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Pharmacological Cognitive Enhancement Among International Medical Students: Assessing Study Habits as a Novel Factor

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Abstract  

Introduction

Pharmacological cognitive enhancement (PCE) among healthy individuals with off-label use of medications raises ethical and safety concerns in academia. Among the few studies that have examined this phenomenon in medical students, the desire to improve performance and cope with high levels of stress are the most common associated factors implicated. Our main objective was to update current literature by exploring a novel factor by investigating the association between PCE use and student learning approaches among a cohort of international medical students.

Methods

We conducted a cross-sectional study with an anonymous, online survey, distributed to year 1 US international medical students at Universidad Autónoma de Guadalajara. Participants reported PCE medication use, underlying motivators, and answered items characterizing their study habits via the Approaches to Learning and Studying Inventory (ALSI).

Results

A total of 103 student responses were included, with 18 students (17.3%) reporting PCE use and a majority (61.1%) of whom were female. PCE users were less likely to adopt deep or strategic study approaches and were mainly motivated to improve academic performance.

Discussion

We encourage universities to have open discussions about medication risks and forms to improve an active learning without its use, which might be beneficial in curbing the perceived need for pharmacologic enhancement. Further explorations are required to confirm if certain study habits are truly associated with PCE use.

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References

  1. Gatley SJ, Ding YS, Volkow ND, Chen R, Sugano Y, Fowler JS. Binding of d-threo-[11C]methylphenidate to the dopamine transporter in vivo: insensitivity to synaptic dopamine. Eur J Pharmacol. 1995;281(2):141–9. https://doi.org/10.1016/0014-2999(95)00233-b.

    Article  Google Scholar 

  2. Kuczenski R, Segal DS. Effects of methylphenidate on extracellular dopamine, serotonin, and norepinephrine: comparison with amphetamine. J Neurochem. 1997;68(5):2032–7. https://doi.org/10.1046/j.1471-4159.1997.68052032.x.

    Article  Google Scholar 

  3. Volkow ND, Wang G, Fowler JS, Logan J, Gerasimov M, Maynard L, et al. Therapeutic doses of oral methylphenidate significantly increase extracellular dopamine in the human brain. J Neurosci. 2001;21(2):RC121. https://doi.org/10.1523/JNEUROSCI.21-02-j0001.2001.

    Article  Google Scholar 

  4. Ricci G. Pharmacological human enhancement: an overview of the looming bioethical and regulatory challenges. Front Psychiatry. 2020;11:53. https://doi.org/10.3389/fpsyt.2020.00053.

    Article  Google Scholar 

  5. Dresler M, Sandberg A, Ohla K, Bublitz C, Trenado C, Mroczko-Wasowicz A, et al. Non-pharmacological cognitive enhancement. Neuropharmacology. 2013;64:529–43. https://doi.org/10.1016/j.neuropharm.2012.07.002.

    Article  Google Scholar 

  6. Vrecko S. Just how cognitive is “cognitive enhancement”? On the significance of emotions in university students’ experiences with study drugs. AJOB Neurosci. 2013;4(1):4–12. https://doi.org/10.1080/21507740.2012.740141.

    Article  Google Scholar 

  7. Darwig J, Gaum PM, Pauli R, Nassri L, Lang J. The relevance of pharmacological neuroenhancement for stress and resilience-a multistudy report. Front Public Health. 2022;10:971308. https://doi.org/10.3389/fpubh.2022.971308.

    Article  Google Scholar 

  8. Smith ME, Farah MJ. Are prescription stimulants “smart pills”? The epidemiology and cognitive neuroscience of prescription stimulant use by normal healthy individuals. Psychol Bull. 2011;137(5):717–41. https://doi.org/10.1037/a0023825.

    Article  Google Scholar 

  9. Shahidi F, Dowlatkhah HR, Avand A, Musavi SR, Mohammadi E. A study on the quality of study skills of newly-admitted students of Fasa University of Medical Sciences. J Adv Med Educ Prof. 2014;2(1):45–50.

    Google Scholar 

  10. Bin Eid A, Almizani M, Alzahrani A, Alomair F, Albinhamad A, Albarrak Y, et al. Examining learning styles with gender comparison among medical students of a Saudi University. Adv Med Educ Pract. 2021;12:309–18. https://doi.org/10.2147/AMEP.S295058.

    Article  Google Scholar 

  11. Alzahrani SS, Soo Park Y, Tekian A. Study habits and academic achievement among medical students: a comparison between male and female subjects. Med Teach. 2018;40(sup1):S1–9. https://doi.org/10.1080/0142159X.2018.1464650.

    Article  Google Scholar 

  12. Dort JM, Trickey AW, Kallies KJ, Joshi AR, Sidwell RA, Jarman BT. Applicant characteristics associated with selection for ranking at independent surgery residency programs. J Surg Educ. 2015;72(6):e123–9. https://doi.org/10.1016/j.jsurg.2015.04.021.

    Article  Google Scholar 

  13. Go PH, Klaassen Z, Chamberlain RS. Residency selection: do the perceptions of US programme directors and applicants match? Med Educ. 2012;46(5):491–500. https://doi.org/10.1111/j.1365-2923.2012.04257.x.

    Article  Google Scholar 

  14. Biggs J, Kember D, Leung DY. The revised two-factor study process questionnaire: R-SPQ-2F. Br J Educ Psychol. 2001;71(Pt 1):133–49. https://doi.org/10.1348/000709901158433.

    Article  Google Scholar 

  15. McManus IC, Richards P, Winder BC. Intercalated degrees, learning styles, and career preferences: prospective longitudinal study of UK medical students. BMJ. 1999;319(7209):542–6. https://doi.org/10.1136/bmj.319.7209.542.

    Article  Google Scholar 

  16. Marraccini ME, Weyandt LL, Rossi JS, Gudmundsdottir BG. Neurocognitive enhancement or impairment? A systematic meta-analysis of prescription stimulant effects on processing speed, decision-making, planning, and cognitive perseveration. Exp Clin Psychopharmacol. 2016;24(4):269–84. https://doi.org/10.1037/pha0000079.

    Article  Google Scholar 

  17. Repantis D, Bovy L, Ohla K, Kuhn S, Dresler M. Cognitive enhancement effects of stimulants: a randomized controlled trial testing methylphenidate, modafinil, and caffeine. Psychopharmacology. 2021;238(2):441–51. https://doi.org/10.1007/s00213-020-05691-w.

    Article  Google Scholar 

  18. Becker M, Repantis D, Dresler M, Kuhn S. Cognitive enhancement: effects of methylphenidate, modafinil, and caffeine on latent memory and resting state functional connectivity in healthy adults. Hum Brain Mapp. 2022;43(14):4225–38. https://doi.org/10.1002/hbm.25949.

    Article  Google Scholar 

  19. Beyer C, Staunton C, Moodley K. The implications of methylphenidate use by healthy medical students and doctors in South Africa. BMC Med Ethics. 2014;15:20. https://doi.org/10.1186/1472-6939-15-20.

    Article  Google Scholar 

  20. Carlier J, Giorgetti R, Vari MR, Pirani F, Ricci G, Busardo FP. Use of cognitive enhancers: methylphenidate and analogs. Eur Rev Med Pharmacol Sci. 2019;23(1):3–15. https://doi.org/10.26355/eurrev_201901_16741.

    Article  Google Scholar 

  21. Mattick K, Dennis I, Bligh J. Approaches to learning and studying in medical students: validation of a revised inventory and its relation to student characteristics and performance. Med Educ. 2004;38(5):535–43. https://doi.org/10.1111/j.1365-2929.2004.01836.x.

    Article  Google Scholar 

  22. Entwistle N, Tait H, McCune V. Patterns of response to an approaches to studying inventory across contrasting groups and contexts. Eur J Psychol Educ. 2000;15(1):33–48. https://doi.org/10.1007/BF03173165.

    Article  Google Scholar 

  23. Entwistle N, McCune V. The disposition to understand for oneself at university: integrating learning processes with motivation and metacognition. Br J Educ Psychol. 2013;83(Pt 2):267–79. https://doi.org/10.1111/bjep.12010.

    Article  Google Scholar 

  24. Retief M, Verster C. Prevalence and correlates of non-medical stimulants and related drug use in a sample of South African undergraduate medical students. S Afr J Psychiatr. 2016;22(1):795. https://doi.org/10.4102/sajpsychiatry.v22i1.795.

    Article  Google Scholar 

  25. Plumber N, Majeed M, Ziff S, Thomas SE, Bolla SR, Gorantla VR. Stimulant usage by medical students for cognitive enhancement: a systematic review. Cureus. 2021;13(5):e15163. https://doi.org/10.7759/cureus.15163.

    Article  Google Scholar 

  26. Emanuel RM, Frellsen SL, Kashima KJ, Sanguino SM, Sierles FS, Lazarus CJ. Cognitive enhancement drug use among future physicians: findings from a multi-institutional census of medical students. J Gen Intern Med. 2013;28(8):1028–34. https://doi.org/10.1007/s11606-012-2249-4.

    Article  Google Scholar 

  27. Cohen YG, Segev RW, Shlafman N, Novack V, Ifergane G. Methylphenidate use among medical students at Ben-Gurion University of the Negev. J Neurosci Rural Pract. 2015;6(3):320–5. https://doi.org/10.4103/0976-3147.158749.

    Article  Google Scholar 

  28. Merwid-Ląd A, Passon M, Drymluch P, Głuszyński M, Szeląg A, Matuszewska A. Do Medical Universities Students Use Cognitive Enhancers while Learning?-Conclusions from the Study in Poland. Life (Basel). 2023;13(3):820. https://doi.org/10.3390/life13030820.

    Article  Google Scholar 

  29. Leuner K, Kurz C, Guidetti G, Orgogozo JM, Müller WE. Improved mitochondrial function in brain aging and Alzheimer disease - the new mechanism of action of the old metabolic enhancer piracetam. Front Neurosci. 2010;4:44. https://doi.org/10.3389/fnins.2010.00044.

    Article  Google Scholar 

  30. Acosta DL, Fair CN, Gonzalez CM, Iglesias M, Maldonado N, Schenkman N, et al. Nonmedical use of d-Amphetamines and Methylphenidate in Medical Students. P R Health Sci J. 2019;38(3):185–8.

    Google Scholar 

  31. Dedos SG, Fouskakis D. Dataset and validation of the approaches to study skills inventory for students. Sci Data. 2021;8(1):158. https://doi.org/10.1038/s41597-021-00943-6.

    Article  Google Scholar 

  32. Mhata NT, Ntlantsana V, Tomita AM, Mwambene K, Saloojee S. Prevalence of depression, anxiety and burnout in medical students at the University of Namibia. S Afr J Psychiatr. 2023;29:2044. https://doi.org/10.4102/sajpsychiatry.v29i0.2044.

    Article  Google Scholar 

  33. Coombes R. Medical students need better mental health support from universities, says BMA. BMJ. 2018;361:k2828. https://doi.org/10.1136/bmj.k2828.

    Article  Google Scholar 

  34. Lucchetti G, Damiano RF, DiLalla LF, Lucchetti ALG, Moutinho ILD, da Silva EO, et al. Cross-cultural differences in mental health, quality of life, empathy, and burnout between US and Brazilian medical students. Acad Psychiatry. 2018;42(1):62–7. https://doi.org/10.1007/s40596-017-0777-2.

    Article  Google Scholar 

  35. Dresler M, Sandberg A, Bublitz C, Ohla K, Trenado C, Mroczko-Wasowicz A, et al. Hacking the brain: dimensions of cognitive enhancement. ACS Chem Neurosci. 2019;10(3):1137–48. https://doi.org/10.1021/acschemneuro.8b00571.

    Article  Google Scholar 

  36. Brehm BJ, Summer SS, Khoury JC, Filak AT, Lieberman MA, Heubi JE. Health status and lifestyle habits of US medical students: a longitudinal study. Ann Med Health Sci Res. 2016;6(6):341–7. https://doi.org/10.4103/amhsr.amhsr_469_15.

    Article  Google Scholar 

  37. Maslen H, Faulmuller N, Savulescu J. Pharmacological cognitive enhancement-how neuroscientific research could advance ethical debate. Front Syst Neurosci. 2014;8:107. https://doi.org/10.3389/fnsys.2014.00107.

    Article  Google Scholar 

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Authors and Affiliations

  1. Milken Institute of Public Health, George Washington University, Washington, D.C., USA

    Parker Sheldon

  2. Unidad Académica Ciencias de la Salud, Universidad Autónoma de Guadalajara, Zapopan, Mexico, 45129

    Javier Mendez-Montejano & Maria G. Zavala-Cerna

  3. Nuvance Health, Danbury, CT, USA

    Andrew J. Michalak

  4. Kansas University Medical Center, Kansas City, MO, USA

    Juliana J. Navarro

  5. University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Cersten Bradley

  6. HCA MountainView Hospital, Las Vegas, NV, USA

    Milliejoan Mongalo

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  1. Parker Sheldon
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Correspondence to Maria G. Zavala-Cerna.

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The protocol and questionnaires were submitted to the IRB with approval number: CEI/2021/004.

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Sheldon, P., Mendez-Montejano, J., Michalak, A.J. et al. Pharmacological Cognitive Enhancement Among International Medical Students: Assessing Study Habits as a Novel Factor. Med.Sci.Educ. (2024). https://doi.org/10.1007/s40670-024-02113-w

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