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OBJECTIVE: The objective was to determine and compare demographic features, professional activities and adversities, physical health conditions, and self-care behaviors related to the most frequently self-reported mental health problems among psychiatrists and psychiatry trainees. METHODS: A cross-sectional, retrospective, comparative study was conducted on a total of 330 (48.2%) psychiatry trainees and 355 (51.8%) psychiatrists from Mexico through an online survey. Demographic features, professional activities and adversities, physical and mental health problems, self-care behaviors, and social support were examined. Comparative analyses and multiple logistic regression models were performed. RESULTS: Major depression, anxiety, and burnout were the most common mental health problems reported with a higher frequency of anxiety disorders in psychiatry trainees. Being a woman, having a physical health problem, and lack of restful sleep were the main risk factors in both groups. Consultation in the government sector and having patients with severe suicidal ideation affected more psychiatry trainees. Perceived discrimination and inadequate eating schedules were risk factors for mental health problems for psychiatrists. CONCLUSION: Psychiatry trainees constitute a vulnerable group for anxiety disorders. Particular attention should be paid to how students cope with the training experience to determine whether additional support is required. These professionals face major stressors leading to a high prevalence of depression, burnout, and anxiety. Encouraging psychiatrists to have better health habits is a step in the right direction, which must be accompanied by tangible organizational avenues to do so and creating a culture that truly promotes self-care.
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Saúde Mental , Psiquiatria , Estudos Transversais , Feminino , Humanos , México/epidemiologia , Discriminação Percebida , Estudos Retrospectivos , Fatores de Risco , AutorrelatoRESUMO
METHODS: A systematic analysis was performed of the medical specialization academic programs of 20 different countries to establish which medical specialties take into account mental health issues in the specialty curricular design and which mental health content these programs address. The criteria that were explored in the educational programs include: 1) name of the medical specialties that take into account mental health content in curriculum design, 2) name of the mental health issues addressed by these programs. After independent review and data extraction, paired investigators compared the findings and reached consensus on all discrepancies before the final presentation of the data. Descriptive statistics evaluated the frequency of the data presented. RESULTS: Internal medicine, family medicine, neurology, pediatrics and geriatrics were the specialties that included mental health topics in their programs. In four countries: Bangladesh, Serbia, the Netherlands and France, 50%of all graduate specialty training programs include mental health content. In ten countries: Germany, Sweden, the United Kingdom, Mexico, Belgium, India, Russia, Canada, Israel and Spain, between 20% and 49% of all graduate specialty training programs include mental health content. In six countries - Brazil, Chile, Colombia, Croatia, Kenya, and the United States-less than 20% of all graduate specialty training programs include mental health content. DISCUSSION: The proposal that we have made in this article should be taken into account by decision-makers, in order to complement the different postgraduate training programs with mental health issues that are frequently present with other physical symptoms. It is not our intention that the different specialists know how to treat psychiatric comorbidities, but rather pay attention to their existence and implications in the diagnosis, evolution and prognosis of many other diseases. The current fragmentation of medicine into ever finer specialties makes the management of comorbidity ever more difficult: a reorientation of post- graduate training might improve the situation.
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Medicina , Saúde Mental , Criança , Comorbidade , Currículo , Humanos , Especialização , Estados UnidosRESUMO
Abstract Introduction Medical residents (MR) are an important pillar for a future effective health system. As such, it is important to study all the factors throughout their training that may influence their professional development, like gender-based violence (GV). Objetive To design and evaluate the psychometric proprieties of subtle GV among medical residents' assessment scale (SGEVRA). Method The design was carried out in two phases: (1) in the qualitative phase, three focus groups were interviewed to obtain information about GV during medical training; and (2) in the quantitative phase, the information was incorporated into the instrument and the psychometric properties were tested. Results A total of 1,645 medical residents (MRs) completed the instrument. Exploratory factor analysis led to a final two factor model comprised of 31 items that explained 74.9% of the variance. The factors were labelled as gender discrimination (factor 1) and sexual violence (factor 2); both demonstrated high internal consistency using Cronbach's alpha (factor 1: .987; factor 2: .935). Discussion and conclusion The SGEVRA is a brief, valid, and reliable instrument for assessing subtle GV among MR.
Resumen Introducción Los residentes médicos (MR) son un pilar importante para un futuro sistema de salud efectivo. Por ello, es importante estudiar todos los factores a lo largo de su capacitación que puedan influir en su desarrollo profesional, como la violencia de género (GV). Objetivo Diseñar y evaluar las propiedades psicométricas de la Escala de Violencia Sutil de Género en médicos residentes (SGEVRA, por sus siglas en inglés). Método El diseño se realizó en dos fases: (1) cualitativa: se entrevistó a tres grupos focales para obtener información sobre la VG durante la capacitación médica; y (2) cuantitativa, donde la información se incorporó al instrumento y se evaluaron las propiedades psicométricas. Resultados 1,645 residentes médicos (MR) completaron el instrumento. El análisis factorial exploratorio condujo a un modelo final de dos factores compuesto por 31 reactivos que explicaron el 74.9% de la varianza. Los factores fueron etiquetados como discriminación de género (factor 1) y violencia sexual (factor 2); ambos demostraron una alta consistencia interna con el alfa de Cronbach (factor 1: .987; factor 2: .935). Discusión y conclusión SGEVRA es un instrumento breve, válido y confiable para evaluar GV en MR.
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BACKGROUND: Major depressive disorder (MDD) is highly prevalent among medical students (MS). Abuse experiences, as well as stress, are among the factors associated with MDD. However, their association with MDD in MS has been scarcely addressed. METHODS: A cross-sectional study design was used to evaluate the association between MDD and possible risk factors, focusing on current and past abuse experiences inside and outside the academic setting in a large representative MS sample (nâ¯=â¯1,068) using self-report instruments to assess MDD (PHQ-9) and perceived academic stress levels during exam season. RESULTS: Depressive symptom severity directly correlates with levels of perceived academic stress. The prevalence of MDD was 16.2%. A history of emotional abuse during childhood or adolescence, as well as most types of current abuse were associated with MDD. Multiple logistic regression analysis showed that current emotional abuse outside school had the strongest association with MDD in MS, followed by a personal history of depression and suicide attempt, a family history of depression, and perceived academic stress levels. LIMITATIONS: Cross-sectional design, participants represent a specific population, and other variables that could be associated with MDD: comorbid psychiatric disorders, current antidepressant treatment and protective factors (resilience and health-promoting coping strategies) were not evaluated. CONCLUSIONS: MDD is strongly associated with several risk factors that include most types of current and past abuse experiences. Timely identification of individuals at-risk will be critical to establish preventive strategies to limit the impact of MDD in MS and offer prompt therapeutic alternatives when needed.
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Maus-Tratos Infantis/psicologia , Transtorno Depressivo Maior/psicologia , Estudantes de Medicina/psicologia , Adolescente , Adulto , Criança , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Família , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , México/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Estresse Psicológico/psicologia , Tentativa de Suicídio , Adulto JovemRESUMO
RESUMEN: Introducción: En el año de 2011 había en México 3 823 psiquiatras, con una tasa estimada de 3.4 por cada 100 mil habitantes. Es necesario mantener actualizada esta información para alcanzar los objetivos globales de atención a la salud mental. Objetivo: Estimar el número total de psiquiatras en México en 2016; determinar su distribución geográfica y comparar los resultados con los obtenidos en el año 2011. Método: Estudio comparativo y longitudinal. Se consultaron diversas fuentes para actualizar el número de psiquiatras en 2016 y conocer sus características sociodemográficas. Se compararon estas características con las encontradas en 2011. Resultados: Un total de 4 393 psiquiatras ejercen su especialidad en México en 2016. Sobre una población de 119 530 753 habitantes, se obtuvo una tasa de 3.68 psiquiatras por cada 100 000 habitantes. Existe una pobre distribución de estos especialistas en el país. Alrededor del 60% de todos los psiquiatras ejercen en las tres mayores ciudades de México. Discusión y conclusión: La tasa nacional de psiquiatras se incrementó en comparación con la obtenida en 2011, sigue siendo inferior a la recomendada por la Organización Mundial de la Salud (OMS). La distribución geográfica de los psiquiatras es inequitativa debido a la centralización y a factores económicos.
ABSTRACT: Introduction: In 2011 we had 3823 psychiatrists in Mexico, with an estimated rate of 3.4 per 100 000 inhabitants. In order to achieve the global targets of mental health attention, it is important to update this information. Objetive: To estimate the total number of psychiatrists in Mexico in 2016; detemine their geographic distribution and compare the results with the ones obtained in 2011. Method: Longitudinal and comparative study. Diverse sources of information were consulted in order to update the number of psychiatrists in 2016 and to know their sociodemographic characteristics, that were compared with the ones obtained in 2011. Results: 4 393 psychiatrists practiced their specialty in Mexico in 2016. With a population of 119 530 753 inhabitants, we obtained a rate of 3.68 psychiatrists per 100 000 inhabitants. There's a poor distribution of theese specialists in the country. Around 60% of all psychiatrists practice in the tree major cities of Mexico. Discussion and conclusion: The national rate of psychiatrists increase in comparisson with the one we found in 2011, it remains lower that the one recommended by the World Health Organization (WHO). Geographic distribution of the psychiatrists is inequitative because of centralization and economic factors.
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INTRODUCTION: AFECTS is a novel psychometric instrument that provides an integrated framework based on affective temperamental traits and their trait dimensions. It has the potential to be used in clinical and research fields to study psychopathology and mental health. It is now necessary to field-test this instrument with diverse populations and psychopathological entities. OBJECTIVE: The primary aim was to test the construct validity and the internal consistency of the Spanish Version of the AFECTS instrument on Mexican subjects. AFECTS characteristics were then compared between general population and stable psychiatric patients. METHODS: A cross-sectional design involving 350 subjects from the general population in México City and 91 stable patients with a bipolar disorder (BPD, n=20), major depressive disorder (MDD, n=35), or with a schizophrenia (n=36) diagnosis. RESULTS: A six-factor structure in trait dimensions, explaining 61.4% of the variance, with a Cronbach׳s alpha of 0.93 was found. Euthymic (23%) and hyperthymic (12%) affective temperaments were the most frequent, while dysphoric (3%) and apathetic (3%) were the least. Trait dimension differences were found in Volition, Sensitivity, and the Instability Index between the groups, particularly those with a bipolar disorder. LIMITATIONS: Use of a self report instrument, and a small sample not representative of the Mexican population or patients with psychiatric conditions. CONCLUSIONS: The Spanish Version of the AFECTS instrument has adequate psychometric properties. This version of AFECTS will allow the use of this instrument among Spanish speaking populations and contribute to the continued research efforts on integrative models such as AFECT.
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Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/psicologia , Personalidade , Inquéritos e Questionários/normas , Temperamento , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , PsicometriaRESUMO
OBJECTIVE: Second-generation antipsychotics (SGAs) are among the first-line treatments for bipolar disorder and schizophrenia, but have a tendency to generate metabolic disturbances. These features resemble a metabolic syndrome for which a central autonomic imbalance has been proposed that may originate from the hypothalamic suprachiasmatic nuclei. In a clinical trial, we hypothesized that melatonin, a hormone that regulates the suprachiasmatic nucleus, could attenuate SGA-induced adverse metabolic effects. METHODS: In an eight-week, double-blind, randomized, placebo-controlled, parallel-group clinical trial, we evaluated the metabolic effect of melatonin in SGA-treated patients in terms of weight, blood pressure, lipid, glucose, body composition, and anthropometric measures. A total of 44 patients treated with SGAs, 20 with bipolar disorder and 24 with schizophrenia, randomly received placebo (n = 24) or melatonin 5 mg (n = 20). RESULTS: The melatonin group showed a decrease in diastolic blood pressure (5.1 versus 1.1 mmHg for placebo, p = 0.003) and attenuated weight gain (1.5 versus 2.2 kg for placebo, F = 4.512, p = 0.040) compared to the placebo group. The strong beneficial metabolic effects of melatonin in comparison to placebo on fat mass (0.2 versus 2.7 kg, respectively, p = 0.032) and diastolic blood pressure (5.7 versus 5.5 mmHg, respectively, p = 0.001) were observed in the bipolar disorder and not in the schizophrenia group. No adverse events were reported. CONCLUSIONS: Our results show that melatonin is effective in attenuating SGAs' adverse metabolic effects, particularly in bipolar disorder. The clinical findings allow us to propose that SGAs may disturb a centrally mediated metabolic balance that causes adverse metabolic effects and that nightly administration of melatonin helps to restore. Melatonin could become a safe and cost-effective therapeutic option to attenuate or prevent SGA metabolic effects.
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Antioxidantes/uso terapêutico , Melatonina/uso terapêutico , Transtornos Mentais/complicações , Doenças Metabólicas/tratamento farmacológico , Doenças Metabólicas/etiologia , Adulto , Análise de Variância , Antropometria , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: The etiology of depressive symptoms associated with the transition to menopause is still unknown; hormonal changes, serotonergic system or insomnia, could be a trigger to depressive symptomatology. The aim of the present study was to evaluate gonadal hormonal levels, platelet serotonin concentrations and platelet tryptophan concentrations in a group of depressed perimenopausal women and their healthy counterparts. METHODS: A total of 63 perimenopausal women between 45 and 55 years old were evaluated; of these, 44 were depressed patients, and 19 were perimenopausal women without depression. The instruments that were applied included the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Depression Rating Scale (HDRS) and the Green Climacteric Scale (GCS); gonadal hormone levels and platelet tryptophan and serotonin concentrations were measured in all participants. Differences in hormonal levels and tryptophan and serotonin concentrations were evaluated with respect to specific symptoms, such as insomnia, hot flashes, nervousness, depressed mood and loss of interest. RESULTS: No differences between groups were observed with respect to hormonal levels and tryptophan and serotonin concentrations; mean sleep hours and insomnia were significantly correlated with platelet tryptophan concentrations. CONCLUSIONS: In this sample, all symptoms of depression could not be explained by platelet tryptophan and serotonin concentrations and hormonal levels; differences were observed only when we evaluated insomnia and hot flashes.
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Plaquetas/metabolismo , Depressão/etiologia , Hormônios Gonadais/sangue , Perimenopausa/psicologia , Serotonina/sangue , Distúrbios do Início e da Manutenção do Sono/psicologia , Triptofano/sangue , Ansiedade/etiologia , Ansiedade/fisiopatologia , Depressão/sangue , Depressão/fisiopatologia , Transtorno Depressivo/etiologia , Transtorno Depressivo/fisiopatologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Fogachos/etiologia , Fogachos/fisiopatologia , Humanos , México , Pessoa de Meia-Idade , Perimenopausa/sangue , Escalas de Graduação Psiquiátrica , Autorrelato , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologiaRESUMO
The prevalence of depression in Medical Students (MS) is higher than in the general population and changes with time. It is not known whether the prevalence of depression is higher and the associated factors different between students that initiate the last and first academic years in Medical School. Objective To compare the prevalence of depression and the associated factors in MS that start their academic courses in the first and the last academic years. Methods This is a cross sectional, observational and analytical study. A total of 1871 MS participated: 1240 were in the initiation of the first academic year, and 631 in the initiation of the last academic year. Participants answered a written survey conformed by a questionnaire about risk factors for depression and assessed for current depression with the Patients Health Questionnaire-9 (PHQ-9). Results The prevalence of depression (PHQ-9>10) was significantly higher in last year MS compared to first year MS (5.7 vs. 3.5%). The percentage of MS with a personal history of depression was higher in last year compared to first year MS (12.1% vs. 7.1%), as was the mean for previous depressive episodes (3.2 vs. 1.6). The age of onset for depressive episodes was higher in the last year group. Conclussions The prevalence of depression in MS that initiated the academic year is higher in the last year than at the beginning of the first year of the career, and could be attributed, among other factors, to a cumulative phenomenon resulting from the allostatic load that this academic process currently generates. A personal history of depression and other situational factors are associated to the presence of depression in a differential manner according to the academic year and should be considered in future studies.
La prevalencia de depresión en estudiantes de la Facultad de Medicina (EM) es mayor que en la población general y cambia a lo largo del tiempo. No se conoce si la prevalencia de depresión es mayor y los factores asociados son diferentes en estudiantes que inician el último y el primer año académico de la carrera de Medicina. Objetivo Comparar la prevalencia de Depresión y los factores asociados en EM que inician el año académico en primer año y aquellos que realizan el año de internado. Método Este es un estudio observacional, transversal y analítico. Participaron un total de 1871 EM: 1240 que iniciaban el primer año de la carrera y 631 que iniciaban el año de internado. Los alumnos contestaron una encuesta en papel compuesta por el Cuestionario sobre Factores de riesgo para Depresión y el Cuestionario sobre la Salud del Paciente (PHQ-9, por sus siglas en inglés) para evaluar la presencia actual de depresión. Resultados La prevalencia de Depresión (PHQ-9>10) resultó significativamente mayor en los estudiantes de internado comparados con los de primer año (5.7 vs. 3.5%). El porcentaje de alumnos con antecedente personal de depresión fue mayor en los alumnos de internado con respecto a los de primer año (12.1% vs. 7.1%), como lo fue el promedio de episodios depresivos previos (3.2 vs. 1.6). La edad de inicio del primer episodio depresivo fue significativamente mayor para los del quinto año. Conclusiones La prevalencia de Depresión en EM que inician el año académico es mayor en la etapa final de la carrera y puede ser atribuible, entre otros factores, a un fenómeno acumulativo de carga alostática que actualmente genera este proceso educativo. Los antecedentes personales para depresión y los factores situacionales se asocian a la presencia de depresión de una forma diferente de acuerdo al año académico y deben de ser considerados en futuros estudios.
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Introduction In several countries, the number of candidates to enter Psychiatry is diminishing. In Mexico, the kind of factors that influence the preference for a medical specialty and the way the selection tendencies change across the years of the medical career is not well known. In this study we analyzed the specialty preferences in a representative sample of students from different years of Medicine School at the National Autonomous University of Mexico (UNAM). Material and methods Descriptive cross-sectional study. Specialty preferences were assessed in students enrolled in the 2009-2010 school year of the Medicine School through a questionnaire designed expressly for this research. Data were analyzed quantitatively and qualitatively. Results A total of 2737 students participated. Most of the students (n = 2634) had already considered a specialty. Preferred specialties were General surgery (n=403, 14.72%), followed by Internal medicine (n=382, 13.96%) and Pediatrics (n=261, 9.54%). On the other hand, Radiology (n=314, 11.47%), Pediatrics (n=280, 10.23%) and Family medicine (n=263, 9.61%) were all specialties that students would not choose. For Psychiatry, there was a greater tendency only among first year students to see it as a choice of specialty. Compared with men (n=114, 11.53%), the percentage of women (n=259, 14.81%) who considered Psychiatry as an option of medical residency was higher. Discussion We could see that Psychiatry is neither the most preferred nor the most rejected specialty among medical students. Unfortunately, misconceptions still prevail around it and they do not favor its selection as a potential option of residency. It would be necessary to strengthen the knowledge about mental health and psychiatry, and to have the teachers promoting it in order to change the trends of selection.
Introducción En diversos países el número de candidatos para ingresar a la especialidad de Psiquiatría es cada vez menor. En México desconocemos a detalle los factores que inciden en la preferencia por una especialidad médica y la forma en que esa tendencia se va modificando a través de los años de la carrera de Medicina. En este estudio analizamos las preferencias de especialidad en una muestra representativa de estudiantes de los diferentes años de la carrera de Medicina en la Universidad Nacional Autónoma de México (UNAM). Material y métodos Estudio transversal descriptivo. Por medio de un cuestionario diseñado ex profeso para la indagación de las preferencias de especialidad, se evaluaron a los alumnos inscritos en el ciclo escolar 2009-2010 de la carrera de Medicina que aceptaron participar. Los datos se analizaron cuanti y cualitativamente. Resultados Participaron 2737 estudiantes. La mayor parte de los alumnos (n=2634) ya tenía considerada una opción de especialidad. Con una p<0.001, las especialidades preferidas fueron: Cirugía general (n=403, 14.72%), seguida de Medicina interna (n=382, 13.96%) y Pediatría (n=261, 9.54%). Mientras que Radiología (n=314, 11.47%), Pediatría (n=280, 10.23%) y Medicina familiar (n=263, 9.61%) se mencionaron como las especialidades que no elegirían. En cuanto a la Psiquiatría, sólo entre los alumnos de primer año se observó una mayor tendencia a considerarla como una opción de especialidad. En comparación con los hombres (n=114, 11.53%), fueron más las mujeres (n=259, 14.81%) que la consideraron como una alternativa para cursar una residencia. Discusión Si bien la Psiquiatría no se encuentra entre las especialidades más rechazadas por los alumnos participantes, tampoco figura dentro de las preferidas. Desafortunadamente siguen prevaleciendo concepciones erróneas a su alrededor que no favorecen su selección como una potencial especialidad a cursar. Sería necesario reforzar el conocimiento sobre la salud mental y la psiquiatría y su promoción por parte de los docentes en la búsqueda de un cambio en las tendencias.
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There are few available and reliable data regarding the number and geographic location of psychiatrists in Mexico. It is important to have these data in order to know if the mental health needs of the country are being met. This study is an attempt to update both the current data on this subject by locating the most psychiatrists possible, and also to learn more about how they manage their medical practice. Methods Descriptive and cross-sectional study. Several sources available in Mexico were consulted such as Mexican Psychiatry Associations, health care institutions, universities, telephone directories among several others, to locate psychiatrists and to identify where and what kind of practice they have. Results According to our several data bases, 3823 psychiatrists were counted in Mexico, 225 of these being child and adolescent psychiatrists. The rate of psychiatrists obtained was 3.47 psychiatrists per 100 000 inhabitants and 0.69 child and adolescent psychiatrists per 100 000 inhabitants under 15 years. 56% of psychiatrists practiced in the Federal District. There are 1.8 male psychiatrists for every female psychiatrist. Discussion The number of psychiatrists in Mexico is still below the rate that the World Health Organization recomends. The distribution by gender is shifting towards more equality. Psychiatrists were found to be grouped in urban areas of the country. The number of psychiatrists and child and adolescent psychiatrists seems to be insufficient to cover the needs of the country.
Existe poca información disponible y actualizada acerca del número de psiquiatras en México y sobre su localización geográfica. Es importante conocer estos datos para saber si se cubren las necesidades de salud mental del país. Este estudio busca actualizar tanto los datos disponibles sobre este tema al localizar el mayor número de psiquiatras posibles, como el tipo de práctica en su especialidad y si cuentan con la certificación correspondiente. Metodología Se trata de un estudio descriptivo y transversal. Se consultaron múltiples fuentes disponibles en México, como las asociaciones psiquiátricas mexicanas, las instituciones hospitalarias, las universidades, los directorios telefónicos y otros, para localizar a los psiquiatras, identificar dónde ejercen y conocer el tipo de su práctica profesional. Resultados Considerando nuestras diversas fuentes de búsqueda, se contabilizó un total de 3 823 psiquiatras para una población total de 112 000 000 de habitantes. Del número total de psiquiatras, 225 tienen la subespecialidad de paidopsiquiatría. Se obtuvo una tasa de 3.47 psiquiatras por cada 100 000 habitantes y de 0.69 paidopsiquiatras sobre una población de 100 000 habitantes menores de 15 años. El 56% se encuentra en el Distrito Federal. Hay 1.8 psiquiatras varones por cada mujer en esa especialidad. Discusión El número de psiquiatras en México aún está por debajo de la tasa recomendada por la Organización Mundial de la Salud. La distribución por género está cambiando hacia una más equitativa. Se encontró que los psiquiatras están agrupados en las zonas urbanas del país. El número de psiquiatras y paidopsiquiatras es insuficiente para cubrir las necesidades de salud mental del país.
RESUMO
The study and analysis of different factors related to the academic performance of medical students remains a topic of interest, either for selection processes or for the establishment of strategies and interventions to support students who may need it. It is said that there are two groups of features associated with academic performance: the academic (high school grades, scores on entrance exams) and non-academic (personality traits, presence or absence of psychopathology, sociodemographic aspects) characteristics. The purpose of this study was to identify the influence that different features of a group of medical students from the High Academic Performance Program (HAPP) at Universidad Nacional Autonoma de Mexico (UNAM) had on their school performance. Materials and methods This paper presents the one year follow up of a cohort of students initially studied during the selection process to entry the HAPP of Medicine School at UNAM. We evaluated all first-year medical students of UNAM who, during 2009-2010, continued to be part of the HAPP and who agreed to participate in this research. At the end we studied 94 students (48 men, 46 women) with a mean age of 18.3 years. The analyzed variables were: academic performance, demographic factors, academic background, personality, abstract thinking, creative thinking, mental disorder. For the initial evaluation at the entrance to University we used the Minnesota Multiphasic Personality Inventory -2 (MMPI-2), the sub-scale of abstract reasoning from the Differential Aptitude Test (DAT), a semi-structured interview to investigate demographic and academic characteristics, and the figural test from the Torrance Test of Creative Thinking. In a second assessment (at the end of the first year), we applied the MMPI-2 (for a second time with the intention to avoid the pressure that students could have during the selection process to enter the HAPP) and Mini-International Neuropsychiatric Interview (MINI) to assess the presence of psychopathology. Also, final grades were collected from the academic file of each student. For statistical analysis we used ANOVA, multiple linear regression models, bivariate correlations and cluster analysis. Results The general knowledge test was presented as the only significant predictor for both the final average for all subjects separately, and for the final general average. Results: The general knowledge test was the only significant predictor for both the final average and the final grades for each subject. Characteristics of creative thinking (e.g fluency) or personality traits (such as MMPI-2 Mania scale) were significant predictors for the final average for most of the subjects, however they were not consistent at all. Anatomy (r= 859), developmental biology (r=852), biochemistry (r=. 893) and cell biology and tissue (r=.889) were subjects whose average had a high correlation with the global final average, while public health (r=.696) and medical psychology (r=.670) showed a moderate correlation. The score of abstract thinking (r=.029) had not any correlation with the final average that these students got at the end of the year. A comparison between the two measurements (one at the entrance to Medicine School and the other one year later) of the MMPI-2 was made and we found that there was a pattern of consistency between measurements and all correlations among the different scales that shape the inventory were significant (p<.001). Hypochondriasis, Depression, Hysteria and Psychasthenia scales, tended to rise significantly. In order to evaluate the presence of psychopathology in these students at the end of the first year of Medicine School, the MINI it was used. Of the 96 students, it was found that 77 (80.20%) had no psychopathology, and that 19 (19.79%) had one or more mental disorders at the moment of the interview. The disorders that presented the participants were: major depressive disorder (n=15), generalized anxiety disorder (n=7), bipolar disorder (n=1) and anorexia nervosa (n=1). To determine the influence of the presence of psychopathology on the students final grades, we analyzed the differences between the group of students without any mental disorder and the group with psychopathology. There was no statistically significant difference in the general final average (U=678 500, Z0-.503, p=0.615), and it was a characteristic that only made a difference for the final grades of Anatomy (U=475, Z=-2.50, p=0.012) and Public Health (U=544, Z=-2.007, p=0.045). None of the socioeconomic aspects influenced the students' academic performance. Discussion For the group of the evaluated students, we only found that the general test scores of knowledge is a significant and consistent predictor for average subjects in the first year and the final general average. Conclusions The general knowledge test was a useful predictor for final grades because it seems to summarize many of the skills and habits related to student academic success.
Antecedentes El estudio y análisis de los factores relacionados con el desempeño escolar de los estudiantes de Medicina continúa siendo un tema de interés, ya sea con fines de selección o para el establecimiento de estrategias o intervenciones de apoyo para los alumnos. El propósito de este estudio fue identificar la influencia que tenían las diferentes características de un grupo de estudiantes del Programa de Alta Exigencia Académica (PAEA) al finalizar el primer año de la carrera de Medicina en la Universidad Nacional Autónoma de México (UNAM) en su rendimiento escolar. Material y métodos En este artículo se presenta el seguimiento a un año de una cohorte de alumnos del PAEA inicialmente estudiada a su ingreso a la Facultad de Medicina de la UNAM. En total se estudiaron 94 alumnos (48 hombres, 46 mujeres), con una media de edad de 18.3 años. Las variables evaluadas fueron: desempeño académico, factores sociodemográficos, trayectoria académica, rasgos de personalidad, pensamiento abstracto, pensamiento creativo, trastorno mental. Estas se midieron a través del Inventario Multifásico de la Personalidad Minnesota-2 (MMPI-2), la sub-escala de razonamiento abstracto del Test de Aptitudes Diferenciales (DAT); una entrevista semi-estructurada, la prueba figural del test de Pensamiento Creativo de Torrance, y la Mini-entrevista Neuropsiquiátrica Internacional (MINI). Para el análisis estadístico se emplearon ANOVA, modelos de regresión lineal múltiple por pasos hacia atrás, correlaciones bivariadas y análisis de clusters. Resultados El Examen General de Conocimientos se presentó como el único predictor significativo tanto para el promedio final de todas las asignaturas por separado, como para el promedio final general. Características del pensamiento creativo (como la fluidez) o de los rasgos de personalidad (como la escala de Manía del MMPI-2) se mostraron como predictores significativos para el promedio final de la mayoría de las materias, sin embargo no fueron constantes en todas. Anatomía (r=859), biología del desarrollo (r=852), bioquímica (r=.893) y biología celular y tisular (r=.889) fueron asignaturas cuyo promedio tuvo una correlación elevada con el promedio final general; mientras que salud pública (r=.696) y psicología médica (r=.670) presentaron una correlación moderada, y el puntaje de pensamiento abstracto (r=.029) no tuvo ninguna correlación con el mismo. Se realizó una comparación entre las mediciones (inicial y un año después) del MMPI-2 y se observó que existía un patrón de constancia entre las mediciones y todas las correlaciones resultaron significativas (p<.001). De los 96 alumnos evaluados un 19.79% resultó positivo para algún trastorno mental (el depresivo mayor fue el más frecuente). Sin embargo esto sólo afectó en el promedio de Anatomía (U=475, Z=-2.50, p=0.012) y en el de Salud Pública (U=544, Z=-2.007, p=0.045). Ninguno de los aspectos socioeconómicos influyó en el desempeño académico de los estudiantes. Discusión Para el grupo de alumnos evaluados, sólo se encontró al puntaje del examen general de conocimientos como un predictor significativo y constante para el promedio de las asignaturas del primer año y el promedio final general. Conclusiones El examen general de conocimientos se mostró como una evaluación de utilidad pues parece resumir muchas de las habilidades y hábitos del estudiante que se relacionan con un buen desempeño académico.