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dissertation entitled

THE USE OF SELECTED COPING STRATEGIES
AS PREDICTORS OF ACADEMIC PERFORMANCE
IN MEDICAL SCHOOL

presented by

Norma Irene Baptista

has been accepted towards fulfillment
of the requirements for

Joctoral—degree in ——Education—

 
    

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Date 4-21- 1999

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THE USE OF SELECTED COPING STRATEGIES AS PREDICTORS OF
ACADEMIC PERFORMANCE IN MEDICAL SCHOOL

By
Norma Irene Baptism

DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY
Department of Education

1999

ABSTRACT

THE USE OF SELECTED COPING STRATEGIES AS PREDICTORS OF
ACADEMIC PERFORMANCE IN MEDICAL SCHOOL

By

Norma Irene Baptista

Stress among medical students has been linked to poor academic performance, while
supportive social relationships have been associated with the alleviation of psychological
stress. This study examines students' coping mechanisms and social support as
predicrors of academic performance. A tOtal of 73 students from the College of Human
Medicine at Michigan State University participated in the study.

The Coping Response Inventory (CRI-Adult) was the data collection procedure used
for this study. This inventory provides areas for the students to record demographic
information, description of a problem or situation they experienced within the put 12
months, and their responses to 48 items related to that specific situation.

The problems the students described were categorized as follows: academic
performance, workload, adjustment to medical school, family relationships, social
relationships, health, financial constraints, multiple events and other or unspecified.

The Independent Sample T-TeSt and the Levene's teSt at a significant level of P>.05
were used to test the Study's hypothesis.

The data show that the major stressors for the students were workload, academic
performance and social relationships. It was found that 25.7% of males reported
workload concerns, while 18.4% of females reported having academic difficulties and
18.4% of females also reported having multiple stressors. It was also found that 26.3%

of students age 21 to 25 reported social concerns, while 36% of students age 26 to 30

Norma Irene Baptista

reported academic difficulty as their main srressor. Additionally, 21% of single students
reported social stressors, while 36% of married Students reported workload as their main
concern. 26.9% of second year students reported workload as their main source of
stress, while 19.1% of first year students reported social Stressors.

The statistical teSts results showed: (1) that students reporting academic difficulties
used more cognitive avoidance c0ping mechanisms than the students who did n0t report
academic difficulties, (2) that females in the sample used more cognitive avoidance
coping mechanisms than males, and (3) that Students ages 21 to 25 used more cognitive
avoidance coping mechanisms than the older students.

 

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TABLE OF CONTENTS

CHAPTER I
INTRODUCTION

Stress and Coping Mechanisms ...............................................................
Social Support ...........................................................................................
Statement of Purpose ...............................................................................
Significance of the Research .....................................................................
Limitations ...............................................................................................
Research Questions ..................................................................................

Hypothesis ...............................................................................................
Definition of Terminology .......................................................................

Organization of the Study ........................................................................

CHAPTER II
REVIEW OF RELATED LITERATURE ..........................................................

The General Adaptation Theory .............................................................
The Cognitive Appraisal .........................................................................
The Transactional Model ........................................................................
The Main Sources of Stress Experienced by Medical Students and

Their Effect on Academic Performance ..............................................

CHAPTER III
RESEARCH METHODOLOGY .......................................................................

Research Questions .................................................................................
Hypothesis ..............................................................................................
Population and Sample .........................................................................
Informed Consent .................................................................................
Data Collection .......................................................................................
Instrumentation ......................................................................................
CRI-Adult Scales ....................................................................................
CRI-Adult Scales and Descriptions ........................................................
Reliability ...............................................................................................
Organization of the Inventory ...............................................................
Criteria for Interpreting CRI-Adult Standard Scores ..............................
Academic Performance .......................................................................

Data Analysis .........................................................................................

iv

Page

2

5

6

9

9

9
10
11
12

14
14
15
16

24
24
25
26
27
27
27
29
29
30
31
32
32
33

CHAPTERIV

DISCUSSION OF FINDINGS ............................................................................. 34
Results of the CRI-Adult Inventory ........................................................ 35
Table 1 .......................................................................................... 35
Table 2 .......................................................................................... 36
Table 3 ......................................................................................... 37
Table 4 ......................................................................................... 38
Table 5 ......................................................................................... 39
Table 6 ......................................................................................... 40
Testing of Hypothesis .............................................................................. 41
CHAPTER V
SUMMARY AND RECOMMENDATIONS .................................................... 46
Summary of Findings ................................................................................ 48
Recommendations ..................................................................................... 49
APPENDICES
A. Sample Letter ....................................................................................... 53
B. Consent Form ...................................................................................... 55
C. CRI-Adult Answer Sheet .................................................................... 57
Part 1 ............................................................................................ 58
Part 2 ............................................................................................ 59,60
D. CRI-Adult Profile ............................................................................... 62
E. The Pearson Correlation Table 7 ........................................................ 65
Table 8 ......................................................................................... 66
Table 9 ....................................................................................... 67
Table 10 ....................................................................................... 68
Table 11 ....................................................................................... 69
Table 12 ....................................................................................... 70
Table 13 ....................................................................................... 71
Table 14 ...................................................................................... 72
Table 15 ...................................................................................... 73
Table 16 ...................................................................................... 74
BIBLIOGRAPHY ................................................................................................. 7S

CHAPTER 1

INTRODUCTION

Traditionally, medical education has long been the route to an attractive career.
Usually, pre-medical and entering medical students have idealistic views about becoming
physicians. They often express their desire to serve humanity or participate in break
through research or treatment to eliminate diseases. They also tend to glamorize the
physician’s life more than the students in the advanced levels. Some students admit they
are attracted to the social position, respect, income and prestige that doctors enjoy. For
these reasons and others, medical schools have traditionally received a great number of
applicants. From society perspective the selection of students is critical because of the
length and the cost of training. Therefore, a considerable amount of attention has been
focused on finding accurate and valid predictors of success in medical school.

In 1976, The Association of American Colleges compiled the results of a series of
studies. The authors, Cuca, Sakakeeny and Johnson, (1976), related medical students’
personality factors, Medical College Achievement Test (MCAT) scores, and premedical
Grade Point Averages (GPA’s) to their academic success. The studies suggested that there

was not a clear and definitive correlation between these factors and academic success, and

that other factors may have intervened. Although none of the studies reviewed identified
specific predictors for the academic success of medical students, medical colleges across
the country still make their admission decision based heavily on high MCAT scores and
high GPA’s.

Admissions officers will certainly find solace in Mitchell’s review of recent research
validating the use of pre-admission academic data in selecting medical school applicants,
(Mitchell, 1990). He presents evidence that the MCAT can be combined with GPA’s for
college selectivity, to yield median validity coefficients of 0.49 for pre-clinical (first and
second year of medical school) studies and 0.38 for clinical (third and fourth year of
medical school) performance at several medical schools.

However, Rogers (1989) cautions against over emphasis on psychometric and
statistical influences in determining who is to be selected for medical training. He also
suggests that medical schools could either select students to match the demands of their
curriculum or they can design a curriculum that assures success of those students they
seek to attract.

Perhaps, a useful approach to the selection of applicants for medical school is the one
that includes the assessment of the individual’s ability to deal successfully with highly
stressful situations.

Stress and Coping Mghagg' ms

Stress continues to play an important role in current theoretical approaches to

psychological health and disorder. Since the 1960’s, the prevalent research approach to

stress and its relation to physical and mental health has been directed at the study of

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significant life events or life changes. The measurement of these life events was pioneered
by the development of the Schedule of Recent Experiences (SRE) by Holmes and Rahe
(1967). Many research studies have utilized this sale for assessing stress in relationship to
a wide variety of physical and psychological outcomes (Dohrenwend and Dohrenwend,
1976).

Since the original development of the SRE and the studies that followed, many
questions have been raised with regard to the psychometric properties of the scale and
the adequacy of the research employing it (e.g., Brown and Harris, 1978). The early
phases of stress research had a characteristic emphasis on the prediction of illness rates
from knowledge of stressful life events and conditions. More recent research has focused
on 1) the impact of life events and conditions; 2) the psychological and social situations
that determine both the meaning of the events and 3) the individual or group capacities
for dealing with stressors.

Recent research has also moved away from defining stress in terms of amount of
change, per the Schedule of Recent Experiences, to a consideration of other properties of
life events or other aspects of context that may be more useful in explaining the meaning
and impact of events. Much attention, for example, has been given to questioning the
commonsense expectation that events with undesirable implications are more stressful
than those with desirable implications. More recently, stressful life events and their role
in facilitating life transitions have been closely studied through a structured approach that
is intended or directed to understand the ways people handle transitions and manage

change (Selye, 1978).

 

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Brammer (1990) defines stress as a condition that causes a reaction. In other words, the
greater the intensity of the conditions, the greater the chances for these conditions to
cause the stress reactions-called stressors. The results of these external stressors leads to
stress responses. The intensity of the stress response is related to the strength of the
stressors opposed by the strength of the person’s coping resources/ skills. Brammer
believes that one key in managing our stressors is the condition of our coping skills.
Although stress management includes a cluster of special coping skills, the extent of stress
reduction is also a function of our support systems, attitudes about change, problem-
solving capacities, thought control, and behavior change methods. According to
Schneider (1984) each potential source of stress becomes a stressor only when the person:
1) fails to recognize the event or circumstance stressful; 2) does not fully understand what
makes the circumstance stressful; 3) does not see any alternative way to react to the
source of stress in order to reduce its impact; 4) currently lacks positive factors in his or
her life; and 5) lacks the presence of supportive, ongoing relationships. Schneider also
considers that individuals who are able to recognize, understand, and maintain flexibility
in the context of ongoing support are able to limit, and often thrive on, the impact of
stress on their lives.

Most recently, growing research among psychologists, such as Suls and Fletcher
(1985), Clark and Hovanitz (1989); and Endler and Parker (1990) has indicated that
caping skills help to alleviate health-destroying stressors. Kobassa and Pucetti’s work
(1983) with executives indicates that perceived support from superiors was associated

with low illness rates. Key protective attitudes uncovered by these studies were hope,

 

 

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positive self-regard, and self-empowerment. These attitudes are postulated to reduce
subjects’ sense of helplessness; to serve as buffers against depression, and to facilitate
immune responses.

Seed—Sum

“Social Support” refers to all that is involved in the caring relationships among people.
Our embeddeness in a continuing network of such relationships is perhaps what counts
most.

Gottlieb, Hobfoll and Stokes (1980) focused on social networks, their structure,
density and the personal characteristics of the provider and the needy person, and they
also identified some approaches to social support to call attention to the transactions
occurring in personal relationships.

This secure place in one or more networks has profound effect upon how we think
and how we feel about our surroundings, and particularly about how we affirm the value
of ourselves, (Pilicuk and Hiller Parks, 1986). In general, as social support has been more
widely used to describe the help or guidance received by people such as relatives, friends
and competent individuals who also provide the culturally expected close personal
relationships.

The research on social support is profuse and confirms the common sense observation
that support is essential to good mental health and psychological growth (Gottlieb, B.,
Social Networks and Social Support, 1981).

Brammer (1990) describes support as the help we receive from friends, relatives,

colleagues, and mentors. This support is organized into informal systems called

 

 

 

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networks. He also defines support system as a network of all the helpers working for the
benefit of the person. Other research, such as Sarason and Sarason (1983), has found
significant relationships between social support and life transitions, job performance and
improved performances on academic tasks and exams.

For this study the researcher will concentrate on the Approach and the Avoidance
coping mechanisms. Approach coping mechanisms are problem - focused behavioral
coping responses, they include overt actions intended to deal directly with the situation.
Individuals using this mechanisms are directed towards dealing with the problem, they
intend to involve attempts to manage the way in which stressful events are perceived.
Looking for personal or professional help is an example of Approach caping
mechanisms. In contrast, Avoidance coping mechanisms are disengagement or passive
responses in attempt to withdraw without steps to change or solve stressful situations.
An example of passive coping is day dreaming. Individuals who use these type of
responses perceive stressful events as being uncontrollable (Moos, Rudolf H., 1993).
Statement of £2ng

The educational process of becoming a physician involves a series of stressful events
students must deal with as they progress through medical school. While many of the
stressful events that medical students experience are the result of social pressure and the
maturation process common to all young adults, some are unique to the process of
medical education. It is well known that all medical students face stressful circumstances
during the course of their education, and that their success in dealing with stress is

dependent upon how well they can adjust to a continually changing and demanding

 

 

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environment. At most medical schools, issues of increased stress appears to come about
and interfere with the student’s progress through the four year curriculum. First year
students muSt deal with stress involving their sense of competency. They find that not
only is the course material complex, placing increased intellectual demand on them, but
also that competition is keen and they may no longer be earning honor grades as they
once did as undergraduates. Exacerbating competency concerns, first year students must
master a vast quantity of material in a limited time period and must learn to set self-
imposed limits on the amount of material which can be learned. They also must come to
recognize the sacrifices a career in medicine will require and must make personal and
social adjustments (Elam, 1994).

First and second year students receive little personal formative feedback from faculty
and no immediate reward for their hard work. They also note an increased level of
fatigue stemming from continuous academic pressures. Often, they may question their
commitment to medicine, lose some early idealism, and question their motives for
_ becoming a physician (Gaensbauer and Mizner, 1980).

According to Mosley, et al. (1994), it has been found that medical education is an
extremely intense and stressful experience, and that the continuous demanding and
competitive environment students face often exerts a negative effect on their academic
performance, physical health, and psychological well-being.

Numerous common academic frustrations can precipitate a stress reaction in medical
students. The following are just few examples of issues which can contribute to stress

reactions: having to master large amounts of difficult material, fearing failure on final

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examinations, receiving limited positive feedback, having problems in interaction with
other fellow students (peer-group study), and having to manage diverse demands during
extremely long study hours both inside and outside the classroom.

Beyond curricular and personal oriented stresses, medical students also face
maturational stressors. Personal development issues include relations with a spouse or
significant other, childbearing and child care, physical health and wellness, finances,
housing concerns, and lack of leisure time. The complexity of stressful situations from
curricular and/ or personal events, can have an impact upon medical school performance.

Medical students may react to academic frustrations with anxiety responses which
may either enhance or impede their actions. Debilitating anxiety may manifest itself in
dysfunctional behaviors; for example, students may stop attending classes, resort to
ineffective study techniques such as spending hours listening to tape lectures, become
cynical, and, more destructively, may resort to cheating, drug or alcohol abuse, and
suicidal thinking. The net result of such dysfunctional behaviors is decreased self-esteem,
depression, anxiety, loneliness and alienation, and failure to perform to their capability
(Westo and Peterson, 1980).

The purpose of this study is to investigate whether the use of selected (Approach
and/ or Avoidance) coping mechanisms by first and second year medical students, is
related to their academic performance.

With this study, the researcher will examine coping strategies medical students use

while going through considerable stress. Participants will be first and second year medical

students who are enrolled and attending classes at the College of Human Medicine,
Michigan State University during Fall of 1997.
Si ' 1 cc f Researc

Stress among medical students has been linked to poor academic performance, while
supportive social relationships have been associated with the alleviation of psychological
stress. This study will examine students’ coping skills as potential buffers against stress.
The study will also attempt to raise awareness about the need for greater attention to the
psychological well-being of medical students; in particular those students in the first and

second preclinical years.

Mien;
This study will be limited by:

1. The sample subjects will be students from one medical program.

2. The extent to which the selected inventory measures all stress related situations, and
the impact of stress on each student’s life over the course of the study.

3. The inability to control for past experiences of each student in dealing with stress,
and the uniqueness of their impact.

4. The accuracy of the description of the source of stress that students will report.

5. The accuracy of the student’s reports regarding their academic standing, i.e., good
academic standing, academic difficulties and/ or on academic probation.

c ion
1. Is there variation in students’ selected (Approach and/ or Avoidance) coping strategies

and their academic performance

2. Is there variation in students’ selected (Approach and/ or Avoidance) coping
mechanisms when they are grouped by gender?

3. Is there variation in students’ selected (Approach and/ or Avoidance) coping
mechanisms when they are grouped by age?

4. Is there variation in students’ selected (Approach and/ or Avoidance) coping
mechanisms when they are grouped by marital status?

5. Is there variation in students’ selected (Approach and/ or Avoidance) coping
mechanisms when they are grouped by ethnic background?

6. Is there variation in students’ selected (Approach and/ or Avoidance) coping
mechanisms when they are grouped by preclinical year.

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To respond to the research questions, the following hypothesis will be tested:

Hypothesis 1: There is a positive relationship between the students’ use of selected

(Approach and/ or Avoidance) coping strategies and their academic performgce,

Null: There is no relationship between the students’ use of selected (Approach and/ or

Avoidance) caping strategies and their academic performance.

Hypothesis 2: There is a relationship between the students’ use of (Approach and/ or

Avoidance) selected coping mechanisms and their gender,

Null: There is no relationship between the students’ use of selected (Approach and/ or

Avoidance) coping mechanisms and their gender.

Hypothesis 3: There is a relationship between the students’ use of selected (Approach

and/ or Avoidance) coping mechanisms and their age,

10

Null: There is no relationship between the students’ use of selected (Approach and/ or
Avoidance) coping mechanisms and their age.
Hypothesis 4: There is a relationship between the students’ use of selected (Approach
and/ or Avoidance) coping mechanisms and their marital status.
Null: There is no relationship between the students’ use of selected (Approach and/ or
Avoidance) coping mechanisms and their marital status.
Hypothesis 5: There is a relationship between the students’ use of selected (Approach
and/ or Avoidance) coping mechanisms and their ethnic background.
Null: There is no relationship between the students’ use of selected (Approach and/ or
Avoidance) coping mechanisms and their ethnic background.
Hypothesis 6: There is a relationship between the students’ use of selected (Approach
and/ or Avoidance) coping mechanisms and their year in the program.
Null: There is no relationship between the students’ use of selected (Approach and/ or
Avoidance) coping mechanisms and their year in the program.
Definition of Terminology

Stress: The response of the body to any demands or pressure. It is the force that
precipitates the disruption of a person’s normal sense of well-being. Stress also refers to
any factor that threatens the health of the body or has adverse effects on its functioning,
such as injury, disease or worry. The existence of one form of stress tends to diminish
resistance to other forms. (The Bantam Medical Dictionary, 1990)

Coping Skills/Reponses: Coping refers to efforts to master conditions or harm, threat

or challenge. Lazarus defines coping responses as “those direct active tendencies aimed at

11

eliminating or minimizing a stressful event which are task and reality oriented.”
(Lazanrs,1997).

Social Support: It is help we receive from friends, relatives, colleagues and mentors.
Early definitions referred to an emotional caring dimension. For example, Moss (1973)
defined support as “the subjective feeling of belonging, of being accepted or being loved,
of being needed all for oneself and for what one can do.”

Approach Coping Responses: In general, approach coping is problem-focused; it reflects
cognitive and behavioral efforts to master or resolve life stressors.

Avoidance Coping Responses: Avoidance coping tends to be emotion-focused; it reflects
cognitive and behavioral attempts to avoid thinking about a stressor and its implications,
or to manage the effect associated with.

Academic Performance: For the purpose of this study, academic performance will be
defined as the students’ academic status (i.e., in good standing, on academic probation,
failing courses at the time they complete the study’s inventory).

Organizatign 9f the Study

For the purpose of convenience and methodical procedure, this study will be
organized in five chapters.

Chapter I is the introduction to the study and background, a statement and purpose of
the study, the significance of the research and the limitations of the project. This chapter
will also address the research questions, hypothesis and the definition of terminology.

Chapter II is a review of the literature, focusing on research involving medical

students and their stress coping mechanisms.

12

Chapter III is an introduction and description of the methodology, study’s population
sample, the process of survey, description of the survey instrument and the analysis of
data.

Chapter IV is a detailed discussion of the findings.

Chapter V is the summary and recommendations.

13

CHAPTER 11

REVIEW OF RELATED LITERATURE

This chapter does not purport to be an exhaustive review of the literature available
on the general topic of stress coping mechanisms. Instead, it is intended to be a brief
historical review on the subject of stress coping mechanisms, and in more detail, the
literature pertinent to this study. These include a review of the following: (a) the General
Adaptation Theory, (b) the Cognitive Appraisal Model, (d) the Transactional Model and

(e) the main sources of stress experienced by medical students and their effect on

academic performance.

The General Adaptation Theogy

Hans Selye (1956) was one of the first who tried to explain the process of stress-
related illness. His “General Adaptation Syndrome” theory consists of three stages that
individuals encounter in dealing with” stressful situations:

1. The alarm reaction, in which an initial shock phase of lowered
physiological/ immune resistance is followed by countershock during which the

individual’s defense mechanisms become active.

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2. The stage of maximum adaptation which if successfully accomplished, the individual
returns to an equilibrium. However, if the stressor continues or the defense does not
work, he will encounter the third stage.

3. Exhaustion stage which results when the adaptive mechanisms collapse. This stage is
seen as the precursor to a host of somatic and emotional illness.

In spite of its popularity, Selye’s theory has been criticized for failing to take under
consideration individual differences in relation to how people deal with stressful
situations (e.g. some people thrive in extremely stressful jobs, without negative health
consequences). Nevertheless, Selye’s theory initiated research efforts that have focused
more on the psychological aspects of stress, such as the nature of the stress and its effect
on the individual’s behavior.

The Cognitive Appraisfl

The Cognitive Appraisal Model is one of the psychological models that seeks to
explain stress and individual differences in people’s reaction to it. According to Lazarus
and Folkman’s model (1984) appraisal is composed of primary and secondary processes.
In the primary appraisal, the person may ask him or herself how relevant to his/ her well
being a situation may be. This represents a basic risk assessment. If the encounter is
relevant to the person’s well being, he or she may judge the situation (in terms of Lazarus
and Folkrnan’s model, 1984) as a challenge, threat or harm. With the secondary appraisal,
the individual is concerned with what can he or she do to resolve the situation. In other I
words, during the secondary appraisal, the individual makes a conscious decision about

how to deal with the stressful event. The decision-making process must take under

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consideration the individual’s coping resources (e.g. social support), his or her preferred
coping style (e.g. Approach or Avoidance coping mechanisms), the options available to
the person and the nature of the situation (Cox; 1987).

The Tmactipnal‘ Model

Cox, (1985), Cox and Mackay, (1981), Ferguson and Cox, (1991), discuss their model
as a primary appraisal process that takes into account a number of different personal and
situational factors. Each person, according to his/ her different experiences, judges a
particular situation as challenging, anxiety-producing or depressing. The last two
appraisals are the only ones experienced as negatively stressful. The four factors that
contribute to the appraisal process are:

0 the external and internal demands that the person experiences,

0 their personal coping abilities and resources,

0 the amount or degree of control they have over coping, and

0 the support that they received from others in coping with stressful situations.

The transactional model has given more importance to the concept of control, since
under this model control, contributes to both primary and secondary appraisals. For
example, when a person is faced with a situation, the primary appraisal occurs when the
person asks him or herself if the situation represents a problem to him or her. On the
other hand, a secondary appraisal occurs when the person asks him/ herself, how and
how well they can cope with the problem, (Cox, 1987). Therefore, in the transactional

model, primary appraisal is seen as a continual process or monitoring process while the

16

secondary appraisal is seen as an activity that involves decision making contingent upon
the primary appraisal.

According to Cooper and Payne (1991), primary appraisal is a subject of mediation
dictated by individual differences. Individual differences may exist in relation to the
person’s perception of the situation as being negatively stressful or not. For example, a
negatively stressful situation is usually accompanied by a person’s negative feelings or
emotions such as anxiety or depression. These emotions could vary in intensity
according to each individual, and they could also indicate the level of stress experienced
by each individual. (Cox, 1985,1990).

According to Bandura (1977), an eminent Social. Learning theorist, people vary in
their ability to cope with demands, and in their perceptions of those abilities. Such
variations may be a function of their intelligence, their experience and education, or their
beliefs in their ability to cope. As Bandura, Cooper and Payne (1991) also believe that
people may vary in the amount of control they can exercise over any situation but not
only as a function of that situation but also as a function of their beliefs about control.
Additionally, people may vary in their need for social support, the skills that they have
in utilizing that support and their perception of that support.

The Main Spurces of Stress Exgrienced by Medical Students and Their Effe_ct on

Academic Performance.

Even though numerous studies have documented the stress that medical students
experience, the literature related to stress coping mechanisms and how they may affect

the academic performance of medical students is sparse. Also, no study on this subject

utilizing the CRI-Adult inventory has appeared in the literature. Therefore, only the
most relevant literature sources related to the subject of this study are considered in this
section.

In their book, Making It In Medical School, Coombs and St. John (1979), refer to
freshman medical students’ source of stress as falling into two broad categories: actual and
anticipated. Some examples of actual sources of stress are those related to the workload
and the increased pressure to study constantly. The fear of academic failure is an
anticipated source of stress. Some of the other stressors that these authors mention have
to do with status loss, unfamiliar academic pressures, financial constrains and social
isolation. They also report that 20-30% of medical students seek psychological assistance,
while some 40% acknowledge considering dropping out during the first two years.

Early studies on medical student stress such as the Gaensbauer and Mizner (1980),
hypothesize that “students’ emotional problems derive as much from the nature of
developmental stresses they must face as from their own individual vulnerability and that
to study this developmental stresses might prove fruitful in determining what type of
coping strategies or tasks would be most helpful” (page 60). To support their hypothesis,
Gaensbauer and Mizner reviewed the files of all students who sought psychiatric
consultation at the University of Colorado Medical School over ten years. After
reviewing the case files, they “attempted to identify recurring themes which might
reflect specific developmental issues which must be dealt with by all medical students”
(pages. 66-67). They concentrated on specific developmental tasks that confront students

and the ensuing stresses that are likely to occur if they are not successfully managed.

18

Gaensbauer and Mizner’s findings support Boyle and Coomb’s observation (1971), which
identifies academic pressure and fear of failure as two of the main stressors for the first
year medical student. According to Gaensbauer and Mizner, the initial task for the first
year student is “to determine personal capabilities in this new context and to perform in
a manner that equals one’s ability, while maintaining sense of adequacy” (pages 57-68).
They also suggest that failure to develop such coping strategies could likely result in the
student’s decreased self-esteem, depression and anxiety. Additional results could be the
students’ withdrawal from competition and their inability to perform academically at
their best level. Another major source of stress for first year medical students is the load
or vast amount of information that needs to be learned within a short period of time.
This is often referred to as “load”. In addition to the academic demands, a third source of
stress for first year medical students is the lack of time for personal and social
relationships. Due to the demands on the students’ time, the tasks of reestablishing and
building new social relationships may become difficult. A common mistake that first
year students make is to give to academics their exclusive attention, to the neglect of their
personal and emotional needs. The result is often a feeling of dehumanization deriving
from this “tunnel vision”. It occurs when students’ excessive academic demands preclude
time for any pursuit of personal needs or interests.
According to Elam (1994), all medical students face stressful circumstances during the

course of their medical education. Success in dealing with stress is dependent upon how
well they can adjust to a changing and demanding environment. At most medical schools,

issues of developmental stress appear along the lines of the four-year curriculum. First

19

year students must deal with stresses involving their sense of competency . They find that
not only is the course material complex, placing increase intellectual demands on them,
but also that competition is keen and they may no longer be earning honors grades as they
once had as undergraduates. Exacerbating competency concerns, first year students must
master a vast quantity of material in a limited time period and they must learn to set self-
imposed limits on the amount of material which can be learned. They also must come to
recognize the sacrifices a career in medicine will require and must make personal and
social adjustments in response. Some of developmental stressors that medical students
encounter in the third and fourth years have to do with their transition from the lecture
hall to the hospitals where they directly participate in patient care during the last two
years of medical school. Throughout this time, students continue to participate in regular
lectures with attending physicians, residents and other allied health professionals. All
together depending on the rotation, the students spend between ten and fourteen hours

per day in the hospital and generally take overnight calls every third or fourth day.

Besides curricular and medically oriented stresses, Elam mentions other
developmental issues that medical students face. Those are: relationships with spouse or
significant other, childbearing and child care, physical health and wellness, finances,
housing concerns, and lack of leisure time. She asserts that the complexity of
developmental stress—either from curricular or personal events, or interaction between the
two—can have an impact upon the student’s medical school performance.

Thomas H. Mosley, et al. (1994) reviewed the effects of the medical school

environment on the academic performance, physical health, and psychological well-being

20

of 69 third year students. The results of the study showed that 23% of the students
suffered clinical depression and 57% endorsed high levels of somatic distress. Stress
accounted for a large percentage of distress variance (i.e., 29% to 50%), and caping efforts
contributed significant variance to the prediction of distress. Coping efforts classified by
Engagement (Approach) strategies were associated with fewer depressive symptoms, while
Disengagement (Avoidance) strategies were associated with higher levels of depressive
symptoms. These results suggest that training in Engagement strategies may be a useful
intervention to lessen the negative consequences of stress among medical students.

In terms of social support, it is well known that the heavy work load and uncertainty
become more difficult to manage when medical students are unable to find strength in a
group of close friends. Students often complain about the difficulties that they have in
developing a new support network or just making friends and socializing, which can be
frustrating due also to the lack of free time. In addition, family and close friends may have
difficulty in understanding why medical students must dedicate most of their time
studying, thus creating more stress.

Rospenda, Halpert and Richman’s study (1994), they examined social support as a
defense against stress and hence as a potential strengthener of student’s academic
performance of 112 third year medical students. After assessing role stress (stress involving
compelling demands between school, social and family life), social support, and sources of
support (outside or inside medical school), their findings reveal that no buffering effect
was found for social support. In fact, social support from outside medical school exhibits

significant variance in academic performance and the students’ levels of stress. For

21

instance, higher levels of outside support were associated with poorer clerkship grades for
women, but with lower levels of stress for men. Contrary to the study hypothesis, social

support in general was related to lower levels of academic performance for both men and
women.

Stewart, et al. (1995), conducted a study on stress and vulnerability in medical
students. They gave a survey to 140 Hong Kong Chinese students in their second year of
their medical education, and compared them with 138 students who completed the same
survey prior to the beginning of their first year of medical school, and 74 non-medical
university students in their second year. The relevant findings of the research were the
following: there was a loss of opportunity to maintain social and recreational sources of
gratification correlated with increased anxiety. There was no difference between the sexes
with regard to the development of anxiety and depression symptoms. Academically less
successful students reported somewhat higher levels of depressive ideation and
symptomatology. Trait anxiety (chronically experienced anxiety, as opposed to situational
anxiety) correlated with the development of distress. Active coping styles (Approach) and
positive reinterpretation (Positive Appraisal) as coping strategies correlated negatively
with distress, while wishful thinking (Avoidance) correlated positively with distress.

Finally, one of the most recent considerations regarding medical students stress is that
of John A. Toews, et al. (1997). This study based on the self-reporting of 1,681 medical
students, medical residency program trainees, and graduate science students from four
Canadian schools of medicine. The study results showed few significant differences

between the respondents at the four schools. For example, in terms of the medical

22

students and medical residency program trainees, it was found that the main concerns of
the respondents in these groups were the volume of their work and the limited time
available for learning. Among other findings, while all groups reported having support
from friends and spouses/ partners, medical residency program trainees received more
support from these sources than the other groups. In terms of gender, the study mentions
some differences related to women reporting higher levels of stress than men, and also
women as more likely than men to report concerns about the volume and complexity of
the learning material. The study supports the notion that, for medical students, stressors
include the volume of material to be learned, academic performance anxiety and
evaluations. The researchers assert that while the external demands of a situation affect the
response to it, a person’s assessment of his or her own coping skills, and the ability to

negotiate the situation also significantly affects the response.

23

CHAPTER III

RESEARCH METHODOLOGY

The purpose guiding this study is to investigate if the use of selected (Approach and/ or
Avoidance) coping strategies and by preclinical (first and second year) medical students,
is related to their academic performance . The study will focus on two basic types of
coping strategies: approach versus avoidance. The efficacy of these strategies when
applied to academic and non-academic sources of stress in medical students will be
examined. Quantitative methodology will be used in this study.

Due to its ability to identify attributes of the sample population (first and second
year medical students); the economy of its design; the rapid turn around in data
collection; and convenience, the COping Response Inventory (CRI-Adult) is the preferred
type of data collection instrument for this study. The nature of the inventory is cross
sectional, and it will be administered to groups of forty to thirty Students at a single time.
Research Qpegipm
1. Is there variation in students’ selected (Approach and/ or Avoidance) coping strategies

and their academic performance
2. Is there variation in students’ selected (Approach and/ or Avoidance) coping

mechanisms when they are grouped by gender?

24

3. Is there variation in students’ selected (Approach and/ or Avoidance) coping
mechanisms when they are grouped by age?

4. Is there variation in students’ selected (Approach and/ or Avoidance) coping
mechanisms when they are grouped by marital status?

5. Is there variation in students’ selected (Approach and/ or Avoidance) coping
mechanisms when they are grouped by ethnic background?

6. Is there variation in students’ selected (Approach and/ or Avoidance) coping
mechanisms when they are grouped by preclinical year.

meat:

To respond to the research questions, the following hypothesis will be tested:

Hypothesis 1: There is a positive relationship between the students’ use of selected

(Approach and/ or Avoidance) coping strategies and their academic mgfprmance.

Null: There is no relationship between the students’ use of selected (Approach and/ or

Avoidance) coping strategies and their academic performance.

Hypothesis 2: There is a relationship between the students’ use of selected (Approach

and/ or Avoidance) coping mechanisms and their gm;

Null: There is no relationship between the students’ use of selected (Approach and/ or

Avoidance) coping mechanisms and their gender.

Hypothesis 3: There is a relationship between the students’ use of selected (Approach

and/ or Avoidance) coping mechanisms and their age

Null: There is no relationship between the students’ use of selected (Approach and/ or

Avoidance) coping mechanisms and their age.

25

Hypothesis 4: There is a relationship between the students’ use of selected (Approach
and/ or Avoidance) coping mechanisms and their marital status.
Null: There is no relationship between the students’ use of selected (Approach and/ or
Avoidance) coping mechanisms and their marital status.
Hypothesis 5: There is a relationship between the students’ use of selected (Approach
and/ or Avoidance) coping mechanisms and their ethpic background.
Null: There is no relationship between the students’ use of selected (Approach and/ or
Avoidance) coping mechanisms and their ethnic background.
Hypothesis 6: There is a relationship between the students’ use of selected (Approach
and/ or Avoidance) coping mechanisms and their year in the program.
Null: There is no relationship between the students’ use of selected (Approach and/ or
Avoidance) coping mechanisms and their year in the program.
Population and Sample

The population of the study will be comprised of all medical students in the

first and second years of the College of Human Medicine at Michigan State University.

This school has at least 110 students in each class or academic year. The total population

for the first and second year of this particular program is comprised by 205 students, of

these, 106 are males and 99 are females. The youngest student is 23 years old, with the

oldest being 44 years of age. To gain access to this population, the researcher will contact

the office of student affairs at the medical program (see Appendix A, page 53).

To assure representativeness of sample, all students in the first and second year class

attending the selected medical school, will be invited to participate in completing the

26

Coping Response Adult Inventory (CRI- Adult). Since the researcher will have access to
all students in the two academic levels or years, a single stage sampling procedure will be
used. The selection of individuals for this study will be based on each student’s
willingness to participate. No less than 70 students will constitute the sample for this
study.
Infomed Consent

Prior to the administration of the CRI-Adult Inventory, the students will be asked to
give their informed consent to use the information given on the Inventory for the
research by signing a letter of consent, (see Appendix B, page 54).
Data Collegion

The CRI—Adult Inventory will be administered to groups of thirty to forty medical
students at a time on a designated date and room at the selected school. Consideration in
timing will be given to accommodate the students' schedule.

The researcher will have to relay on the accuracy of the students’ reports regarding
their academic standing.
Instrumentation

Contemporary theories emphasize the multidimensional aspects of appraisal and
coping processes. In brief, researchers have used two main conceptual approaches to
classifycoping responses. One approach emphasizes the orientation or focus of coping
(problem-focused or emotion focused), whereas the other emphasizes the method of
coping (cognitive or behavioral), (e.g., Billings 8t Moos, 1981, 1984; Folkman 8L Lazarus,

1985; Lazarus 8c Folkman, 1984; Roth 8: Cohen, 1986). The Coping Responses

27

Inventory-Adult Form (CRI-Adult) combines these two approaches. It assesses eight
types of coping responses that reflect these focus-and methods of coping domains. The
inventory considers the orientation or focus of coping and separates coping responses
into approach and avoidance responses. Each of these two sets of coping responses is
divided into two categories that reflect cognitive or behavioral coping methods. In
general, approach coping is problem-focused; it reflects cognitive and behavioral efforts
to master or resolve life stressors. In contrast, avoidance coping tends to be emotion-
focused; it reflects cognitive and behavioral attempts to avoid thinking about a stressor
and its implications, or to manage the affect associated with it.

Over 100 studies have been conducted on the reliability and validity of the CRI-Adult.
Developed and designed by Rudolf H. Moos. In 1981, the CRI-Adult was a 19-item
inventory which was originally used in studies of alcoholic patients (Billing 8C Moos,
1981). Later on, a revised 32-item version was utilized in studies done on depressed
patients (Billing 8: Moos, 1984). In these earlier studies, researchers primarily focused on
findings based on indices of coping that are conceptually and empirically comparable to
the scales in the current version of the CRI-Adult. A new 72-item version was
administered to a group of more than 1,800 adults, some of whom had drinking
problems. Overall, the group included more than 1,100 men and 700 women. The
subjects in the study were asked to identify a recent stressful event and to rate their
reliance on each of the coping items on a four-point scale. Analysis of the data from this
field trial led to the current 48-item version of the CRI-Adult which is composed of eight

scales that reflect approach and avoidance coping. The eight scales are shown in Table 1.

28

Table 1
Cfl-Adult Mes

 

Approach coping resmnses
Cognitive 1. Logical Analysis
2. Positive Reappraisal

Avoidance coping responses
5. Cognitive Avoidance

6. Acceptance or Resignation

Behavioral 3. Seeking Guidance 86 Support 7. Seeking Alternative Rewards

4. Problem Solving

8. Emotional Discharge

 

According to Rudolf Moos, (CRI-Adult, Professional Manual, page 14) to reduce

redundancy and shorten the inventory, he combined dimension that were conceptually
similar and highly intercorrelated. This resulted in the eight scales described in Table 2
Table 2

CRI—Adult Seges an_d Descriptions

 

Scales

Descriptions

 

Approach Coping Responses
1. Logical Analysis

2. Positive Reappraisal

3. Seeking Guidance and Support

4. Problem Solving

Avoidance Coping Responses
5. Cognitive Avoidance

6. Acceptance or Resignation
7. Seeking Alternative Rewards
8. Emotional Discharge

Cognitive attempts to understand and prepare
mentally for stressor and its consequences.

Cognitive attempts to construe and restructure a
problem in a positive way while still accepting
the reality of the situation.

Behavioral attempts to seek information,
guidance or support.

Behavioral attempts to take action to deal
directly with the problem.

Cognitive attempts to avoid thinking realistically
about a problem.

Cognitive attempts to react to the problem

by accepting it.

Behavioral attempts to get involved in substitute
activities and create new sources of satisfaction.
Behavioral attempts to reduce tension by
expressing negative feelings

 

29

eli ili

More than 90% of the respondents in the final field trial participated in a 12-month
follow-up in which they again complete the CRI-Adult. In general, the coping indices
were moderately stable over time among men and women (average rs- .45 and .43,
respectively, for the eight indices). Positive Reappraisal, Seeking Guidance and Support,
Cognitive Avoidance, and Emotional Discharge were somewhat more stable (average
rs- .49 and .47 for men and women respectively) than Logical Analysis and Problem
Solving (average rs- .41 and .39 for men and women respectively) these stability’s are
comparable to those found in a study done over 1 to 2 year interval among alcoholic and
depressed patients and normal controls. (Billings 8C Moos, 1985a; Fondacaro 85 Moos,
1987; Holahan 8L Moos,1987a).

Individual propensities toward approach and avoidance coping may remain
moderately stable over longer intervals. For example, in a study done by Swindle,
Cronkite 8C Moos, 1989, a 3 year stability coefficients of between .34 and .48 for Seeking
Guidance and Support, Problem Solving, and Emotional Discharge coping among
depressed patients was found. Among alcoholic patients and their spouses, it was also
found somewhat lower 8-year stability coefficients averaged between .13 and .38 for
indices of cognitive approach, behavioral-approach, and avoidance coping. Avoidance
coping was the most stable (rs- .38 and .30 for patients and spouses, respectively). Thus,
there is some consistency over time in individuals' coping responses despite the variety of

stressful circumstances they encounter.

30

Qggm' iog pf the Inventory

The front (top sheet) of the CRI-Adult answer sheet contains areas for recording basic
demographic information and the description of the problem or situation. (see Appendix
C, page 55).

The description of the problems or situations the students will respond will be

categorized as follows:

Academic Performance

Load or Academic Load

Adjustment to medical school

Family

Health

Social Relationships

Financial

Multiple (more than one of the above)
Other (Unspecified)

PPNP‘PH‘P’NE“

A template for scoring the scales of the inventory is also provided. Part 1 of the
Inventory, includes 10 stressor-appraisal items which are not scored but provide
important information about how the individual perceives the stressor.

Part 2 of the Inventory, includes forty eight items that relate to both approach and
avoidance coping responses, (see Appendix C, pages 58,59). A four point scale is used to
rate students’ reliance on each coping item. Also, a profile form which allows the
conversion of raw scores to T scores is included, (see Appendix D, page 60).

The CRI-Adult can be hand-scored by using the provided scoring template. A profile
area is provided on the reverse side of the answer sheet. This profile allows the researcher

to convert the subject's raw scores to T scores (M- 50; SD- 10) and to plot the

31

respondent’s coping responses profile. The coping response profile is based on two types
of coping responses, those are: approach coping responses and avoidance coping. The profile
will be marked with horizontal lines to facilitate interpretation of scores. A dotted
horizontal line marks the mean of the T-score distribution. The higher the T—score, the
more the student utilizes a specific coping response. The lower the T-score, the less the

student utilizes a specific coping response. The T-score interpretation is shown in

 

 

Table 3.
Table 3
Criteria for Integpreting CRI-Adult Standard Scores
T- score range Equivalent percentile range Description
234 _>_ 6 Considerably below average
35 - 40 7 - 16 Well below average
41 - 45 17 - 33 Somewhat below Average
46 - 54 34 - 66 Average
55 - 59 67 - 83 Somewhat above average
60 -65 84 - 93 Well above average
366 394 Considerably above average

 

Academic Performance

The information data about the academic performance of students will be gathered
through the student’s own volunteered response to the description of the problem or
situation section on the CRI—Adult answering sheet. The student will have the
opportunity to explain if the nature of his/ her problem was due to his/ her academic

difficulties, e.g., failing to pass a course or more, and being on academic probation.

32

Data Analysis

An attempt will be made to find if there is a relationship between the students’ coping
response and their academic difficulties. The approach coping response identified as
Seeking Guidance (SG) will be used to measure the students’ social support.

After obtaining students’ CRI—Adult T-scores, these will be used for statistical
analysis, an the researcher will compare results among individuals according to the
following independent variables: gender, age, marital status, ethnic background and pre-
clinical year. This will be done by obtaining the means and standard deviation for each
one of the variables already mentioned.

To measure the relationship between the selected (Approach and/ or Avoidance)
coping responses, the Pearson Correlation Coefficient will be used.

Null hypothesis will be tested at a significant level of p > .05, using the Statistical
package for Social Sciences (SPSS).

To test the independent variable (Academic Performance), the Analysis of Variance
(ANOVA) will be used. The purpose of the ANOVA is to test whether the difference
or variance among the means of the two samples is significant or can be attributed to
change.

To examine the main and interactive effects of coping mechanisms and social

support on academic performance, multiple regressions will be performed between the

two samples.

33

CHAPTER I V

DISCUSSION OF FINDINGS

The Coping Response Inventory for Adult (CRI-Adult Inventory) which consists
of two parts. Part 1 has 10 questions that assess the students’ sources of stress. These
questions are not scored but provide important information about how the student
perceives the stressor(s). The sources of stress are categorized as follows : academic
performance, academic or workload, adjustment to medical school, family, health,
social relationships, financial, multiple and other. In Part 2, which includes 48 items,
the students are asked to indicate how often they engaged in a particular behavior in
connection with the problem or source of stress they described in Part 1. Each of the
48 items measures either an Approach or an Avoidance coping response. The
Approach coping responses are defined as follows: LA or logical analysis, PR or
positive reappraisal, SG or seeking guidance and support, and PS or problem solving.
The Avoidance coping responses are defined as follows: CA or cognitive avoidance,
AR or acceptance and resignation, SR or seeing alternative rewards, and ED or
emotional discharge. A four-point scale was used to rate the students’ reliance on each

coping item, (see Appendix C, page 57 for CRI-Adult Inventory).

34

Results of the CRI—Adult Inventog

The results of the administration of the CRI-Adult Inventory to the students can be

seen by the following tables:

Table 1

Number and Percent of Students Responding to the CRI-Adult Inventog: N - 73

 

 

 

 

 

 

 

 

 

Year in School Number %
1 47 64.5
2 26 35.5
Total 73 100%
Eli—dc;
Male 35 48.0
Female 38 52.0
Total 73 100%
m
21-25 39 54.0
26-30 24 33.0
31-35 4 5 .5
36-40 5 6.5
4144 1 1.0
Total 73 100%
MEL—Mus.
Single 53 73.0
Married 19 26.0
Divorced 1 1.0
Total 73 100%

35

Table 2

Frequency of Types of Strgssor Repgrted by Medical Students: N-73

 

 

 

Stressor # of Students Responding %
Academic 11 15.0"
Load 14 19.3"
Adjustment 7 9.7
Social 11 15.0"
Family 6 8.2
Health 4 5.5
Finances 4 5.5
Multiple 10 13.6
Other 6 8.2
Total 73 100%

 

1. Academic - academic performance, i.e., failing courses, on academic probation.
2. Load - workload or amount of material to be learned.
3. Adjustment - transition into medical school.

4. Social - social relationships, i.e., friendships and dating.
5. Family - family relationships and marriage difficulties.
6. Health - own or family.

7. Finances - financial difficulties or constraints.

8. Multiple - having more than one type of stressor.

36

9.Unspecified - student selected nm to specify the source of stress.
* Most frequently reported stressors were related to load, academic difficulties and

social relationships.

 

 

 

Table 3
Fregpeng; pf Types of Stressor Reported by Gender: N-73
km; W

Male % Female % Total
Academic 4 11.4 7 "* 18.4 11
Load 9 ”25.7 5 13.1 14
Adjust 4 11.4 3 g 8 7
Social 6 17 5 13.1 1 1
Family 2 5.7 4 10.5 6
Health 1 2.8 3 8 4
Finances 3 8.5 1 2.6 4
Multiple 3 8.6 7 I"”184 10
Unspecified 3 8.6 3 8 6
Total 35 100 38 100 73

 

The most frequent type of stressors reported by gender were as follows:

*Workload or academic load, with males expressing more concerns related to the
workload than females.

*"’Academic standing or difficulties, with females reporting as having more difficulties

than males.

37

*“Multiple, with a high percentage of females reporting this as their main stressor.

****More females than males reported having multiple sources of stress.

 

 

 

Table 4
Frequeng pf Types of Stressors Reported by Age Group: N-73
Stressor Age Group

21-25 °/o 26-30 % 3 1-3 5 % 36-40 % 41-44 % Total
Academic 1 2.6 9 I"‘36 1 16.6 11
Load 9 23.6 3 12 2 33.4 14
Adjust 4 10.5 2 8 1 16.6 7
Social 10 26.3 1 4 1 1
Family 1 2.6 3 12 2 67 6
Health 3 8 1 4 4
Finances 2 5.2 1 16.6 1 100 4
Multiple 5 13.1 3 12 1 16.6 1 33 10
Unspecified 3 8 3 12 6
Total 38 100 25 100 6 100 3 100 1 100 73

 

The most frequent type of stressors reported by age were as follows:

* Load, with students ages 21 to 25 years old reporting more workload type of stressor

than the older the students.

*"’Academic, with students ages 26 to 30 years old reporting more academic difficulties

than the rest of the students.

“*Social, with students ages 21 to 25 years old reporting more social stressors than the

older students.

 

 

 

 

Table 5
Erggugpcy pf Types of Stressgr Repgrted by Marital Status: N -73
Stressor Marital Status

Single °/o Married % Divorced % Total
Academic 8 15 3 15 1 1
Load 7 13.2 7 "’36 14
Adjust 7 13.2 7
Social 11 "21 1 1
Family 2 3.7 4 20 6
Health 3 5.6 1 5 4
Finances 2 3.7 2 10 1 100 4
Multiple 8 15 2 10 10
Unspecified 5 9.4 1 5 6
Total 53 100 19 100 1 100 73

 

The most frequent type of stressor reported by marital status were as follows:
*Workload or academic load, with equal number of single and married students
expressing workload as their main stressor.

“Academic standing or performance, with single students expressing more academic
difficulties than married students.

“*Social relationships, with single students reporting social as their main stressor.

39

““Multiple, with more single students reporting multiple sources of stress than
married Students.

Table 6

Frequency of Types of Stressor Reported by Year in School: N-73

 

 

 

 

Spam Year Years 1 8L 2 3/9

1 % 2 % Combined
Academic 7 14.7 4 15.3 11 15
Load 7 14.7 7 *26.9 14 "'”"’19
Adjust 6 12.7 1 3.8 7 9.6
Social 9 “19.1 2 7.5 11 15
Family 4 8.5 7.5 6 8.2
Health 2 4.2 7.5 4 5.5
Finances 3 6.3 3.8 4 5.5
Multiple 6 12.7 15.3 10 14
Unspecified 3 6.3 3 1 1.5 6 8.2
Total 47 100 26 100 73 100%

 

The most frequent type of stressor reported by first and second year students were:
*Workload or academic load, with equal number of first and second year students
reporting workload as their main stressor.

“Academic standing or performance, with more first year students reporting academic

difficulties than second year students.

40

M"Social relationships, with more first year students reporting social relationships
type of stressor than second year students.

The Pearson Correlation Sample coefficient Analysis was applied to both Approach
and Avoidance coping responses to examine how they, as test variables, were related to
each other, (see Appendix E, Table 7, page 65 for The Pearson Correlation).

The results of the Pearson Correlation Coefficient showed no relationship among
the test variables. Therefore, an Independent Sample T-Test and the Levene’s Test for
Equality of Means procedures, at a significant level of P > .05 were used to compare
means among the test variables (Approach and Avoidance coping responses) and the
grouping variables (gender, age, marital status, academic performance, workload,
social, etc.)

Testing of Hypothesis

On the basis of the T-test and the Levene’s Test for Equality of Variance, the
researcher reports the following findings:

Hypothesis 1: There is a positive relationship between the students' use of selected
(Approach and/or’Avoidance) coping mechanisms and their academic performance.
Null: There is no relationship between the students' use of selected (Approach and/ or
Avoidance) coping mechanisms and their academic performance.

No statistically significant difference was found between the Approach coping
responses (LA, PR, SG and PS) and the students who reported academic difficulties.
Therefore, there is no relationship between the student’s academic performance and

the use of Approaching coping mechanisms, (see Appendix B, Table 8, page 66).

41

In terms of the Avoidance coping responses (CA, AR, SR and ED), only CA or
Cognitive Avoidance showed a statiStically significant difference (F - 3.884, P < 0.53),
with students who reported academic difficulties scoring higher in the use of cognitive
avoidance type of coping mechanisms.

Hypothesis 2: There is a relationship between the students' use of selected (Approach
and/ or Avoidance) coping mechanisms and their gelld_er_.

Null: There is no relationship between the students' use of selected (Approach and/ or
Avoidance) coping mechanisms and their gender.

No statistically significant difference was found between the Approach coping
responses (LA, PR, SG and PS) and the students’ gender. Therefore, there is no positive
relationship between the students’ gender and their use of Approach coping
mechanisms, (see Appendix E, Table 9, page 67).

In terms of the Avoidance coping responses (CA, AR, SR and ED), only CA or
Cognitive Avoidance showed statistically significant difference (F - 8.691, P < .004),
with females using more cognitive avoidance type of responses than males. This
suggests, that there is a positive relationship between the students’ gender and their use
of CA or Cognitive Avoidance coping mechanisms. Some examples of cognitive
avoidance type of responses that the students with academic difficulties mentioned they
used were: try to forget about the problem or source of stress, try not to think about
the problem, daydreaming or imagine a better time or place they were in, put off
thinking about the situation, even though they knew they would have to deal with it

at some point, they try to deny how serious the problem really was, and they wish the

42

problem would go away or somehow be over with, (see Appendix E, Table 10, page
68).

Hypothesis 3: There is a relationship between the students' use of selected (Approach
and/ or Avoidance) coping mechanisms and their _age_.

Null: There is no relationship between the students' use of selected (Approach an/ or
Avoidance) coping mechanisms and their age.

No statistically difference was found between the Approach coping responses (LA,
PR, SG and PS), and the students’ age. Therefore, there is no positive relationship
between the students’ age and their use of Approach coping mechanisms, (see
Appendix E, Table 11, page 69).

In terms of the Avoidance coping responses (CA, AR, SR and ED), only CA or
Cognitive Avoidance showed statistically significant difference (F - 9.138, P < .003)
with students ages 21 to 25 years old scoring higher in the use of cognitive avoidance
type of coping mechanisms the the Other students. This finding suggests that there is a
positive relationship between the students’ ages 21 to 25 years old and their use of CA
or Cognitive Avoidance mechanisms, (see Appendix B, Table 11, page 69).

No statistically significant difference was found between the Approach coping
responses (LA,PR, SG and PS) and students ages 26 to 30 years old. Therefore, there is
no positive relationship between students ages 26 to 30 years old and their use of
Approach coping responses, (see Appendix E, Table 12, page 70).

There is some statistically significant difference (F -3.72, P > .56) between CA or

Cognitive Avoidance and students ages 26 to 30 years old. Therefore, there is some

43

positive relationship beWeen students ages 26 to 30 years old and their use of
Cognitive Avoidance.

Some statistically significant difference was (P -3.020, P > .087) found between the
Approach coping response PR or Positive Reappraisal and students ages 36 to 44 years
old. Therefore, there is some positive relationship between students ages 36 to 44 years
old and their use of positive Reappraisal while undergoing stress, (see Appendix B,
Table 13, page 71).

Hypothesis 4: There is a relationship between the students' use of selected (Approach
and/ or Avoidance) coping mechanisms and their marital status.

Null: There is no relationship between the students' use of selected (Approach and/ or
Avoidance) caping mechanisms and their marital status.

No Statistically significant difference was found between bOth the Approach and the
Avoidance c0ping responses (LA, PR, SG, PS, CA, AR, SR and ED), and the students’
marital status. Therefore, there is no positive relationship between the students’ marital
status and their use of Approach and / or Avoidance coping responses, (see Appendix
B, Table 14, page 72).

Hypothesis 5: There is a relationship between the students' use of selected (Approach
and/ or Avoidance) coping mechanisms and their minority/non-minority status.

Null: There is no relationship between the students' use of selected (Approach and/ or
Avoidance) coping mechanisms and their minority/non-minority status.

No statistically significant difference was found between both the Approach and the
Avoidance coping responses and the minority versus non-minority students.

Therefore, there is no positive relationship between the minority versus non-minority

44

students and their use of Approach and/ or Avoidance coping responses, (see Appendix
B, Table 15, page 73).

Hypothesis 6: There is a relationship between the students' use of selected (Approach
and/ or Avoidance) coping mechanisms and their year in the program.

Null: There is no relationship between the Students' use of seleCted (Approach and/ or
Avoidance) coping mechanisms and their year in the program.

Finally, in terms of the students’ use of selected coping responses and their year in
the program, no statistically significant difference was found between both the
Approach and the Avoidance coping mechanisms (LA, PR, SG, PS, CA, AR, SR and
ED) and the students’ year in the program. Therefore, there is no positive relationship
between the students’ year in the program and their use of Approach and/ or

Avoidance coping mechanisms, (see Appendix E, Table 16, page 74).

45

CHAPTER V

SUMMARY AND RECOMMENDATIONS

Medical schools have always received a great number of applicants. Selection of
students is critical because of the length and the cost of training. Therefore, a
considerable amount of attention had been focused on finding accurate and valid
predictors of success in medical school.

Studies such as Cuca, Sakakeeny and Johnson, (1976) have tried to identify
predictors of academic success in medical students. Factors included in these studies
were the students’ personality, the Medical College Achievement Test (MCAT) scores,
and premedical Grade Point Averages (GPA’s). The studies suggested that there was
not clear and definite correlation between these factors and academic success, and that
other factors may have intervened.

Medical colleges across the nation still make their admission decision based heavily
on high MCAT and GPA scores.

It is well known that all medical students face stressful circumstances during the
course of their education and that their success in dealing with stress is dependent upon

how well they can adjust to a continually changing and demanding environment.

46

 

 

is:

dat

 

 

 

Sta:

prc

3?

ite

*1)

Perhaps, a more accurate approach to the selection of applicants for medical school
is the one that assesses the individual’s ability to deal successfully with highly stressful
situations.

This study focuses on the medical students’ use of selected (Approach and/ or
Avoidance) coping mechanisms and their effect on academic performance.

The Coping Response Inventory (CRI-Adult) was the selected instrument for the
data collection of the study.

First and second year students form the College of Human Medicine at Michigan
State University were the selected population sample for this Study. This inventory
provides areas for recording the students’ demographic information, the description of
a problem or situation they experienced within the past year, and their responses to 48
items related to the specific situation. Each item measures either an Approach and/ or
Avoidance response. The approach coping response identified as Seeking Guidance
(SG) was used to measure the students’ social support.

The problems the students’ described were categorized as follows: academic
performance, workload, adjustment to medical school, family relationships, social
relationships, health, financial constrains, multiple stressors and other or unspecified.

The Pearson Correlation Coefficient Analysis was applied to both Approach and
Avoidance coping mechanisms. The results of the Pearson Correlation showed little
or no relationship among them. Therefore, an Independent Sample T—Test and the

Levene’s Test at a significant level of P > .05 were used to test the study’s hypothesis.

47

Summary of Findings

The results of the administration of the CRI-Adult Inventory show that the major
stressors for the surveyed medical students were: workload or academic load (19.3% of
the students reported workload as the main source of stress) followed by academic
difficulties and social relationships as second major stressors (15% of the students
reported academic difficulties as major source of stress, and also 15% of the students
reported social relationships as major source of stress.

With respect to gender differences, the study shows that more men than women
reported workload or academic load concerns. More women than men reported having
academic difficulties and more women than men reported having multiple sources of
stress.

In regards to students’ age, the study shows that students ages 21 to 25 years old
reported more workload concerns than the rest of the surveyed students. Students ages
26 to 30 years old reported having more academic difficulties than younger or older
students did.

In terms of the students’ marital status, the study shows that equal number of single
and married students expressed workload or academic load concerns. Single students
appeared to have more academic difficulties than married students did. Single Students
also reported more social relationship difficulties than the married ones.

In terms of year in school or first versus second year students, both first and second
year students reported workload or academic load as their main source of stress. First

year students reported more academic difficulties than second year students did. First

48

year students also reported more social relationship difficulties than second year
students did. For example, most of the single students mentioned having difficulties in
continuing friendships or breaking engagements or long term relationships.

The T-Test and Levene’s Test results Show 1). that the students who reported
academic difficulties used more cognitive avoidance mechanisms when compared with
students who did not report having academic difficulties, 2). that females in the sample
used more cognitive avoidance than males, 3). that students ages 21 to 25 years old
used more cognitive avoidance than the older Students, and 4). that students ages 36 to
44 years old used more Positive Reappraisal coping mechanisms than the younger
students.

Law

The study results Show that the students who reported academic difficulties used
more cognitive avoidance mechanisms than the other students’ in the sample. These
results suggest that, in assessing the personal qualities of applicants to medical school,
admissions officers should include some techniques for determining an applicant’s basic
strategies in identifying and addressing stressors. This can be done through several
means: objective measures (e.g., the CRI-Adult Inventory), and asking applicants to
answer problem solving and/ or stress related type of questions on their written essays
at the time of their application or during their interviews at the prospective medical
schools. While there is no evidence to suggest the use of these techniques as screening

devices, the results of these measures could be useful in other ways.

49

Pre—medical and academic advisors of medical students need to raise awareness
among their students about the importance of having experience in problem solving, as
well as the use of effective coping mechanisms, since they could enhance the students’
well being while in their pre-medical and pre-clinical years.

More prevention services are needed to help pre-medical and medical students
acquire effective long-term stress reduction skills. Perhaps, classes or lectures as part of
the pre-medical, as well as the firSt-year medical curriculum could be introduced in
schools and used as training opportunities for students to develop both problem
solving and effective coping skills.

Other services that can be provided by medical schools are consultation and
referral services to students who require psychological type of evaluation and
treatment due to extreme stressful experience(s).

In order to manage the vast amount of material to be learned in medical schools,
pre-medical as well as medical students need to be trained about effective cooperative
learning techniques or group study techniques. These are participatory study groups in
which each student is in charge of a task or learning material, and each student
contributes with a specific information. When the group comes together, each student
presents his or her information to the other members of the group. In this way, at the
end of each study group meeting, the students not only have learned their independent
pieces of information but they have also integrated all relevant pieces of the learning

material effectively.

50

Finally, in contrast to the traditional school system of lectures supported by
laboratory work that occurs in the pre-clinical years, medical schools could explore
more alternatives to the traditional system, such as the “problem based learning
system”. Under this approach, the students with faculty guidance present themselves or
are presented with case scenarios. The students research and discuss the sample cases,
learning the information necessary to diagnose a fictional patient. With this system, the
students exercise initiative in directing their education, there is more opportunity for
cooperative or team learning, and problem solving skills are developed more towards
clinical thinking skills. This system when effectively used could provide the students
with training in Approach coping mechanisms such as logical analysis, positive
reappraisal, seeking guidance or looking for assistance in gathering accurate
information, and problem solving. Most importantly, medical students under the
“problem based learning system” are provided with the opportunity to develop
effective coping devices that they can apply while under going stress due to school,
career and life pressures.

More in depth ad longitudinal studies are needed to demonstrate particular trends
among medical students; especially those trends that are related to problem solving and
the use of coping mechanisms. Future research should also investigate samples from
other medical schools, data collected longitudinally through out the program, the
effects of the stress intervention efforts on medical school students and comparative

studies between pre-clinical and clinical years.

51

APPENDIX A

52

November 17, 1997

Director
College of Human Medicine
A-254 Life Sciences Building

Dear Director:

1 am requesting your consideration and support in conducting a study about the types
of coping mechanisms and social support medical students use in dealing with stress,
and how these relate to their academic success. This particular study will include
students from the College of Human Medicine at Michigan State University. The
study will be conducted as a doctoral degree requirement in higher educational
administration.

Students will be asked to complete the Coping Responses Inventory for Adults. This
brief (30 minutes) self-report inventory will identify cognitive and behavioral
responses that first and second year medical student used to cope with a recent
problem or stressfiil situation. In order to administer the inventory I will carefully
make the necessary arrangements (date, location and time), taking under consideration
the students’ academic schedule.

Individual students are free to participate or not in the study. At any time, a student
can decide to withdraw from the study even afier agreeing to participate. There will be
no penalty for those students who choose not to participate or to withdraw. Any data
collected form of those who decide to withdraw will be destroyed immediately.

Numbers will be assigned to students’ responses to ensure the students’ anonymity.

Sincerely,

Norma Baptista
Ph.D Candidate

53

APPENDIX B

54

CONSENT FORM FOR
FIRST AND SECOND YEAR MEDICAL STUDENTS

I voluntarily agree to participate in the research study, THE USE OF SELECTED
COPING STRATEGIES AS PREDICTORS OF ACADEMIC PERFORMANCE,
which will be conducted during the 1997/98 academic year. I know that this study is
being conducted as dissertation research for Norma Baptista's doctoral studies at
Michigan State University. The purpose of this research is to explore the
relationship between the use of coping mechanisms as predictors of academic
performance in medical students. It is my understanding that my participation in this
study involves the following:

I I will allow the researcher to administer the research inventory. This will take
about one half-hour to one hour of my time.

I I will allow the researcher to utilize the information collected through the
inventory. I understand that the collected information will be kept in the
researchers home in a locked cabinet, to ensure no other person could take or
read it.

I I realize that although my name will not be used and every effort will be made
to keep my identity confidential, it is possible someone at the School could
determine my identity.

In addition, I understand that:

I The data collected through the research inventory will be used in the
dissertation, as well as possible articles, presentations or instruction.

I The College may or may not choose to make changes based on the findings of
this study.

I I may choose not to participate in this study or withdraw from it at any time
without penalty.

Signature Date

 

If you have any questions or concerns, please contact Norma Baptista at
(517) 355-9674 or (517) 663-2320

55

APPENDIX C

56

CRI-ADULT ANSWER SHEET Form: Actual ldeal

 

 

 

 

 

 

Name Date / / Sex Age
Marital Status Ethnic Group Education
Part 1

Describe the problem or situation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DN = Definitely No MN = Mainly No MY = Mainly Yes DY = Definitely Yes

1. Have you ever faced a problem like this before? [DN MN MY DY I

2. Did you know this problem was going to occur? l DN MN MY DY j

3. Did you have enough time to get ready to handle this problem? lDN MN MY DY ]

4. When this problem occurred. did you think of it as a threat? l DN MN MY DY I

5. When this problem occurred. did you think of it as a challenge? l DN MN MY DW

6. Was this problem caused by something you did? LDN MN MY DH

7. Was this problem caused by something someone else did? [RN MN MY DH

8. Did anything good come out of dealing with this problem? j DN MN MY DY J

9. Has this problem or situation been resolved? I DN MN MY Dfl

l0. If the problem has been worked out. did it turn out all right for you? [ DN MN MY DY I
Part 2

N = No. Not at all 0 = Yes. Once or twice 8 = Yes. Sometimes F = Yes. Fairly often
1 2 3 4 s 6 F“, a
NOSFNOSFNOSFNOSFNOSFNOSFNOSFNOSF
9 10 11 12 13 14 15 16
NOSFNOSFNOSFNOSFNOSFNOSFNOSFNOSF
17 18 19 20 21 22 23 24
NOSFNOSFNOSFNOSFNOSFNOSFNOSFNOSF
25 26 27 28 29 30 31 32
NOSFNOSFNOSFNOSFNOSFNOSFNOSFNOSF
33 34 35 36 37 36 39 40
NOSFNOSFNOSFNOSFNOSFNOSFNOSFNOSF
41 42 43 44 45 46 47 48
NOSFNOSFNOSFNOSFNOSFNOSFNOSFNOSF

 

 

 

 

 

 

 

 

 

 

MB Psychological Assessment Resources, Ind/PD. Box 998/0dessa. FL 33556/ron-rree 1.300.331-rtsr

Copyright '4': I993 by Psychological Assessment Resources. Inc. All rights reserved. May not be reproduced in whole or in part in any form or by any
means without written permission of Psychological Assessment Resources. Inc. 2 3 4 5 6 7 8 9 Printed in the USA

This form is printed in blue ink on carbonless paper. Any other version is unauthorized. Reorder fl RO—2329 Toll Free 180033l-TEST

57

Part 1

This booklet contains questions about how you manage important problems that come up in your
life. Please think about the most important problem or stressful situation you have experienced in
the last 12 months (for example, troubles with relative or fiiend, the illness of a relative or fi'iend,
an accident or illness, financial or work problems). Briefly describe the problem in the space
provided in Part 1 of the answer sheet. If you have not experienced a major problem, list minor
problem that you have had to deal with. Then answer each of the 10 questions about the problem
or situation (listed below and again on the answer sheet) by circling the appropriate response:

8.

9.

 

Circle "DN" if your response is DEFINITELY NO. DN MN MY DY

 

 

Circle MN ifyour response is MAINLY NO. 9“ MN MY DY

Circle "MY" if your response is MAINLY YES. DN MN (My DY

 

 

 

 

 

 

 

 

Circle "DY" if your response is DEFINITELY NO. DN MN MY GYD

 

. Have you ever faced a problem like this before?

Did you know this problem was going to occur?

Did you have enough time to get ready to handle this problem?
When this problem occurred, did you think of it as a threat?
When this problem occurred, did you think of it as a challenge?
Was this problem caused by something you did?

Was this problem caused by something someone else did?

Did anything good come out of dealing with this problem?

Has this problem or situation been resolved?

10. If the problem has been worked out, did it turn out all right for you?

58

Part 2

Read each item carefully and indicate how often you engaged in that behavior in connection with
the problem you described in Part 1. Circle the appropriate response on the answer sheet:

 

 

 

 

 

 

 

 

 

 

 

 

Circle "N" if your response is NO. Not at all. N) O S F
Circle "0" if your response is YES. Once or Twice. N G) S F
. . . . N 0 (S) F
Circle "S" if your response IS YES, Sometimes.
N o . Q)
Circle "F" if your response is YES, Fairly often.

There are 48 items Part 2. Remember to mark all your answers on the answer sheet. Please
answer each item as accurately as you can. All your answers are strictly confidential. If you not
wish to answer an item, please circle the number of that item on the answer sheet to indicate that
you have decided to skip it. If an item does not apply to you, please write NA (Not Applicable) in
the box to the right of the number for that item. If you wish to change an answer, make an X
through your original answer and circle the new answer. Note that answers are numbered across
in rows on Part 2 on the answer sheet.

1. Did you think of different ways to deal with the problem?

2. Did you tell yourself things to make yourself feel better?

3. Did you talk to your spouse or other relative about the problem?

4. Did you make a plan of action and follow it?

5. Did you try to forget the whole thing?

6. Did you feel that time would make a difference-that the only thing to do was to wait?

7. Did you try to help others deal with a similar problem?

8. Did you take it out on other people when you felt angry or depressed?

9. Did you try to step back from the situation and be more objective?

10. Did you remind yourself how much worse things could be?

59

ll.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

Did you talk with a friend about the problem?

Did you know what had to be done and try to make things work?

Did you try not to think about the problem/

Did you realize that you had no control over the problem?

Did you get involved in new activities?

Did you take a chance and do something risky?

Did you go over in your mind what you would say or do?

Did you try to see the good side of the situation?

Did you talk with a professional person (e. g., doctor, lawyer, clergy)?

Did you decide what you wanted and try hard to get it?

Did you daydream or imagine a better time or place than the one you were in?
Did you think that the outcome would be decided by fate?

Did you try to make new fiiends/

Did you keep away from people in general?

Did you try to anticipate how things would turn out?

Did you think about how you were much better off than other people with similar problem?
Did you seek help from persons or groups with the same type of problem?
Did you try at least two different ways to solve the problem]

Did you try to put off thinking about the situation, even though you knew you would have to
at some point?

Did you accept it; nothing could be done?

Did you read more often as a source of enjoyment?

Did you yell or shout to let off steam?

Did you try to find some personal meaning in the situation?
Did you try to tell yourself that things would get better?

Did you try to find out more about the situation?

60

36.

37.

38.

39.

40.

41.

42.

43.

45.

46.

47.

48.

Did you try to learn more things on your own?

Did you wish that the problem would go away or somehow be over with?
Did you expect the worst possible outcome?

Did you expend more time in recreational activities?

Did you cry to let your feelings out?

Did you try to anticipate the new demands that would be placed on you?

Did you think about how this event could change your life in a positive way?

Did you pray for guidance and/or strength?

. Did you take things a day at a time, one step at a time?

Did you try to deny how serious the problem really was?
Did you lose hope that things would ever be the same?
Did you turn to work or other activities to help you manage things?

Did you do something that you didn't think would work, but at least you were doing
something?

61

APPENDIX D

62

CRl-ADULT PROFILE

 

 

 

TSCORE RAW RAWZ RAW3 RAW4 RAWS RAWG RAW?— RAWB TSCORE ‘
80+ 14-18 80
79 13 79
78 18 78
77 77
76 18 17 76
75 18 12 75
74 17 16 74
73 17 73
72 18 16 11 72
71 15 71
70 16 70
69 17 15 14 10 69
68 18 68
67 18 16 18 14 15 13 67
66 9 66
65 17 17 13 14 65
64 15 17 12 64
63 13 8 63
62 16 16 14 16 12 11 62
61 12 61
60 15 15 15 11 10 7 60
59 13 11 59
58 14 10 9 58
57 14 12 14 6 57
56 13 10 56
55 13 13 9 8 SS
54 11 9 5 S4
53 12 8 7 53
52 52 10 12 8 52
51 11 7 6 4 51
50 11 11 50
49 10 9 7 49
48 10 6 5 3 48
47 10 9 8 6 47
46 5 4 46
4S 8 9 2 45
44 9 7 5 3 44
43 8 4 43
42 8 7 6 4 2 1 42
41 7 3 41
40 6 3 40
39 7 5 2 1 O 39
38 S 6 38
37 6 4 1 2 0 37
36 4 5 36
35 1 35
34 5 3 3 4 0 34
33 0 33
32 4 2 32
31 2 3 31
30 30
29 3 1 1 2 29
28 0 28
27 2 0 1 27
26 26
25 25
24 1 0 24
23 23
22 0 22
21 21
20 20
1A.__L..SF 1" LAB—.58 ED

 

 

 

 

 

 

 

 

63

 

 

 

 

 

APPENDIX E

Table 7

 

 

 

 

 

LA PR S6 PS EA AR SR ED '

Pearson. LA 1.000 .426“ .555“ .545“ -.032 -.145 .233" .099
Correlation PR .426“ 1.000 .504*1 .469“ .064 -.203 .296* -.108
56 .555" .504*1 1.000 .513“ -.028 -.033 .020 .002

PS .545“ .469“ .513" 1.000 -.164 -.331** .097 .141

CA -.032 .064 -.028 -.164 1.000 .473" .157 284*

AR -.145 -.203 -.033 -.331** .473" 1.000 -.223 278*

SR .233* .296* .020 .097 .157 -.223 1.000 .160

ED .099 --108 .002 2141 .284* 178* .160 1.000

Sig. (Z-tailed) LA . .000 .000 .000 .789 .221 .049 .405
PR .000 . .000 .000 .591 .085 .012 .364

so .000 .000 . .000 .816 .781 .870 .989

PS .000 .000 .000 . .169 .005 .421 .238

CA .789 .591 .816 .169 . .000 .189 .015

AR .221 .085 .781 .005 .000 . .060 .017

SR .049 .012 .870 .421 .189 .060 . .179

ED 305 364 -989 .238 .015 .017 -179 .

N LA 73 73 73 72 73 73 72 73
PR 73 73 73 72 73 73 72 73

so 73 73 73 72 73 73 72 73

PS 72 72 72 72 72 72 71 72

CA 73 73 73 72 73 73 72 73

AR 73 73 73 72 73 73 72 73

SR 72 72 72 71 72 72 72 72

ED 72 72 72 7? 72 72 72 72

 

 

 

 

 

 

 

 

 

**,Corre|ation is significant at the 0.01 level (2-tailed).
*, Correlation is significant at the 0.05 level (Z-tailed).

65

 

Table 8

 

Levene's Test for

Egualigy of Variances

t-test for E uality of Means

 

 

 

95% Confidence

Interval of the Mean

Mean Std. Error

Sig.

df

Si .
(Z-tagiled)

Difference

Difference

LOWE!

Upper

 

LA Equal
variances
assumed
Equal
variances
not

.___mms_d

1.886

.174

-.558

—.629

71

1 5.462

.579

.538

-1.5205

-1 .5205

2.7250

2.41 58

-6.9540

-6.6562

3.91 30

3.6152

 

PR Equal
van ances
assumed
Equal
variances
not

.____assem

.061

.806

-2.089

-2.316

71

15.183

.040

.035

-5.8563

~5.8563

2.8040

2.5286

1 1.4473

1 1.2403

-.2653

-.4 723

 

56 Equal
variances
assumed
Equal
vanances
not

.437

.511

-.912

-.928

71

13.997

.365

.369

-3.3299

-3.3299

3.6530

3.5894

10.6139

1 1.0287

3.9540

4.3689

 

. ggumed

PS Equal
variances
assumed
Equal
variances
not

. ____assymssl

.040

.841

-.741

—.677

70

12.940

.461

.510

-2.0596

-2.0596

2.7796

3.0433

-7.6034

-8.6374

3.4842

4.5182

 

CA Equal
vaflances
assumed
Equal
variances
not

‘ 8551111189

3.884

.053

-.948

-1.294

71

20.157

.346

.210

-2.7185

-2.7185

2.8677

2.1007

-8.4364

-7.0982

2.9995

1.6613

 

AR Equal
variances
assumed
Equal
variances
not

1.615

.208

.527

.607

71

1 5.831

.553

1 .4648

1 .4648

2.7813

2.4144

-4.0810

-3.6580

7.0107

6.5876

 

SR Equal
variances
assumed
Equal
variances
not

. gsgmgg

.039

.845

-.770

-.716

70

1 3.099

.444

.487

-2.2101

-2.2101

2.8700

3.0874

-7.9342

-8.8751

w

3.5139

4.4548

 

ED Equal
variances
assumed
Equal
variances
not

__assumed

 

.964

 

 

.329

 

.236

.207

 

71

12.558

 

.814

.839

 

.7933

.7933

 

3.3542

3.8281

 

-5.8948

-7.5066

 

7.481 3

9.0931

 

*CA Shows statistically significant difference (F +3. 889,P> .,053) with students reporting
academic difficulties using more cognitive avoidance than students who did n0t report
academic difficulties.

No statistically significant difference between Approach coping responses and the students
reporting academic difficulties.

66

 

Table 9

 

Levene‘s Test for

F

Egualig of Variances

 

5&-

df

 

LA Equal
variances
assumed
Equal
variances
not

. _mumed

.196

.659

1.311

1.311

71

70.41 0

233'

.194

.194

t-testfor ual ofMeans
##—

Std. Error
Difference

Mean
Difference

2.5338

 

2.5338

 

1 .9324

1 .9330

9i Confidence

Lower

 

-1.3192

-1.3210

mm of the M
Jam.

6.3868

6.3887

 

PR Equal
variances
assumed
Equal
variances
not

.457

.501

1 .080

1 .082

71

70.952

.284

.283

2.2158

2.2158

2.0519

2.04 70

-1.8755

-1.8658

6.3071

6.2974

 

50 Equal
variances
assumed
Equal
variances
not

. .___mum

1.932

2.438

2.400

71

58.513

.017

.020

6.1632

6.1 632

2.5274

2.5683

1.1236

1.0231

1 1.2027

1 1.3033

 

PS Equal
variances
assumed
Equal
variances
not

. __mumssl

.085

.771

1 .403

70

69.090

.165

.165

2.7833

2.7833

1.9833

1 .9835

-1.1723

-1.1736

6.7389

6.7402

 

CA Equal
variances
assumed
Equal
variances
not

8.691

2.827

2.861

71

68.1 58

5.5391

5.5391

1.9591

1 .9360

1 .6328

1 .6760

9.4454

9.4022

 

AR Equal
variances
assumed
Equal
variances
not

, ____mmssl

.496

.484

1.122

1.126

71

70.985

.265

.264

2.2203

2.2203

1 .9781

1 .9724

-1.7239

-1.7127

6.1645

6.1533

 

SR Equal
variances
assumed
Equal
variances
not

.065

.800

-.410

-.410

70

69.939

.683

.683

-.8486

-.8486

2.0722

2.0706

-4.9814

—4.9784

3.2841

3.281 1

 

 

ED Equal
variances
assumed
Equal
variances
not

 

.635

 

.428

 

2.137

2.146

 

71

70.966

 

.036

.035

 

4.9767

4.9767

 

2.3291

2.3189

 

.3326

.3528

 

9.6208

9.6006

 

 

. __assumed

*CA shows statistically significant difference (F+8.691,P >004).

No statiStically significant difference between Approach coping responses and the students'

gender.

67

 

Table 10

 

Levene's Test for

Egualig of Variances

 

an

df

 

[PR

SC

[AR

SR

‘ED

 

.____ass.umssl

.___mmssl

__assumad

Equal
variances
assumed
Equal
variances
not

3.691

.059

.489

.526

71

55.408

Z-Stfil'ed

.626

.601

t-test for Equality 0

Mean
Difference

1.0162

1.0162

fMeans
,__L

 

Std. Error

Difference
_

2.0762

1.9312

95% Confidence

Lower
-3.1237

—2.8534

Interval of the
U53

5.1560

4.8857

 

Equal
variances
assumed
Equal
variances
not

.211

.648

-.649

-.626

71

41.869

.519

.535

-1.4226

-1.4226

2.1934

2.2718

-5.7962

-6.0077

2.9510

3.1625

 

Equal
variances
assumed
Equal
variances
not

m

.016

.900

-.235

—.245

71

51.164

.815

.807

-.6582

-.6582

2.7970

2.6816

-6.2353

-6.041 3

4.9190

4.7249

 

Equal
variances
assumed
Equal
variances
not

.329

.568

-.861

-.864

70

43.545

.392

.392

-1.8438

-1.8438

2.1419

2.1339

-6.1157

-6.1458

2.4280

2.4581

 

Equal
variances
assumed
Equal
variances
not

m

3.762

.056

.832

.926

71

60.440

.408

.358

1.8197

1.8197

2.1870

1 .9650

-2.5409

-2.1102

6.1804

5.7497

 

Equal
vanances
assumed
Equal
vaflances
not

.032

.859

1.417

1 .444

71

48.166

.161

.155

2.9651

2.9651

2.0928

2.0527

-1.2079

-1.1618

7.1381

7.092 1

 

Equal
vafiances
assumed
Equal
vafiances
not

1.063

.306

.066

.061

70

37.557

.947

.952

.1458

.1458

2.1996

2.3855

-4.241 1

-4.6852

4.5327

4.9768

 

Equal
variances
assumed
Equal
variances
not

.086

 

 

.770

 

.469

.452

71

41.678

 

 

.654

 

1.1956

1.1956

 

2.5514

2.6474

 

-3.8917

-4.1482

6.2829

6.5394

 

 

 

No statiStically significant difference between Approach coping responses and students'

age.

68

Table 11

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LeveneTs Test for
uaii of Variances t-testfor ual ofM s _
95% Confidence
51. Mean Std. Error M3! the
F 519. t df 2431 Difference Difference Lower U r
LA Equal
variances .018 .893 -1.670 71 .099 —3.2081 1.9212 -7.0389 .6226
assumed
Equal
variances -1.655 66.332 .103 -3.2081 1.9383 —7.0777 .6614
‘ nm assume;
PR Equal
variances .199 .657 .463 71 .645 .9570 2.0687 -3.1678 5.0818
assumed
Equal
variances .465 70.568 .644 .9570 2.0599 —3.1508 5.0648
'56 Equal
variances .619 .434 -.052 71 .959 -.1365 2.6351 -5.3907 5.1177
assumed
Equal
variances -.052 70.842 .959 -.1365 2.6184 -5.3576 5.0846
‘PS Equal
variances 1.823 .181 1.052 70 .297 2.1026 1.9992 -1.8847 6.0898
assumed
Equal
variances 1.065 69.961 .291 2.1026 1.9749 -1.8363 6.0414
‘CA Equal
variances 9.138 .003 -i.510 71 .136 -3.0754 2.0371 -7.1373 .9865
assumed
Equal
variances -1.547 67.625 .126 -3.0754 1.9876 -7.0419 .8911
. not assumed
AR Equal
variances .288 .593 -1.133 71 .261 -2.2436 1.9808 -6.1931 1.7059
assumed
Equal
variances -1.139 70.744 .259 -2.2436 1.9700 -6.1718 1.6846
‘ sum
SR Equal
variances .276 .601 -.672 70 .504 -1.3916 2.0704 -5.5209 2.7376
assumed
Equal
variances -.668 66.401 .507 -1.3916 2.0845 -5.5531 2.7698
‘ED Equal
variances .042 .839 -1.498 71 .139 -3.5483 2.3693 -8.2726 1.1760
assumed .
Equal
variances -1.497 69.561 .139 —3.5483 2.3701 -8.2758 1.1792

 

 

No statistically significant difference between Approach coping responses and students'

ages 21 to 25.

*CA shows statistically significant difference (F +9.138,P>.003).

69

 

TablelZ

 

Levene‘s Test for
Equality of Variances

 

51.

df

 

LA Equal
variances
assu
Equal
variances
not

. .____.i§.illm£.il

3.691

.059

.489

.526

71

55.408

_ 5233i“;

.626

.601

t-test for Quely of Means

1.0162

1.0162

Difference

 

Std. Error

Difference

2.0762

1.9312

Lower
-3.1237

-2.8534

—

95—! Confidence
Interval of the Mean

Dear
5.1 560

4.8857

 

PR Equal
variances
assumed
Equal
variances
not

.211

.648

-.649

-.626

71

41.869

.519

.535

-1 .4226

-1 .4226

2.1934

2.2718

-5.7962

-6.0077

2.9510

3.1625

 

SC Equal
variances
assumed
Equal
variances
not

.016

-.235

-.245

71

51.164

.815

.807

-.6582

-.6582

2.7970

2.6816

-6.2353

-6.041 3

4.9190

4.7249

 

PS Equal
vanances
asuuned
Equal
vanances
not

.___auumssi

.329

.568

-.864

70

43.545

.392

.392

-1 .8438

-1.8438

2.1419

2.1339

-6.1157

-6.1458

2.4280

2.4581

 

Equal
variances
assumed
Equal
variances
not

mm!

3.762

.056

.832

.926

71

60.440

.408

.358

1 .8197

1.8197

2.1870

1 .9650

-2.5409

-2.1 102

6.1804

5.7497

 

 

AR Equal
variances
assumed
Equal
variances
not

.032

.859

1.417

1 .444

71

48.166

.161

.155

2.9651

2.9651

2.0928

2.0527

-1 .2079

-1.1618

7.1381

7.0921

 

SR Equal
variances
assumed
Equal
variances
not

1 .063

.306

.066

70

37.557

.947

.952

.1458

.1458

2.1996

2.3855

-4.241 1

-4.6852

4.5327

4.9768

 

‘ ED Equal
variances
assumed
Equal
variances

not

 

.086

 

 

.770

 

.469

.452

71

41.678

 

.641

.654

 

1.1956

1.1956

 

 

2.5514

2.6474

-3.8917

-4.1482

 

6.2829

6.5394

 

 

No statistically significant difference between Approach coping responses and students'

ages 26 to 30.

*CA shows some statistically significant difference (F + 3.72,P> .56).

70

 

Table 13

 

Levene's Test for

Egualig of Variances

t-test for Equality o

 

Sig:

df

Si .
(2-ta?1ed)

if Mea__ns

 

Mean
Difference

 

Std. Error
Difference

95% Confidence

Lower

interval of the Mean

Upper

 

LA Equal
variances
assumed
Equal
variances
not
assum

1.889

.174

1.557

.913

71

2.054

.124

.455

7.5333

7.5333

4.8396

8.2473

-2.1166

-27.0663

17.1833

42.1330

 

PR Equal
variances
assumed
Equal
variances
not

in

3.020

.087

1.510

4.555

71

5.212

.135

.005

7.7381

7.7381

5.1244

1 .6988

-2.4796

3.4240

17.9558

12.0522

 

 

SC Equal
variances
assumed
Equal
variances
not

. assumed

1.047

.310

.285

.196

71

2.077

.777

.862

1.8857

1 .8857

6.61 78

9.6301

-11.3098

-38.1090

15.0813

41.8804

 

PS Equal
variances
assumed
Equal
variances
not
as um

.891

.349

.596

.823

70

2.366

.553

.485

2.9855

2.9855

5.0114

3.6294

-7.0095

-10.5318

12.9805

16.5028

 

CA Equal
variances
assumed
Equal
variances
not
assumed

.000

.992

1.575

1.309

71

2.117

.120

.315

8.0524

8.0524

5.1119

6.1512

-2.1404

-17.0625

18.2452

33.1672

 

AR Equal
vaflances
assunned
Equal
vanances
not

‘ assumgg

2.535

.116

-.758

-.451

71

2.056

.451

.695

-3.7905

-3.7905

5.0019

8.4112

-13.7640

-39.0519

6.1 830

31.4709

 

SR Equal
vaflances
assunned
Equal
vaflances
not

._____as12ms1

1.653

.203

1.378

3.119

70

3.268

.172

.047

7.0580

7.0580

5.1201

2.2626

-3.1537

.1806

1 7.2696

13.9353

 

ED Equal
variances
assumed
Equal
variances
not

__asallmad

 

1.621

 

 

.207

 

1.259

2.323

 

71

2.721

 

.212

.112

 

7.5286

7.5286

 

5.9806

3.2406

 

—4.3964

-3.4099

 

19.4536

1 8.4671

 

*PR shows some statistically significant difference (P +3.020,P>.87).

71

 

Table 14

 

LevenersTest for

Equality of Variances

t-te_st ii

lr Egualitv of Means

 

S‘L

df

Si .
(2-ta?led2

 

PR

SC

AR

SR

 

.____as§_llmd

.._____a§.:.lim_c.d

Equal
variances
assumed
Equal
variances
not

.722

.398

-2.592

-2.382

71

29.450

.012

.024

 

Mean

Difference

Std. Error
Difference

95% Confidence

JL_ower

interval of the Mean

Upper

 

-5.4274

-5.4274

2.0937

2.2 782

-9.6021

-10.0838

-1.2526

-.7710

 

Equal
variances
assumed
Equal
variances
not

.____a§.§u_m_c1

.516

.475

-1.326

-1.387

71

37.571

.189

.174

-3.0349

-3.0349

2.2890

2.1884

-7.5991

-7.4667

1.5293

1.3969

 

Equal
variances
assumed
Equal
variances
not

as umed

.606

.439

.020

.019

71

33.274

.984

.985

.7556-02

.755E-02

2.9473

2.9924

-5.8191

-6.0286

5.9342

6.1436

 

Equal
vanances
assumed
Equal
vaflances
not
u

1.348

.250

-.599

-.673

70

40. 540

.551

.505

-1.3605

-1.3605

2.2721

2.0223

-5.8920

-5.4459

3.1710

2.7250

 

Equal
variances
assumed
Equal
variances
not
assumed

.025

.876

—1.421

-1.403

71

33.407

.170

-3.2434

-3.2434

2.2825

2.3125

-7.7945

-7.9461

1.3078

1 .4593

 

Equal
variances
assumed
Equal
variances
not

.993

.322

.217

.202

71

30.058

.829

.842

.4840

.4840

2.2346

2.4016

-3.9717

4.4204

4.9396

5.3883

 

Equal
variances
assumed
Equal
variances
not

2.870

.095

-3.176

-3.774

70

51.414

.002

-6.8731

-6.8731

2.1644

1.8214

-11.1898

-10.5289

-2.5563

-3.2173

 

‘ assumed
ED Equal

variances
assumed
Equal
variances
not

2.946

 

 

.090

 

-2.846

-3.254

71

46.109

 

 

.006

.002

 

-7.2575

-7.2575

 

2.5500

2.2306

 

-12.3420

-11.7472

 

-2.1730

-2.7679

 

 

No statistically significant difference between Approach and Avoidance coping responses
and the students' marital status.

72

TablelS

 

LeveneTs Test for
Equality of Variances

 

slq.

 

Equal
variances
assumed
Equal
variances
not

.130

.719

-1.714

-1.743

69

48.637

gz-i'all'adz
.091

.088

t-test for Qualig oif Means
F__

Mean
Difference

-3.5408

-3.5408

 

Std. Error

Difference

2.0661

2.0312

-7.6626

-7.62 34

95§Confidence

inmal of the
Lower

Upar
.581 1

.5419

 

PR Equal
variances
assumed
Equal
variances
not

.018

.895

-.323

-.320

69

45.177

.748

.751

-.7066

-.7066

2.1879

2.2102

-5.0713

-5.1577

3.6582

3.7446

 

SC Equal
variances
assumed
Equal
variances
not

2.797

.099

-2.597

-2.238

32.199

.011

.032

-6.9353

-6.93 53

2.6704

3.0991

-12.2627

-1 3.2464

-1 .6079

-.6242

 

PS Equal
variances
assumed
Equal
variances
not

.095

.759

-2.725

-2.778

49.309

.008

.008

-5.5272

-5.5272

2.0282

1 .9897

-9.5743

-9.5249

-1.4800

-1.5295

 

Equal
variances
assumed
Equal
variances
not

.812

.371

1.771

1 .909

69

56.803

.081

.061

3.7757

3.7757

2.1323

1 .9783

-.4782

-.1860

8.0296

7.7374

 

AR Equal
variances
assumed
Equal
variances
not

.025

.876

1 .998

2.008

69

47.091

.050

.0 50

4.0691

4.0691

2.0370

2.0265

.414E-03

7.39E-03

8.1329

8.1457

 

SR Equal
variances
assumed
Equal
variances
not

. __aaslimesl

.369

.545

.713

.674

68

40.005

.478

.504

1.5471

1.5471

2.1685

2.2970

-2.7800

-3.0954

5.8742

6.1896

 

ED Equal
variances
assumed
Equal
variances
not

__assllmeL

 

1.963

 

 

.166

 

1.546

1 .470

 

69

40.677

.127

.149

 

 

3.7979

3.7979

 

2.4570

2.5828

-1.1037

-1.4195

 

8.6995

9.0153

 

 

No statistically significant difference bctween Approach and Avoidance coping responses

and the students'

race.

73

 

Table 16

 

Levene's Test for

 

 

 

Equality of Variances t-test for Equality of Means
95% Confidence
Mean Std. Error interval of the Mean

Si .
F Sig; t df (2-taglled) Difference Difference Lower Upper

 

LA Equal
variances .724 .398 .191 70 .849 .3923 2.0540 -3.7042 4.4889
assumed
Equal

3153““ .184 44.433 .855 .3923 2.1282 -3.8956 4.6803

. assumgq

 

PR Equal
variances .179 .674 -.669 70 .506 -1.4672 2.1933 -5.8416 2.9071

assumed
Equal

:zrtiances -.690 53.514 .493 -1.4672 2.1268 -5.7320 2.7975

umed

 

‘SC Equal
variances 2.978 .089 .199 70 .843 .5549 2.7930 -S.0156 6.1254
assumed
Equal
mm” .174 34.749 .863 .5549 3.1828 -5.9082 7.0180
assumgg

 

PS Equal
variances 1.679 .199 -1.319 69 .191 -2.7470 2.0824 -6.9013 1.4074
assumed
Equal
mums -1.412 59.598 .163 -2.7470 1.9454 -6.6388 1.1449
sum

 

‘CA Equal
variances .075 .785 -.905 70 .369 -1.9745 2.1829 -6.3282 2.3792
assumed
Equal
mm“ -.928 52.799 .357 -1.9745 2.1269 -6.2410 2.2920
assumed

 

 

‘ AR Equal
variances .382 .538 -.423 70 .674 -.8860 2.0940 -5.0623 3.2904
assumed
Equal

mm” -.416 46.901 .679 -.8860 2.1280 -5.1672 3.3953

‘ §§§ngg

 

SR Equal
variances 1.246 .268 1.503 69 .138 3.2548 2.1662 -1.0667 7.5762
assumed

Equal

mums 1.608 59.598 .113 3.2548 2.0236 -.7937 7.3032

. §S§Qfll§d

 

ED Equal
variances 1.232 .271 .555 70 .580 1.3617 2.4514 -3.5275 6.2509
assumed
Equal

mum” .588 57.438 .559 1.3617 2.3161 -3.2755 5.9989

_asaumaii

 

 

 

 

 

 

 

 

 

 

 

 

No statistically significant difference between Approach and Avoidance coping responses
and students' year in school.

74

BIBLIOGRAPHY

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Brammer, Lawrence M., How to Cope with Life Transitions, The Challenge of
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Endler, Norman 5., and Parker, James D. A., Assessment of Multidimensional Coping:
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