title: Identifying medical students at risk of underperformance from significant stressors.
abstract: BACKGROUND
  Stress is associated with poorer academic performance but identifying vulnerable students is less clear. A series of earthquakes and disrupted learning environments created an opportunity to explore the relationships among stress, student factors, support and academic performance within a medical course.
  
  
  METHODS
  The outcomes were deviations from expected performances on end of year written and clinical examinations. The predictors were questionnaire-based measures of connectedness/support, impact of the earthquakes, safety, depression, anxiety, stress, resilience and personality.
  
  
  RESULTS
  The response rate was 77%. Poorer than expected performance on all examinations was associated with greater disruptions to living arrangements and fewer years in the country; on the written examination with not having a place to study; and on the clinical examination with relationship status, not having the support of others, less extroversion, and feeling less safe. There was a suggestion of a beneficial association with some markers of stress.
  
  
  CONCLUSIONS
  We show that academic performance is assisted by students having a secure physical and emotional base. The students who are most vulnerable are those with fewer social networks, and those who are recent immigrants.
authors.affiliation: University of Otago, Christchurch, P O Box 4345, Christchurch, 8140, New Zealand. tim.wilkinson@otago.ac.nz.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Wilkinson
authors.affiliation: University of Otago, Christchurch, P O Box 4345, Christchurch, 8140, New Zealand.
authors.forename: Jan M
authors.initials: JM
authors.lastname: McKenzie
authors.affiliation: University of Otago, Christchurch, P O Box 4345, Christchurch, 8140, New Zealand.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Ali
authors.affiliation: University of Otago, Christchurch, P O Box 4345, Christchurch, 8140, New Zealand.
authors.forename: Joy
authors.initials: J
authors.lastname: Rudland
authors.affiliation: University of Otago, Christchurch, P O Box 4345, Christchurch, 8140, New Zealand.
authors.forename: Frances A
authors.initials: FA
authors.lastname: Carter
authors.affiliation: University of Otago, Christchurch, P O Box 4345, Christchurch, 8140, New Zealand.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Bell
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology; D004190:Disasters; D055866:Earthquakes; D004504:Education, Medical, Undergraduate / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D004521:Educational Measurement / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D017533:Marital Status; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D065840:Protective Factors; D012111:Residence Characteristics; D055500:Resilience, Psychological; D012307:Risk Factors; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires
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