BACKGROUND
Medical students experience high anxiety, depression, and burnout, with
resilience levels often below general populations globally. Higher resilience
levels measured by the validated Connor-Davidson Resilience Scale
(CD-RISC-25) are associated with reduced stress, exhaustion, and higher life
satisfaction. Therefore, exploring the protective potential of resilience is
essential. This mixed-methods study investigates resilience among medical
students and behaviors that may enhance resilience. We hypothesized that
students would demonstrate lower resilience scores than the general
population and that healthy lifestyle behaviors would support resilience.
METHODS
Resilience was assessed in 48 of 110 third-year medical students at The
University of South Carolina School of Medicine Greenville using the
CD-RISC-25, administered via Qualtrics with a $25 incentive. Scores were
compared to national norm quartiles. CD-RISC items were divided into seven
domains: hardiness, coping, adaptability/flexibility, meaningfulness/purpose,
optimism, regulation of emotion/cognition, and self-efficacy. Participants
could opt into semi-structured follow-up interviews to investigate
resilience-enhancing behaviors. Interviews were analyzed thematically, and
lifestyle and emotional questions were independently scored on a Likert-type
scale by two reviewers.
RESULTS
Mean CD-RISC-25 score was 72.2 vs. 79.0 in the US general population;
Quartiles were Q1(lowest) 41.7%, Q2 29.2%, Q3 20.8%, Q4(highest) 8.3%. The
highest scoring domain of resilience was self-efficacy, while the lowest was
optimism. Reviewer consistency was excellent (? = 0.84). 16 participants were
interviewed. Thematic analysis of the interviews revealed Q3 and Q4
participants report highly structured lifestyle behaviors (Q1 vs Q3+Q4
(P=0.0071), Q2 vs Q3+Q4 (P=0.011)) but allowed flexibility during hardship
(ns between Q3+Q4 and lower quartiles).
CONCLUSIONS
The average CD-RISC-25 score fell in the lowest quartile, associated with
anxiety, depression, and PTSD. Thematic analysis of semi-structured interview
results suggests well-structured lifestyle behaviors may support resilience,
while “giving oneself grace” during hard times. Findings highlight the need
for resilience-supportive interventions in medical education globally.