[01] Lim Yu Ern, Faculty of Medicine, Melaka Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia. [02] Fathima Shamla Mohammed Ziyamdeen, Faculty of Medicine, Melaka Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia. [03] Sabryne bt Mohd Zeidi, Faculty of Medicine, Melaka Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia. [04] Narmatha a/p Tamilselvan, Faculty of Medicine, Melaka Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia. [05] Vicknesh Waren a/l Mohan, Faculty of Medicine, Melaka Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia.

The aim of this research is to study the effect of positive and negative reinforcement on stress, anxiety, confidence, mood and short term memory among MMMC students. In this study, 60 participants were randomly assigned into two groups, out of which 30 were assigned into the positive reinforcement group and the other 30 into the negative reinforcement group. The planned intervention specific to each group was applied and the participants were asked to read and answer a comprehensive text for assessment of short term memory. Upon completion of it, the participants were given the post–intervention questionnaire. Finally, the participants were asked to fill a feedback form before leaving the room. The mean score for each variable and mean % for memory score was calculated using Epi info version 7 and Graph pad and the results were compared between the positive and negative reinforcement group. After application of the intervention, mean anxiety score was significantly higher, in the negative reinforcement group and significantly lower in the positive reinforcement group, with a mean of 6.5 and 4.6, respectively. All other variables also showed an increase following negative reinforcement but was not significant. However all the variables showed a significant change following positive reinforcement, with the highest change seen in mood with a score of 7.0. In conclusion, positive reinforcement has reduced the stress and anxiety level, increased the confidence level and improved the mood significantly. Whereas, negative reinforcement has increased the stress level and anxiety, and had no significant changes in mood and confidence. Students also prefer positive reinforcement over negative reinforcement. In conclusion, positive reinforcement has a better effect on reducing stress, anxiety and improving mood, confidence and short term memory.

Positive Reinforcement, Negative Reinforcement, Stress, Anxiety, Confidence, Mood, Short Term Memory, Medical Students

[01] Reinforcement. (n.d.). In Alleydog.com's online glossary. Retrieved from: https://www.alleydog.com/glossary/definition-cit.php?term=Reinforcement [02] McLeod, S. (2018). B. F. Skinner | Operant Conditioning | Simply Psychology. [online] Simplypsychology.org. Available at https://www.simplypsychology.org/operant-conditioning.html [Accessed 8 Nov. 2018]. [03] R. Butler, Laura & Luiselli, James. (2007). Escape-Maintained Problem Behavior in a Child With Autism. Journal of Positive Behavior Interventions - J POSIT BEHAV INTERV. 9. 195-202. 10.1177/10983007070090040201. [04] Steege, M. W., Wacker, D. P., Cigrand, K. C., Berg, W. K., Novak, C. G., Reimers, T. M., Sasso, G. M. and DeRaad, A. (1990), USE OF NEGATIVE REINFORCEMENT IN THE TREATMENT OF SELF‐INJURIOUS BEHAVIOR. Journal of Applied Behavior Analysis, 23: 459-467. doi: 10.1901/jab990.23-459 [05] Fosco WD, Hawk LW, Rosch KS, Bubnik MG. Evaluating cognitive and motivational accounts of greater reinforcement effects among children with attention-deficit/hyperactivity disorder. Behav Brain Funct. 2015; 11: 20. Published 2015 Apr 29. doi: 10.1186/s12993-015-0065-9 [06] Reisinger, J. J. (1972), THE TREATMENT OF “ANXIETY‐DEPRESSION” VIA POSITIVE REINFORCEMENT AND RESPONSE COST1. Journal of Applied Behavior Analysis, 5: 125-130. [07] Olivier George, Chapter 12 - Negative Reinforcement Mechanisms in Addiction, Editor(s): Mary Torregrossa, Neural Mechanisms of Addiction, Academic Press, 2019, Pages 179-188, ISBN 9780128122020 [08] Bouxsein KJ, Roane HS, Harper T. Evaluating the separate and combined effects of positive and negative reinforcement on task compliance. J Appl Behav Anal. 2011; 44 (1): 175-9. [09] Miltenberger, R. G., Romaniuk, C., & Tiffany Kodak. (2013, February 27). THE EFFECTS OF DIFFERENTIAL NEGATIVE REINFORCEMENT OF OTHER BEHAVIOR AND NONCONTINGENT ESCAPE ON COMPLIANCE. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1901/jaba.2003.36-379 [10] Effects of Positive and Negative Reinforcement in a Concurrent Operants Arrangement on Compliance and Problem Behavior. (2015, January 21). Retrieved from https://www.sciencedirect.com/science/article/pii/S2007471914709780#sec0015 [11] Stallings, J. A. CHANGING TEACHER BEHAVIOR: A CHALLENGE FOR THE 1980'S. Paper presented at the Annual Meeting of the American Educational Research Association, Los Angeles, CA, 1981. (ED 200 596) [12] Lujan, J. HOW TEACHER BEHAVIOR RELATES TO STUDENT EFFORT IN CLASSROOMS FOR LOW AND HIGH STATUS STUDENTS. [13] Martin, J.; Veldman, D. J.; and Anderson, L. M. "Within Class Relationships Between Student Achievement and Teacher Behaviors." American Educational Research Journal 17 (1980): 479- 490. [14] Medley, D. M. TEACHER COMPETENCE AND TEACHER EFFECTIVENESS: A REVIEW OF PROCESS-PRODUCT RESEARCH. Washington, D. C.: American Association of Colleges for Teacher Education, 1977. (ED 143 629). [15] Michaels, J. W. "Classroom Reward Structures and Academic Performance." REVIEW OF EDUCATIONAL RESEARCH 47 (1977): 87-98. [16] -Quest, K., L., Bloomington, I., Bloomington, I. and University, I. (2018). Reinforcement in the Classroom. [online] Iidc.indiana.edu. Available at: https://www.iidc.indiana.edu/pages/reinforcement-in-the-classroom [Accessed 8 Nov. 2018]. [17] Diedrich, Jennifer L., "Motivating Students Using Positive Reinforcement" (2010). Education and Human Development Master's Theses. 9. [18] E. Laule, G., A. Bloomsmith, M. and J. Schapiro, S. (2010). The Use of Positive Reinforcement Training Techniques to Enhance the Care, Management, and Welfare of Primates in the Laboratory. [online] Tandfonline.com. Available at: https://www.tandfonline.com/doi/abs/10.1207/S15327604JAWS0603_02 [Accessed 9 Nov. 2018]. [19] Hackenberg T. D. (2009). Token reinforcement: a review and analysis. Journal of the experimental analysis of behavior, 91 (2), 257-86. [20] Insko, C. A. (1965). Verbal reinforcement of attitude. Journal of Personality and Social Psychology, 2 (4), 621-623. http://dx.doi.org/10.1037/h0022485 [21] Sankey, C., Richard-Yris, MA., Henry, S. et al. Anim Cogn (2010) 13: 753. https://doi.org/10.1007/s10071-010-0326-9 [22] Wilson, F., & Rolls, E. (1990, April 01). Learning and memory is reflected in the responses of reinforcement- related neurons in the primate basal forebrain. Retrieved from https://doi.org/10.1523/JNEUROSCI.10-04-01254.1990 [23] Lloyd K, Becker N, Jones MW and Bogacz R (2012) Learning to use working memory: a reinforcement learning gating model of rule acquisition in rats. Front. Comput. Neurosci. 6: 87. doi: 10.3389/fncom.2012.00087 [24] Glaser, E. (2018). The Nature of Reinforcement: Part I. (Volume I), Part II. (Volume II)... [Online] Eric.ed.gov. Available at: https://eric.ed.gov/?id=ED040595 [Accessed 8 Nov. 2018]. [25] A. Abel, E., Gadomski, M. and T. Brodhead, M. (2016). EBSCOhost | 117856157 | A Brief Report of Time-on-Task Behavior in a Child With Autism: Comparing Material and Social Reinforcement in the Home Environment.. [online] Web.a.ebscohost.com. Availableat: https://web.a.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=21648204&AN=117856157&h=ta6wZBTTi%2fgAUUda%2fH%2bL8x5JyMuu4VehofHE0bCJALinjkfbkCNYnagS7OoQ%2bFWHHvibI6%2b3yRuiAPzLhqQVkg%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d21648204%26AN%3d117856157 [Accessed 6 Dec. 2018]. [26] Wheatley, R. K., West, R. P., Charlton, C. T., Sanders, R. B., Smith, T. G., & Taylor, ~v1. J. (2009). Improving behavior through differential reinforcement: A praise note system for elementary school students. Education and Treatment of Children, 32, 551-571. Retrieved March 11, 2010, from ERIC database [27] Sutherland, K. S., Wehby, J. H. and Yoder, P. J. (2002) ‘Examination of the Relationship Between Teacher Praise and Opportunities for Students with EBD to Respond to Academic Requests’, Journal of Emotional and Behavioral Disorders, 10 (1), pp. 5–13. doi: 10.1177/106342660201000102 [28] Ware, B. "What Rewards Do Students Want?" PHI DELTA KAPPAN 59 (1978): 355-356. [29] Pintel, L. (2006). The effect of positive reinforcement on the achievement of 3rd grade students' spelling. [online] Rdw.rowan.edu. Available at: http://rdw.rowan.edu/cgi/viewcontent.cgi?article=1923&context=etd [Accessed 6 Dec. 2018].. [30] Putra Zebua, K. (2017). THE USE OF VERBAL REINFORCEMENT TO MOTIVATE THE 11th GRADE STUDENTS OF SMA BUDYA WACANA YOGYAKARTA TO SPEAK ENGLISH. [ebook] Yogyakarta. Available at: https://core.ac.uk/download/pdf/127701756.pdf [Accessed 6 Dec. 2018]. [31] Nights of the Pufflings By: Bruce McMillan https://www.bc.edu/research/intasc/researchprojects/enhanced_assessment/PDF/Paper_td.pdf