A causal model of critical thinking in a sample of Iranian medical students: associations with self-esteem, hardiness, and positive affect

Background: Medical students’ ability to think critically influences professional decision-making processes and may have direct and indirect implications for the quality of medical care. Few studies have previously investigated the role of psychological factors in the prediction of critical thinking among university students. The current study addresses the testing a model that examines the effect of self-esteem, psychological hardiness (the positive capacity to cope with stress) and positive affect (how much emotions are experienced as positive affects) on critical thinking. Methods: In a cross-sectional study, 200 medical sciences students enrolled at the Babol University of Medical Sciences (Babol City, Iran) were randomly invited to enter the study during the 2014/15 academic year. The participants completed four reliable and valid questionnaires: California Critical Thinking Skills Test Form B (CCTST-B); Positive Affect Schedule (PAS); Ahvaz Psychological Hardiness Inventory (AHI); and Rosenberg Self-Esteem Scale (RSES). A causal model of the relationship between variables was tested using path analysis. We used the software Statistical Package for Social Sciences (SPSS) v.23 for the regression model to test the suitable models and fitness of the components. P<0.05 was considered significant. Results: Self-esteem had a significant positive direct effect on critical thinking (β=0.458). The number of semesters the students had passed had a significant direct effect on critical thinking (β=0.249). Neither psychological hardiness nor positive affect had direct effects on the students’ critical thinking. An indirect positive mediating effect was revealed between psychological hardiness and critical thinking through self-esteem (β=0.177). Also, positive affect had an indirect significant effect on critical thinking through self-esteem (β=0.189). Conclusion: Self-esteem mediates the effect of psychological hardiness and positive affect on critical thinking in medical students.