¿ESTAMOS HACIENDO LO SUFICIENTE PARA ABORDAR LOS PROBLEMAS DE AUTOESTIMA EN LOS ESTUDIANTES DE MEDICINA Y DE OTRAS CIENCIAS DE LA SALUD?

Los altos niveles de estrés psicosocial derivados de los exámenes continuos, las largas horas de estudio, la presión extrema para tener éxito y muchos otros factores ponen a los estudiantes de Medicina y de otras Ciencias de la Salud (como la Fisioterapia y la Enfermería, entre otras) en riesgo de problemas de salud mental como la baja autoestima, que se asocia con mayores tasas de depresión y suicidio.

Los altos niveles de estrés psicosocial derivados de los exámenes continuos, las largas horas de estudio, la presión extrema para tener éxito y muchos otros factores ponen a los estudiantes de Medicina y de otras Ciencias de la Salud (como la Fisioterapia y la Enfermería, entre otras) en riesgo de problemas de salud mental como la baja autoestima, que se asocia con mayores tasas de depresión y suicidio.
Si bien los estudiantes de Medicina y de otras Ciencias de la Salud tienden a ser extremadamente hábiles cuando ingresan a la Universidad (alumnos de excelente rendimiento, primeros de su clase, medallas de oro, etcétera), las encuestas muestran con frecuencia que casi la mitad de ellos informa tener una baja autoestima o una disminución en la autoestima desde su ingreso a la misma.
Estudios como estos revelan la necesidad de investigar más sobre las causas de la baja autoestima en los estudiantes de Medicina y de otras Ciencias de la Salud. Ya que solo cuando aislemos a los culpables, podremos abordar estos problemas. Sin embargo, identificar los problemas solo será el comienzo de la solución. Resolver los problemas no será una tarea fácil ni una tarea corta para las escuelas de Medicina. Implicará la promoción de profesores inspiradores y afectuosos en vez de cínicos y abusivos, la creación de una atmósfera en la que los estudiantes se sientan seguros compartiendo sus frustraciones sin temor a represalias, la oferta de atención de salud mental accesible y confidencial, y el rechazo y castigo de cualquier forma de hostigamiento a través de programas como el de reportes anónimos.

CONFLICTOS DE INTERÉS Y FUENTE DE FINANCIACIÓN
Los autores declaran no poseer conflictos de interés. Fuente de financiación: ninguna. 1 Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Cátedra de Psiquiatría, San Lorenzo, Paraguay. High levels of psychosocial stress derived from continuous examinations, long study hours, extreme pressure to succeed, and many other factors put medical and other health sciences students (physiotherapy, nursing, among others) at risk for mental health issues such as low self-esteem, which is associated with higher rates of depression and suicide.
Self -esteem can be defined as the belief that one is competent to live and deserving of happiness, and therefore capable of facing life with confidence, benevolence and optimism (1). Low self-esteem can be quite prevalent in the health sciences students' group. It can have a regulating effect on the behavior of the students, and it can be a determining factor for adaptation in the personal and social spheres. Likewise, it can also influence academic performance (2).
While medical and other health sciences students tend to be extremely accomplished when they get into the University (overachievers, first in their class, valedictorians, etcetera), surveys frequently show that almost half of them report having low self-esteem or a decrease in self-esteem since entering University.
Many factors can be argued to be contributors to this phenomenon, including fear-based teaching, extreme study overload, old and ineffective teaching methods (such as 2-hour-long mandatory lectures), and even cases of sexual harassment or discrimination based on gender, gender identity or sexual orientation. Many of these problems are systematic and structural issues that are strongly ingrained into the culture of the medical schools and have been passed on from many generations. Many of the parties involved in perpetuating these issues keep defending some of these conducts in the name of tradition.
In this issue of Medicina Clínica y Social journal, Camacho et al. present a replication study (3) from a previous article (4) published by Barrios et al. While the study is small, the results reveal an important gender gap, since the number of female students with low self-esteem more than doubles that of their male counterparts.
Studies such as these reveal the need for more research into the causes of low self-esteem in medical and other health sciences students. Since only when we isolate the culprits of this problem, will we be able to address these issues. However, identifying the issues will only be the beginning of the solution. Fixing these problems will not be an easy task nor a short one for medical schools. It will involve promoting inspiring and caring teachers over cynical and abusive ones, creating an atmosphere where students feel confident sharing their frustrations without fearing retribution, offering accessible and confidential mental health care, and discouraging any form of harassment through programs such as anonymous reporting.
Hopefully, medical schools' authorities will be encouraged to take the necessary steps to transform medical schools into safe environments where future doctors, physiotherapists, nurses and others, can thrive and succeed not only in their professional careers, but also in their personal lives.

CONFLICTS OF INTEREST AND FUNDING
Conflicts of interest: none. Funding source: none.