RESEARCH REPORT

Resilience Does Not Predict Academic Performance inGross Anatomy

Rodrigo Enrique Elizondo-Omana,* Marıa de los Angeles Garcıa-Rodrıguez,Jose Miguel Hinojosa-Amaya, Eliud Enrique Villarreal-Silva, Rosa Ivette Guzman Avilan,Juan Jose Bazaldua Cruz, Santos Guzman-LopezDepartment of Human Anatomy, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey,Nuevo Leon, Mexico

Few studies have evaluated resilience in an academic environment as it relates to aca-demic success or failure. This work sought to assess resilience in regular and remedialstudents of gross anatomy during the first and second semesters of medical school and tocorrelate this personal trait with academic performance. Two groups of students werecompared: the first group included first-year medical students in the regular course, andthe second group included first-year medical students who did not pass the regular anat-omy course and so were enrolled in the remedial course. Both groups completed anony-mous surveys designed to gather demographic data and establish scores on the Connor-Davidson resilience scale, which includes 25 statements rated zero to four on a Likertscale (maximum score 100). The average resilience score was the same for both groups,80 6 9. The average anatomy grades differed significantly between regular students(67 6 15.0) and remedial students (61 6 12.0). While there was no overall correlationbetween resilience score and anatomy grade, regular students with resilience scores of 75or greater showed slightly better academic performance than their classmates. Similarly,remedial students with resilience scores of 87 or greater faired better academically. Resil-ience does not predict academic performance in gross anatomy, and further work is nec-essary to identify those intrinsic and extrinsic factors that influence students’ achieve-ments. Anat Sci Educ 3:168–173, 2010. © 2010 American Association of Anatomists.

Key words: gross anatomy; resilience; academic success; achievement

INTRODUCTION

The term ‘‘resilience’’ was coined in the 1970s to describe thecapacity of certain children to make significant achievementsin life despite adverse living conditions that would beexpected to predispose them to ‘‘fault’’ or failure (Best et al.,1997). Resilience has since been recognized as a multidimen-

sional characteristic of each person that varies with context,

time, age, gender, and cultural origin (Werner and Smith,

1992; Bush and Wilson, 1997; Bosworth and Earthman,

2002). Individuals establish their own bio-psycho-spiritual

balances and adapt their bodies, minds, and spirits to the spe-

cific circumstances they face (Sagor, 1996; Werner and Smith,

1992). Intrinsic and extrinsic stressors are constantly present,

and it is one’s ability to adapt to these stressful factors that

leads to success or failure. Resilience can therefore be inter-

preted as a measure of success in maintaining life balance in

the face of stressors (Bosworth and Earthman, 2002).Yiu (2005) reported that medical school introduces many

stressors that can affect students’ well-being (Malik, 2000).Such stressors include information overload, financial debt,limited free time, new or strained interpersonal relationships,culture shock (Kovatz et al., 2006), and fear of academic fail-ure (Rak and Patterson, 1996; Malik, 2000). In a more spe-cific sense, we suggest that failure of the regular gross anat-omy course and the subsequent requirement to pass a reme-

*Correspondence to: Dr. Rodrigo E. Elizondo-Omana, Departamentode Anatomıa Humana, Facultad de Medicina, Universidad Autonomade Nuevo Leon, Ave. Madero y Dr. Aguirre Pequeno s/n. Col. MitrasCentro. Monterrey, Nuevo Leon, Mexico. C.P.64460. E-mail:rod_omana@yahoo.com

Received 18 February 2010; Revised 26 March 2010; Accepted 7 May2010.

Published online 21 June 2010 in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ase.158

© 2010 American Association of Anatomists

Anat Sci Educ 3:168–173 (2010) JULY/AUGUST 2010 Anatomical Sciences Education

dial anatomy course (Daly, 2010) constitutes a significantstressor for students and that only more resilient studentswould ultimately succeed in the remedial course (Elizondo-Omana et al., 2004).

Few studies have evaluated resilience in an academicenvironment (Embry, 1997; Gonzalez and Padilla, 1997;Henderson and Millstein, 2002; Kiessling et al., 2004), butthey have generally found that resilience factors into aca-demic success or failure (Sagor, 1996). We designed a studyto correlate resilience of gross anatomy students (regular andremedial) with their academic performance. We hypothesizethat students with higher scores on a standardized resiliencescale would attain higher anatomy course grades than stu-dents with lower resilience scores on the same scale.

METHODS

Described here is an observational study comparing resiliencescores and academic performance in two groups of medicalstudents, the first group being ‘‘regular’’ students attemptinggross anatomy for the first time and the second group being‘‘remedial’’ students enrolled in a second anatomy course afterhaving failed the regular course in an earlier semester. Afterproviding informed consent, students completed anonymoussurveys that gathered demographic data and established ascore on the Connor-Davidson resilience scale (Connor andDavidson, 2003). Final grades in the gross anatomy coursewere later extracted from students’ academic files.

The same survey and process were used for all students.The regular and remedial groups differed by the course inwhich students were enrolled and by the semester of saidcourse. Regular students took the standard (regular) grossanatomy course in the first semester of their first year of med-ical school. Remedial students had failed the regular anatomycourse in their first semester and so were enrolled in the re-medial intensive gross anatomy course in addition to theirother (most commonly second semester) courses. This extracourse load was considered an additional stressor faced by re-medial students but not regular students. We have previouslydemonstrated that there is no significant difference betweenthe grades of first-time students in the gross anatomy regularcourse and remedial students, despite the latter having al-ready been exposed to the course material. Repeating thegross anatomy course is not considered an academic advant-age (Elizondo-Omana et al., 2006).

The survey used in this study is shown in the Appendix,including demographic questions and the 25-item Connor-Davidson resilience assessment instrument. Students used aLikert scale to rate each statement from zero (never) to four(always), yielding a possible resilience score between zero and100. Final anatomy course grades also had a possible rangefrom zero to 100, with 70 or above considered passing. Aca-demic mastery was demonstrated by a grade above 85 (basedon the best students’ grades in previous courses).

The regular and remedial groups were sub-divided intoquartiles based on resilience scores: (1) top quartile resiliencescores 87 to 100, (2) second quartile scores 81 to 86, (3)third quartile scores 75 to 80, and (4) bottom quartile scores50 to 74. Data were analyzed with Microsoft Office Excel1

97-2004 (Microsoft Corporation, Redmond, WA). The Pear-son correlation test was used to evaluate the relationshipbetween resilience scores and anatomy grades. The Student’sT test was used to compare the average age of students in

each group. The Chi test was used for categorical variables.Statistical significance was taken to be P less than 0.05.

RESULTS

Demographic Characteristics

The regular group included 113 students, 58 male and 55female. Most students were originally from Monterrey

Table 1.

Demographic Characteristics

Regularstudentsa

Remedialstudentsb

n Percentage n Percentage

Sex

Male 58 51.3 27 39.1

Female 55 48.7 42 60.9

Semester

First 32 28.3 0 0.0

Second 81 71.7 44 63.7

Third 0 0 7 10.1

Fourth 0 0 18 26.2

Marital status

Unmarried 113 100 68 98.6

Divorced 0 0 1 1.4

Type of family

Nuclear 100 88.5 54 78.3

Extended 5 4.4 5 7.3

Reconstituted 1 0.9 2 2.9

Disintegrated 6 5.3 7 10.1

Compound 1 0.9 1 1.4

Type of education

Private 47 41.6 14 20.3

Public 66 58.4 55 79.7

Origin

Local 78 69 38 55.1

Out of town 35 31 31 44.9

an 5 113; bn 5 69.

Anatomical Sciences Education JULY/AUGUST 2010 169

(locals, 78/113, 69%) rather than from other cities (non-locals, 35/113, 31%). More students came from public highschools (66/113, 58%) than from a private high school (47/113, 42%). The average age at the start of the gross anatomycourse was 18 years (SD 5 61 year). See Table 1.

The remedial group included 69 students, 27 male and 42female. All of these students had previously taken the regulargross anatomy course and failed to earn a passing grade. Themajority of students (63%) remediated anatomy during theirsecond semester. Slightly more than half of the remedialgroup (38/69, 55%) was from Monterrey. Seventy-nine per-cent of remedial students came from public high schools. Theaverage age was 19 years (SD 5 62 years). See Table 1.

Resilience

No significant difference in resilience scores was observedbetween regular and remedial students (average resiliencescore 80 6 9 for both groups). The frequency distribution ofresilience scores is shown in Table 2.

Academic Performance

The average final anatomy grade was 67 6 15.0 for regularstudents and 61 6 12.0 for remedial students, a statistically-significant difference. The pass rate (determined by obtaininga minimum grade of 70) was 63% for regular students and70% for remedial students.

Resilience and Academic Performance

Compared to those of their respective regular or remedialpeers, the average anatomy grades tended to be higher forregular students whose resilience scores were at least 75 andfor remedial students whose resilience scores were at least 87(Table 3). In a broader sense, however, the Pearson correla-tion test showed no correlation between resilience score andfinal anatomy grade (Fig. 1).

Only 15 (15/113, 13%) regular students attained a grade of85 or better, our operational definition of academic mastery.The mean resilience score for these students was 85.33 6 8.75.

Gender, Resilience, and AcademicPerformance

There was no statistically-significant difference between menand women in either resilience scores or anatomy grades inthe regular and remedial groups.

DISCUSSION

The objective of the present study was to evaluate resiliencyin medical students as it relates to academic performance ingross anatomy. As a remedial anatomy course represents anadditional stressor beyond those experienced by medicalschool peers, we hypothesized that more-resilient studentswould pass the course more often than less resilient stu-dents. A possible confounding factor in comparing anatomycourse grades between a group studying the subject for the

Table 2.

Frequency of Distribution According to the Score on the ResilienceScale

Score resilience scale

Total50–74

points

75–80

points

81–86

points

87–100

points

Regular 31 24 31 27 113

Remedial 19 19 12 19 69

Total 50 43 43 46 182

Table 3.

Correlation Between the Score on the Resilience Scale and the Anatomy Grade

Students Resiliencescale score

Anatomy grade

AverageStandard

deviation Range

Regular 50–74 points 64 16 52

75–80 points 69 14 51

81–86 points 67 15 56

87–100 points 68 16 58

Remedial 50–74 points 59 12 39

75–80 points 59 10 34

81–86 points 62 15 49

87–100 points 63 13 43

170 Elizondo-Omana et al.

first time and another group remediating through the samematerial is that prior teaching might predispose to betteracademic performance. We have previously shown that thereis no significant difference between the grades of first-timeand remedial students in gross anatomy (Elizondo-Omanaet al., 2004, 2006).

Gender, Resilience and Academic Performance

Previous studies have conflicting results as to whether genderinfluences resilience. From work done in Kuwait, Al-Naserand Sandman (2000) reported greater resilience in men thanwomen. In contrast, Connor and Davidson (2003) found nosignificant difference in the resilience scores of men andwomen. Our findings are in line with those of Connor andDavidson: There was no statistically-significant difference inresilience scores of men and women in the regular or reme-dial group. In terms of anatomy course grades, men andwomen performed similarly in both the regular and remedialgroups, without any statistically-significant differences. In ourstudy, gender affected neither resilience score nor academicperformance.

Origin, Resilience and Academic Performance

Our medical school is in Monterrey, Mexico, but the percent-age of students from other cities (‘‘non-locals’’) is substantial,30.1% in the regular group. This number is even higher(42.5%) in the remedial group, suggesting that being a non-local student may somehow negatively influence academicperformance. It is possible that students from other citiestend to participate in different activities and are subject toadditional pressures compared to local students, perhapsincluding doing laundry and other household chores andbeing responsible for managing money and paying for serv-ices. One might expect these additional stressors to bereflected in lower resilience scores, and indeed the average re-

silience scores were lower for non-local compared to localstudents in both the regular and remedial groups, but this dif-ference was not statistically significant (Table 1). Moreover,there was no significant difference in anatomy grades betweenlocals and non-locals in either the regular or remedial group.Despite the theoretical stress of living away from home dur-ing medical school, our findings suggest that place of origindoes not affect resilience or academic performance. There is adearth of previous reports in the literature for contextualiza-tion of these findings.

Resilience and Academic Performance

The correlation coefficient for resilience score and anatomygrade was only 0.107, independent of group (regular or reme-dial), indicating that these two variables are not significantlyrelated. While resilience may influence academic performance,so too do many other circumstances and student characteris-tics. Academic performance likely depends on such factors asintellectual capacity, intrinsic and extrinsic motivation, andpersonality type. Our results indicate that resilience score isnot related to academic performance.

Regular Versus Remedial Group

Two direct comparisons were made between the regular andremedial groups of students. First, no statistically-significantdifference was found in the average resilience scores of thegroups. We had expected remedial students to be less resil-ient, but this was not the case. If, as we had hypothesized,resilience were a positive predictor of academic perform-ance, then it would have been a relative lack of resilienceduring their first attempt at the anatomy course that led cer-tain students to fail and subsequently constitute the remedialgroup in our study. Our findings suggest, however, that fac-tors other than resilience weigh more heavily on academicperformance.

The second comparison between the regular and remedialgroups was on academic performance. Here, regular studentsoutperformed their remedial counterparts, with a statistically-significant six-point higher average anatomy grade. It shouldbe noted that the average grade was not a passing grade in ei-ther group. Ultimately, the hypothesis that students withhigher resilience scores would earn better grades in anatomywas disproven in our study. Resilience and academic perform-ance appear to be independent variables.

CONCLUSIONS

Neither gender, place of origin, nor course grade wasrelated to resilience score in regular or remedial anatomystudents.

While regular students with resilience scores of at least 75and remedial students with resilience scores of at least 87tended to earn slightly higher anatomy grades among their re-spective groups, we observed no general correlation betweenresilience and academic performance. From the present study,we must conclude that resilience is not the most influentialdeterminant of academic achievement. Further work is neces-sary in order to identify the intrinsic and extrinsic factorsthat influence students’ well being and academic performance.With this information, new educational strategies can bewisely designed to enhance student success.

Figure 1.

Anatomy grade and resilience score are not significantly correlated with eachother (r 5 0.107).

Anatomical Sciences Education JULY/AUGUST 2010 171

NOTES ON CONTRIBUTORS

RODRIGO ENRIQUE ELIZONDO-OMANA, M.D., Ph.D,is an associate professor and research coordinator in theDepartment of Human Anatomy at the School of Medicine,Universidad Autonoma de Nuevo Leon, Monterrey, NuevoLeon, Mexico. He teaches human gross anatomy to graduateand undergraduate students and is a candidate levelresearcher in the National System of Researchers (SNI) inMexico.

MARIA DE LOS ANGELES GARClA-RODRIGUEZ,M.D., is a resident of ophthalmology at the Dr. Jose EleuterioGonzalez University Hospital, Monterrey, Nuevo Leon, Mex-ico. She was formerly an associate instructor of anatomy inthe Department of Human Anatomy at the School of Medi-cine, Universidad Autonoma de Nuevo Leon, Monterrey,Nuevo Leon, Mexico.

JOSE MIGUEL HINOJOSA-AMAYA, M.D., is an instruc-tor and faculty coordinator in the Department of HumanAnatomy at the School of Medicine, Universidad Autonomade Nuevo Leon, Monterrey, Nuevo Leon, Mexico. He teacheshuman gross anatomy and is a member of the clinical-ori-ented anatomy research group.

ELIUD ENRIQUE VILLARREAL-SILVA, M.D., is a coor-dinator of activities in the gross anatomy laboratory in theDepartment of Human Anatomy at the School of Medicine,Universidad Autonoma de Nuevo Leon, Monterrey, NuevoLeon, Mexico. He teaches human gross anatomy and is amember of the clinical-oriented anatomy research group.

ROSA IVETTE GUZMAN AVILAN, M.D., is an assistantprofessor in the Department of Human Anatomy at theSchool of Medicine, Universidad Autonoma de Nuevo Leon,Monterrey, Nuevo Leon, Mexico. She teaches human grossanatomy to graduate and undergraduate students and isinvolved in medical education research.

JUAN JOSE BAZALDUA CRUZ, M.D., is a assistant pro-fessor in the Department of Human Anatomy at the Schoolof Medicine, Universidad Autonoma de Nuevo Leon, Monter-rey, Nuevo Leon, Mexico. He teaches human gross anatomyto graduate and undergraduate students and is involved inmedical education research.

SANTOS GUZMAN-LOPEZ, M.D., Ph.D., is Chair of theDepartment of Human Anatomy of the School of Medicine,Universidad Autonoma de Nuevo Leon, Monterrey, NuevoLeon, Mexico. He teaches human gross anatomy to graduateand undergradute students and is a level one researcher in theNational System of Researchers (SNI) in Mexico.

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172 Elizondo-Omana et al.

APPENDIX

Connor-Davidson Scale for the Evaluation of Resilience

Folio____ Date__/__/__ Semester ____

INSTRUCTIONS: Complete the following.

Age ___ Sex ___ 1 Male; 2 Female

Marital status ___ 1 Single; 2 Married; 3 Divorced; 4 Common-law; 5 Widow(er)

Type of family ___ 1 Nuclear; 2 Extended; 3 Reconstituted; 4 Disintegrated;5 Compound (see explanations below)

Nuclear: the father, mother and children live under the same roof

Extensive: mother, father, children and some other person(s) with a family tie (uncles,grandparents etc) live under the same roof.

Reconstituted: the children live with one parent who has remarried or lives in common-lawwith another person.

Disintegrated: the children with one parent due to divorce or marital separation.

Compound: mother, father, children and some other person(s) with no family tie live under the same roof.

Type of middle education (secondary) ___ 1 Private; 2 Public

Origin __________________

INSTRUCTIONS: Answer the following questions, assigning a value from zero to four as indicated.

Scale: 0 5 Never, 1 5 Rarely, 2 5 Sometimes, 3 5 Frequently, 4 5 Always

1. I have the capacity to adapt to change _____

2. I have close and certain interpersonal relations _____

3. Sometimes, God and destiny can help me _____

4. I can handle any situation that occurs _____

5. Previous successes give me confidence for new challenges _____

6. I see the good side of things _____

7. Fighting with stress gives me strength _____

8. I tend to return after diseases or difficulties_____

9. Things have reasons for occurring _____

10. I give my best effort no matter what _____

11. I can reach my goals _____

12. When things seem impossible, I give up _____

13. I know when to ask for help _____

14. I focus and think clearly under pressure _____

15. I prefer to take leadership when solving problems _____

16. I am not easily discouraged when I face failure _____

17. I think I am a strong person _____

18. I make difficult or unpopular decisions _____

19. I can handle disagreeable feelings _____

20. I should act on a hunch _____

21. I have a strong feeling of determination _____

22. I have control over my life _____

23. I like challenges _____

24. I work at obtaining my goals _____

25. I am proud of my achievements _____

Anatomical Sciences Education JULY/AUGUST 2010 173