title: Relationship among Medical Student Resilience, Educational Environment and Quality of Life.
abstract: BACKGROUND
  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 (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.
  
  
  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.
authors.affiliation: Center for Development of Medical Education, School of Medicine of the University of São Paulo, Sao Paulo, Brazil; Evangelical Medical School of Parana, Curitiba, Brazil.
authors.forename: Patricia
authors.initials: P
authors.lastname: Tempski
authors.affiliation: Department of Medicine, School of Medicine of the University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Itamar S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Center for Development of Medical Education, School of Medicine of the University of São Paulo, Sao Paulo, Brazil.
authors.forename: Fernanda B
authors.initials: FB
authors.lastname: Mayer
authors.affiliation: Center for Development of Medical Education, School of Medicine of the University of São Paulo, Sao Paulo, Brazil.
authors.forename: Sylvia C
authors.initials: SC
authors.lastname: Enns
authors.affiliation: Department of Medicine, School of Medicine of the University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Perotta
authors.affiliation: Department of Obstetrics and Gynecology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil.
authors.forename: Helena B M S
authors.initials: HB
authors.lastname: Paro
authors.affiliation: Center for Development of Medical Education, School of Medicine of the University of São Paulo, Sao Paulo, Brazil.
authors.forename: Silmar
authors.initials: S
authors.lastname: Gannam
authors.affiliation: Center for Development of Medical Education, School of Medicine of the University of São Paulo, Sao Paulo, Brazil.
authors.forename: Munique
authors.initials: M
authors.lastname: Peleias
authors.affiliation: State University of São Paulo, Botucatu, Brazil.
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: Garcia
authors.affiliation: ABC Foundation Medical School, Santo Andre, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Baldassin
authors.affiliation: School of Medicine of Marilia, Marilia, Brazil.
authors.forename: Katia B
authors.initials: KB
authors.lastname: Guimaraes
authors.affiliation: ABC Foundation Medical School, Santo Andre, Brazil.
authors.forename: Nilson R
authors.initials: NR
authors.lastname: Silva
authors.affiliation: School of Medicine of Rio Preto, Rio Preto, Brazil.
authors.forename: Emirene M T Navarro
authors.initials: EM
authors.lastname: da Cruz
authors.affiliation: Department of Psychiatry, School of Medicine, State University of Campinas, Campinas, Brazil.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Tofoli
authors.affiliation: Department of Pathology, School of Medicine of the University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Paulo S P
authors.initials: PS
authors.lastname: Silveira
authors.affiliation: Center for Development of Medical Education, School of Medicine of the University of São Paulo, Sao Paulo, Brazil; Department of Medicine, School of Medicine of the University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Milton A
authors.initials: MA
authors.lastname: Martins
mesh_terms: D000293:Adolescent; D000328:Adult; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D008297:Male; D010465:Perception; D011788:Quality of Life; D055500:Resilience, Psychological; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult