Empowerment in Preclinical Medical Education: The Role of Self-Directed Learning, Mental Well-Being, and Academic Performance

Abstract

The environmental and psychological demands of preclinical medical education may create concerns for the negative well-being of first- and second-year medical students. Amid a highly competitive and stressful environment, preclinical medical students face many stressors in the early years of medical school. These stressors, such as learning vast amounts of material in a limited time, finding effective study strategies, and adjusting to their new identity and environment, may leave some students “powerless.” The degree of psychological distress reported in preclinical medical education has led to the rise of wellness and other curricular initiatives aimed at curbing these morbidities. However, successfully managing these stressors may depend not only on external interventions but also on the student’s internal competencies and learned skills. A student’s inner aptitudes and competencies may play a crucial role in their overall well-being and success in the competitive realm of preclinical medical education. Self-directed learning readiness is the psychological readiness of an individual to take control of their learning. To be effective, this incorporates several self-oriented and learned skills, such as planning and implementation, self-monitoring, learning motivation, and interpersonal communication. The student’s ability to navigate psychological distress may be influenced by their internal competencies, and those with higher self-directed learning readiness may be more adept at managing these challenges.

This dissertation hypothesizes students can be empowered to face the challenges of preclinical medical education through the interaction between their self-directedness, mental well-being, and academic performance. This interactive relationship produces “empowerment” in the student to overcome the challenges of transitioning and remaining in medical school. The study examined the potential relationships between self-directed learning readiness (SDLR), mental well-being, and academic performance in preclinical medical students in their first and second years of study (M1 and M2). It also examined the differences in SDLR and mental well-being among different preclinical students and under different curricula and how they evolved longitudinally and cross-sectionally during the preclinical years. Data was collected using a 55- item questionnaire distributed online via an online web survey application (REDCap) n=600. Data was analyzed using Pearson’s correlations, analysis of variance, t-tests, and multivariate analysis of variance, focusing on high- and low-performing students to discern variations in these relationships over the progression between M1 and M2 students.

In M1 and M2 students, SDLR showed a moderate negative correlation with negative mental well-being and a positive correlation with academic performance. Negative mental well-being correlated significantly with academic performance in M1 and not M2. SDLR accounted for approximately 40% of the variance in academic performance in M1, but only 7% in M2. It also contributed to 24% of negative mental well-being in M1 and 16% in M2. Negative well-being contributed 21% of the variance in academic performance in M1. Being female, an M1 student, a younger student (20–23 years), and the spring semester were associated with higher levels of depression, anxiety, and stress, and lower levels of SDLR. Depression contributed the greatest proportion to the variance in SDLR and academic performance. Learning motivation was the most reported self-directed learning skill and was high in both the fall and spring semesters in M1 and M2 preclinical students. Students in both preclinical years scored the highest in their learning motivation for SDLR. However, they lacked commensurate planning and implementation skills—the ability to set learning goals and implement effective strategies to achieve them. This lowest reported skill by students, however, strongly correlated with academic performance and contributed the greatest amount of variance to their grade point average.

High levels of negative emotional states and low self-directedness could be detrimental to preclinical students’ general well-being and academic success, respectively. Mental well-being promotions, interventions, and training opportunities to improve self-directed learning should start at the beginning of the preclinical year and continue through medical education. Mental well-being campaigns must incorporate tools for developing and improving self-directed learning readiness and opportunities to boost students’ mental health and academic performance.