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Self-esteem level, self-esteem stability, and procrastination: Predictors of academic achievement in first year medical students

ProQuest Dissertations and Theses, 2009
Dissertation
Author: Cheri Neustadter Koinis
Abstract:
Although the admissions process for acceptance into all U.S. medical schools is rigorous, there are still approximately 10% of those who matriculate across the U.S. who experience academic difficulty, or worse, fail. One might question, if only the best are selected, how can student failure or marginal performance occur? This study investigated two hypotheses in 68 first-year medical students at the University of New Mexico School of Medicine. The hypotheses were as follows: (a) that procrastination would mediate the relationship between self-esteem level and academic achievement in first-year medical students and (b) that self-esteem stability would moderate the relationship between self-esteem level and procrastination. Results indicated no mediation but did show moderation of the relationship between self-esteem level and procrastination. However, this significant outcome only occurred when using the Rosenberg Self-Esteem Scale, Self-Handicapping Scale, and the Contingent Self-Esteem Scale to measure self-esteem level, procrastination, and self-esteem stability, respectively. Results were not significant when using the Name Letter Preference Task, Procrastination Assessment Scale-Students and Instability of Self-Esteem Scale to measure variables as mentioned. These results are discussed in a framework highlighting the importance of using specific instruments to measure specific variables. Keywords. medical education, medical students, self-esteem, self-esteem level, self- esteem stability, procrastination, academic achievement.

101 TABLE OF CONTENTS 102 PARTS A AND B 103 PART A: REVIEW OF THE LITERATURE 104 105 Introduction 106 Studies Using Affective Variables in the 107 Medical School Admissions Process 108 Self-Esteem 109 Definitions 110 Level 111 Contingent, Implicit, Explicit Self-Esteem 112 Stability and Instability 113 Level and Stability: Are they Different? 114 115 Self-Concept Clarity 116 117 Procrastination 118 Definitions 119 Why Do People Procrastinate? 120 Self-Handicapping 121 122 Academic Achievement 123 Effect of Boosting Self-Esteem on Academic 124 Achievement 125 Self-Concept 126 127 Conclusion 128 129 References 130 131 PARTB 132 Abstract 133 134 Introduction 135 136 Self-Esteem 137 138 Contingent, Implicit, Explicit Self-Esteem 139 Self-Esteem Stability and Instability 140 Self-Esteem Level, Self-Esteem Stability, and 141 Academic Achievement 142 Self-Esteem and Procrastination 143 144 Hypotheses 145 146 iv

147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 Method Participants Measures Background Information Form Rosenberg Self-Esteem Scale Name-Letter Preference Task Contingent Self-Esteem Scale Instability of Self-Esteem Scale Procrastination Assessment Scale-Students Self-Handicapping Scale Academic Achievement Measure Procedures Recruitment Testing Procedures Awarding the Incentives Study Summary Results Results Preliminary Data Analyses Hypothesis Testing Testing the Mediating Hypothesis Result: Analyses of Mediation Models Testing the Moderating Hypotheses Discussion Mediation Moderation General Discussion Limitations of the Study Conclusion References V 66 66 68 68 68 69 70 70 71 72 73 73 73 74 74 75 75 75 79 79 81 85 93 93 96 97 100 102 104

193 LIST OF APPENDIXES 194 195 Appendix A: UNM Informed Consent Form 115 196 Appendix B: Background Information Form 118 197 Appendix C: Rosenberg Self -Esteem Scale (RSES) 119 198 Appendix D: Instability of Self-Esteem Scale (ISES) 120 199 Appendix E: Contingent Self-Esteem Scale (CSES) 121 200 Appendix F: Procrastination Assessment Scale-Students (PASS) 123 201 Appendix G: Self-Handicapping Scale (SHS) 127 202 Appendix H: Name-Letter Preference Task (NLPT) 129 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 vi

239 240 LIST OF TABLES 241 Page 242 Table 1: Demographic Characteristics of Participants 67 243 244 Table 2: Descriptive Statistics for all Measured Variables 76 245 246 Table 3: Correlations Among all Measured Variables 78 247 248 Table 4: Results of Moderating Analysis for Relationship 249 Between Self-Esteem Level and Self-Handicapping by 250 Self-Esteem Contingency - Model A 88 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 vii

284 285 LIST OF FIGURES 286 287 Figure 1: Proposed conceptual model showing 288 procrastination mediating the relationship between 289 self-esteem level and academic achievement. 64 290 291 Figure 2: Proposed conceptual model of self-esteem stability 292 moderating the relationship between self-esteem level 293 and procrastination. 65 294 295 Figure 3: Testing for Mediation 79 296 297 Figure 4: Representation of the mediational relationship 298 between self-esteem level and academic 299 achievement by self-handicapping 82 300 301 Figure 5: Representation of the mediational relationship 302 between self-esteem level and academic 303 achievement by PASS 83 304 305 Figure 6: Representation of the mediational relationship 306 between self-esteem level (as measured by the NLPT) 307 and academic achievement by the PASS 84 308 309 Figure 7: Representation of the mediational relationship 310 between self-esteem level (as measured by the NLPT) 311 and academic achievement by the SHS 85 312 313 Figure 8: Testing for Moderation 86 314 315 Figure 9: Relationship between self-esteem and 316 procrastination for those high in self- esteem 317 stability/low contingency (CSES Grp =1) and 318 those low in self-esteem stability/high 319 contingency (CSES Grp = 2) 91 320 321 Figure 10: Representation of the mediational relationship 322 among self-esteem level and academic achievement by 323 self-handicapping in the low-contingent self-esteem 324 group only 93 325 326 327 328 329 viii

330 331 332 333 334 SELF-ESTEEM LEVEL, SELF-ESTEEM STABILITY, AND 335 PROCRASTINATION: PREDICTORS OF ACADEMIC ACHIEVEMENT IN 336 FIRST-YEAR MEDICAL STUDENTS 337 PART A 338 A REVIEW OF THE LITERATURE 339 by 340 CHERI NEUSTADTER KOINIS 341 Fielding Graduate University 342 343 344 345 346 347 348 349 350 351 ix 352 353

354 Abstract 355 Self-Esteem Level, Self-Esteem Stability, and Procrastination: Predictors of Academic 356 Achievement in First-Year Medical Students 357 Review of the Literature Part A 358 by 359 Cheri Neustadter Koinis 360 Although the admissions process for acceptance into all U.S. medical schools is 361 rigorous, there are still approximately 10% of those who matriculate across the U.S. who 362 experience academic difficulty, or worse, fail. This literature review looks at a number of 363 studies that support using affective variables for admission to medical school (Roessler, 364 Lester, Butler, Rankin, & Collins, 1978; Lipton, Huxham, & Hamilton, 1984; Hojat, 365 Robeson, Damjanov, Veloski, Glaser, & Gonnella, 1993; Hobfall, Anson, & Antonovsky, 366 1982; Peng, Khaw, & Edariah, 1995; Lumsden, Bore, Millar, Jack, & Powis, 2005). 367 These studies compared cognitive predictors with non-cognitive predictors. Considering 368 non-cognitive factors as part of the medical student selection process is important 369 because medical students are more than their GPA and MCAT scores. Medical students 370 have diverse personality variables contributing to how they think and feel. Many such 371 variables may contribute positively or negatively toward academic success. Affective 372 variables that may contribute to academic achievement include self-esteem level, self- 373 esteem stability, and procrastination. For example, if a student performs poorly on an 374 exam, self-esteem may be impacted negatively, triggering feelings of academic 375 inadequacy and a lack of motivation to continue studying. Furthermore, as 376 x

377 this literature review shows, low self-esteem often leads to a downward spiral of 378 decreased ability to concentrate on studies, lack of motivation, and on going 379 procrastination, likely resulting in more marginal or failing test performance. 380 Marginal performance or failure in the first year of medical school can lead to a 381 significant financial burden on both the student and the school. These situations may have 382 a strong emotional impact on the student. In many cases an entire year must be repeated. 383 If there is a way to identify academic difficulty before it occurs, interventions may be 384 implemented thereby reducing emotional and financial stress and increasing personal 385 well-being. 386 387 KEY WORDS: self-esteem, self-esteem level, self-esteem stability, procrastination, 388 academic achievement, medical education, medical students 389 390 391 392 393 394 395 396 397 398 399 xi

Part A Review of the Literature Introduction Admittance to a school of medicine is extremely competitive. Based on data from the Association of American Medical Colleges (AAMC, 2008), in 2008, on average, 558,053 applications were submitted to 130 U.S. allopathic (excluding osteopathic) medical schools by 42,231 students (an average of 13 applications per applicant). Of those applicants, 17,759 matriculated. Students are admitted based on scores on the Medical College Admission Test (MCAT), total undergraduate grade point averages, basic sciences grade point averages, and extra-curricular activities in the medical field. If a student performs at a high level on all admission criteria for a particular medical school, the student is invited for an interview. Data are then reviewed by admissions committees and students are accepted, placed on an alternate list, or rejected. Although this seems to be a rigorous process, approximately 10% of medical students perform marginally or fail (personal communication with three schools of medicine assessment departments, April 2007). This situation places a psychological as well as a financial burden on the students. Depression and anxiety result and financial debt increases when students need to repeat courses or entire years. Although the process to select medical students is rigorous, the process is primarily based on cognitive characteristics. It is important to note that students consist of more than numbers representing their intellectual ability. From this reviewer's perspective, what appears to be missing from the admissions process is the use of affective (also known as non-cognitive) measurements to look at who these potential medical students are as people.

2 Studies Using Affective Variables in the Medical School Admissions Process A number of studies have been conducted that support using affective variables for admission to medical school (Roessler, Lester, Butler, Rankin, & Collins, 1978; Lipton, Huxham, & Hamilton, 1984; Hojat, Robeson, Damjanov, Veloski, Glaser, & Gonnella, 1993; Hobfall, Anson, & Antonovsky, 1982; Peng, Khaw, & Edariah, 1995; Lumsden, Bore, Millar, Jack, & Powis, 2005). These studies compared cognitive predictors with non-cognitive predictors. Cognitive predictors consisted of cumulative undergraduate grade-point average and verbal, physical science, and biological science MCAT subtests. (Roessler et al., 1978; Hojat et al., 1993; Hobfoll et al., 1982; Peng et al., 1995). Non-cognitive predictors included measures such as the Self-Derogation Scale, the 15 needs scales, and the Validity Scale of the Edwards Personal Preference Schedule; the Barratt Impulsivity Scale; the Depression Scale (scale 2), Psychopathic Deviate Scale (scale 4), and Ego Strength scales (Es) of the Minnesota Multiphasic Personality Inventory; the Capacity for Status, Tolerance, Intellectual Efficiency, Sociability, and Communality scales of the California Psychological Inventory; and the Eysenck Personality Inventory. Roessler et al. (1978) selected these personality trait measures because they have been shown to be related to medical school performance and to quantify psychopathology which was hypothesized to be related to poor performance. Roessler et al. (1978) tested 189 students at Baylor College of Medicine between 1974 and 1975. Multiple regressions were performed for cognitive variables alone and combined cognitive and personality variables. Results ranged from r = .45 to r = .64 for combined cognitive and personality variables. Each of these correlations was significantly greater than the corresponding correlations using cognitive predictors alone.

3 Results showed that adding personality to the usual cognitive variables enhanced the prediction of mean basic sciences grades taken during the first 2 years of medical school and National Board of Medical Examination (NMBE) scores. McDonald and Gynther (1963) administered the Edwards Personal Preference Schedule (EPPS), a 225-item test which measures 15 normal needs variables (e.g., achievement, aggression, etc.) and the Interpersonal Check List (ICL) with a 128-item test measuring 8 interpersonal variables including (a) managerial-autocratic, (b) competitive-narcissistic, (c) blunt-aggressive, (d) skeptical-distrustful, (e) self-effacing- masochisti,; (f) docile-dependent, (g) cooperative-over conventional, and (h) responsible- overgenerous. These instruments were administered to 66 medical students at the Medical College of South Carolina. Results showed that applicants who endorsed more, rather than less of the following attributes were more likely to perform successfully in medical school: (a) students who can accept routine, (b) students who are less dependent upon others, (c) students who are achievement-oriented, and (d) students who describe themselves as friendly and responsible. In a similar study, Gough and Hall (1964) administered the California Psychological Inventory (CPI) to 98 medical students attending the University of California School of Medicine. Results showed that those successful in medical school also endorsed a high degree of personal maturity, concern for others, and self-confidence and were low on narcissistic achievement drive or compulsive striving. Hojat et al. (1993) conducted a study using 175 second-year medical students at lefferson Medical College in 1989-1990. Students were asked to complete 11 psychosocial questionnaires used to predict performance in medical school. MCAT

4 scores were also used. Three composite measures of performance were used as criterion measures, basic science exam grades, clinical exam grades, and rating of clinical competence. A multiple regression was performed. When the psychosocial measures were added to the statistical models in which the common variances of the MCAT scores were already determined, significant increments in the common variances were observed for basic sciences grades and clinical exam grades. Where only 4% of the common variance in the ratings of clinical competence could be accounted for by the MCAT scores, 14% could be accounted for by the psychosocial measures. The noncognitive measures increased the degree of the relationship between the predictive and criterion measures of the students' academic performances beyond only using the conventional (cognitive) admission measures (Hojat et al., 1993). Peng, Khaw, and Edariah (1995) conducted a study at the Universiti Kebangsaan Malaysia with 101 first-year medical students. Cattell's 16 Personality Factor Questionnaire (16PF) was administered at the beginning of year 1 and compared with medical school scores at the end of year 2. Personality variables including willingness to take risks, being enthusiastic, self-opinionated, imaginative, experimental, resourceful, and driven, correlated positively with performance, whereas being self-assured had a negative correlation with performance. Additionally, problem students were more reserved, emotionally less stable, and more apprehensive than non-problem students. As the previous studies indicate, considering non-cognitive factors as part of the medical student selection process is important because medical students are more than their GPA and MCAT scores. Indeed, these students have diverse personality variables contributing to how they think and feel. As discussed above, many such variables may

5 contribute positively or negatively toward academic success. Several other affective variables not yet discussed that may contribute to academic achievement include self- esteem and procrastination. For example, if a student performs poorly on an exam, self- esteem may be impacted negatively, triggering feelings of academic inadequacy and a lack of motivation to continue studying. Furthermore, as the literature shows, and from this reviewers' experience, low self-esteem often leads to a downward spiral of decreased ability to concentrate on studies, lack of motivation, and ongoing procrastination, likely resulting in more marginal or failing test performance. Self-Esteem Definitions Self-esteem, a controversial construct (Dawes, 1996) has been defined in a variety of ways. For example, Maruyama, Rubin, and Kingsbury (1981) defined self-esteem as the degree to which individuals generally feel positive about themselves. According to these authors, self-esteem continues to develop over time and may change in various situations. Other researchers suggest self-esteem is a decision people make about their merit (Coopersmith, 1967; Crocker & Park, 2004; Crocker & Wolfe, 2001), while others define self-esteem as a feeling of affection for oneself (Brown, 1993, 1998; Brown & Marshall, 2001,2006). Finally, if one views self-esteem on a continuum from high to low people may refer to the way they evaluate their abilities and characteristics. For example, a student who doubts his or her ability in school may have low academic self-esteem but also think he or she is good at sports and therefore have high athletic self-esteem. Brown and Marshall (2006) call these beliefs self-evaluations since they refer to the way people

6 evaluate their physical attributes, abilities, and personality characteristics (Brown & Marshall, 2006). In short, there are multiple ways in which self-esteem has been conceptualized and defined within the professional literature. As previously discussed, some authors refer to self-esteem in a more global manner, whereas others delineate specific self- esteem-related areas. Furthermore, self-esteem has been conceptualized according to levels (high or low) and stability (stable or unstable). Self-esteem level and self-esteem stability will be reviewed more thoroughly in the following sections. Level Research has shown that people with low self-esteem feel less confident about themselves than people with high self-esteem (Blaine & Crocker, 1993; Campbell, 1990). When people with low self-esteem fail, they become preoccupied with themselves and feel humiliated, ashamed, and relate the failure to other aspects of themselves (Brown & Dutton, 1995; Kernis, Brockner, & Frankel, 1989). In particular, people with low self- esteem who base their self-worth on academics may be more emotionally hurt by failure than people with high self-esteem who feel more confident about themselves (Baumeister, 1998; Park, Crocker, & Kiefer, 2007). Brown (1993) and Rosenberg (1965) define individuals with high self-esteem as those who globally like themselves. People with high self-esteem who fail tend to focus on their strengths rather than their weaknesses (Brown & Dutton, 1995; Baumeister & Tice, 1985; Brockner, Derr, & Laing, 1987; Dodgson & Wood, 1998; Heatherton & Vohs, 2000; Shrauger & Rosenberg, 1970).

7 Contingent, Implicit, Explicit Self-Esteem. High self-esteem can be further defined as contingent, implicit, or explicit. Contingent self-esteem is defined by Deci and Ryan (1995) as "feelings about oneself that result from—indeed, are dependent on-matching some standard of excellence or living up to some interpersonal or intrapsychic expectations" (1995, p. 32). Explicit self-esteem may be defined as "conscious, verbal" (Bosson, Brown, Zeigler-Hill, & Swann, 2003, p. 169) self-evaluation and implicit self- esteem may be defined as "automatic, nonverbal" and unconscious (Bosson, Brown, Zeigler-Hill, & Swann, 2003, p. 169) self-evaluation. A popular instrument developed by Josef Nuttin, Jr. (1985, 1987) and further investigated by a number of researchers (e.g., Kitayama & Karasawa, 1997; Koole & Pelham 2003; Gawronski, LeBel, & Peters, 2007) is called the Name-Letter Preference Task (NLPT). The NLPT measures implicit self-esteem by asking individuals to rate the letters of the alphabet on a 1-7 Likert scale. People with high implicit self-esteem tend to rate the first initials of their first and last names highest. According to Greenwald and Banaji (1995) "implicit self-esteem is the introspectively unidentified (or inaccurately identified) effect of the self-attitude on the evaluation of self-associated and self- dissociated objects" (p. 11). The theory follows that if individuals like themselves, they have a positive bias toward things connected to themselves. Therefore, "the name letter effect qualifies as a measure of implicit self-esteem because a) name letters are associated with self; b) name letter evaluations are generally positively biased; c) people are unaware of being biased toward their own name letters and, d) positive bias for name letters cannot easily be accounted for by factors other than the association between name letters and self (Koole & Pelham, 2003, p. 99).

8 Stability and Instability Stability can be thought of on a continuum with instability on the opposite end. Both of these constructs have also been found to be important components of self-esteem. Stable self-esteem may be defined as having short-term fluctuation. Unstable self-esteem may be defined as having long-term fluctuation (Rosenberg, 1986; Kernis & Waschull, 1995). These fluctuations may change because of an external event such as a grade, or because of something internally generated, such as a thought about a relationship. According to Rosenberg (1986) and Kernis and Waschull (1995), feelings of unstable self-esteem move between "worthiness and worthlessness" (Kernis & Waschull, 1995, p. 95). Trzesniewski, Donnellan, and Robins (2003) conducted two meta-analytic studies to examine the rank-order stability of self-esteem from ages 6 through 83. Rank-order stability is generally assessed by correlating self-esteem scores across two points in time. Test-retest correlations reflect the degree to which the relative ordering of individuals is maintained over time. In Study 1, Trzesniewski, Donnellan, and Robins, (2003) conducted a meta analysis of 50 published articles (n = 29,839) and Study 2 analyzed data from four large national studies (n = 74, 381). Self-esteem showed continuity over time (correlations ranged from .50 to .70), comparable to stability found for personality traits. Self-esteem stability was low during childhood, increased throughout adolescence and young adulthood, and declined during midlife and old age. One might question the decline of self-esteem stability during midlife and old age. Throughout midlife, people tend to experience few environmental changes, that is, they know who they are personally,

socially, and career-wise. In contrast, intense life changes tend to occur in late adulthood and old age. For example, children move out of the house, retirement occurs, and illness or death of a loved one all may lead to changes in how one perceives oneself in the familial and social world. In addition, health problems may cause dependency on others resulting in reduced feelings of worth. These events may change how one feels about the self contributing to less stable self-esteem. The literature reviewed could not explain this occurrence. Neither reliability of self-esteem measures, self-esteem scale, age difference, gender, ethnicity, nationality (U.S. vs. non-U.S.), or year of publication seemed to contribute to this phenomenon (Trzesniewski, Donnellan, & Robins, 2003). Level and Stability: Are they Different? In general, correlations between self-esteem level and self-esteem stability have ranged from the low teens to the low .30s. These results suggest that self-esteem level and self-esteem stability are independent components (Kernis & Waschull, 1995; Greenier, et al., 1999). Although one might equate low self-esteem with unstable self- esteem, this is not always correct. Research has shown that individuals with both high and low levels of self-esteem have different degrees of self-esteem stability and instability (Kernis, Grannemann, & Barclay, 1989; Kernis & Waschull, 1995; Greenier et al., 1999; Campbell, Chew, & Scratchely, 1991; Kernis, Brockner, & Frankel, 1989). Compared to those with stable self-esteem, those with unstable self-esteem have feelings about the self that are more affected by daily events, both positive and negative. In addition, when reporting on the most negative event of the day, those with unstable self- esteem are more likely than those with stable self-esteem to focus on events that pertain to feelings of acceptance/rejection. (Greenier et al., 1999).

10 To illustrate this concept, de Man and Becerril Gutierrez (2002) conducted a study with 131 undergraduate students hypothesizing the possible moderating effect of stability on the relationship between level of self-esteem and suicidal ideation. Correlation analyses and an analysis of covariance showed that suicidal ideation was significantly related to level of self-esteem but not to stability of self-esteem. An interaction effect showed that self-esteem stability did not affect those with high self- esteem, however self-esteem stability acted as a protective aspect for those with low self- esteem. It is important to keep in mind that since these findings are based on responses of university students only, results may not be generalized to the public. Another study conducted by de Man, Becerril Gutierrez, and Sterk (2001) again used 131 undergraduate students to examine the relationship between level and stability of self- esteem and depression. Results from this study found significant differences in depression when compared to those with high and low self-esteem; however, there was a significantly larger difference among individuals with unstable self-esteem. Respondents with low, unstable self-esteem had the highest mean depression score (15.88), and the lowest mean depression score was found for respondents with high, stable self-esteem (3.41). These results were similar to those found in a comparable study conducted by Roberts and Monroe (1992); however, results differed in a related study by Kernis, Grannemann, and Mathis (1991). Kernis et al. (1991) reported that those with low, stable self-esteem had the highest mean depression score (43.98) and those with high, stable self-esteem had the lowest mean depression score (32.36). However, it is important to note that in the de Man, Becerril Gutierrez, and Sterk (2001) study, the cumulative

11 interaction between level and stability of self-esteem was only apparent at the low self- esteem level. That is to say, individuals with low, unstable self-esteem may have a greater propensity toward depression (de Man, Becerril Gutierrez, & Sterk, 2001). Results from the Kernis et al. (1991) study showed self-esteem stability moderating the negative relationship between self-esteem level and depression. That is, "instability is related to higher levels of depression for those with high self-esteem, but lower levels of depression for those with low self-esteem" (Kernis, Grannemann, & Mathis, 1991, p. 83). Kernis, Paradise, Whitaker, Wheatman, and Goldman (2000) theorized that individuals with stable self-esteem appear more confident and make decisions more easily than those with less stable self-esteem (Kernis, 2005). Kernis and colleagues' (e.g., 1995, 1998, 2000, 2005) research has shown that individuals with unstable self-esteem "a) have self feelings that are more affected by everyday positive and negative events (Greenier et al., 1999), b) experience greater increases in depressive symptoms when faced with daily hassles (Kernis et al., 1998); c) report greater tendencies to over- generalize negative implications of specific failures and attribute negative outcomes to internal, stable, and global factors (Kernis, Paradise et al., 2000); d) have more impoverished self concepts (Kernis, Paradise et al., 2000), e) regulate goal-directed behaviors suboptimally (Kernis, Paradise et al., 2000), and f) adopt a cautious, self- esteem-protective orientation toward learning as opposed to curiosity and challenge seeking" (Kernis, 2005, p. 20). A study by Kernis, Greenier, Herlocker, Whisenhunt, and Abend (1997) further illustrates this theory by comparing the effects of level and stability of self-esteem to reactions of good and poor test performances. Results showed that individuals with high,

12 unstable self-esteem who performed well were more likely to talk about it but did not feel good about the positive outcome. On the other hand, individuals with high, unstable self- esteem and poor performance tended to become angry at the test writer and doubted their ability. Results from the Kernis, Greenier, Herlocker, Whisenhunt, and Abend (1997) study are similar to results from prior studies (Kernis, Brockner, & Frankel, 1989; Kernis, Cornell, Sun, Berry, & Harlow, 1993, Study 1; Kernis et al., 1997). Kugle, Clements, and Powell (1983) conducted a study to examine self-esteem level and self-esteem stability in regard to students' achievement and students' self- assessment accuracy related to their academic standing. The relationship between self- esteem level and self-esteem stability was also examined. Level of self-esteem was measured by administering the Piers-Harris Children's Self Concept Scale on two occasions to 87 second graders. Stability of self-esteem for each student was calculated by determining agreement among item responses on two occasions. Results indicated that level and stability of self-esteem are not related to one another, that stability of self- esteem is related to the accuracy of students' perceptions of their academic ability, and that both level and stability of self- esteem are positively correlated with academic achievement. However, only stability of self-esteem remained predictive of achievement once ethnic differences were controlled. Although this study is old, results show self- esteem level and self-esteem stability as different components and that both self-esteem level and self-esteem stability are positively correlated with academic achievement. One more study by Kernis, Grannemann, and Barclay (1992) looked at self- esteem stability and level as predictors of making excuses. Results show that individuals with high and low, unstable self-esteem make excuses following failure. However, those

13 with high, unstable self-esteem made excuses to increase their self-esteem and those with low, unstable self-esteem made excuses to protect their self-esteem. Kernis and colleagues (e.g., 1992, 1995, 2003, 2005) have conceptualized that individuals with high, unstable self-esteem exhibit behavior that either protects or improves their self-esteem. Examples of excuses include not having enough time to study or blaming the instructor for writing poor test questions (Kernis, 2003: Kernis & Waschull, 1995). Individuals with high, stable self-esteem do not need continuous validation from others. For example, they exhibit appropriate feelings after success or failure (Deci & Ryan, 1995; Kernis et al., 1997; Kernis, 2003). People with high, unstable self-esteem may exhibit inappropriate feelings after failure and try to protect their self-esteem (Kernis, 2003). In summary, self-esteem level and stability are both important in relation to academic achievement, and the literature suggests that those with high, stable self-esteem may feel more confident about themselves in the learning process. Results from a study conducted by Kernis et al. (2000) suggest that those with high, stable self-esteem feel a stronger sense of self as compared to those with high, unstable self-esteem. For those with high, stable self-esteem, learning is about satisfying the self rather than avoiding guilt or anxiety. Self-Concept Clarity Self-concept clarity (SCC) is an important aspect of self-esteem especially as it relates to stability of one's self-esteem (Campbell, 1990; Kernis, Cornell, Sun, Berry, & Harlow, 1993; Bower, 2006). Self-concept clarity is defined as "the extent to which the contents of an individual's self-concept, or perceived personal attributes, are clearly and

Full document contains 141 pages
Abstract: Although the admissions process for acceptance into all U.S. medical schools is rigorous, there are still approximately 10% of those who matriculate across the U.S. who experience academic difficulty, or worse, fail. One might question, if only the best are selected, how can student failure or marginal performance occur? This study investigated two hypotheses in 68 first-year medical students at the University of New Mexico School of Medicine. The hypotheses were as follows: (a) that procrastination would mediate the relationship between self-esteem level and academic achievement in first-year medical students and (b) that self-esteem stability would moderate the relationship between self-esteem level and procrastination. Results indicated no mediation but did show moderation of the relationship between self-esteem level and procrastination. However, this significant outcome only occurred when using the Rosenberg Self-Esteem Scale, Self-Handicapping Scale, and the Contingent Self-Esteem Scale to measure self-esteem level, procrastination, and self-esteem stability, respectively. Results were not significant when using the Name Letter Preference Task, Procrastination Assessment Scale-Students and Instability of Self-Esteem Scale to measure variables as mentioned. These results are discussed in a framework highlighting the importance of using specific instruments to measure specific variables. Keywords. medical education, medical students, self-esteem, self-esteem level, self- esteem stability, procrastination, academic achievement.