Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Dr. Chelsea D. Williams

Second Advisor

Dr. Diamond Y. Bravo

Third Advisor

Dr. Fantasy T. Lozada

Fourth Advisor

Dr. Terri N. Sullivan

Fifth Advisor

Dr. Rosalie Corona


Medical diplomacy is a foundational part of Cuban domestic and foreign policy (Feinsilver, 2010). Cuba has an abundance of doctors, encouraged by the country’s free medical education program (Hand et al., 2020), and has made a significant impact with its well-established healthcare system, provision of healthcare for all of its citizens, and healthcare support internationally. The current study aims to focus on processes underlying Cuban medical students’ academic performance, as they are a critical component of this successful system, and a population that has received limited empirical attention. Thus, the current study used path analyses to examine the relations between improved family relationships and academic performance mediated by belongingness and moderated by family legacy (i.e., having family members working in the medical field), and sex differences among Cuban medical students (N = 637) residing in Cuba (M age = 21.36, SD = 2.04). We found that improved family relationships significantly predicted increased belongingness to the field of medicine which, in turn, predicted increase perceptions of academic performance for Cuban medical students, this mediation only held for male and not female students. In other words, only male medical students with improved family relationships reported more feelings of belonging to the school of medicine and higher academic performance, this was not true for female students. Discussion on societal implications for sex differences will be addressed. Limitations, implications, and future direction will be further discussed.


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