Critical thinking is a metacognitive process that encompasses a variety of underlying skills and is essential in both educational and social contexts. It is considered a key skill for informed decision-making, problem-solving, and forming logical conclusions [1,2]. It allows for the development of a particularly critical ability in disciplines such as medicine, where professionals often need to evaluate and synthesize complex data to gain a deeper understanding of information [3,4]. Problem-based learning in medical education has been identified as an effective strategy for fostering the development of critical thinking and transferable skills [3]. This pedagogical approach motivates students to construct their own knowledge and take responsibility for their learning through an active and self-directed focus [4]. Furthermore, various factors, such as the learning environment and teacher support, can influence the development of critical thinking [5]. Thus, active participation and collaboration in the classroom fosters knowledge construction and critical reflection, promoting high-level cognitive skills such as analysis, synthesis, and evaluation, as well as argumentation and the use of evidence to justify hypotheses [6]. Moreover, there is a clear and consistent relationship between achievement goals, self-efficacy, study strategies, and critical thinking in medical students, where mastery goals and a deep approach to information processing are positively related to critical thinking and academic performance [7].

Anxiety is a mental health disorder characterized by fear, excessive worry, and a constant feeling of being overwhelmed, affecting people’s daily lives [24]. Medical students may experience persistent worries about their academic performance, which can contribute to the onset of generalized anxiety and other psychological morbidities [25]. Generalized anxiety has a high prevalence among medical students, with studies reporting prevalence rates ranging from 7.7% to 65.5%, indicating that these students are at a higher risk of experiencing anxiety compared to their non-medical peers [26]. Thus, anxiety can be related to various stressors, a lack of balance, relationship difficulties, uncertainty about the future, and financial burdens [27,28]. In addition, generalized anxiety can have negative effects on academic performance and satisfaction with studies as it increases sensory perception processing, affects the balance between stimulus-driven and goal-directed behaviors, impairs inhibitory control, affects short and long-term memory, and can influence executive processes and decision-making [29]. In addition, generalized anxiety can negatively affect the emotional and physical well-being of medical students, increasing levels of depression and leading to a decrease in quality of life, as well as a higher prevalence of emotional exhaustion [30].

Satisfaction with studies is a critical measure that refers to the subjective evaluation students make regarding the quality of the educational services they receive and to what extent these meet or exceed their expectations [8]. This indicator, essential for the success of educational institutions, can reflect both the quality of the curriculum and faculty, as well as the effectiveness of student support policies. Thus, it is crucial not only for higher education institutions but also for individual students, as their level of satisfaction can directly impact their engagement, performance, and retention [9]. Satisfaction with studies can also be influenced by factors such as academic difficulties, social adjustment, external commitments, and a sense of belonging [10].

In medical education, satisfaction with studies is a relevant factor due to the high prevalence of mental health problems among students. Distress, academic stress, ongoing difficulties balancing academic and personal responsibilities, and a lack of time for recreational and leisure activities can affect students’ quality of life and satisfaction with their studies [11,12]. In this regard, the relationship between these factors and academic performance can be complex and closely interconnected. Understanding these factors can be crucial to ensuring student engagement and success [11]. Understanding these connections can lead to the creation of more effective interventions that address the challenges faced by medical students and promote their overall well-being [13,14].

Academic self-efficacy refers to the beliefs one holds about their ability to organize and execute the actions necessary in handling academic situations. These beliefs influence the choices, effort, perseverance, and resilience of individuals in relation to academic tasks [31]. Self-efficacy and critical thinking are positively related, as students possessing well-developed critical thinking skills tend to present higher academic self-efficacy [19]. Additionally, it has been inferred that academic self-efficacy can act as a mediator between critical thinking and study satisfaction in university students [32,33]. However, more research is needed to specifically explore this mechanism in the population of medical students. In addition, generalized anxiety can negatively affect academic self-efficacy, as self-efficacy beliefs determine how people feel, think, are motivated, and behave, and anxiety can generate doubts about one’s capabilities and limit participation in challenging academic tasks [34]. Academic self-efficacy may play a mediating role in the relationship between generalized anxiety and satisfaction with studies [35]. Nevertheless, more research is needed to specifically examine this mechanism in the population of medical students and how it could be applied in interventions to improve satisfaction with studies in this population.