Abstract
Personality dimension negative emotionality is known to be associated with academic achievement. The present study focuses on the influence of negative emotionality (neuroticism) on the medical students’ academic achievements. The main objective of this study was to ascertain the negative emotionality scores among the first year Malaysian medical students studying in Malaysia and India, further to find out the association between negative emotionality and their academic achievements. The current study sample includes 60 first year Malaysian medical students from Universiti Sultan Zainal Abidin, Malaysia, and USM-KLE IMP, Belgaum, India. They were selected by convenient sampling technique. The Medico-Psychological questionnaire was used to find out the negative emotionality scores among the students and these scores were compared with academic scores. The data were analyzed using SPSS- 20. Thus, the study result goes with the prediction that there is a significant correlation between academic achievement and negative emotionality. We concluded that negative emotionality has a negative impact on medical student’s academic achievement regardless of the fact whether they study in their own country or overseas.
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Introduction
Negative emotionality is generally defined as the tendency to show various forms of negative affect. This is a personality trait characterized by anxiety, moodiness, worry, envy, and jealousy.Citation1–Citation3 Individuals who score high on neuroticism are more likely to experience feelings such as anxiety, anger, envy, guilt, and low mood in a stress-inducing environment.Citation4 People with this trait respond poorly to stress and interpret ordinary situations as threatening and they find minor frustrations as hopelessly difficult.Citation5 Students with this trait are often self-conscious and shy in behavior and also have trouble controlling urges and thus delaying gratification.Citation6 According to Eysenck’s (1967) theory of personality, neuroticism is interlinked with low tolerance for stress or aversive stimuli.Citation7 Their negative emotional reactions tend to persist for unusually long periods of time. These problems in emotional regulation diminish the ability of a person to think with clarity, make decisions, and cope with stress. These disturbances in psychological homeostasis affect the academic performance of medical students. Generally, it is believed that lack of satisfaction and gratification in one’s life achievements can correlate to high neuroticism scores and increase a person’s likelihood of falling into clinical depression.Citation8 Medical students suffer from stress during their training period and negative emotionality gets exaggerated, which have a negative influence on their coping ability.Citation9,Citation10 At the commencement of their medical schooling students need to identify the demands which lead to their being stressed. Reasons for their stresses include the following: living away from home, transition to a more independent living with less supported condition, and coping with students’ demands. Furthermore, exposure to serious illnesses and deaths may provoke a stressful reaction among medical students.Citation11,Citation12 Studies that have tried to identify the sources of stress among medical students generally pointed to three main areas: academic pressures, social issues, and financial problems.Citation13–Citation19 The majority of stressful incidents in traditional curricula are related to medical training rather than to personal problems.Citation14–Citation17 Workload and feeling overwhelmed by the information load are major sources of stress. Fears of failing or falling behind are particular preoccupations.Citation13–Citation17 In the UK, the General Medical Council recommends that medical schools should have mechanisms in place to identify symptoms of stress that might be early signs of mental health issues or illness.Citation20–Citation23 Medical schools in the US and Canada tackle the problem at an earlier stage by undertaking prevention in the form of health promotion programs.Citation24,Citation25 These interventions have been shown to reduce the effects of stress on medical student’s health and academic performance.Citation26–Citation29 Staying with strong emotions requires a high degree of awareness because intense emotions can take over reasoning powers. Maintaining awareness during emotional processing will allow you to “ride the waves”.Citation30 A number studies evidenced that Year-I medical students suffer from negative emotionality over the globe including Malaysia.Citation31–Citation33 Malaysian medical education usually is a 5-year program with 2 years of housemanship in hospitals owned by Ministry of Health, Malaysia.Citation17,Citation18 Almost all medical schools of Malaysia have a module focusing on professional personality development.Citation34–Citation36 Although this module exists throughout the 5-year course, more emphasis is on the preclinical students of Year I and II.
Hypothesis
It has been hypothized that negative emotionality score significantly affects the academic achievement of medical students.
Objectives
The objectives of this study were to assess the extent of negative emotionality among Year-I medical students and to evaluate the impact of negative emotions on academic performance of the Malaysian medical students studying in native country and overseas. Therefore, this study has made an effort to explore the influence of negative emotionality on Malay medical student’s academic achievements in new medical schools in Malaysia and India.
Materials and methods
The study adopted descriptive survey with evaluative approach and cross-sectional research design. The subjects of the study were medical students of Year I from the Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu, Malaysia, and the Malaysian students studying overseas in Universiti Sains Malaysia-KLE Society India International Medical Program (USM-KLE IMP), Belgaum, India. Students were selected by convenient sampling technique during their professional personality development sessions. “Convenience sampling involves drawing samples that are both easily accessible and willing to participate in a study”.Citation37 “It is the least costly to the researcher, in terms of time, effort and money. There is an element of convenience sampling in many qualitative studies, but a more thoughtful approach to selection of a sample is usually justified.”Citation38 USM-KLE IMP is a medical school especially for Malaysian medical students at Belgaum, India. This school maintains and promotes similar medical education system as per Malaysian Medical Council. As Dr Vidya Bhagat worked in both the medical schools, it was easy to select the study sample. Sixty medical students from each institute were assessed to measure their extent of negative emotionality as a dimension of personality. The students were voluntarily involved in the survey.
The assessment tool
Medico-psychological questionnaire was used to measure the variables. This questionnaire is a standardized scale developed by Dr Bharathraj for neurosis and it consists of 50 items based on five neurotic traits – hysteria, anxiety neurosis, neurasthenia, reactive depression, and obsessive–compulsive disorder. The negative, positive, and doubtful responses are scored to obtain the negative emotionality score. The academic scores of the participating students were collected from the academic office of respective colleges with the consent of higher authorities.Citation39 The study instrument was validated prior to this study and has been extensively used all over India and also in Malaysia.
Study group
Sixty Year-I medical students from each institution were recruited for the study. The study instrument was again pretested and validated. Most of the sections of this questionnaire demonstrated acceptable values, with a range between 0.672 and 0.882, which indicated that both instruments possessed good internal consistency and reliability. Convergent validity was evidenced by significant correlations between the items of each section and the total mean in each section (rs= 0.332–0.718; P<0.05).Citation40,Citation41 Therefore, the total participants were 120.
Study period
Study was conducted from February to July in the year 2014.
Data analysis
Data were keyed in and analyzed using SPSS 20 (IBM Corporation, Armonk, NY, USA). Fisher’s exact test and Pearson’s chi-square test were used to analyze the data.
Ethical approval
This study was approved by the ethical committee of both UniSZA and USM-KLE IMP. Informed written consent was obtained from each and every study participant.
Results
Of the study participants from UniSZA and USM-KLE IMP, 20 students were male, ten from each institution. Their age range was 18–21 years. All the research participants belonged to Malay race and Islamic religion. Among the 120 participants, 26 and 94 medical students were found to be stable and unstable, respectively. Among the participants from USM-KLE IMP, ten and 50 students were found to be stable and unstable, respectively, whereas from UniSZA, 16 and 44 students were found to be stable and unstable, respectively. Stable emotion is defined as one’s feeling of self-worth and security, whereas unstable emotion means one’s actions reflect a strong sense of power, responsibility and self-determination, as opposed to submissiveness to intrapsychic or externally based pressures.Citation42–Citation45
Among the 60 participants who belonged to USM-KLE IMP, only ten students scored ≥60 marks who were considered stable, and the remaining 50 students were considered unstable. Among them, 34 and 16 students scored ≥60 marks and ≤60 marks, respectively. There was a statistically significant (P=0.05) difference observed between stable and unstable group of USM-KLE IMP (). Almost a similar result was observed among the participants who belonged to UniSZA – only 16 students scored ≥60 marks who were considered stable and the remaining 44 students were considered unstable. Among them, 23 and 21 scored ≥60 marks and ≤60 marks, respectively. Among the participants from UniSZA, a high statistically significant (P=0.001) differences were observed between the stable and unstable group (). There was a statistically significant difference (P=0.0001) between negative emotionality and academic achievement when compared to all students of the study (). No statistically significant differences were observed for negative emotionality (P=0.184; ) and academic achievements (P=0. 323; ) between the students of UniSZA and USM-KLE IMP.
Discussion
The current study revealed that the 60 Malaysian medical students from each of the medical schools studying in Malaysia and India, respectively, vary in their personality trait neuroticism. The forecasted views in the hypothesis that negative emotions affect students’ academic achievement has been theorized in the current study (–). Although no statistically significant differences were observed among the two groups of students ( and ), the overall group showed a significant negative emotionality affecting their academic score (). Negative emotionality is a personality dimension that has a negative effect on the student’s academic achievement.Citation28,Citation46 Henceforth, the current study findings were found to be consistent with other studies.Citation28,Citation39 The optimal level of academic achievement and the negative emotionality score of students should be less than 16.Citation29
The correlation between the two variables, negative emotionality score and academic achievement, was found to be significant in the present study, despite the fact that students studying in their own country and overseas showed no statistically significant differences ( and ). Multiple studies have reported that living and studying overseas at many occasions increase stress and mental illness.Citation47,Citation48 USM-KLE IMP is a medical school in India but follows the curriculum as per Malaysian Medical Council and Quality Assurance authority. USM-KLE IMP mainly admit Malaysian students with the rare exception of a few foreigners. Therefore, the current study sample did not have the additional demands of adapting to a new a new culture and were better able to cope. A number of studies have reported that studying and living overseas very often decreases stress and other coping difficulties with similar sociocultural environment.Citation49–Citation53 Although they lived overseas, they almost had their own style of living. Nevertheless, the Malaysian medical students studying in Indian medical schools had to cope up and adjust with the Indian students, who are from different sociocultural background, and also with Indian medical educational system. Therefore, for the current study, we selected students who belonged to the same ethnicity and nationality so as to obtain similar results. However, the study results obtained are in agreement with our predicted hypothesis – high negative emotionality scores are associated with lower academic achievement in the overall group.
The overall result brings out the importance of conceptualizing the positive and negative effects of the emotional dimension and trait personality toward academic achievement. The findings of this study are consistent with the meta-analysis that has provided the first comprehensive empirical review of the validity of the Eysenck’s personality scales as statistical predictors of academic performance.Citation54 As expected, academic performance of medical students were significantly associated with neuroticism.Citation54 A Romanian study stated that the personality factors associated with the academic stress of first year medical students were predicted by trait anxiety, sex, and neuroticism; this study also share similar views with the current study.Citation55 One multicenter Flemish study on medical students’ personality characteristics and academic performance found that the medical student scores were highest on extroversion and agreeableness.Citation56 Medical students who scored high in gregariousness, neuroticism, and excitement-seeking are significantly less likely to successfully appear for examination.Citation56 One meta-analytic study that analyzed the relationship between big five personality traits and students’ academic achievement in a public university of Malaysia found that personality is likely to play significant roles in influencing students’ academic achievement. This study also shares similar views with the current study.Citation54 Therefore, it is important to optimize the achievement of students not only in academics but also in other fields as we know that the future of our country lies in these budding personalities.
Limitations of the study
This is a cross-sectional study and has its inherent limitation. Moreover, sample size was only 120. Therefore, it is quite difficult to generalize the study findings. Students’ anxiety, socioeconomic, genetic, and intellectual aspects also contribute to academic achievement. The current study did not explore these areas because of insufficient time and no research fund was obtained. Therefore, more extensive research in this regard is advocated to promote and produce more holistic medical doctors for the community.
Conclusion
This study has analyzed negative emotionality and its association with academic achievement and has ascertained that the negative emotions of Malaysian medical students studying in Malaysia and overseas, regardless of their residential location, have significantly affected their academic performance. Medical students of UniSZA, Malaysia, are more concerned about negative emotionality than students of USM-KLE IMP, India, in this aspect. Although the students studying overseas are affected, no statistical significance was observed regarding the association between negative emotionality and their academic achievements. Thus, the result of the current study theorizes the hypothetical view. This study also emphasizes that negative emotionality has an adverse impact on medical student’s academic achievement regardless of the fact whether they study in their own country or overseas. This study emphasizes that students should develop awareness regarding their emotionality and self-regulate their emotional stability; thereby, they can improve their academic achievement and professional personality. In addition, medical institutions can also make use of this result to mend and guide their students to optimize their skills and abilities in order to help them to achieve better in their academics. Since the professional development and mentor–mentee program exist in both the universities, this information can be used by the faculties in their professional personality development sessions held for medical students. And mentors of each students can use this information in menting their mentees.
Disclosure
The authors report no conflicts of interest in this work.
References
- EbischSJHBelloASpitoniGFEmotional susceptibility trait modulates insula responses and functional connectivity in flavor processingFront Behav Neurosci2015929726594159
- HumeDEmotions and Mood Available from: http://catalogue.pearsoned.co.uk/samplechapter/0132431564.pdfAccessed March 12, 2016
- MillonTGrossmanSMillonCMeagherSRamnathRPersonality Disorders in Modern Life2nd edHoboken, NJJohn Wiley & Sons, Inc2004 Available from: http://www.turkpsikiyatri.org/arsiv/personality.disorders.millon.pdfAccessed March 12, 2016
- MatthewsGDearyIJWhitemanMCPersonality Traits3rd edCambridge, UKCambridge University Press2009 Available from: http://assets.cambridge.org/97805218/87786/frontmatter/9780521887786_frontmatter.pdfAccessed March 12, 2016
- HettemaJMNealeMCMyersJMPrescottCAKendlerKSA population-based twin study of the relationship between neuroticism and internalizing disordersAm J Psychiatry2006163585786416648327
- CarducciBJThe Psychology of Personality: Viewpoints, Research, and Applications2nd edMaiden, MAWiley-Blackwell2009
- EysenckHJThe Biological Basis of PersonalityPiscatawayTransaction Publishers1970
- PoropatAEThe Eysenckian personality factors and their correlations with academic performanceBr J Educ Psychol2011811415821391963
- Stults-KolehmainenMASinhaRThe effects of stress on physical activity and exerciseSports Med20144418112124030837
- KendallEMurphyPO’NeillVBursnallSA report to the workers’ compensation and rehabilitation commissionWestern AustraliaCenter for Human Services, Griffith University2000 Available from: http://www.mentalhealthpromotion.net/resources/occupational-stress-fractors-that-contribute-to-its-occurrence-and-effective-management.pdfAccessed March 12, 2016
- RabkinJGStrueningELLife events, stress, and illnessScience1976194426910131020790570
- SallehMRLife event, stress, and illnessMalays J Med Sci200815491822589633
- ShendarkarATPatilVA study of stressors in medical college students (hostelities) in northern MaharashtraJ Indian Acad Forensic Med2013353227229
- SalamAYousufRBakarSMHaqueMStress among medical students in Malaysia: a systematic review of literaturesInt Med J2013206649655
- RahmanNIIsmailSBintiTNStress among preclinical medical students of University Sultan Zainal AbidinJ App Pharm Sci20133117681
- RahmanNIIsmailSAliRMStress among the first batch of MBBS students of Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Malaysia: when final professional examination is knocking the doorInt Med J201522416
- EvaEOIslamMZMosaddekASPrevalence of stress among medical students: a comparative study between public and private medical schools in BangladeshBMC Res Notes20158132726223786
- RahmanNIAAzizAAZainal ZulkifliMAPerceptions of students in different phases of medical education of the educational environment: Universiti Sultan Zainal AbidinAdv Med Educ Prac20156211
- IsmailSSalamAAlattraqchiAGEvaluation of doctors’ performance as facilitators in basic medical science lecture classes in a new Malaysian medical schoolAdv Med Educ Prac20156231
- VitalianoPPRussoJCarrJEHeerwagen JH. Medical school pressures and their relationship to anxietyJ Nervous Mental Dis198417212730736
- MorrisonJMore on medical student stressMed Educ200135761761811437960
- LeeJGrahamAVStudents’ perception of medical school stress and their evaluation of a wellness electiveMed Educ200135765265911437967
- GrantARixAMattickKJonesDWinterPIdentifying good practice among medical schools in the support of students with mental health concerns: a report prepared for the General Medical CouncilCardiffCardiff University2013 Available from: http://www.gmc-uk.org/Identifying_good_practice_among_medcal_schools_in_the_support_of_students_with_mental_health_concerns.pdf_52884825.pdfAccessed March 12, 2016
- SharifiradGMarjaniACharkaziAQorbaniMShahnaziHStress among Isfahan medical sciences studentsJ Res Med Sci201217440240623267406
- BarikaniAStress in medical studentsJ Medical Educ2009111,24144
- AbramovitchHSchreierAKorenNAmerican medical students in Israel: stress and coping – a follow-up studyMed Educ20003489089611107012
- WolfTMRandallHMFaucettJMA survey of health promotion programs in U.S. and Canadian medical schoolsAm J Health Promot19883333610288481
- BhagatVNayakRDNeuroticism and academic performance of medical studentsInt J Humanit Soc Sci Invent2014315155
- BhagatVExtroversion and academic performance of medical studentsInt J Humanit Soc Sci Invent2013235558
- BarlowSThe five stages of emotional healing2016 Available from: http://susannabarlow.com/healing/the-five-stages-of-emotional-healing/Accessed March 12, 2016
- SaravananCKingstonRGinMIs test anxiety a problem among medical students: a cross sectional study on outcome of test anxiety among medical students?Int J Psychol Studies2014632431
- BernhardtVRothkötterHJKastenEPsychological stress in first year medical students in response to the dissection of a human corpseGMS Z Med Ausbild2012291Doc 12
- YusoffMSBRahimAFABabaAIsmailSBSidiHEsaAB(2013). Psychological distress of first year medical students who underwent two different admission processes during a stressful periodSains Malays2013423423428
- LimVKMedical education in MalaysiaMed Teach200830211912318464135
- ShahabudinSHMedical education in MalaysiaTeach Learn Med1992428085
- Jayasuriya-IllesingheVNazeerIAthaudaLPereraJRole models and teachers: medical students perception of teaching-learning methods in clinical settings, a qualitative study from Sri LankaBMC Med Educ2016161126727954
- TeddlieCYuFMixed methods sampling a typology with examplesJ Mix Methods Res20071177100
- MarshallMNSampling for qualitative researchFam Prac1996136522526
- RajBManual of the Medico-Psychological QuestionnaireMysoreSwayamsiddha Prakashana1960
- NunnallyJCPsychometric Theory2nd edNew YorkMcGraw-Hill197821
- BarmanMPHazarikaJKalitaAreliability and validity of Assamese version of EORTC QLQ-C30 questionnaire for studying the quality of life of cancer patients of AssamWorld Appl Sci J2012175672678
- KernisMHWaschullSBThe interactive roles of stability and level of self-esteem: research and theoryAdv Exp Soc Psychol19952793141
- RogersCRA Theory of Therapy, Personality, and Interpersonal Relationships, as Developed in the Client-Centered FrameworkToronto, CanadaMcGraw-Hill1959 Available from: http://bibliotecaparalapersona-epimeleia.com/greenstone/collect/ecritos2/index/assoc/HASH01a5/4583605e.dir/doc.pdfAccessed March 30, 2016
- deCharmsRPersonal Causation: The Internal-Affective Determinants of BehaviorNew York, USAAcademic Press1968
- DeciELRyanRMIntrinsic Motivation and Self-Determination in Human BehaviorNew York, USAPlenum1985
- ValienteCSwansonJEisenbergNLinking students’ emotions and academic achievement: when and why emotions matterChild Dev Perspect20126212913523115577
- McCabeLEducation Abroad. Mental Health and Study Abroad: Responding to the ConcernInternational Educator2005 Available from: https://www.nafsa.org/_/File/_/InternationalEducator/EducationAbroadNovDec05.pdfAccessed February 13, 2016
- OluwafunmilolaOODepression Among International Students [thesis]FinlandCentral Ostrobothnia University of Applied Sciences2012 Available from: https://www.theseus.fi/bitstream/handle/10024/44723/KEMI_OMODONA.pdf?sequence=1Accessed February 13, 2016
- BerryJWAcculturation: living successfully in two culturesInt J Intercult Relat2005296697712
- WuHPGarzaEGuzmanNInternational student’s challenge and adjustment to collegeEduc Res Int2015201519
- MustaffaCSIliasMRelationship between students adjustment factors and cross cultural adjustment: a survey at the Northern University of MalaysiaIntercultural Communication Studies2013122279300
- LeeSBradleyKDRelation between general self-efficacy, assertiveness, spirituality, and acculturative stress among international studentsProceedings of the Mid-Western Educational Research Association Annual Meeting2005Columbus, OH Available from: http://www.uky.edu/~kdbrad2/InternationalStudents.pdfAccessed February 13, 2016
- ThomsonGRosenthalDRussellJCultural stress among international students at an Australian universityProceedings of Australian International Education Conference2006Perth, Australia18 Available from: http://aiec.idp.com/uploads/pdf/Thomson%20(Paper)%20Fri%201050%20MR5.pdfAccessed February 13, 2016
- IbrahimNFYusofNSHCRazakNFANorshahidiNDA meta-analysis of the relationship between big five personality traits and students’ academic achievement, Universiti Teknologi Mara, MalaysiaProceeding of the Social Sciences Research ICSSR 2014 (e-ISBN 978-967-11768-7-0)9–10 June 2014Kota Kinabalu, Sabah, Malaysia Organized by http://WorldConferences.net. Available from: http://worldconferences.net/proceedings/icssr2014/toc/papers_icssr2014/IC%20063%20NUR%20SAFWATI%20BINTI%20IBRAHIM%20-%20A%20Meta-Analysis%20Of%20The%20Relationship%20Between.pdfAccessed March 13, 2016
- BobMHPopescuCAPîrlogRBuzoianuADPersonality factors associated with academic stress in first year medical studentsHVM Bioflux2014614044
- LievensFCoetsierPDe FruytFDe MaeseneerJMedical students’ personality characteristics and academic performance: a five-factor model perspectiveMed Educ200236111050105612406265