In Mexico, psychological well-being (PW) has been little studied during medical training. Most research tends to focus on pathologies such as depression, anxiety, stress, burnout and suicidal ideation (1-3), leaving a gap in knowledge about the importance of caring for PW of physicians (4).

During their training, doctors are exposed to long working hours and highly competitive environments; in addition, they face situations of abuse or harassment (5,6). This situation results in the deterioration of their PW, which facilitates the development of physical (7) and psychological (8-10) pathologies, and in a weakening of their ability to empathize with people (11,12).

It is increasingly relevant to study the PW. Starting from humanistic psychology, it articulates the concepts of Erikson’s life-cycle theories (1959), Roger’s fully functioning person (from 1961) and Maslo’s self-realization (1968), mainly (13), to what today is known as positive psychology, which was given its name by Seligman in the late 1990s (14). Two approaches have been proposed for its study: hedonics and eudaimonics. The first is mainly related to happiness, satisfaction with life and positive or negative affectivity (subjective well-being); the second is linked to the development of human potential (psychological well-being) (13).

PW includes both evaluative elements and reactions and emotional states that the person experiences throughout life (7). For the present study, PW is understood according to the multidimensional model proposed by Ryff in 1989, which is composed of six dimensions: (i) self-acceptance, which refers to the degree of satisfaction that a person has with himself or herself, being aware of his/her strengths and limitations; (ii) autonomy, which indicates the ability to maintain individuality and independence in decision-making; (iii) positive relations with others, which refer to the extent to which the person has stable and socially significant social networks; (iv) environmental mastery, which refers to the perception of an individual’s control and influence over his/her environment; (v) purpose in life, which relates to the goals that the individual sets for himself or herself in life and which give meaning to it; and (vi) personal growth, which considers the effort to continue developing all personal potentialities and capabilities (15). This model has been used the most, since adequate reliability and validity indicators have been found (13).

Studies performed worldwide have found that PW is associated with low work burnout (16), and is also considered an important predictor of interpersonal relationships and optimal psychological functioning (17). In general, people with high levels of PW have been shown to cope better with the demands and challenges of the environment (18), are more productive and valued at work, endure pain better, take better care of their health, show more flexible thinking and accept different opinions (14); in addition, some research shows that PW has a role in both prevention and recovery from physical illness (7). Other studies have shown that an education based on psychological well-being improves students’ learning and creativity (19), and helps them to be more motivated and perform better academically (20,21).

In the field of medical education, a negative correlation has been observed between well-being and anxiety (22). In addition, it has been shown that it is possible to modify PW through intentional activities. An example of this are several studies carried out in different parts of the world in the last decade, which agree that after applying a mindfulness-based program in population of the health area, an improvement was observed in both PW and attitudes associated with patient-centered care, including empathy (23-25); a reduction in burnout, anxiety and other emotional problems of the students was also achieved (26,27). In this sense, other studies suggest that through this type of interventions, medical errors related to the doctor’s lack of awareness about his/her own cognitive and affective processes could be reduced (28). All this indicates that with appropriate interventions aimed at medical residents, it is possible to improve PW levels and its consequences. In Mexico, no information was found on this subject in relation to medical residents.

Based on the available evidence, it is concluded that incorporating activities aimed at caring medical residents’ PW into the curriculum, based on the promotion of positive thinking, emotions and behaviors and the development of individual strengths, will be very beneficial, not only on a personal level, which will be reflected in a decrease in stress, anxiety and depression, but also in better academic achievement, professional performance and greater empathy with patients.

To identify the PW levels in first to fourth year medical residents of a public university in Mexico.

Descriptive, cross-sectional, not experimental study.

The objective of the study was to identify the levels of PW of medical residents of a public university in Mexico and the need to include this aspect in the formal curriculum of medical education. From the paradigm of positive psychology on PW, the situation prevailing among medical residents in this study was evidenced, highlighting the importance of incorporating into the formal curriculum of the medical specialties permanent activities aimed at promoting PW, taking as an example universities from other countries where it has already been proven to be effective in reducing the risk of developing depression, stress, anxiety and burnout, focusing on recognizing students’ strengths and achievements, which will help them to develop a more rewarding work during their training stage and in their later professional life (30).

Under this line, the results showed that most of the population studied has medium to low levels of PW, after considering the global scores. In the analysis of the sociodemographic variables, men had the lowest levels, while those living in consensual union and those who came from outside the host city had the lowest levels, similar to what was found in a study carried out in Chile, in students of health careers (19). It should be noted that the scale was validated with the study population and that better adjustments were found with only 4 dimensions and not with 6, as in the original Ryff scale, similar to the validation made in Mexican university students in 2017 (31).

With regard to the analysis of the self-acceptance dimension, it was observed that first and second year residents had medium levels, third year residents had the lowest levels, while fourth year residents had the highest levels. This does not coincide with the theory, since it mentions that throughout their professional training, many doctors see a deterioration in their perception of their talents and potential (11), and although from the first to the third year such a situation was observed, in last year residents this changed, and most showed high levels of self-acceptance, which was possibly due to the size of the sample of these residents.

Autonomy and personal growth were merged as one dimension. After adaptation to the study population, a trend towards low levels was observed in first, second and third year residents, while most of fourth year residents had medium levels. This situation could be due to the fact that decision-making regarding academics and patients is usually in the hands of treating physicians or senior residents.

In terms of the dimension of positive relations with others, it was again observed that first and second year residents had low levels, and third year residents had medium levels; most fourth year residents had again low levels. In accordance with what has already been mentioned about the adverse context in which the residents find themselves (5,6), and taking into consideration that most of the population in this study comes from different Mexican states, most of which had low levels, it can be inferred that being far from their families and friends, added to the working hours that prevent residents from sharing with them, could explain this result, since personal relationships could be affected.

Finally, in the dimension of environmental mastery, it was observed that most first- to third-year residents had low levels, while fourth-year residents were divided in half between medium and low levels. These findings are an essential part of the study, as they confirm that medical residents do not have the tools to cope with the adverse environments in which they carry out their daily activities as students and as doctors, so they are absorbed by their context, without being able to regain control. This could be related to the results of research showing the development of pathologies such as depression, anxiety, stress and burnout during the training period (2,3-6) which suggests that there is a lack of psychological strategies to prevent them as an obligation of medical education.

A strength of the present study is that the scale was adapted to the population following strict psychometric criteria. The tools cannot be used without proper psychometric validation, as this leads to distorted and inaccurate scores, by not taking into account the psychosocial factors that induce variability in the population studied (29,32). On the other hand, this causes problems when comparing the data obtained with those of the present study, since in most cases the authors do not offer the validation work that they carried out with their scales. More work using strict psychometric procedures is required in order to compare their results with those obtained in this research.

More than half of the residents had medium to low levels on the psychological well-being scale, both in the overall score and in each of its dimensions. This highlights the importance of making relevant adjustments to the formal curriculum of medical education, taking up again the contributions offered by positive psychology, since this has shown an improvement in psychological well-being, and therefore a decrease in depression, anxiety and stress symptoms. In other words, it is pertinent to begin to include psychological well-being as one more competence to be developed during medical education. It is important to do more research in this population.

The conditions of schedules and activities of the participants did not make it easy for them to attend the sessions in which the information was collected, so they were excluded from the study.

The authors wish to express their gratitude to Dr. Jorge Sánchez Mejorada, for his support in approaching medical residents and in facilitating the collection of information; also to the authorities of the UMRR where the survey was conducted.