Exploring the Mediation of Stress and Emotional Exhaustion on Academic Ineffectiveness and Cynicism Among University Students
Article information
Abstract
Objective
This study explored the indirect effects of emotional exhaustion and academic ineffectiveness on the relationship between perceived stress and cynicism in university students, also examining the moderating role of preprofessional internship (PI).
Methods
A cross-sectional predictive study was conducted that explored the relationship of predictor variables with some criterion variable. Data were obtained through an anonymous survey to which 950 students from two private universities responded (Mage=23.2±2.2 years, 52.7% women). Structural equation modeling was used to test mediation and moderation.
Results
Emotional exhaustion and academic ineffectiveness mediated the relationship between perceived stress and cynicism. Likewise, the implementation of PI moderated both the relationship between perceived stress and emotional exhaustion and the relationship between emotional exhaustion and cynicism.
Conclusion
These findings provide evidence that perceived stress is associated with increased cynicism through symptoms of emotional exhaustion and academic ineffectiveness. Furthermore, this relationship is moderated by the completion of PI.
INTRODUCTION
University students usually experience different stressful situations due to overloaded activities, longer study hours, mandatory academic requirements, low participation in recreational activities, among others [1,2]. Especially, health science students are likely to present higher levels of stress because they begin to clinically care for patients as part of their professional training at an early age, with a lack of knowledge and experience [3]. In addition, they have courses that involve a greater emotional effort in dealing with other people [4]. In the academic health field, there is a strong demand for access to the best medical residency programs; this implies that students, throughout their academic training, participate in different activities (e.g., exams, lectures, health promotion campaigns, among others) to gain acceptance [5].
These aspects can develop higher levels of burnout throughout university studies since they promote prolonged and constant exposure to emotional and interpersonal stressors [6]. Specifically, academic burnout presents three dimensions that explain the appearance of feelings of emotional exhaustion, cynical attitudes, and academic ineffectiveness [7]. One of the major consequences of burnout in university students is cynicism, which refers to an attitude of inhibition, indifference, and detachment towards academic activities, as well as demotivation and rejection of studies [8,9]. It is considered as the cognitive dimension of burnout due to a perception of a certain injustice or an assessment of incongruence between the effort given and the rewards obtained [10].
Another characteristic of increased prevalence in university students with burnout is emotional exhaustion, which is defined as a feeling of nervousness, frustration, fatigue, and lack of energy, due to the overload of academic demands [7], as well as the loss of emotional and physical resources [11]. In addition, mild transitory ailments (e.g., headache, back pain, among others) and psychosomatic problems experienced by students are considered as another predictive aspect of emotional exhaustion, as referred to in the theoretical model of emotional exhaustion by González Ramírez and Landero Hernández12 In a meta-analysis conducted by Kaggwa et al. [3], it was reported that 27.8% of health science students experienced stress due to the overload of their activities. In another meta-analytic study conducted in students of clinical specialties on various continents, it was shown that 40.8% of university students experienced feelings of fatigue and loss of energy due to multiple academic factors, such as starting the preprofessional internship (PI) program or the development of competencies that serve in clinical practice [13].
Likewise, evidence has been reported that 30.2% of students reported emotional exhaustion in the face of academic demands, leading to a higher manifestation of stress in a study of 1,600 university students from 6 countries [14]. This central component of burnout is of greater concern in Latin American university students who tend to carry out extracurricular activities such as volunteering and social work related to health, where they show a greater physical and psychological effort to provide better emotional treatment to the people they serve, which can lead to higher levels of academic burnout [15].
Perceived stress is based on the theory of interaction between the subject and his environment [16], which postulates that stress develops within a situation that the person values as demanding and lacks the resources to cope with it [17]. In the academic context, students’ stress occurs due to a greater mismatch between the resources needed to meet academic demands and the requirements of the activity itself [18,19]. Students who report elevated levels of stress tend to exhibit emotional and cognitive impairment, which manifests itself as a greater perception of emotional exhaustion [12,20]. Furthermore, having high levels of stress will make it difficult for them to control their behaviors and obtain adequate academic performance, which favors the appearance of academic ineffectiveness [21].
Emotional exhaustion is one of the most prevalent predictors of cynicism, especially in South American university students who have more stressful experiences (somatic and physiological) in the face of economic and social demands [18]. Since it is more difficult for them to pay the expenses required for their professional training and basic needs, many students are forced to work to finance their subsistence [22]; while in social demands we can recognize the negative relationship with teachers or peers, as well as the increase in academic demands due to changes in student policies (e.g., increased hours in PI, more formative or extracurricular course) [23].
The lack of resources to cope with these demands, along with the overexertion of health professionals, favors the manifestation of physiological and emotional reactions experienced as negative, which generate an imbalance between perceived expectations and the reality of the university environment. This, in turn, can promote disaffection with academic activities and even desertion or abandonment of studies [10,22].
González Ramírez and Landero Hernández [12] report that one of the most prevalent symptoms of emotional exhaustion in university students is difficulty sleeping or getting up (insomnia) due to the overload of tasks that brings with it states of drowsiness and daytime sleepiness that affect motivation for studies, which can foster rejection or disinterest in university life [24,25]. This, together with the perception of a lack of reciprocity between the effort made and the achievements obtained, can reinforce greater cynicism [12,26]. Specifically, health sciences students start their professional training with the intention of helping others; however, when they start PI and realize the limitations of the healthcare system (e.g., precarious infrastructure, prolonged daily hours of unpaid PI, poor delimitation of rights and obligations), they generate greater feelings of frustration, rejection, indifference, and emotional distancing from academic activities [15,25-27].
It has also been recorded that the reduction in mood experienced by university students in certain areas of health sciences influences the appearance of cynicism, especially allowing the development of a contemptuous or cynical mood that helps them to deflect negative feelings inherent to clinical care [28,29]. This is in line with González Ramírez and Landero Hernández [12] who reinforced the concept of emotional exhaustion by adding certain somatic, emotional, and physiological symptoms that are the product of stress and tend to increase cynical attitudes.
Academic ineffectiveness is also considered as a cognitive dimension of burnout, since it is defined as the tendency to perceive negatively or pessimistically the achievements experienced in relation to studies [7]. Likewise, it is determined as the lack of competencies that people must solve problems, achieve their goals, or participate in the academic context [30]. Unlike other dimensions, academic inefficiency has an independent development because it is usually generated because of a lack of personal resources, while emotional exhaustion and cynicism are due to the overload of student work and situations of conflict with peers [6,10,11]. Consequently, there are proposals that identify academic ineffectiveness as a predictor of cynicism [31,32], since the latter is conceived as a negative coping strategy that helps students overcome unpleasant events. These strategies are generated due to the increased incidence of emotional fatigue and the low efficacy in the face of studies [26].
It should be noted that PI is a crucial period in student training because it allows them to develop competencies that help them build their professional identity within the real work environment, which is a requirement to obtain a professional degree [15,33]. In addition, it is a medium that triggers greater feelings of burnout in students due to the large number of demands required [34]. Despite this, no studies have been found that analyze the moderating effects of PI on the relationship of emotional exhaustion with stress and cynicism in university students of health sciences, making this study a pioneer in South America. Students who do PI in health care settings are likely to experience a higher mental workload, impaired cognitive skills, and less time for studies [35]. In turn, subjects who begin their training in the field of health sciences tend to show a certain degree of idealism, as they are oriented toward helping other people and doing the right thing [36].
However, when PI is performed, idealism tends to disappear, due to a greater experience of emotional fatigue, the development of insensitive attitudes, and less interest in helping their patients, and cynicism toward academic activities increases [27,37]. For example, Chacaltana Linares and Rojas Cama38 reported that university students in clinical training who do their internship have a high degree of burnout and a reduction in the performance of recreational activities. Likewise, the study by Miranda-Ackerman et al. [39] reported a higher prevalence of burnout, especially in the dimensions of emotional exhaustion and cynicism, in bachelor’s degree students in the health field who take PI during the last internship period, as opposed to students who are just starting their university studies.
Consequently, the present study proposed the following hypotheses: (H1) Emotional exhaustion maintains a significant indirect effect on the relationship of perceived stress with cynicism. (H2) Academic ineffectiveness maintains a significant indirect effect on the relationship of perceived stress with cynicism. (H3) PI performance moderates the relationship between perceived stress and emotional exhaustion. (H4) PI performance moderates the relationship of emotional exhaustion with cynicism (Figures 1 and 2).
Mediation model. This model illustrates the mediating role of emotional exhaustion and academic inefficacy in the relationship between perceived stress and cynicism. The arrows represent the hypothesized causal pathways, where perceived stress influences emotional exhaustion and academic inefficacy, which in turn contribute to cynicism.
Moderation model. This model extends the mediation framework by incorporating pre-professional practices as a moderating variable. The dashed arrows indicate the moderating effects, suggesting that pre-professional practices may influence the strength of the relationships between perceived stress, emotional exhaustion, and cynicism. The direct and indirect pathways from perceived stress to cynicism remain consistent with the mediation model.
METHODS
Procedure for selecting participants
In the first instance, the authors were asked for the corresponding permissions to use the measurement instruments, which were cordially granted. Then, through a letter issued by the Universidad César Vallejo, the selected universities were contacted to coordinate possible evaluation dates. The application of the instruments was carried out between March and April 2019 with the permission of the teachers, who granted 30 minutes to apply the instruments inside the university classroom. Written informed consent was obtained from all participants. Before the evaluation, the instructions, purpose, and precautions were explained to all students. Similarly, it was mentioned that the survey was anonymous, ungraded, and individual.
Additionally, students could withdraw from the study at any time if they wanted. Two trained researchers oversaw the collection and supervision of the correct execution of the data, where 10 subjects were excluded because they did not meet the inclusion criteria. The survey attrition rate was 1.05%. It should be noted that the code of ethics and deontology of the Peruvian College of Psychologists was always respected, as well as the ethical principles described in the Declaration of Helsinki.
Participants
This was a cross-sectional predictive study, since it explored the relationship of predictor (independent) variables with some criterion variables (dependent variables) [40]. The sample size was 950 students from two private universities in the city of Lima, Peru. A total of 501 women (52.7%) and 449 men (47.3%), 17 to 37 years old (mean=23.2, standard deviation=2.21 years), were pursuing careers in health sciences (medicine=460, psychology=245, nursing=120, and nutrition=125), of which 54.8% did not do PIs, while 45.1% of the participants did PIs. The sampling was nonprobabilistic and purposeful. Inclusion criteria were 1) health science students, 2) 18 years of age or older, 3) the ability to understand the questions on the questionnaires, and 4) the completion of the written informed consent. Exclusion criteria were indication of alcohol or drug use, improperly completed surveys, or refusal to respond to the informed consent form. An a priori size calculator for the structural equation model was used to calculate the required sample size (n=518), given the number of observed and latent variables in the model, the minimum expected effect size of 0.20, a probability level of 0.05 and a statistical power of 0.95 according to previous statistical mediation studies [41].
Instruments
Perceived stress
We used the Perceived Stress Scale of Cohen et al. [42] in the Peruvian version for university students validated by Guzmán-Yacaman and Reyes-Bossio [43]. This measure is composed of 7 items and has a Likert scale with five response alternatives ranging from 0 (never) to 4 (very often). A higher score represents a high expression of stress levels. An example item is “In the last month, how often have you felt nervous or stressed?” Cronbach’s alpha for stress expression was 0.77 in Peruvian university students [43].
Emotional exhaustion
The Emotional Fatigue Scale of González Ramírez and Landero Hernández [12] in the Peruvian version validated by Dominguez Lara [44] was used to measure emotional fatigue. It has 10 items structured in a unidimensional model. The response modality is Likert with alternatives from 1 (rarely) to 5 (always). Higher scores demonstrate a greater presence of emotional exhaustion. Examples of items are: “I feel low in mood, like sad, for no apparent reason” and “I feel tired at the end of the study day.” Reliability yielded a Cronbach’s alpha value of 0.87 [44].
Academic ineffectiveness
Furthermore, we used the academic ineffectiveness subscale of the Maslach Burnout Inventory-Student Survey (MBI-SS) created by Schaufeli and Buunk [7] and adapted by Hederich-Martínez and Caballero-Domínguez [45] (2016). It consisted of five items that are reverse scored with a Likert scale of seven response alternatives (0=every day, to 6=never). Students with higher scores had a high degree of academic ineffectiveness. An example of the item is: “In my opinion, I am a good student.” The adapted version showed a Cronbach alpha coefficient of 0.82 for the academic ineffectiveness subscale.
Cynicism
We used the cynicism subscale of the MBI-SS created by Schaufeli and Buunk [7] and adapted in Colombia by Hederich-Martínez and Caballero-Domínguez [45]. It presents 4 items that are scored directly with a Likert scale of seven response alternatives, ranging from 0 (never) to 6 (every day). Higher scores determine a more cynical attitude. Examples of items are “I have lost enthusiasm for my career” or “I doubt the importance and value of my studies.” The adapted version showed adequate reliability for cynicism with a Cronbach alpha coefficient of 0.72.
Ethical considerations
Ethical approval for this study was obtained from an independent ethics committee prior to its execution (Reference 046-2019). Following this approval, permission was requested and obtained from the academic authorities of the two universities to apply the measurement instruments. After receiving permission from these institutions, possible dates for evaluation and data collection were coordinated. With the permission of the teachers, who allocated 30 minutes, access to the classrooms was granted. Furthermore, all participants were informed that the survey was anonymous, their names would not be revealed, and their information would be kept confidential and used exclusively for research purposes. Participants were also informed that they were not required to answer all questions and that they could withdraw from the study at any time if they wished. All procedures adhered to the ethical guidelines established in the Declaration of Helsinki and followed the ethical and professional principles outlined in the Code of Ethics and Deontology of the Peruvian College of Psychologists. Before data collection, the study’s objectives were clearly explained, and written informed consent was obtained from all participants. Informed consent was the first document attached to the survey.
Data analysis
Descriptive results and internal consistency values were demonstrated for each of the variables analyzed. Structural equation modeling (SEM) was used to test the direct and indirect effects of the statistical mediation model, which was found with the unweighted least squares estimator [46], as has been demonstrated in previous studies [41].
In mediation models, it is recognized that a third variable affects the direct relationship (independent variable to a dependent variable) because it considers another causal path or an indirect effect that goes from the independent variable to the mediator and from the mediator to the dependent variable [40].
For partial mediation, both direct and indirect effects should be found to be statistically significant; however, full mediation is recognized when the direct effect is found to be reduced to a nonsignificant relationship. The overall fit of the model was considered with the approximation root mean square error (RMSEA), the comparative fit index (CFI), the Tucker-Lewis index (TLI) and the standardized root mean square residual (SRMR) [47]. These indexes are often used to evaluate multiple mediation models, which can be understood as simultaneous mediation models that are represented with SEM [48]. The openaccess statistical program jamovi (version 1.8.4; https://www.jamovi.org/) was used for the analysis of the results.
Through subgroup analysis, the moderating effect of regression paths that integrated the mediating variable of emotional exhaustion was tested. The difference in the statistical significance path coefficient between the two groups (PI and no PI) was considered evidence that there was a moderation effect in this path, which would demonstrate significance for moderate mediation indices. Bootstrapping was performed with 5,000 samples for moderate mediation analysis based on the conditioning parameter by factoring subgroups according to the categories of the moderator variable (with and without PI) using the Jamovi Advanced Mediation Model (jAMM) module of the jamovi statistical program [49].
RESULTS
Table 1 reports the descriptive data of the study variables that refer to a nonnormal distribution of the data regarding health care self-efficacy and psychological distress. The study variables presented adequate reliability values (ω>0.70). The correlational validity of the variables was considered using a confirmatory factor analysis as a preliminary step for predictive models with indirect effects. Which reported significant relationships between the variables used (Table 2) and adequate goodness of fit indices (χ2/df=1.11, SRMR=0.012, RMSEA=0.026 [0.019–0.036], CFI=0.99, and TLI=0.99). The structural predictive model with indirect effects of the research objective presented adequate goodness of fit indices (χ2/df=1.41, SRMR=0.022, RMSEA=0.056 [0.029–0.076], CFI=0.99, and TLI=0.99).
Descriptive data of the study variables
Correlation of variables using confirmatory factor analysis
The indirect effects obtained were significant for the mediating variables, emotional fatigue, and academic ineffectiveness. Specifically, two indirect pathways were found to predict cynicism: stress-exhaustion-cynicism (β=0.133, p<0.001) and stress-inefficacy-cynicism (β=0.052, p<0.001). This allows us to conclude that both predictive models refer to total mediation, since the direct effect (stress-cynicism) was reduced to a nonsignificant relationship (β=0.004, p=0.931). The dependent variable of emotional exhaustion had an explained variance of 0.326 considering a measure of medium effect (0.25≥R2≥ 0.50) that is above the minimum recommended value of practical significance in clinical research (R2≥0.04) [50] and provides greater causal predictive validity (Table 3).
Analysis of mediation effects
In Table 4, our objective was to assess whether the indirect effects of perceived stress on cynicism are moderated by the execution of PI. It is recognized that PI significantly moderated the effect of perceived stress on emotional exhaustion (β=0.086, p<0.05), such that perceived stress had a greater positive effect for students who performed PI (β=0.159, p<0.01) compared to those who did not perform PI (β=0.076, p<0.05). Furthermore, PI moderated the relationship of emotional exhaustion with cynicism (β=0.241, p<0.05), given that emotional exhaustion had a greater positive effect on cynicism in students who performed PI (β=0.253, p<0.01) as opposed to those who did not perform (β=0.153, p<0.05). Therefore, the hypothesis that PI moderates the effect of perceived stress on emotional exhaustion and the relationship between emotional exhaustion and cynicism in Peruvian university students is significantly confirmed.
Bootstrap mediation and moderate mediation effect
DISCUSSION
The present study is of great importance to the scientific literature, as it addresses for the first time, in the Latin American context, a structural model of cynicism in health sciences students. It is recognized that within the university environment there are demands related to studies, social and financial aspects, which generate physiological and emotional reactions that hinder the fulfillment of academic work [18,22]. Among these demands are long study hours, exam demands, pressure to behave professionally, work overload, conflicts with teachers or classmates, family responsibilities and duties, lack of financial resources to pay for their studies, and personal expenses [23,51,52]. One of the most stressful academic demands is the completion of PI, as students experience greater stress when combining the demands of the work environment (with mostly no economic benefits) and academics, since they tend to prioritize only one goal, that of an intern or students [34,53]. On the other hand, the university context not only poses demands, but also provides specific resources that are positively valued and facilitate the fulfillment of academic objectives, which allow personal growth and development [18]. Students with greater resources can counteract the negative effects of academic demands [54].
The model allowed us to successfully verify the proposed hypotheses. The first hypothesis was confirmed, where emotional exhaustion significantly mediated the relationship between stress and cynicism (H1). Similarly, Basri et al. [19] showed that emotional exhaustion was able to explain to a greater extent the relationship between academic stress and study rejection in a group of Indian university students. For several authors, emotional exhaustion is a strong predictor of cynicism throughout academic life [9,27,55]. According to Lee et al. [26], university students who are more emotionally exhausted due to the overload of academic work become less enthusiastic and find it difficult to concentrate on their studies, leading to a state of cynicism and even feelings of hatred about university activities. Additionally, academic demands and the lack of resources to cope with them can reinforce the prevalence of somatic, emotional, and physiological symptoms more characteristic of emotional exhaustion [12] as a result, the student tends to lose interest and enthusiasm for his or her professional education [21]. Likewise, emotional exhaustion can lead to different psychological reactions (for example, anxiety, depression, compassion fatigue, among others) and alter the relationship that students have with teachers or with their peers, leading to greater cynical attitudes towards studies [52].
The second research hypothesis confirms the indirect relationship of academic ineffectiveness on the relationship of perceived stress with cynicism (H2). This can be explained by Lesener et al. [18], who report that university students who lack personal resources (e.g., low self-efficacy or loss of commitment) to cope with stressful situations (academic, economic, or social demands) are more likely to experience cynical attitudes and to distance themselves from their studies. The results are similar to those reported by Gonzaga and Oblianda [21], who identified that the relationship between stress and cynicism was explained to a greater extent by a negative perception of self-efficacy in achieving academic goals. Other studies report similar findings in university students from different sociocultural contexts such as China and North America [56,57]. A meta-analytic review revealed that university students who adapt favorably to the educational context have higher perceptions of academic effectiveness and lower levels of study stress [58]. In addition, academic ineffectiveness influences the cynical attitudes of university students in the health sciences, as it facilitates the deterioration of their academic performance and the loss of interest in their professional careers [31,32]. From what has been said, it is evident that academic ineffectiveness is a link in the relationship between stress and cynicism, given that it may favor a perception of uselessness with respect to their abilities to face academic demands and the contribution that their participation in the class may have, which is related to the loss of interest and enthusiasm [18]. This may promote greater detachment and indifferent attitudes towards studies [21].
Another finding of the study was that PI performance had a moderating effect on the relationship between perceived stress and emotional exhaustion (H3). Therefore, although various authors point out that perceived stress may be related to emotional exhaustion in health science students [59,60], the magnitude of this effect may be modulated by various social factors such as studying and working simultaneously. Corrales et al. [53] report that students who complete PI have more homework overload and physical exhaustion when they have to attend classes after completing their daily PI day, as well as less time to do their homework, study for exams and obtain good grades. This is due to the increased responsibilities during the last semesters of university and the fulfillment of certain baccalaureate requirements that include attending workshops and seminars for professional specialization, as well as the development of an academic research project (thesis) and constant evaluation by professors or internship supervisors [51]. Such academic situations reinforce a higher degree of stress on emotional exhaustion in students completing PI compared to the other group. Therefore, university students in the last cycles of their professional training are not only affected by symptoms of an emotional nature, but also by the physiological, somatic and cognitive symptoms described in the theoretical model of emotional exhaustion of González Ramírez and Landero Hernández [12]. The latter have greater experiences of stress, discomfort, and exhaustion than workers, since when the weekend arrives, the latter can forget about their work and carry out other activities; however, students must perform their homework at the end of classes and during the weekend simultaneously while completing PI [15,34].
It was confirmed that the completion of the PI had a moderating effect on the relationship between emotional exhaustion and cynicism in university students (H4). In particular, students who present feelings of exhaustion, lack of energy, low mood, and homework overload tend to experience a view of pessimism, rejection, contempt, and indifference towards their studies [26,61]. Furthermore, according to a longitudinal study by Kim et al. [9], it was shown that emotional exhaustion promotes cynicism over time. Students who start with the PI program are exposed to a greater occurrence of academic demands that intensify feelings of nervousness or emotional exhaustion [53], which lead to physical and mental deterioration that generates cynical attitudes to relieve stress, let off steam or cope with the negative feelings inherent to clinical practice (e.g., contemptuous or cynical humor) [28]. From this, it can be argued that the cynicism developed by students performing PI may be linked to the disillusionment between the expectations for starting clinical care and the reality that exists within the hospital context [27,36]. This is caused by disappointment and frustration in the face of altruistic expectations to perform PI, because in this context, situations of indifference in patientphysician care are manifested by more experienced professionals [35,62]. Therefore, university students who observe such experiences are more likely to develop a high degree of academic cynicism [4,38,39].
Limitations
Some limitations were encountered in the present investigation. First, a significant limitation of this study is that it focuses exclusively on university students enrolled in health science-related fields. This sample restriction may affect the generalizability of the results, as students from other disciplines might experience different levels of stress, emotional exhaustion, academic ineffectiveness, and cynicism. The specific characteristics of health science programs, such as the intense academic workload and practical demands, could uniquely influence the variables investigated. Therefore, the findings of this study may not be representative of the general student population and should be interpreted with caution when applying the conclusions to students in other academic fields. It is recommended that future studies include a more diverse sample of students from different disciplines to enhance the understanding of these phenomena in a broader context. Second, the results were obtained using self-report questionnaires, which may imply bias in the common method. In future studies, it is suggested to collect data through multiple informants, such as teachers, family members, or classmates. Finally, the design of the cross-sectional study limits the causal interpretation of the results, which may generate a possible bias in the research by not providing solid evidence of causality. Therefore, it is suggested that other researchers conduct longitudinal studies to verify whether the relationships remain stable over time.
Public health implications
The findings of the current study provide evidence that perceived stress can trigger increased cynicism through symptoms of emotional exhaustion with academic ineffectiveness, which are moderated by the completion of the PI. Therefore, our findings have obvious implications for university health centers, organizations, and public health agencies interested in designing, implementing, and executing educational programs related to the prevention of emotional exhaustion and perceived stress, improving academic efficiency, and PI among university students through psychological interventions. Similarly, future health campaigns implemented in university centers should focus on communicating the dangers of psychological stress resulting from overloaded academic activities, longer study hours, mandatory academic demands, low participation in recreational activities, among others. Finally, the identification of possible mental health problems in university students will be of great help in the application of support, protection, and basic care measures related to mental health.
Conclusion
The study provides some of the first empirical data to examine the extent to which emotional exhaustion and academic ineffectiveness have an indirect effect on the relationship of perceived stress with cynicism. Furthermore, it was shown that PI performance had a moderating effect on the relationship between perceived stress and emotional exhaustion, as well as the relationship between emotional exhaustion and cynicism in university students. Despite the cross-sectional nature of this study, the results found may help in the recognition of possible mechanisms of mediation and moderation of perceived stress with cynical attitudes in health sciences university students.
Notes
Availability of Data and Material
The data sets generated to support the findings of this study are not publicly available but can be requested from the corresponding author.
Conflicts of Interest
The authors have no potential conflicts of interest to disclose.
Author Contributions
Conceptualization: Cristian Ramos-Vera, Miguel Basauri-Delgado. Data curation: Cristian Ramos-Vera, Miguel Basauri-Delgado. Formal analysis: Cristian Ramos-Vera, Miguel Basauri-Delgado. Funding acquisition: Yaquelin E. Calizaya-Milla, Jacksaint Saintila. Investigation: Cristian Ramos-Vera. Methodology: Cristian Ramos-Vera. Project administration: Yaquelin E. Calizaya-Milla, Jacksaint Saintila. Resources: Cristian Ramos-Vera. Software: Cristian Ramos-Vera. Supervision: Jacksaint Saintila. Validation: Cristian Ramos-Vera. Visualization: Cristian Ramos-Vera. Writing—original draft: Miguel Basauri-Delgado. Writing—review & editing: Yaquelin E. Calizaya-Milla, Jacksaint Saintila.
Funding Statement
Funding for Open Access Charge: Universidad Señor de Sipán and Universidad Peruana Unión.
Acknowledgments
We thank the authorities of the two universities who have given us the necessary authorization and support; we also thank all students who participated in the study.