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THE INFLUENCE OF SELF-COMPASSION TOWARDS RESILIENCE
AMONG INDONESIAN MEDICAL STUDENTS
Mutia Rahayu Priatni, Ratih Arruum Listiyandini
mutiayeey@gmail.com
Faculty of Psychology, YARSI University
Jendral Suprapto Street, Cempaka Putih, Central Jakarta
Indonesia
ABSTRACT
As a medical student, their activities cannot be separated from problems that can
cause stress. Previous research has shown that stress on medical students is very high
compared to the other non-medical sector faculty. In overcoming various challenges and
problems, every student must be able to be resilient, be able to survive, and be able to
improve the disappointments. In addition, one of the things needed to help student’s
psychological condition is through the existence of self-compassion. Therefore, this study
aims to see the influence of self-compassion towards resilience among medical students.
The sample in this research was 292 medical students. Research used adaptation of Self-
compassion Scale (SCS) and Connor-Davidson Resilience Scale (CD-RISC) instrument.
Regression test results showed among Indonesian medical students, self-compassion has
significant influence toward resilience by 24.6% effective contribution (R = 0.496, p <0.05).
The results of this study are expected to give information about the urgency of improving
self-compassion in order to assist the development of medical students’ resilience.
Keywords: resilience, self-compassion, medical students, Indonesia
Background
Students are individuals studying at universities, both at universities and institutions
or academies. Monks (in Triyana, 2015) mentions that students are classified as late
adolescence and early adulthood with the age of 18-21 and 22-24 years old. During that
developmental period, students are in transition from late adolescence to early adulthood.
This transitional period is a difficult stage of development. The developmental task of this
period is full of emotional problems and tensions, the period of social isolation, the period
of commitment, the period of dependence, the change of values, creativity and adjustment
to the new lifestyle (Hurlock, in Rahmawati, 2016). Adjustment is an individual process in
responding to environmental demands and the ability to coping with stress (Rathus &
Nevid, 2002). Individual failure in adjustment can lead to psychological disorders, such as
fear, anxiety, and aggressiveness (Shneiders, 1964).
According Higher Education Board of Accreditation (BAN-PT) data In Indonesia,
there are 71 universities in Indonesia who have accredited S1 or S1 medical programs
(http://www.ban-pt-universitas.co). Medical education is different from other higher
education because of its distinctive graduate characteristics, which must integrate science,
skills, ethics, morals, law, and culture. In addition, medical education is oriented to the
demands of development and the needs of the community in the future. Medical students
will be educated within 5½ years using various learning techniques (Anggraini, 2014;
Christyanti, Mustami'ah, & Sulistiani, 2010).
The characteristics and orientation of medical education described earlier can be
demands for medical faculty students, and can also cause stress. Research conducted on
medical faculty students in India shows the stress on medical faculty students is very high
compared to other non-medical sector faculty students (Navas, 2012). Another study of 90
medical students at the University of Indonesia showed that the prevalence of stress in
medical faculty students is quite high, around 30-70% students have higher stress (Carolin,
2010). In addition, Amelia, Asni, & Chairilsyah (2014) mentions the source of the problem
in medical students come from academic and non-academic. Academic problems including
lecture schedules and dense lab work, stacking assignments, many exam materials, low
GPA and other academic problems, while non-academic problems are such as financial,
family, interpersonal and intrapersonal issues.
Stress will cause negative impact on cognitive, physiological, psychological, and
behavior. Negative impacts on cognition include difficulty of concentrating, difficulty of
remembering, and difficulty for understanding the lesson. Psychological negative impact is
difficult to motivate yourself, the emergence of feelings of anxiety, sadness, anger,
frustration, and others. Physiologically negative effects include health problems, decreased
body resistance, weakness, dizziness, and insomnia. Negative impact on the behavior that
arises is delaying completion of college assignments, lazy to attending lecture, drug and
alcohol abuse (Heiman & Kariv, 2005). On some campuses, the stress of lectures is the
most common that makes the students stop before they get a degree that amounts to 25%
(Santrock, 2003).
In overcoming various challenges and problems, every student must be resilient, that
is to be able to rise, to survive, and to thrive in the difficulties that he faces (Amelia, Asni,
& Chairilsyah, 2014). Resilience helps students in preventing burnout, helps students rise
from difficult conditions, and can protect from the negative effects of difficulty (Houpy,
Lee, Woodruff, & Pincavage, 2017). According to Reivich & Shatte (in Helton & Smith,
2004), resilience is one's ability to survive, rise, and adjust to difficult conditions. Resilience
is created from stress management, learning from experience, and growing as an individual.
A resilient medical student will develop in the context of a supportive relationship with
peers and lecturers in a positive work environment, and through the development of self-
management strategies and the development of positive and professional individual
identities (Finn & Hufferty, 2014).
According to Daradjat (1988), calmness of the soul has an effect to optimize
intelligence among students. When experiencing anxiety, stress, or depression, one of the
things needed to help psychological calm is through the existence of self-compassion. Self-
compassion is an attitude of having attention and kindness when facing various difficulties
in life or lack in ourselves, an understanding that his suffering, failure, and deprivation are
part of everyone's life Neff (2003a). Cassell (2009) explains that compassion as a positive
emotion becomes an important thing in health practice. Mills & Chapman (2016) argue that
self-compassion among medical students can help clarify misconceptions, inform education,
and improve application in clinical practice. Previous studies of self-compassion in health
practice workers have the advantage of well-being in physicians, and potentially increased
compassionate to patients (Boellinghaus, Jones, and Hutton, 2014; Mills, Wand, and Fraser,
2015; Raab, 2014, in Mills & Chapman, 2016). Therefore, self-compassion is required by
medical faculty students.
Neff, Hsieh, & Dejitterat (2005) study found students with self-compassion will have
more intrinsic motivation to develop, understand new material, and focus on avoiding poor
performance in academic matters. In addition, students with self-compassion, less fear of
failure and more confidence in their strengths than students with low self-compassion
(Smeets, Neff, Alberts, & Peters, 2014). Other studies have found that self-compassion may
aid student reactions to academic difficulties as well as social difficulties, in the transition
from school to college (Terry, Leary, & Mehta, 2012). More precisely, students with high
levels of self-compassion can cope with social and academic struggles, lack of
homesickness and depression, and a lack of dissatisfaction in university issues (Smeets,
Neff, Alberts, & Peters, 2014). Self-compassion can help resilience in reducing individual
reactions to negative events. This is supported by experiments conducted by Leary, Tate,
Adams, Allen, & Handcock (2007), which states that individuals who have high self-
compassion, exhibit less extreme reactions, lack of negative emotions, and are more likely
to see problems into perspective, compared with individuals with low self-compassion
(Smeets, Neff, Alberts, & Peters, 2014). Therefore with the existence of self-compassion
then the resilience is expected to increase or better. This study aims to analyze the role of
self-compassion toward resilience in medical faculty students.
Method
Design
The research design used in this study was included in non-experimental research
design with explanatory research type.
Participants
Population used in this research is medical faculty student residing in Jakarta area.
According to PDDIKTI (2016), the population of medical faculty students in Jakarta area is
9,583. Characteristics of the sample used is medical students are active in the late
adolescence (18-21 years) and early adulthood (22-24 years) and in the pre-clinic level.
Based on the field study, the number of participant are 292 students. Based on the
demographic data obtained, it can be seen that the majority of respondents from the total
sample are female (68.33%), age range 18-21 years (81.3%), and Muslims (69%). Based on
the respondents' study, the majority of respondents from total samples came from private
universities or private universities (76.33%), were in the 2nd year (36.3%), and had GPA in
the range of 2.76-3, 50 (55.33%). In addition, based on respondents' residence, the majority
of respondents live in boarding places (65.66%).
Measurement
In this study, the measuring instrument used to measure self-compassion is by using
Self-compassion Scale (SCS) by Kristin D. Neff (2003). This measuring instrument is a
scale consisting of 26 items and has six aspects, namely self-kindness, self-judgment,
common humanity, isolation, mindfulness, and over-identified. Here’s one example item of
each aspect; “I’m tolerant of my own flaws and inadequacies” (self-kindness), “When times
are really difficult, I tend to be tough on myself” (self-judgment), “I try to see my failings as
part of the human condition” (common humanity), “When I think about my inadequacies it
tends to make me feel more separate and cut off from the rest of the world” (isolation),
“When something painful happens I try to take a balanced view of the situation”
(mindfulness), and “When something upsets me I get carried away with my feelings” (over-
identified). Self-Compassion Scale (SCS) was tested on 292 respondents of medical
students in Jakarta, and the reliability coefficient is α = 0.874, with range values of
corrected item total correlation around r = 0.207 – 0.582.
The measuring tool used to measure resilience is the Connor-Davidson Resilience
Scale (CD-RISC) compiled by Connor & Davidson (2003). The scale consists of 25 items
and has five aspects: personal competence, positive acceptance, tolerance of negative affect,
self-control, and spiritual influences. Here’s one example item of each aspect; “I can handle
unpleasant feelings” (personal competence), “When things look hopeless, I don’t give up”
(positive acceptance), “I work to attain my goals” (tolerance of negative affect), “I am not
easily discouraged by failure” (self-control), and “I take pride in my achievements”
(spiritual influences). Connor-Davidson Resilience Scale (CD-RISC) was tested by 292
respondents of medical students in Jakarta, and the reliability coefficient is α = 0.898, with
range values of corrected item total correlation around r = 0.251 – 0.639.
Analysis Technique
In this study, researchers will use regression analysis. Regression analysis aims to
make a decision whether the rise and fall of the criterion variable can be done through an
increase in predictor variables or not. In addition, regression analysis also aims to predict
the extent to which changes in the criterion variables when the predictor variables are
raised-down (Sugiyono, 2013).
Results
Descriptive statistics described on total mean score of self-compassion is M = 88.56
(SD = 12.106, min. = 35, max. = 120). Each aspect of self-compassion has its mean score,
which are self-kindness (M = 17.62, SD = 3.093), self-judgment (M = 16.20, SD = 3.413),
common humanity (M = 14.51, SD = 2.698), isolation (M = 13.19, SD = 3.056),
mindfulness (M = 14.28, SD = 2.457), and over-identification (M = 12.75, SD = 2.975). In
addition, total mean score of resilience is M = 70.31 (SD = 10.727, min. = 24, max. = 96).
Normality test is done by Kolmogorov-Smirnov Test and get the result that is p = 0.977.
Self-compassion with resilience has significance value in linearity test of p = 0.490. It can
be concluded that self-compassion forms linear or straight line with resilience because
Deviation from Linearity value (F = 0.980) has significance p > 0,05.
Based on the data in Table 1, it was found that the regression model can explain the
function of self-compassion as a predictor variable to resilience (F = 94.396, p < 0.05). It
can be concluded that self-compassion plays a significant role to resilience in pre-clinical
students of medical faculty. The value of R-square or coefficient of determination obtained
at 0.246 or equal to 24.6%. It shows that the role of self-compassion against resilience is
24.6% and other 75.4% is influenced by other factors.
Table 1
R
R-Square
F
Sig.
Adjusted R
Square
Std. Error of
the Estimate
Regression Equation
Self
Compassion
0,496
0,246
94,396
0,000
0,243
9,334
Y = 31.425+ 0,439X
Researchers also used multiple regression tests to find out how each dimension of
self-compassion contributes to the resilience. It was found that the dimension of self-
compassion contribute significantly to predict resilience with F = 29.609 (p < 0.01) and R2 =
0.384. Based on the calculation, it showed that self-kindness (β = 0.948, p = 0.000),
mindfulness (β = 1.058, p = 0.000), and common humanity (β = 0.670, p = 0.005) have
positive role on resilience of medical students. While the aspects of self-judgment (β = -
0.529, p = 0.009) has a negative role to resilience. In addition, the researchers also found
that isolation (β = 0.379, p = 0.149) and over-identification (β = 0.501, p = 0.068) did not
have a role in resilience among medical students in Jakarta.
Based on data from different test results it was found that there was no significant
difference in resilience on the basis of sex (p = 0.090), and age (p = 0.580). Meanwhile, it
was found that there was a significant difference in resilience based on the type of college (p
= 0.027) on the resilience of medical faculty students. Students from State-based
Universities (PTN) showed higher resilience than students from Private-based Universities
(PTS). .
Discussion
The result of the research gives knowledge about the role of self-compassion in
affecting resilience. The effective contribution is 24.6%, and 75.4% is influenced by other
factor outside self-compassion variable. The results of this study support the results of
previous research that self-compassion can help aspects of resilience. Individuals who have
high self-compassion, exhibit a reaction that is not extreme, lack of negative emotions, and
more likely to see the problem into perspective, compared with individuals with low self-
compassion (Leary, Tate, Adams, Allen, & Hancock, 2007).
The ability to manage negative emotional responses and seeing a problem from
multiple perspectives is essential for medical students to be able to rise from the problems it
faces. Self-compassion includes self-kindness, mindfulness, and common humanity. Self-
compassion means expanding the compassion that is owned just as it is given to others.
Self- compassion not only benefit to make medical students more positive to themselves
when experiencing failure or error, but it is also help medical students in establishing good
relationships with patients, as well as colleagues. Resilient medical faculty students will
develop in the context of a supportive relationship with peers and lecturers in a positive
work environment, and through the development of self-management strategies and the
development of positive and professional individual identities (Finn & Hufferty, 2014).
Overall, the role of self-compassion against resilience was 24.6%. 75.4% of other
factors which contribute to resilience among medical faculty students have not been
explained in this study. Through literature studies, researchers predicts that other factors
which can contribute to resilience are personality, motivation, and learning skills
(McManus, in Finn and Hafferty, 2014), parenting styles (Permata & Listiyandini, 2015),
secure attachment style (Neff & McGehee, 2010), coping style and social support
(Thompson, McBride, Hosford, & Halaas, 2016).
In addition to seeing the role of self-compassion toward resilience in medical faculty
students, researchers also conducted additional demographic-related tests. Additional test
results based on sex and age found no significant difference in resilience among medical
faculty students (p > 0.05). Otherwise, based on the type of college, it indicates significant
resilience difference between medical faculty students who came from states-based
university with medical faculty students from private-based university (p < 0,05). In
Indonesia, the selection of exams admitted to the PTN is felt more difficult due to the high
competitiveness among students. High competition to enter university is followed by
competition in studying at states-based University, thus requiring medical students to be
better able to adapt, overcome negative emotions, and can survive and rise from problems
encountered. This is supported by the opinion of Barankin & Khanlou (in Permata &
Listiyandini, 2015) which states that environment have an influence for individual to be
stronger in the face of pressure and able to survive is one of the external protective factors
that can affect resilience.
In the process of this research, researchers realize there are still weaknesses and
limitations in the research process undertaken. Looking at previous research conducted by
Permata & Listiyandini (2015), other demographic factors that affect resilience are socio-
economic and respondent tribes. Based on the theory, high socio-economic level is one of
the environmental protective factors that can affect individual resilience (Barankin &
Khanlou, in Permata, 2015). But in this study, the socioeconomic and ethnic levels were not
studied further by the researchers. This is a drawback of this study, so it needs to be studied
further in subsequent research.
Generalization of the results of this study can only be done for medical faculty
students in the Jakarta area, so it couldn’t be used as a reference for medical faculty students
in other areas. Thus, to know the description of the role of self-compassion toward
resilience in medical faculty students outside Jakarta, it is necessary to conduct research
with a wider population area.
Conclusion
From the result of the research which have been analyzed, it can be concluded that
the hypothesis proposed in this research is acceptable, that is self-compassion has
significant role to resilience in medical faculty student, that is 24.6% (β = 0.439, p < 0.05).
This shows that the higher self-compassion that is owned by medical faculty students, the
higher the resilience they have.
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