Expanding Mental Toughness In Underrepresented In Medicine, Rural, Nontraditional Students: A High-impact Intervention Within A Prematriculation Program

Mental toughness (MT) is a performance psychology construct that equips individuals to face adversity and persist toward their goals. The current study expanded upon a pilot MT intervention to equip medical students with foundational skills for managing stress and adversity. In the initial pilot study by Shohat et al. (2024), conducted outside the School of Medicine’s Prematriculation Program (PMAT), MT education improved participants’ understanding of MT. Building on these findings, we developed a comprehensive (incorporating education, skill acquisition, and application phases) MT program within PMAT, to support underrepresented in medicine (URiM), rural, and nontraditional students. PURPOSE: To evaluate the expanded MT intervention’s impact on medical students’ MT levels within PMAT. METHODS: The MT program consisted of four weekly 1-hour workshops focused on MT’s key dimensions: attention regulation, emotion regulation, generalized self-efficacy, buoyancy, success mindset, optimistic style, overcoming adversity, and context knowledge. Participants (n = 14) rated their MT levels using the Mental Toughness Index before and after the intervention. To assess changes, we conducted a Wilcoxon Signed-Rank Test and calculated Cohen’s d for effect size. Bootstrapping was used to establish a 95% confidence interval for effect size to improve robustness due to sample size limitations. All analyses were conducted in MATLAB R2024b. RESULTS: The Wilcoxon Signed-Rank Test indicated a significant increase in MT levels, p = .004. Cohen’s d was 1.44, representing a large effect, with a 95% confidence interval [0.24, 1.43], suggesting that, even at the lower end, the intervention likely had a small to moderate practical effect on MT. CONCLUSIONS: This study provides strong evidence that the expanded MT intervention significantly improved participants’ MT levels, suggesting large practical effects. These findings support the continued use and potential scaling of MT workshops within PMAT and beyond to equip medical students with essential psychological skills for academic and socioeconomic challenges. Future research should examine the retention of MT improvements and expand the sample size.