:Hydrocortisone
keywords: Sri Lanka; cortisol; exam stress; quality of life; thyroxine