Life Orientation Test- Revised (LOT-R) Versus Academic Score in Various First Year Health Professional Students

Abstract

Introduction:
Health field per se requires mental, physical and psychological steadiness and wellbeing. In modern times decline in psychological and physical health has been observed in student after admission in health education program. Factors like perfectionism, self-esteem, personal and professional consequence have affected their academic score directly or indirectly. Life Orientation Test-Revised (LOT-R) instrument measures optimism in relation to self-esteem of individual. A better score will show more confidence level of the student.

Aim:
To find an association of LOT-R with the academic score of health professional students and assess gender variation.

Materials and methods:
A total of 350 students enrolled for academic year 2015-16 in health professional program of medicine, dental and physiotherapy institutes of Sumandeep Vidyapeeth University were considered. Non-randomized and purposive study was done by providing LOT-R questionnaire to students. Average academic score of Anatomy and Physiology course was used for analysis excluding the biochemistry due to non-availability of tangible data at the time of study. Data was collected, analysed statistically using independent t-test, ANOVA with post-hoc and correlation analysis.

Result:
Statistical significant for one-way ANOVA was assessed for academic score between the group of health professional students. While no statistical correlation of significance was observed for LOT-R score with that of academic score. As per gender distribution there was no statistical significant observation for LOT-R score within the groups.

Conclusion:
The present study highlighted the need of student's counseling for their approach towards health education; as their career. Psychological self-reliance and optimism improves the academic score. A study needs to be compared with the socio-economic status of the student to have a better understanding of the LOT-R.

Full text

Journal of Clinical and Diagnostic Research. 2016 Oct, Vol-10(10): CC01-CC05 11
DOI: 10.7860/JCDR/2016/20643.8645 Original Article
INTRODUCTION
Worldwide medical schools are ensuring that graduates are
knowledgeable, skillful and professional [1,2]. To achieve this
outcome every school has a specific curriculum which is as per
the statuary norms of the country’s Medical Council. The output
of curriculum implementation is achieved by didactic lectures,
practical and clinical sessions, modeling, supervision by instructor,
and various teaching learning tools and techniques.
Researchers have reported international decline in psychological
and physical health of a student after joining the health education
field [3,4]. Moreover, factors like self-esteem, perfectionism,
coping tactics and extroversion play a negative or positive role in
the student’s response [5]. Over and above these personal and
professional consequences and factors related to medical school
training directly or indirectly affects the academic performance of
the student.
Optimistic people react in a different manner to the situation which
arises in life which may go in favor or against. They take everything
in stride as part of the whole. However, reverse is true for people
who have a negative approach towards life. For them the life never
looks up and everything seems to be gloomy. Optimism appears
to confer resilience to stressful life events, which are associated
with risk for both onset and relapse of psychopathology [6,7].
What an individual expects from future depends upon his approach
towards life. Optimist always projects himself to achieve his target.
This approach gives him enough impetus to face the vagaries of
life. On the other hand pessimistic attitude lacks energy and drive
to fulfill the desired goal and always thinks about failure rather than
success.
Optimism is a trait, which is influenced by various parameters like
childhood environment, the presence of resources like parental
warmth, educational level and financial security, as a predictor
of adult optimism [8-11]. Perhaps optimism is more changeable
during times of life transition, when there is break from prior
experience and outcomes become more uncertain. Level of
optimism changes with the time frame as well as conditions or
environment while performing those tests. Positive psychology
constructs self- efficacy and optimism purpose to motivate the
students for constructive outcome.
Widely researchers have assessed various factors that promote
or inhibit academic achievements. These efforts have targeted
motivational constructs such as self-efficacy [12], optimism [13],
goal therapy [14], hope theory [15].
Researchers found that optimism was directly associated with
social support during first year of college, even, having larger
friendship networks within short time [16]. Some of the researchers
also proved that the level of stress among first year medical
students in India depends on Socio-Economic Status (SES) level
although they have not specified any standard for estimating SES
in their study [17].
Life Orientation Test (LOT) is to assess the individual’s difference in
optimism and pessimism developed by Scheier and Carver [13].
Several studies done using this instrument pointed to controversial
results regarding the construct of uni-dimensionality and also for
Keywords: Educational performance, Optimism, Self-esteem
Physiology Section
Life Orientation Test- Revised
(LOT-R) Versus Academic Score
in Various First Year Health
Professional Students
PUJA DULLOO1, NEERAJ VEDI2, ACHLESHWAR GANDOTRA3
ABSTRACT
Introduction: Health field per se requires mental, physical
and psychological steadiness and wellbeing. In modern times
decline in psychological and physical health has been observed
in student after admission in health education program. Factors
like perfectionism, self-esteem, personal and professional
consequence have affected their academic score directly or
indirectly. Life Orientation Test-Revised (LOT-R) instrument
measures optimism in relation to self-esteem of individual. A
better score will show more confidence level of the student.
Aim: To find an association of LOT-R with the academic score of
health professional students and assess gender variation.
Materials and Methods: A total of 350 students enrolled for
academic year 2015-16 in health professional program of
medicine, dental and physiotherapy institutes of Sumandeep
Vidyapeeth University were considered. Non-randomized and
purposive study was done by providing LOT-R questionnaire to
students. Average academic score of Anatomy and Physiology
course was used for analysis excluding the biochemistry due
to non-availability of tangible data at the time of study. Data
was collected, analysed statistically using independent t-test,
ANOVA with post-hoc and correlation analysis.
Result: Statistical significant for one-way ANOVA was assessed
for academic score between the group of health professional
students. While no statistical correlation of significance was
observed for LOT-R score with that of academic score. As
per gender distribution there was no statistical significant
observation for LOT-R score within the groups.
Conclusion: The present study highlighted the need of student’s
counseling for their approach towards health education; as their
career. Psychological self-reliance and optimism improves the
academic score. A study needs to be compared with the socio-
economic status of the student to have a better understanding
of the LOT-R.

Puja Dulloo et al., Life Orientation Test- Revised (LOT-R) Versus Academic Score in Various First Year Health Professional Students www.jcdr.net
Journal of Clinical and Diagnostic Research. 2016 Oct, Vol-10(10): CC01-CC05
22
co-incidences with anxiety trait, self-esteem and self-mastery [18-
20].
These criticisms led to modification of LOT to Revised Life
Orientation Test (LOT-R) by Scheier, Carver & Bridges in 1994.
In this new version, the items measuring positive and negative
expectation are more strongly linked [21]. This revised instrument
is considered to being good to measure optimism in relation to self-
esteem and personality factors [22]. Self-esteem and confidence
levels show a better individual score, thus, we expect a better
academic score for the individual [23]. The one with less score will
have opposite effect.
Present study was conducted to estimate the level of pessimism
and optimism in first year of health professional students i.e.,
medical, dental and physiotherapy once they join the institute
and compare it with their first academic performance score. First
year students do not typically possess established social network
within the campus. In Indian setup, a student before entering into
the health professional field has been spoon fed to achieve the
desired results. Moreover, in health professional programs they
face a different array of teaching style thus are at a loss as to
how to pursue their studies without being stressed out. In this
new methodology of student centered approach they grow in
professional knowledge as well as improve upon their transferrable
skills of team learning, group work and sharing. With time they
become more confident to take independent decision specifically
in Indian setup where students are overprotected by their parents
in every phase of life. It will be more appropriate to state that Indian
parents decide the course of their child’s profession without even
asking or seeking their permission. Moreover, child is moulded
from the day he/she joins school or may be before that to become
a doctor or an engineer or a lawyer etc; depending on parents
thought or perception.
AIM
To find the correlation between LOT-R and academic score in
health professional students (medical, dental and physiotherapy)
of Sumandeep Vidyapeeth University.
MATERIALS AND METHODS
A questionnaire based, observational, cross-sectional study was
conducted at Smt. BK Shah Medical Institute and Research
Center after approval granted by the ethical committee of
Sumandeep Vidyapeeth University. All the students enrolled for
medical, dental and physiotherapy for 2015-2016 batch were
included in the study. Repeater students from previous batch were
not included. This study was non-randomized and purposive.
Out of 350 students enrolled 333 student’s data was taken for
statistical analysis. Exclusion was based on filling of incomplete
LOT-R test questionnaire. Secondly, students who did not attempt
first formative assessment for Anatomy and Physiology were also
excluded.
All students were given a set of questionnaire based on LOT-R
to analyse their personality type and self-esteem approach. The
questionnaire was distributed in Anatomy lecture hall, having their
roll numbers written so that each student’s academic score could
be compared. Aim and objectives of the study were explained to
the students and verbal consent was received for the same within
the first month of joining respective program. It was assured to the
students that their data will be secure with the primary investigator
and will be used only for present study.
The mean academic score for first formative assessment for
Anatomy and Physiology course were calculated for each student
and was used for our analysis. Academic score from Biochemistry
course was not included due to non-availability of tangible data at
the time of study.
Data collected was compiled and statistically analysed using
SPSS-23.0 software.
RESULTS
Sumandeep Vidyapeeth University has five health professional
programs i.e., medical, dental, physiotherapy, pharmacy and
nursing which are recognized by their respective councils. In
this study, we have included medical, dental and physiotherapy
students with a total population of approximately 2000 out of
which annual intake for medical (MBBS) students is 150, for dental
(BDS) is 100 while for physiotherapy (BPT) is 120.
For the academic session 2015-2016, 350 students were enrolled
at the time of initiation of study i.e., within a month after starting of
the health professional programs.
[Table/Fig-1] specifies the descriptive statistics for the LOT-R
score in medical, dental and physiotherapy students showing
mean value of 15.97±3.53 for medical, 16±3.47 for dental and
15.46±2.77 for physiotherapy student with the number for student
from each program.
[Table/Fig-2] specifies the descriptive statistics for the academic
score in medical, dental and physiotherapy students showing
mean value of 35.71±23.11 for medical, 45.7±18.84 for dental
and 41.78±21.80 for physiotherapy student with the number for
student from each program.
[Table/Fig-3] specifies One-way ANOVA and Post-hoc test for
LOT-R score for health professional students showing no statistical
significance for LOT-R score for medical (MBBS) with dental (BDS)
or with physiotherapy (BPT) students (p>0.05).
[Table/Fig-4] explains One-way ANOVA and Post-hoc test for
academic score for health professional students showing statistical
significance for academic score for medical (MBBS) with dental
(BDS) students (p<0.05) and statistical significance for academic
score for dental (BDS) with physiotherapy (BPT) students
MBBS BDS BPT
Number of Students 138 78 117
Mean 15.97 16 15.46
Standard Deviation (±) 3.53 3.47 2.77
Standard Error 0.30 0.39 0.26
Median 16 16 15
Mode 16 16 14
Sample Variance 12.46 12.03 7.65
Range 19 13 13
Minimum 4 9 9
Maximum 23 22 22
Confidence Level(95.0%) 0.6 0.8 0.5
MBBS BDS BPT
Number of Students 138 78 117
Mean 35.71 45.7 41.78
Standard Deviation (±) 23.11 18.84 21.80
Standard Error 1.89 1.88 1.98
Median 38 46.5 45
Mode 0 50 60
Sample Variance 534.14 354.84 475.15
Range 88 91 77.5
Minimum 0 0 0
Maximum 88 91 77.5
Confidence Level(95.0%) 3.729 3.738 3.924
[Table/Fig-1]: Descriptive statistics for LOT-R score for students from health
professional programs (medical, dental and physiotherapy).
[Table/Fig-2]: Descriptive statistics for academic score for students from health
professional programs (medical, dental and physiotherapy).

www.jcdr.net Puja Dulloo et al., Life Orientation Test- Revised (LOT-R) Versus Academic Score in Various First Year Health Professional Students
Journal of Clinical and Diagnostic Research. 2016 Oct, Vol-10(10): CC01-CC05 33
(p<0.05). Although no statistical significance for academic score of
medical (MBBS) with physiotherapy (BPT) students was observed
p=0.108.
[Table/Fig-5] shows no significant Pearson correlation between
LOT-R score with that of academic score for health professional
students were value are being close to zero and two tailed
significance value is greater than 0.05.
[Table/Fig-6] shows the descriptive statistical values of LOT-R and
academic score variation as per gender of the health professional
students.
[Table/Fig-7] shows independent sample t-test for LOT-R score
and academic score as per gender variation in health profession
students specifying statistical significance (2-tailed) for equal
variances for academic score (p<0.005) but no statistical
significance for LOT-R score for equal variances assumed.
DISCUSSION
In present study, researchers could not find any significant variance
in Medical, Dental and Physiotherapy students as per their LOT-R
score. Although, Medical students had minimum score for LOT-R
of 4 while it was 9 in case of dental and physiotherapy students.
No significant correlation was observed in the LOT-R score in
three different health professional students, however, correlation of
dental and physiotherapy students with that of medical students
was less than zero r-value, but within themselves was of positive
nature although not statistically significant.
In our study, no statistical significant of LOT-R score with that of
academic score of health professional students at 95% confidence
interval was found. Moreover, independent paired t-test for LOT-R
score for gender difference also did not show any statistical
significance although, mean value for male and female score was
almost similar.
Our findings were consistent with that of Stewart in their longitudinal
study for two years were academic performance before and during
medical school were negatively related to reported stress level [24].
Schumacher found no significant difference existing between grade
level and optimism using GRE scale for assessing optimism and
pessimism [25]. Stoecker’s in his study indicated no relationship
between optimism scores and expected grades [26]. However, we
found a correlation between grade expectancies and cumulative
grade-point average suggesting LOT-R measured students’
expectations of how they would perform in the hypothetical
course based on their performance in previous course. Burke
used LOT-R with optimism/pessimism scale demonstrating that
the two scales were not measuring similar constructs and found
only a modest correlation between LOT-R optimism and LOT-R
pessimism (-0.30), concluding that the two dimensions were
relatively independent [27].
MBBS Sum of
Squares df Mean
Square F Sig.
LOT-R
score
Between Groups 20.218 2 10.109
0.948 0.389Within Groups 3519.896 330 10.666
Total 3540.114 332
Dependent
Variable (I) COURSE (J)
COURSE
Mean Difference
(I-J)
Std.
Error Sig.
LOT-R
score
MBBS
BDS -0.0362 0.4626 0.873
BPT 0.5022 0.4104 0.666
BDS
MBBS 0.0362 0.4626 1.000
BPT 0.5385 0.4774 0.781
BPT
MBBS -0.5022 0.4104 0.666
BDS -0.5385 0.4774 0.781
MBBS Sum of
Squares df Mean
Square F Sig.
AS%
Between
Groups 25507.078 2 12753.539
25.003 0.000
Within Groups 168328.567 330 510.087
Total 193835.645 332
Dependent
Variable (I) COURSE (J) COURSE Mean
Difference (I-J)
Std.
Error Sig.
AS%
MBBS
BDS -22.46934* 3.19935 0.000
BPT -5.97362 2.83831 0.108
BDS
MBBS 22.46934* 3.19935 0.000
BPT 16.49573* 3.30141 0.000
BPT
MBBS 5.97362 2.83831 0.108
BDS -16.49573* 3.30141 0.000
LOT-R
score AS%
LOT-R score
Pearson Correlation 1 .008
Sig. (2-tailed) .884
N 333 333
AS%
Pearson Correlation 0.008 1
Sig. (2-tailed) 0.884
N 333 333
Academic Score
LOT-R score
MBBS BDS BPT
MBBS 1
BDS -0.043 1
BPT -0.029 0.068 1
Sex N Mean Std.
Deviation
Std. Error
Mean
AS%
Male 99 38.0530 23.90629 2.40267
Female 234 46.1442 23.91627 1.56346
LOT-R score
Male 99 15.394 3.5046 0.3522
Female 234 15.966 3.1512 0.2060
[Table/Fig-3]: One-way ANOVA and Post-hoc for LOT-R score for medical, dental
and physiotherapy students.
*. The mean difference is significant at the 0.05 level.
[Table/Fig-4]: One-way ANOVA and Post-hoc test for academic score for health
professional students.
*. The mean difference is significant at the 0.05 level.
[Table/Fig-5]: Correlation of LOT-R score with that of academic score for health
professional students.
*. The mean difference is significant at the 0.05 level.
[Table/Fig-6]: Group Statistics as per gender variation for LOT-R Score and
academic score for health professional students.
Levene's
Test for
Equality of
Variances
t-test
for
Equality
of Means
F Sig. t df Sig.
(2-tailed)
Mean
Differe-
nce
Std.
Error
Differe-
nce
AS%
Equal
variances
assumed
.071 .790 -2.822 331 0.005* -8.09 2.87
Equal
variances
not
assumed
-2.823 184.639 0.005* -8.09 2.87
LOT-R
score
Equal
variances
assumed
2.019 .156 -1.463 331 .144 -.5719 .3908
Equal
variances
not
assumed
-1.402 168.232 .163 -.5719 .4080
[Table/Fig-7]: Independent sample t-test for LOT-R score and academic score as
per gender variation in health profession students.
*. The mean difference is significant at the 0.05 level.

Puja Dulloo et al., Life Orientation Test- Revised (LOT-R) Versus Academic Score in Various First Year Health Professional Students www.jcdr.net
Journal of Clinical and Diagnostic Research. 2016 Oct, Vol-10(10): CC01-CC05
44
Harju and Bolen found that optimism was only slightly related
to Grade Point Average (GPA’s) [28]. Chang et al., took an even
stronger stance on the fragility of the relationship between optimism
and GPA’s as they contend that a no significant relationship
exist between optimism and pessimism indices and academic
performance [18].
Glaesmer confirmed the bi dimensionality of the LOT-R and
proposed that optimism and pessimism are two independent
constructs rather than a single bipolar trait and confirmed the
instrument to be employed for measuring disposal optimism or
pessimism in individual diagnostics as well as in epidemiological
research [29].
Present study did not show any statistical significance of optimistic
approach with that of academic score although researchers like
Hall, Spruill and Webster found higher GPA’s in students who felt
they had a greater sense of control over their future [30]. Even
Tanhamani results showed a significant difference between life
orientation with stress, depression and anxiety but no significant
difference between optimism with pessimism females and males
[31]. Study by Singh and Jha also showed non significance for
gender variation for optimistic and pessimist students [32]. Bryant
and Cvengros attempted to differentiate optimism from hope and
they determined that hope refers to specific goal attainment while
optimism is broader and focuses on more general future outcomes
[33]. Maatta et al., findings showed that approximately one quarter
of adolescents in their study used an optimistic achievement
strategy [34]. These students had less depression, better teacher
relations, higher student achievement with less norm breaking
behaviour and higher self-esteem. These researchers’ results were
somehow, contrary to that of ours since they used more than one
parameter for assessing the optimism or pessimistic score.
There are many possible reasons why the association was not
evident in this study. The first possibility is that all of the optimism
survey questions were not answered accurately, since the questions
was in English language and majority of students had Gujarati as
their prior educational background. Test and retest overtime would
be a way of assessing the reliability of responses. Students may
have answered the LOT-R based on what they wished they were
capable of, or they may have under estimated their self- efficacy
as a show of modesty [35].
Avoidance may have been a factor in this study, a factor which is
well known pessimistic trait [28]. This would naturally contribute to
a higher overall optimism score or the optimism bias. As optimism
is sometimes known to under estimate difficulties and overestimate
probabilities of success [36], it is also possible that they would
overestimate their score on LOT-R scale. Seligman mentioned the
lack of effort of some students to apply to their goal as a feature
of unrealistic optimism [37]. These optimistic individuals have
such strong assumption about success that they do not take the
appropriate action to achieve the desired successful goal.
Other possible explanation for high optimistic student having
low achievement could be the sudden influence of other factors
such as home sickness, problems with peer relationship, physical
or mental health issues [36]. Learning disabled students also
have overly optimistic self-efficacy which may results in reduced
academic achievements [38]; although none of such were identified
in our study. A factor which could explain low optimism and high
achievement could be the mirror opposite of unrealistic optimism
i.e., unrealistic pessimism.
LIMITATION
Researchers were unable to include every enrolled student for the
study.
CONCLUSION
No specific correlation was assessed with the optimistic approach
of student with that of their academic score; however we should
continue motivating students in our mentorship program for
positive approach towards the course. Even we can assess the
optimistic or pessimistic approach of students after completion of
first term to analysis any specific change in their thought perception.
Moreover, we should assess the socio-economic status of the
students along with the willingness of student to join the course
to further find association of optimistic- pessimistic approach with
that of academic score.
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PARTICULARS OF CONTRIBUTORS:
1. Associate Professor, Department of Physiology, Smt. B.K. Shah Medical Institute and Research Center, Piparia, Vadodara, Gujarat, India.
2. Resident, Department of Anatomy, Smt. B.K. Shah Medical Institute and Research Center, Piparia, Vadodara, Gujarat, India.
3. Professor and Head, Department of Anatomy, Smt. B.K. Shah Medical Institute and Research Center, Piparia, Vadodara, Gujarat, India.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Puja Dulloo,
Associate Professor, Department of Physiology, Smt.B.K. Shah Medical Institute & Research Center,
Piparia, Vadodara -391760, Gujarat, India.
E-mail: puja_dullo@yahoo.com
FINANCIAL OR OTHER COMPETING INTERESTS: None.
Date of Submission: Apr 10, 2016
Date of Peer Review: Jun 28, 2016
Date of Acceptance: Aug 10, 2016
Date of Publishing: Oct 01, 2016