Complex Thinking as a Predictor of Anxiety Symptoms in Medical Students

Abstract Introduction Medical training is associated with a high prevalence of anxiety symptoms that escalate with curricular advancement. Complex thinking has been proposed as a protective cognitive skill; however, its predictive capacity and evolution throughout training remain poorly explored. This study aimed to determine the predictive capacity of complex thinking for anxiety symptoms in medical students and to analyze the variation of this predictive effect by academic year. Methods A cross-sectional study was conducted among 567 medical students at a Mexican public university. Complex thinking and anxiety symptoms were assessed using the COMPLEX-21 scale and the Beck Anxiety Inventory, respectively. One-way ANOVA with Tukey post hoc comparisons, Pearson correlations, stratified linear regression models, and a Year × Complex Thinking interaction model were conducted. Results In the overall sample, complex thinking was an inverse predictor of anxiety symptoms ( B = − 0.249, 95% CI, − 0.33 to − 0.17; R 2 = 0.062; p < .001). Mean anxiety scores were higher in the third year than in the first year ( M = 21.52 vs. M = 17.57; Tukey-adjusted p = .039), whereas complex-thinking scores remained stable across academic-year groups (range, 81.14–84.14; ANOVA p = .233). Stratified models showed descriptively higher explained variance in the third ( R 2 = 0.110) and fourth ( R 2 = 0.098) years than in the first year ( R 2 = 0.026). However, the Year × Complex Thinking interaction was not statistically significant ( p = .058). Conclusions Complex thinking showed a consistent inverse predictive relationship with anxiety symptoms across academic-year groups. The stability of its levels suggests a potential curricular gap that warrants further evaluation. Integrating complex reasoning into pedagogical models may support student well-being and educational quality.