In their own words: stressors facing medical students in the millennial generation

The impact of financial stress on student wellbeing in Lebanese higher education

BACKGROUND

The financial crisis has indirectly affected Lebanese university students, leading to economic distress. Accordingly, this study aimed to assess the substantial negative impact of financial stress on the mental health and well-being of Lebanese college students.

METHODS

A quantitative research approach was applied and took place from June 13th to July 25th, 2023, targeting 1272 university students aged 17 and above from private and public universities across Lebanon through convenience sampling. The InCharge Financial Distress/Financial Well-Being scale (IFDFW), Pittsburgh Sleep Quality Index (PSQI), Beirut Distress Scale (BDS-10), Perceived Stress Scale (PSS-10), and Well-Being Index (WHO-5) were used to assess the students' well-being. Descriptive analyses of the data was performed using SPSS software version 25.

RESULTS

1272 university students participated in this study, mostly females, with a mean age of 21.64 (± 4.43) years. Participants reported a lack of financial independence, unemployment, and no income. Positive associations were obtained between the BDS total scale as well as the PSS total and PSQI scores, while there was a significant negative relationship between IFDFW and PSQI scores. Those with a higher GPA, majoring in science/health and medicine, living in rural areas, and graduate students were linked to lower PSQI and BDS-10 scores. Financial aid and financial independence were associated with lower PSQI and BDS-10 scores. PSS-10 scores were higher among students majoring in science/health and medicine. Higher scores on the IFDFW scale correlated with lower BDS-10 and PSS-10 scores. In contrast, females had higher BDS-10 and PSS-10 scores. Scoring higher on the PSS-10 and PSQI scales, living off campus, or majoring in science/health and medicine, were associated with higher on the WHO-5 scale.

CONCLUSIONS

A significant impact of financial stress on college students in Lebanon was obtained, affecting their well-being and mental health aspects. Marital status, gender, academic major, region of living, and financial independence also influences students' experiences. Tailored support and further research are needed to address these multifaceted challenges.

Dynamics of Students' Career Choice: a Conceptual Framework-Based Qualitative Analysis Focusing on Primary Care

BACKGROUND

Increasing primary care's attractiveness as a career choice is an important task of socially accountable medical schools. Research has broadly studied influences on medical students' career choice. However, a deeper understanding of the processes behind career decision-making could support medical schools in their efforts to promote primary care careers.

OBJECTIVE

To explore the dynamics of career choice during medical school with a focus on primary care, based on a previously developed conceptual framework.

APPROACH

Qualitative study using a phenomenological, inductive-deductive approach DESIGN AND PARTICIPANTS: Individual interviews were conducted from May 2019 to January 2020 with 14 first-year postgraduate trainee physicians, graduates of the Faculty of Medicine in Geneva, Switzerland, purposively sampled based on their interest in primary care during undergraduate studies. The interview guide was developed to elicit narratives about career-related decision-making. Two authors coded the transcripts. Thematic analysis alternated with data collection until thematic saturation was reached. Emerging themes were discussed and refined within the research team.

KEY RESULTS

Two main themes emerged: (1) developing professional identity, expressed as a changing professional image from unprecise and idealistic to concrete and realistic; priorities changed from content-based to lifestyle-based preferences; (2) individual trajectories of career-related decision-making, determined by different stages of refining professional interests; students navigated this process by employing various strategies, ranging from active exploration to passive behaviors.

CONCLUSIONS

This study's narrative approach illustrates the dynamic nature of career choice and refines elements of a conceptual framework previously developed by the authors. Its findings underline the importance of exploration, for which personal experiences and observations of physicians' work are crucial. To advance efforts to make primary care a more attractive career, students must be sufficiently exposed to primary care in a safe and individualized environment and should be supported in all stages of their career choice process.

Learning pathways composed of core subjects with features of reducing cognitive load have better learning outcomes

BACKGROUND

Changing the course duration or timing of subjects in learning pathways would influence medical students' learning outcomes. Curriculum designers need to consider the strategy of reducing cognitive load and evaluate it continuously. Our institution underwent gradual curricular changes characterized by reducing cognitive load since 2000. Therefore, we wanted to explore the impact of this strategy on our previous cohorts.

METHODS

This cohort study explored learning pathways across academic years of more than a decade since 2000. Eight hundred eighty-two medical students between 2006 and 2012 were included eventually. Learning outcomes included an average and individual scores of subjects in different stages. Core subjects were identified as those where changes in duration or timing would influence learning outcomes and constitute different learning pathways. We examined whether the promising learning pathway defined as the pathway with the most features of reducing cognitive load has higher learning outcomes than other learning pathways in the exploring dataset. The relationship between features and learning outcomes was validated by learning pathways selected in the remaining dataset.

RESULTS

We found nine core subjects, constituting four different learning pathways. Two features of extended course duration and increased proximity between core subjects of basic science and clinical medicine were identified in the promising learning pathway 2012, which also had the highest learning outcomes. Other pathways had some of the features, and pathway 2006 without such features had the lowest learning outcomes. The relationship between higher learning outcomes and cognitive load-reducing features was validated by comparing learning outcomes in two pathways with and without similar features of the promising learning pathway.

CONCLUSION

An approach to finding a promising learning pathway facilitating students' learning outcomes was validated. Curricular designers may implement similar design to explore the promising learning pathway while considering potential confounding factors, including students, medical educators, and learning design of the course.

How Student and Faculty Perceptions Differ on the Stressors that Medical Students Face

OBJECTIVES

Medical education is notorious for the stress that students face as they strive to succeed both academically and clinically. This stress has been linked to declining academic performance and worsening mental health. To combat these negative outcomes, it is essential for medical school faculty and administration to address common stressors among medical students. No studies have addressed whether medical school faculty and students perceive stressors similarly, however.

METHODS

In this two-part study, data collected from medical students in 2021 to 2022 to identify their most significant sources of stress were used to create a survey that queries the frequency and intensity of these stressors. This survey was distributed to medical students and faculty at the same institution. The responses between students and faculty were compared and student data also were analyzed by academic year to observe changes in perception that accompany progression through the medical curriculum.

RESULTS

The results showed that faculty overestimated the impact of certain stressors on medical students (eg, in-house examinations, US Medical Licensing Examination Steps 1 and 2 examinations, and patient interactions). In addition, preclinical students were more concerned with finding extracurricular activities, missing opportunities, and performing research compared with clinical students.

CONCLUSIONS

This study demonstrated that although faculty anticipated most medical student stressors, there are significant gaps that still need to be addressed to better reduce and respond to the stress experienced by medical students.

A scoping review of mental health status in Australian medical students and doctors-in-training (DiT)

Background and Aims

The study and practice of medicine are known to contribute to burnout in medical students and junior doctors. There is limited data on the degree of mental health burden for Australian medical students and doctors-in-training (DiT). This scoping review aims to explore the impact of medical training on the mental health of Australian medical students and DiT. Exploring the mental health landscape across different stages of training will help to establish putative factors underlying psychiatric comorbidities in this demographic.

Methods

The Joanna Brigs Institute (JBI) framework for scoping review was utilized, involving the Population/Concept/Context (PCC) criteria to identify the target population and develop the search strategy. Peer-reviewed articles, published in English from 2012 to 2022 focusing on Australian medical students' and doctors-in-training mental health were considered.

Results

Of the 177 articles identified, 24 studies were included in the review. The majority of the studies focused on DiT (n = 19) of which interns and residents were most well represented (n = 12) followed by surgical training (n = 5), with general practice (GP) (n = 2) and physician specialties (nil) being poorly represented. Most studies were quantitative (n = 18), with qualitative studies(n = 6) under represented. Common mental health themes identified were overall psychological distress, burnout, and depression/suicidal ideation with workplace harassment and discrimination being less well represented.

Conclusions

Australian DiT are not equally represented in the literature with how different specialty training pathways impact their mental health. Most studies were cross-sectional, preventing a detailed longitudinal assessment of burnout and work-associated psychological distress.

Wellness Activities, Stress, and Academic Performance in Medical Students

INTRODUCTION

Medical student wellness has a range of effects from academic performance to tragic mortality. Many factors correlate with academic performance, including study environments, faculty support, research participation, and student attitude. Its relationship with student stress and wellness demonstrates mixed results. This study hopes to help clarify these results and will also assess the interplay of these factors in relation to the pre-clerkship and clerkship phases of medical school.

METHODS

This retrospective descriptive study was conducted using a de-identified database from 2017 to 2023, provided per an Institutional Review Board (IRB) protocol. The subjects were the students of the classes of 2021-2027 at the Kirk Kerkorian School of Medicine at UNLV. The database included performance data including semester, clinical subject, and USMLE Step 1 and Step 2 exam scores. Other data included variables relating to self-perceived stress and time spent in wellness activities before medical school and at the end of the pre-clerkship and clerkship phases of medical school. The effects of these variables were calculated with bivariate correlations and independent samples T-tests using cut-off points calculated from the class means of those variables. A total of 361 medical students were included in the study.

RESULTS

Students with high wellness time had lower stress levels in both the pre-clerkship and clerkship phases of medical school (5.83 vs. 7.3 p < 0.001* and 5.74 vs. 8.49 p < 0.001*, respectively). Students with low stress levels in the pre-clerkship phase scored 5.81 points higher on the Step 1 exam (p = 0.013*). Clerkship phase stress levels were significantly negatively correlated with all clinical subject exams except for pediatrics. Stress levels in the pre-clerkship and clerkship phases had similar relationships with the second and third semester and Step 2 exams, respectively, although not statistically significant. Wellness activity time did not have a significant relationship with academic performance.

CONCLUSION

Stress levels had significant negative relationships with many medical school exams. Although wellness activity time did not have a direct relationship with academic performance, its relationship with stress levels can allude to an indirect effect on academic performance. This, along with fending off burnout and stress, are reasons why medical student wellness should be a priority for medical schools, faculty, and their students.

High risk of burnout syndrome and associated factors in medical students: A cross-sectional analytical study

INTRODUCTION

Although research on burnout syndrome in medical students has increased in recent years, results are inconsistent about which factors are associated with a high risk for burnout syndrome. The aim of this study was to assess the prevalence of high risk of burnout syndrome and to identify factors associated with burnout in medical students in preclinical and clinical training.

METHOD

A cross-sectional study was conducted at the University of Kragujevac, Serbia. The Maslach Burnout Inventory Student Survey and an epidemiological questionnaire on basic socio-demographic and academic characteristics were used. Statistical evaluation was performed through logistic regression analysis, using Odds Ratio (OR) and 95% Confidence Interval (CI).

RESULTS

Among medical students, no statistically significant differences were found in the prevalence of high risk of burnout syndrome in preclinical (14.8%) and clinical grade (15.1%), p > 0.05. High risk for burnout syndrome in preclinical study years was independently associated with the female sex (adjusted OR = 0.41, 95%CI = 0.19-0.91, p = 0.028), and cigarette smoking (adjusted OR = 2.47, 95%CI = 1.05-5.78, p = 0.038). The high risk of burnout syndrome was associated with sedatives use (adjusted OR = 4.03, 95%CI = 1.27-12.73; p = 0.018) only in clinical years medical students. The frequency of alcohol consumption was correlated with the high risk of burnout syndrome in medical students in both preclinical and clinical training, but without statistical significance (both p for trend < 0.1).

CONCLUSION

There was a significant prevalence of burnout among medical students, with some modifiable associated factors revealed.

Associations between medical students' stress, academic burnout and moral courage efficacy

BACKGROUND

Medical students, especially during the clinical years, are often exposed to breaches of safety and professionalism. These contradict personal and professional values exposing them to moral distress and to the dilemma of whether and how to act. Acting requires moral courage, i.e., overcoming fear to maintain one's core values and professional obligations. It includes speaking up and "doing the right thing" despite stressors and risks (e.g., humiliation). Acting morally courageously is difficult, and ways to enhance it are needed. Though moral courage efficacy, i.e., individuals' belief in their capability to act morally, might play a significant role, there is little empirical research on the factors contributing to students' moral courage efficacy. Therefore, this study examined the associations between perceived stress, academic burnout, and moral courage efficacy.

METHODS

A cross-sectional study among 239 medical students who completed self-reported questionnaires measuring perceived stress, academic burnout ('exhaustion,' 'cynicism,' 'reduced professional efficacy'), and moral courage efficacy (toward others' actions and toward self-actions). Data analysis via Pearson's correlations, regression-based PROCESS macro, and independent t-tests for group differences.

RESULTS

The burnout dimension of 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward others' actions. The burnout dimensions 'exhaustion' and 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward self-actions.

CONCLUSIONS

The results emphasize the importance of promoting medical students' well-being-in terms of stress and burnout-to enhance their moral courage efficacy. Medical education interventions should focus on improving medical students' professional efficacy since it affects both their moral courage efficacy toward others and their self-actions. This can help create a safer and more appropriate medical culture.

Evaluation of mental health of students in healthcare education programs at Qatar University

Introduction

Mental health issues among undergraduate health-care students are a growing concern. This research aims to explore the frequency of mental health issues among health-care students in medicine, dentistry, pharmacy, nutrition, biomedical sciences, nursing, and public health at Qatar University.

Methods

Ethics approval was obtained from the institutional review board. A total of 1,378 health-care students were invited to participate. Data were collected online using two validated questionnaires including the Patient Health Questionnaire (PHQ-9) to assess symptoms of depression, and Depression, Anxiety, and Stress Scale (DASS-21), and two open-ended questions investigating risk factors and recommendations for enhancing institutional support.

Results

A total of 270 health-care students completed the survey; 227 female, and 43 male students. According to PHQ-9 cut-off values, 37.7% of students had mild depression symptoms, 25.5% moderate, 14.8% moderately severe and 10% severe symptoms. DASS-21 responses revealed 34.7% displayed severe to extremely severe anxiety symptoms, 15.4% severe to extremely severe stress symptoms and 21% severe to extremely severe depression symptoms. Students aged 18-21 years had significantly higher depression (p=0.03) and stress scores (p=0.05). Qatari students had significantly higher anxiety scores (p=0.05). Responses to open-ended questions were categorized into sub-themes and grouped together into broader themes. Most students reported exam stress and workload as key factors contributing to their negative mental health. Participants' recommendations included reducing academic workload through better curricular planning, providing training to faculty to better support students with mental health issues, and improving mental health services.

Conclusion

This study showed a significant percentage of respondents reported symptoms of stress, anxiety, and depression during undergraduate studies. Participants represent the future healthcare force for the country and there is a need to identify and support students with mental health issues through close monitoring, and work with all stakeholders to improve student support services.

The Influence of Personality Type D and Coping Strategies on Cognitive Functioning in Students

INTRODUCTION

Academic and emotional challenges faced by medical students can affect their psychological well-being and health. Personal characteristics may also predispose one to the manifestation of distress reactions. Individuals with type D personality have an increased tendency to develop depressive reactions and somatic diseases, including the presence of cognitive dysfunction. In students, the presence of cognitive dysfunction may additionally adversely affect academic and psycho-emotional problems. The purpose of this study was to examine the influence of type D personality and coping strategies on cognitive functioning in medical students.

METHODS

A cross-sectional study included 258 medical students (age 19 ± 1.2 years, 79 men). All participants completed psychological questionnaires (DS-14 to identify type D personality, and The Coping Strategy Indication, CSI-to determine coping strategies), as well as extensive neuropsychological testing of cognitive functions.

RESULTS

Among the medical students examined, the frequency of identification of type D personality was 44%. In persons with personality type D, according to psychometric testing, a decrease in the level of functional mobility of nervous processes (FMNP) was noted, which was manifested in an increase in the test completion time (p < 0.001) and an increase in the number of errors (p < 0.001) during the FMNP test, and an increase in the test completion time in the attention concentration test. In addition, in type D participants, an increase in the test execution time during the attention test was noted (p = 0.007). Personality type D was an independent risk factor for cognitive decline in students in multiple linear regression analysis, when type D was analyzed as a dichotomous construct.

CONCLUSIONS

Assessing personal characteristics and identifying personality type D is advisable for medical students, to develop subsequent programs to increase their resistance to academic challenges, improve cognitive function, and also to prepare for future stress loads during professional activities in the field of healthcare.

From corners to community: exploring medical students' sense of belonging through co-creation in clinical learning

BACKGROUND

Belonging is critical for the development and wellbeing of medical students. Belonging, particularly within a 'relational being' paradigm, presents a significant challenge for students, especially within clinical learning environments. Co-creation is a learning relationship in which students are actively involved in the education process. It is inherently relational and promotes belonging within higher education environments. Little is known about utilising co-creation in the curriculum, within medical education. The aim of this study was to explore medical students' experience of co-creation of learning resources within the clinical learning environment.

METHODS

Following ethical approval, medical students were invited to become co-creators of a learning bulletin resource, within the paediatric acute receiving unit, at a paediatric teaching hospital. Interpretative phenomenological analysis (IPA) was used to enable an in-depth exploration of how medical students experienced co-creation within the clinical learning environment. Medical students participated in semi-structured interviews about their experience, which were transcribed verbatim and analysed using IPA. The analysis integrated individual lived experiences into an analytic summary.

RESULTS

Nine medical students participated. Three group experiential themes were identified: identity maturation; learning community and workplace integration. The support found within this co-created learning community, along with maturation of their identity, allowed the participants to experience a challenge to their existing worldview. This shift in perspective resulted in them responding and behaving in the workplace in new ways, which enabled them to belong as themselves in the clinical learning environment. These findings were situated within the developmental concept of self-authorship, as well as contributing to a new understanding of how co-creation promoted social integration.

CONCLUSIONS

Co-creation enabled students to learn in a meaningful way. The relational power of co-creation, can be harnessed to deliver participatory learning experiences, within our increasingly complex healthcare environment, to support the learning, development and integration of doctors of the future.

Emerging adulthood in medical school. Gender, school-related factors and Big Five traits related to medical students’ quarter-life crisis

Background: Quarter-life crisis is the anxiety and discomfort the young might experience at the end of their studies and at the beginning of their career. Objectives: Factors related to medical students’ quarter-life crisis were explored in this study. Methods: in the cross-sectional study, 351 medical students (74.6% female, mean of age: 23.79 years, SD: 1.53 years) filled in the online questionnaire that contained Quarter-life Crisis Questionnaire, International Personality Item Pool version of Big Five markers, and questions about different aspects of medical school. Independent t-test, Mann-Whitney U test and linear regression analysis were performed. Results: Women reported higher quarter-life crisis (t = –3.44, p = 0.001, Cohen’s d = 0.42). Higher quarter-life crisis displayed among those students who did not apply to medical university right after high school (U = 2865.5, p = 0.03, Cohen’s d = 0.24). Students who would have not applied to medical school again (t = –7.93, p < 0.001, Cohen’s d = 0.90); would have not encouraged their children to apply to medical school (U = 10414.5, p < 0.001, Cohen’s d = 0.57); were uncertain to finish university (t = 6.68, p< 0.001, Cohen’s d = 0.74) showed higher quarter-life crisis. Students who failed at least one term for academic reason (U = 11809.5, p = 0.04, Cohen’s d = 0.23); did not feel to get proper knowledge to accomplish a medical job (t = –3.90, p < 0.001, Cohen’s d = 0.54); were not satisfied with their grades (U = 11560.5, p = 0.01, Cohen’s d = 0.27) reported higher quarter-life crisis. Students who did not plan to work in a clinical field and patient care (t =–5.974, p = 0.00, Cohen’s d = 0.93); wanted to work abroad in the future (U = 12931.5, p = 0.00; Cohen’s d =0.27) had higher quarter-life crisis. Personality traits, such as extraversion (β = –0.20, p < 0.001), conscientiousness (β = –0.10, p = 0.01) were significant negative, neuroticism significant positive predictor of quarter-life crisis (β = 0.61, p < 0.001). Conclusion: The explored variables might be indicators of quarter-life crisis, and can be the basis of university counseling, when medical students’ quarter-life crisis and emerging adulthood is in focus.

Coping Strategies of Failing International Medical Students in Two Chinese Universities: A Qualitative Study

Phenomenon: China hosts a large number of international medical students from low-income countries, and some fail examinations in the early stage of the Bachelor of Medicine and Bachelor of Surgery (MBBS) program. Little is known about how failing international medical students cope to recover their academic performance. It would be beneficial to investigate the coping strategies they use to help them recover their academic performance and progress. Approach: Semi-structured interviews were conducted with 21 international medical students at two universities in China from September 2020 to January 2021. These students had passed make-up exams or re-sits and progressed academically. A thematic analysis approach was used to identify major themes in the interview data. Findings: After failing initial exams or re-sits, students were found to adopt seven coping strategies to help them pass future examinations and recover their academic performance: (i) increased help-seeking behaviors, (ii) improved learning motivation and attitudes, (iii) improved learning strategies, (iv) improved exam preparation, (v) utilization of library resources, (vi) enhanced time management, and (vii) enhanced English language skills. Of the seven strategies, seeking help from friends, peers, seniors, and teachers was the strategy reported most frequently. Insights: The results of this study provide insights into the coping strategies that international undergraduate medical students adopt to recover from poor academic performance in Chinese universities. Host institutions should recognize the resilience and agency of such students to make positive changes. Furthermore, institutional efforts should be made to develop contextualized intervention plans that stimulate students' learning motivation and encourage them to adopt self-help strategies by incorporating useful resources (e.g., help from peers, seniors, and teachers). Enrollment should integrate specific English language proficiency criteria, and interviews and entrance exams should be conducted. For some failing students, it may be necessary to provide academic remediation.

Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine

BACKGROUND

Nontraditional students bring to medicine inherent characteristics and perspectives that enrich the learning environment and contribute to expanding diversity in medicine. However, research has shown that these students, by virtue of their sociodemographic backgrounds, face unique challenges in medical education, which ultimately place them at a disadvantage compared to their peers. The purpose of this study is to explore relationships between sociodemographic characteristics, stress, and academic performance, in the context of outcomes that may be undermining efforts to diversify the physician workforce.

METHODS

Using a retrospective observational cohort methodology, we examined institutional and USMLE exam performance data in conjunction with Perceived Stress Scale-4 survey results from six cohorts of students at Kirk Kerkorian School of Medicine at UNLV (n = 358). Using independent samples t-test, mean stress and academic performance were compared between four sociodemographic groups: first-generation college students, underrepresented in medicine (URM), socioeconomically disadvantaged, and age 30 + at matriculation. Results were considered significant where P ≤ .05.

RESULTS

First-generation college students had significantly higher stress at the end of third year clerkships (mean 7.8 vs. 6.8, P* = .03). URM students had significantly lower scores on preclinical exams (mean 81.37 vs. 83.07, P* = .02). The students who were age 30 + at matriculation had significantly lower exam scores on all academic performance measures.

CONCLUSION

Our results echo historic trends in academic performance for racial and ethnic minority students, and we present recent evidence of academic performance disparities based on age at matriculation. Residency program directors continue to use test scores as a primary metric to screen applicants and thus, poor academic performance has profound consequences on career trajectory. Finally, significantly higher stress in the first-generation students may be evidence of underlying psychological distress. Expanding the sociodemographic diversity among physicians, and by extension, medical students, has long been recognized as fundamental to addressing inequities in healthcare. However, results from our study suggest that aspects of medical education are unfavorable and disadvantageous for first-generation, URM, and older medical students. A deeper understanding of the interplay between sociodemographic characteristics and success in medical school is paramount as we pursue diversity in medicine.

Medical student wellbeing during COVID-19: a qualitative study of challenges, coping strategies, and sources of support

BACKGROUND

Medical students face challenges to their mental wellbeing and have a high prevalence of mental health problems. During training, they are expected to develop strategies for dealing with stress. This study investigated factors medical students perceived as draining and replenishing during COVID-19, using the 'coping reservoir' model of wellbeing.

METHODS

In synchronous interactive pre-recorded webinars, 78 fourth-year medical students in the UK responded to reflective prompts. Participants wrote open-text comments on a Padlet site. Responses were analysed using reflexive thematic analysis.

RESULTS

Analysis identified five themes. COVID-19 exacerbated academic pressures, while reducing the strategies available to cope with stress. Relational connections with family and friends were affected by the pandemic, leading to isolation and reliance on housemates for informal support. Relationships with patients were adversely affected by masks and telephone consultations, however attending placement was protective for some students' wellbeing. Experiences of formal support were generally positive, but some students experienced attitudinal and practical barriers.

CONCLUSIONS

This study used a novel methodology to elicit medical students' reflections on their mental wellbeing during COVID-19. Our findings reinforce and extend the 'coping reservoir' model, increasing our understanding of factors that contribute to resilience or burnout. Many stressors that medical students typically face were exacerbated during COVID-19, and their access to coping strategies and support were restricted. The changes to relationships with family, friends, patients, and staff resulted in reduced support and isolation. Recognising the importance of relational connections upon medical students' mental wellbeing can inform future support.

Prevalence of fibromyalgia and irritable bowel syndrome and its association with studying medicine, a cross-sectional study in Al-Baath University, Syria

BACKGROUND

The aim of this study is to assess the prevalence rate of fibromyalgia (FM) and irritable bowel syndrome (IBS) among Al-Baath University students and find out whether studying medicine has an association with a higher prevalence rate.

METHODS

The participants of this observational cross-sectional study were students aged 18-30 years from Al-Baath University. A structured self-estimated electronic questionnaire developed by Google Forms was distributed using social media platforms from 15 February to 15 March, 2023. We used The American College of Rheumatology (ACR) 2016 and Fibromyalgia Rapid Screening Tool criteria to assess the prevalence rate of FM. We used The ROME IV criteria to asses IBS prevalence rate.

RESULTS

The final sample size was 800 individuals. The prevalence of IBS in the study population was 26.8%. Overall, IBS-Constipation was the most common subtype, and the prevalence rate was higher among medical students (14%) compared to other colleges (12.8%) (p = .002). The difference in IBS prevalence between males and females was (9.3% vs. 17.5%, p = .283), but this did not reach the statistical significance. The prevalence of FM according to The ACR in the study population was 3.6%. Females had higher prevalence rate than males (3.1% vs. 0.5%, p = .007). The prevalence of FM was also higher in other colleges compared to medicine (2.3% vs. 1.4%, p = .547), but this did not reach statistical significance.

CONCLUSION

We found an increased prevalence of IBS among medical students. The prevalence of FM did not show any relation to studying medicine. We recommend additional prospective studies to assess whether studying medicine could be a risk factor for these disorders or not.

Feasibility and effectiveness of stress management skill training in medical students

Background

There is limited literature on stress management interventions targeting Indian medical undergraduates. With this background, the study aimed to evaluate the feasibility and effectiveness of stress management intervention on perceived stress, coping and burnout amongst first-year medical undergraduates.

Methods

It was a quasi-experimental study assessing the effect of "Comprehensive Stress Management Skill Training Program". This intervention emphasized on self-awareness of early warning signs of stress, adopting a healthy lifestyle, developing assertiveness at work, maintaining work-life balance. The stress reduction techniques mainly consisted of deep breathing exercises, progressive muscular relaxation and visualization. It was delivered by a team of a psychiatrist and a nurse to hundred first year medical undergraduate students. Medical Students Stressor Questionnaire, Brief COPE Questionnaire and Maslach Burnout Inventory-Student Survey were applied for assessment of perceived stress, burn out, and coping, respectively, at baseline, finish of one and three months of intervention.

Results

Significant improvement was noted in academic stress, interpersonal-related stress, teaching learning-related stress, and total stress scores, emotional exhaustion, and emotion-focused coping at the end of the three months of intervention. Positive feedback about the intervention was given by majority of the students.

Conclusion

Stress management intervention was found to be feasible and effective in improving stress, coping, and emotional exhaustion in first year medical students.

Mental health and quality of life across 6 years of medical training: A year-by-year analysis

BACKGROUND

Despite growing evidence on medical students' mental health deterioration, studies have primarily used short follow-up periods and not followed the students throughout their medical training.

OBJECTIVE

To assess mental health (stress, anxiety, and depression) and quality of life changes throughout their medical program, we followed up with the same cohort of students for 6 years.

METHODS

This longitudinal prospective study followed up with the same group of medical students at a Brazilian public medical school from 2014 to 2020. The study analyzed sociodemographic data, mental health (including depression, anxiety, and stress [DASS-21]), quality of life (WHOQOL-BREF), satisfaction from studying to be a physician, and happiness with life. General linear mixed models were used for the analyses.

RESULTS

The cohort included 80 Brazilian medical students (63.7% women; mean age = 19.6 years [SD = 2.21]). A high prevalence of depressive symptoms, anxiety, and stress was found throughout medical training, with more than 50% of students having significant symptoms. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from studying to become a doctor decreased in the second semester, remained low throughout the program, and never returned to baseline levels.

CONCLUSION

Mental health and quality of life levels remained high throughout the medical program, with better levels in the first and last semesters and falling in the middle of the program. These data can help managers and educators understand how psychological distress affects medical students.

A 2023 nationwide study on adjustment disorder among first year MBBS students in India

Amidst the complex transition to medical college, encompassing a myriad of academic, social, and personal adjustments, MBBS students in India confront multifaceted challenges that can precipitate adjustment disorder, a phenomenon understudied within the Indian context. Therefore, it is of interest to assess adjustment disorder among first-year MBBS students within six months of enrolment. We used a Google form encompassing adjustment disorder new-module 20 for data collection and found that 67% of the 401 responses from first-year medical students exhibited adjustment disorder. The top stressors identified included time pressure, work pressure, financial problems, moving to a new home, and termination of important leisure activities. Female gender, age group 21-25, conflicts in working life, financial problems, own serious illness, family conflicts, pressure to meet deadlines, and excessive workload showed significant associations with adjustment disorder.

Prevalence of alcohol and other psychoactive substance abuse and association with depression among medical students in Niger Delta University, Bayelsa State

Introduction

alcohol and other psychoactive substances have adverse health effects, particularly on young people. This study determined the prevalence of alcohol and other psychoactive substance abuse and its association with depression among Niger Delta University, Bayelsa State, Nigeria, medical students.

Methods

a cross-sectional study involving 243 medical students who completed a patient-rated version of the Mini International Neuropsychiatric Interview (MINI-PR). For analyzing the data, descriptive and inferential statistics were employed.

Results

most respondents were 18 to 24 years old (67.1%), and 52.7% were male; the prevalence of major depressive episodes (current) and lifetime alcohol and other psychoactive use was 30.5%, 25.5%, and 21%, respectively. Also, the prevalence of current alcohol abuse and dependence was 5.8% and 4.9%, respectively. Alcohol use (χ2: 12.57, p = 0.001) and abuse (χ2: 22.33, p = 0.001) were significantly associated with depression. Psychoactive substance use was significantly associated with depression (χ2: 12.91, p = 0.001). The odds of having depression increased with the use of alcohol (OR: 3.54; 95% CI: 1.71-7.33) and psychoactive substances (OR: 4.52; 95% CI: 1.88-10.88).

Conclusion

alcohol and psychoactive substance use were significantly associated with depression. Organizing interventions to reduce such unhealthy social practices among medical students is necessary.

Development and implementation of digital peer mentoring in small groups for first-year medical students

Introduction

Mentoring has become an important educational strategy in medical training. Peer mentoring (PM) can enhance student experience and support transition to higher education. This article documents the implementation of an online peer mentoring program for first year medical students at a newly founded medical school in Germany during the COVID-19 pandemic and its development into in-person PM.

Project description

We developed the program in close collaboration between students and teachers. Students were invited to apply as peer mentors via email; they received instructions and reflected on their role and experiences in meetings before, during and after the semester. One or more peer mentors were assigned randomly to a student group. We evaluated the program with an online survey inspired by the "Modified Mentorship Effectiveness Scale". After successful piloting PM was implemented into the core curriculum.

Results

In 2020 we assigned 17 peer mentors to 14 groups of 6-7 students. Groups met 3 or more times via Zoom®. Overall satisfaction was high. Both student groups reported benefits for their personal and professional identity formation. Atmosphere in online meetings was excellent. Most important topics were exams/learning strategies. In 2021 meetings were held in person. Overall satisfaction, perceived benefits and learning atmosphere were again rated very positively. Most students preferred many-to-many PM and random matching.

Conclusion

The implementation of PM was successful and beneficial for the participating students. PM can help first-year medical students reduce anxiety, improve self-organization and orientation at university. It fosters identity formation and has positive effects on peer mentees as well as on peer mentors.

Exploring challenges and perceptions in the learning environment: an online qualitative study of medical students

BACKGROUND

The teaching and learning environment (TLE) in medical schools is critical for shaping the outcomes and competencies of graduates. Research on TLE has highlighted its influence on student learning approaches and outcomes, yet gaps remain, particularly in qualitative insights, especially in Saudi Arabian contexts. This study aims to explore the students' experiences and perceptions of the TLE in a new medical college.

METHODS

This qualitative study consisted of a total of five focus group discussions (3consequtive sessions for male group and two for female group) conducted virtually using the Zoom videoconferencing application. All the discussion sessions took place during a lockdown because of the COVID-19 pandemic between December 2020 and February 2021. Each session lasted for 45-60 min. Each group was formed of 4-5 students from different academic levels in the Majmaah medical school, which was established 10 years ago and is located in a small city. After "verbatim transcription" of the sessions was made, a framework thematic analysis of the data was performed using the NVivo software.

RESULTS

The study results revealed that various elements, such as educational content, faculty roles, and personal factors, collectively influenced the students' educational experiences. The students valued educational relevance and autonomous decision-making. The multifunctional role of faculty as mentors, evaluators, and resource providers was considered essential in enhancing academic experiences. Additionally, there was an evident need to improve the physical learning environment and facilities to adapt to emerging educational needs. These results align with existing literature, emphasizing the integration of theory and practice and the significant impact of faculty roles in academic experiences.

CONCLUSION

The findings suggest that medical colleges should involve students more in decision-making related to their education and ensure the practical relevance of the educational content. Establishing open communication channels between students and faculty who act as mentors and evaluators is also essential. Furthermore, enhancing supportive infrastructures, such as mental health and financial services, and promoting extracurricular activities are crucial for fostering a more effective and nurturing learning environment.

Development and Evaluation of an Experiential Career Planning Assignment to Train Students to Assess Organizational Fit

Determining if an employment opportunity will be a good match can feel daunting, especially for veterinary graduates entering the workforce. To ease this transition, veterinary educators traditionally have attempted to provide career support through interspersed didactic lectures on career options and the preparation of employment documents. While well intended, this approach fails to address the multiple dimensions of effective career planning or the reality that career planning is a lifelong endeavor. For a career-planning teaching modality to be effective, it must address all stages of career planning and provide a framework that can be adapted throughout a career. Here we describe how a four-stage career-planning model, utilized throughout higher education, was employed to create a career planning assignment for guiding students in assessing organizational fit. We describe how student feedback was used to inform revisions, resulting in an improved educational experience as measured by students' perceptions of the utility of the assignment. Additional recommendations based on instructor reflection are provided to guide creation and implementation of future assignments. Given the growing support for professional skills training in veterinary medical education, we view incorporation of such learning activities as essential to preparing students to enter the modern veterinary workplace.

Reboot coaching programme: a mixed-methods evaluation assessing resilience, confidence, burnout and depression in medical students

BACKGROUND

Poor mental health in medical students is a global concern. Effective interventions are required, which are tailored towards the training-related stressors medical students experience. The Reboot coaching programme is an online, tailored intervention based on cognitive-behavioural principles.

AIMS

To evaluate whether the Reboot coaching programme tailored for medical students was feasible and associated with improvements in mental health outcome indicators.

METHODS

Medical students participated in two group online workshops and a one-to-one coaching call with a Reboot-trained licensed psychological therapist. Participants provided data at: baseline (T1), post-workshops (T2), post-coaching call (T3) and 4-month follow-up (T4). Outcome measures included resilience, confidence, burnout and depression. Feedback was provided regarding the workshops at T2.

RESULTS

115 participants (93/80.9% women; mage = 23.9; SD = 2.8) were recruited, 83 (72.2%) completed all intervention elements and 82 (71.3%) provided T4 data, surpassing recruitment and retention targets. There were significant improvements following baseline in resilience (ps < .001), confidence (ps < .001), burnout (ps < .001) and depression (ps ≤ .001). Most participants agreed the workshops imparted useful skills (n = 92; 99%) and would recommend Reboot to others (n = 89; 95.6%).

CONCLUSIONS

Existing interventions have produced mixed results regarding their effectiveness in improving medical students' mental health. Reboot is a feasible intervention in this group which is associated with improvements in resilience, confidence, burnout and depression. Further controlled studies of Reboot are now needed.

Enhancing self-care education amongst medical students: a systematic scoping review

BACKGROUND

Reports of emotional, existential and moral distress amongst medical students witnessing death and suffering of patients during their clinical postings have raised awareness on the need for better psycho-emotional support during medical school. Furthermore, the stress experienced by medical students stemming from the rigours of their academic curriculum underlines the need for greater awareness on mental health issues and better self-care practices across medical training. With such programmes lacking in most medical schools, we propose a systematic scoping review (SSR) to map and address our research question, "what is known about self-care education interventions amongst medical students?".

METHODS

We adopted the Systematic Evidence-Based Approach to guide a systematic scoping review (SSR in SEBA) of relevant articles published between 1st January 2000 and 30th June 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles were independently and concurrently thematically and content analysed, with complementary categories and themes combined using the Jigsaw Approach. The domains created from the Funnelling Process framed the discussion.

RESULTS

A total of 6128 abstracts were identified, 429 full-text articles evaluated, and 147 articles included. The 6 domains identified were definition, topics, pedagogy, influences, outcomes and assessment. Most interventions were promising, though peer-led mindfulness-based interventions showed most promise in enhancing engagement, positively impacting personal wellbeing, and improving patient care. Overall, however, self-care education was poorly recognized, adopted and integrated into curricula.

CONCLUSION

Greater dedicated time and conducive practice environments within medical school curricula is required to enhance medical student wellbeing. Host organizations must ensure faculty are appropriately selected to instil the importance of self-care, be trained to assess and personalize self-care interventions and provide longitudinal assessment and support. Further study into assessing self-care capabilities is required.

Burnout in early year medical students: experiences, drivers and the perceived value of a reflection-based intervention

INTRODUCTION

According to the 11th Revision of the International Classification of Diseases, burnout is defined as a syndrome resulting from chronic work-related stress that has not been successfully managed. Burnout is increasingly prevalent amongst medical students and has been shown to lead to worsened academic engagement, feelings of inadequacy, poor mental health and increased risk of withdrawal from the course. The aim of this study was to explore the experience of burnout amongst early year medical students and evaluate the perceived impact of a reflection-based intervention on their awareness and experience of burnout.

METHODS

The reflection-based intervention comprised two tutorials covering the presentation, drivers, impact and management strategies for burnout syndrome. These were introduced into the second-year medical curriculum at Imperial College London. As part of the reflection-based intervention, students were invited to complete an anonymous Qualtrics form three times during the academic year. This included the Shirom-Melamed Burnout Measure (SMBM) and a free-text question prompting the student to consider their stressors at the time of completing the intervention. The former is composed of 14-questions measuring the extent of feelings or behaviours suggestive of burnout, divided into three categories: physical fatigue, cognitive weariness and emotional exhaustion. At the end of the academic year, students were invited to participate in an online focus group to further explore their experience of burnout and their perceived value of the reflection-based intervention. Results of the SMBM were explored descriptively; free-text questions and the focus group transcript were analysed using inductive thematic analysis.

RESULTS

A total of 59 submissions for the reflection-based intervention were analysed: 26 students participated and consented in the first round, 8 in the second and 25 in the third round. Overall median burnout scores were 4 (IQR 3-5), 2 (IQR 1-4) and 3 (IQR 2-5) in each round of the SMBM, respectively. A total of 8 (30.8%) met the threshold for severe burnout (≥ 4.4) in round 1 of the questionnaire, zero in the second round and 4 (16%) in the third round. Physical and cognitive fatigue showed higher median scores than emotional exhaustion in every round. Four students participated in the focus group, which had two sections. The first was reflecting on burnout in medical school and the intervention, which revealed four themes: (1) indicators of burnout (often insidious, but may involve lack of energy and motivation, or changes in perceived personality); (2) perceived drivers of burnout (perceived expectation that medical school is supposed to be challenging and consistent prioritisation of work over wellbeing); (3) working habits of medical students (unachievable self-expectations and feelings of guilt when not working); (4) value of the intervention (the teaching and reflection-based intervention prompted students to identify signs of burnout in themselves and consider management strategies). The second section included considerations for implementing burnout interventions into the medical school curriculum, which revealed three themes: (1) desire to learn about burnout (students hoped to gain insight into burnout and methods of prevention as part of their curriculum); (2) importance of community (group interventions and the involvement of Faculty helped students feel less isolated in their experiences); (3) feasibility of interventions (sustainable interventions are likely to be those that are efficient, such as using multiple-choice questions, and with allocated periods in their timetable).

CONCLUSION

Second-year medical students demonstrated symptoms and signs of burnout, including exhaustion, lack of motivation and changes in personality. They also expressed a desire to gain greater awareness of burnout and insight into preventative strategies within the medical curriculum. Whilst certain drivers of burnout can be prevented by students themselves through adequate prevention strategies, many remain systemic issues which require curriculum-level change to be effectively addressed. The students found that the reflection-based intervention was effective at improving their perception of burnout and a convenient tool to use, which could be implemented more widely and continued longer-term throughout medical school.

Pre- and post-examination reflections of first-year medical students in an integrated medical anatomy course

Due to the rigor and pace of undergraduate medical anatomy courses, it is not uncommon for students to struggle and fail initially. However, repetition of coursework places an additional burden on the student, instructor, and institution. The purpose of this study was to compare the exam preparation strategies of repeating and non-repeating students to identify areas where struggling students can be supported prior to course failure. As part of their integrated anatomy course, first-year medical students at Indiana University completed a metacognitive Practice-Based Learning and Improvement (PBLI) assignment prior to and after their first exam. In the PBLIs, students were asked to reflect on their exam preparation strategies, confidence, and satisfaction, as well as their predicted and actual exam performance. PBLI responses from non-repeating and repeating students were then analyzed quantitatively and qualitatively. A total of 1802 medical students were included in this study, including 1751 non-repeating and 51 repeating students. Based on their PBLI responses, non-repeating students were appropriately confident, somewhat satisfied, and more accurate when predicting their exam performance. Repeating students were overconfident, dissatisfied, and inaccurate when predicting their first exam performance on their initial, unsuccessful attempt but were more successful on their second, repeat attempt. Qualitative analysis revealed that repeating students aimed to improve their studying by modifying their existing study strategies and managing their time more effectively. In conjunction with other known risk factors, these insights into repeater and non-repeater exam preparation practices can help anatomy educators better identify and support potential struggling students.

Decreasing the Anxiety and Shame of Medical Students Not Placing into a Residency Using an Innovative Fifth-Year Educational Intervention

US medical students, even before the COVID-19 pandemic, exhibited higher rates of mental health challenges than age-matched cohorts. The National Resident Matching Program (NRMP) match process, which places medical students into residency, is the culmination of medical school training and a well-recognized stressor that amplifies anxiety levels and the mental strain that accompanies medical school. Facing an unprecedented year with a decrease in 2021 NRMP placement percentages, Rocky Vista University College of Osteopathic Medicine (RVUCOM) introduced an innovative new program, the predoctoral internship (PDI), to support students who did not match into a residency program. At no extra expense to the student, this program offers a year-long opportunity to customize experiences in both clinical and academic settings, along with leadership training, aimed at bolstering their residency applications. Alternatively, students could participate in a Master's PDI (MPDI), which allowed students to concurrently pursue a master's degree of their choosing with an external program. RVUCOM achieved 100% placement for students completing the PDI or MPDI program, aligning with the institution's historical graduate trends. Perhaps equally important, students in the program reported feeling supported and less ashamed, fostering loyalty to RVUCOM. Transparency in communication and leaning into institutional values reinforced trust within community partners. The intentional balance of rigor and support, coupled with faculty investment, proved crucial for success. The experience held students accountable, allowing personal and professional growth and fostering the development of a deeper professional identity. RVUCOM's innovative approach to unplaced students not only addresses the challenges faced by RVUCOM students not achieving a residency placement, but also transforms an unforeseen circumstance into an opportunity for growth, resilience, and the development of more competitive and accountable medical graduates.

The relationship between life events, life satisfaction, and coping style of college students

We aimed to investigate the life events, life satisfaction, and coping style of college students, and to assess the relationship between them by performing mediating effect analysis. Our findings may provide a scientific basis for promoting the mental health of college students. Students in a medical college were selected using grade-stratified cluster sampling, and administered a standardized questionnaire survey. Out of 2,000 participants, 1827 participants provided valid questionnaires (response rate: 91.4%). The mean scores of life satisfaction and life events were 181.39 ± 30.28 and 19.32 ± 15.62, respectively. The mean score of coping style was 14.34 ± 7.54, which reflected positive coping style. Analysis of life satisfaction, life events, and factor scores showed that different grades, sibling status (whether the respondent was the only child in the family or not), family location, and life events had a significant association with life satisfaction (p < 0.001). There were significant differences in coping style between male and female students, and between students in different grades (p < 0.001). Positive coping style was found to play a partial mediating role between life events and life satisfaction, and the mediating effect accounted for 33.2% of the total effect. These results suggest that both life events and coping styles are related to college students' life satisfaction. The impact of life events on life satisfaction can be adjusted by psychological interventions to develop coping styles that can help promote the mental health of college students.

Body image perception, eating disorder behavior, self-esteem and quality of life: a cross-sectional study among female medical students

BACKGROUND

Eating disorders are strongly associated with body image concerns. Eating disorders tend to significantly impact the current and future health and quality of life of affected persons, their caregivers, and society. As body image is based on a social construct of ideal body image, it is essential to evaluate it in its cultural context.

METHODS

The current study explored the relationship among body image perception, perceived stress, eating disorder behaviour and quality of life among female medical students (n = 777). Measurements included Body Shape Questionnaire, Body Image Quality of Life Inventory, Eating Attitudes Test-26 and Rosenberg Self-Esteem Scale. Multivariate analysis was conducted.

RESULTS

There was a significant correlation between eating disorder behaviour and perceived body shape, body image, quality of life and self-esteem among our study participants. We also found eating disorder status was significantly associated with BMI, perceived body shape, quality of life and self-esteem.

CONCLUSIONS

This is of clinical implication to female medical students and healthcare professionals to engage early in primary and secondary prevention of eating pathologies. Increasing awareness of these facts among female students can help identify at-risk students and help them seek timely medical help.

Resilience and Sub-optimal Social Determinants of Health: Fostering Organizational Resilience in the Medical Profession

The relationship between social determinants of health (SDOH) and resilience has been investigated at the individual level and, to some extent, at the community level. The aftermath of the COVID-19 pandemic further highlighted the necessity for organizational resilience in the United States. The US public health and health care system began the lengthy process of identifying the resiliency needs of its workforce that expand beyond disaster preparedness. The purpose of this article is to describe the relationship between resilience and SDOH and how medical training can infuse resiliency within the curriculum and clinical practice.

A Multimethod Examination of Medical Students' Experiences With Bereavement and Complicated Grief

Few studies have examined grief in medical students. This study used a multimethod approach to describe how bereavement and CG may impact medical students' educational experience and their perspectives on grief support and training. One hundred three medical students completed an online survey with quantitative and qualitative methods. Seventy-three (71%) students reported experiencing bereavement, of which 12 (18%) screened positive for CG. Medical students who screened positive for CG reported significantly more emotional and behavioral challenges (M = 3.58 [SD = 2.64]) compared to medical students without CG (M = 0.93 [SD = 1.58], p < .001). Qualitative analyses revealed that bereaved and nonbereaved students wanted more grief education and bereavement support from medical institutions. Therefore, it is crucial for medical institutions, to acknowledge that grief and bereavement may impact students' performance due to multifactorial causes.

Reduced burnout in medical and health science students during the pandemic COVID-19 - a follow-up study of a single institution in Hungary

BACKGROUND

The coronavirus pandemic has significantly impacted lives worldwide, especially of medical and health science students. In Hungary, education has been relegated to the online space, with a substantial proportion of students having to attend medical secondments. Increased stress, uncertainty, and the presence of medical secondments can have an impact on students' premature burnout.

METHODS

In 2021, we conducted a follow-up survey among students of the University of Pécs studying medicine and health sciences in two data collection periods (from March to May and September to November). Our online questionnaire consisted of the Maslach Burnout Inventory General Survey for Students and our self-designed questionnaire. We used descriptive and paired two-sample t-tests for data analysis at a 95% confidence interval (p ≤ 0.05).

RESULTS

We excluded from our survey respondents whose data we could not follow-up; finally, 183 students' responses were analyzed. The majority of students were female (n = 148; 80.9%). Overall, there was a significant decrease in both exhaustion (EX) and cynicism (CY) scores (p = 0.001; p = 0.004). Female respondents had higher EX scores, but a significant decrease was observed for both genders (p ≤ 0.05). Excluding paramedic students, a significant decrease in EX scores was observed for the specialties we studied (p ≤ 0.05). General medicine students' CY scores decreased; physiotherapy students' profesisonal efficacy (PE) scores increased significantly (p ≤ 0.05). Students who were on medical secondments (n = 127; 69. 4%) were found to be more affected by burnout, but in all cases, these scores significantly improved (p ≤ 0.05). Students serving in the National Ambulance Service (n = 76; 41.5%), Hospitals (n = 44; 24.0%), or both (n = 7; 3.8%) had a significant decrease in their burnout score (p ≤ 0.05). Students who served in either a hospital or a hospital and National Ambulance Service had significantly improved CY and PE scores (p ≤ 0.05). Students concerned about their health had elevated EX and CY scores, which also improved (p ≤ 0.05).

CONCLUSIONS

In conclusion, medical secondments positively affected student burnout scores for medicine and health sciences students at our institution. This fact implies that it is necessary to have more internships in real-life settings during the training.

TRIAL REGISTRATION

Our survey has been approved by the Medical Research Council (Case No IV/4573-1/2021/ECU).

Impact of students assistance policies on quality of life and mental health

Introduction

Student assistance policies in higher education, in their various modalities, seek to reduce the dropout of a new profile of students, non-traditional, with socioeconomic weaknesses, promoting quality of life (QoL) and mental health during the university journey. In this context, the Student Social Support Center (C.A.S.A) promotes assistance to students who need personal and/or economic support.

Objectives

To evaluate the QoL and the presence of minor mental disorders (MMD) in students from the 1st to the 4th year of medicine at a public college in Brazil, comparing C.A.S.A beneficiaries and non-beneficiaries.

Materials and methods

Cross-sectional study with 283 students. SRQ-20 and WHOQOL-BREF questionnaires were used, in addition to a questionnaire addressing sociodemographic data.

Results

The general average of QoL was regular in the four evaluated domains (physical, psychological, social relationships, environment) and 55.5% of the students have evidence of MMD, in which the QoL scores are lower in all domains. The environment domain, which discusses socioeconomic conditions, has the worst score among C.A.S.A beneficiaries and the best among C.A.S.A non-beneficiaries.

Discussion

The data corroborate the fragile situation of mental health and QoL of medical students. The student assistance modality of the analyzed program possibly presents vulnerabilities in its performance since the environment domain, the one with the lowest score among the program beneficiaries, precisely encompasses financial resources, access to goods and leisure and the individual's physical environment.

The Choice! The challenges of trying to improve medical students' satisfaction with their specialty choices

The authors describe the residency match as a two-step process. The first step, the Choice, is where students use a combination of intuitive and analytic information processing to select the specialty that they believe will provide fulfilment and work-life balance over their entire career. The second step, the Match, uses a "deferred-acceptance" algorithm to optimize pairing of students and their specialty choices. Despite being the rate-limiting step, in the minds of students and other stakeholders, the outcomes of the Choice have typically been eclipsed by the outcomes of the Match. A recently published study found that during their second year of residency training, one in 14 physicians reported specialty choice regret, which associates with symptoms of burnout in residents. While the obvious solution is to design interventions that improve the specialty choices of students, this approach faces significant challenges, including the fact that: 1) satisfaction with specialty choice is a difficult-to-define construct; 2) specialty choice regret may be misattributed to a poor choice; and 3) choosing is a more complicated process than matching. The authors end by suggesting that if we hope to improve satisfaction with specialty choice then we should begin by defining this, deciding when to assess it, and then creating assessment tools for which there is validity evidence and that can identify the underlying causes of specialty choice regret.

Academic burnout in psychology and health-allied sciences: the BENDiT-EU program for students and staff in higher education

Studying at university involves demanding academic and clinical training requirements for students from Psychology and other health-allied fields, potentially having severe physical and mental health implications. Existing training programs for addressing burnout have focused thus far on specific areas (e.g., stress management, physical exercise, mindfulness meditation, etc.) with promising outcomes. However, no comprehensive programs have been developed to train students and staff in the early identification of burnout signs and characteristics as well as in self-assessing personal needs and habits (i.e., primary prevention), or in identifying community resources and evidence-based strategies to overcome burnout (i.e., secondary prevention). This paper describes the content development, refinement, and piloting process of the BENDiT-EU program as part of a European collaborative to address academic burnout for health-allied students. Piloting results showed that participants viewed the program positively and provided helpful suggestions for content improvement and training delivery. Future research directions should target experimental investigations of the program's effectiveness and the longitudinal interaction of burnout with other variables (e.g., resilience).

Health of (dual) health professional students in German-speaking countries: a scoping review

University education marks a new stage in life, which is associated with unknown demands and challenges and can have a negative impact on students' health. Therefore, health promotion in the university setting is becoming increasingly important. In this context, scientific data on the health situation play a crucial role in improving students' health. Thus, the aim of the scoping review was to highlight the current scope of research on the health of health professional students. It also explored problems and outlined key future challenges and solutions. The review was conducted using the Joanna Briggs Institute (JBI) methodology for a scoping review. A total of nine databases (PubMed, CINAHL, CareLit, LIVIVO, Scopus, Psyndex, PEDro, OTseeker, Google Scholar) were systematically searched. The following search criteria were defined: health professional students, health, Germany, German-speaking countries, all types of sources from 2012 to present are selected. The research studies were mapped in a table and health evidence of included studies was summarized narratively. The initial search resulted in 23,938 records. Seven records met the inclusion criteria and were included in the review. Six cross-sectional studies were conducted in Germany, and one cross-sectional study was conducted in Switzerland. In fact, one study included a representative population. Qualitative studies were not found. The most studies investigated health status, health behavior, and personal resources. Most of the studies examined female nursing students. The included studies indicated that the young students reported physical or mental health conditions. In addition, the studies also identified health resources of the students that need to be improved. In summary, there is currently limited health evidence on this group of students in German-speaking countries. Therefore, further research is needed to generate knowledge and comprehensively describe the health situation.

Screen time and sleep among medical students in Germany

Medical students are a vulnerable group for harmful health behaviours due to academic stress. Increased screen time is associated with adverse health behaviour, particularly delayed bedtime, shorter sleep duration and poorer sleep quality. This possible relationship has not yet been examined among medical students in Europe. Medical students at the Technical University of Dresden were invited to participate in an online questionnaire based cross-sectional study. To analyse correlations between screen time and sleep parameters, correlation coefficients, linear regression and mixed-model analysis were calculated. 415 students (average age 24 years, 70% female) were included in the analysis. The students reported an average of 7 h screen time per day and 7.25 h sleep duration per night. Approximately 23% (n = 97) reported sleeping less than 7 h per night and 25% (n = 105) reported fairly to very poor sleep quality. Students who reported more screen time for leisure went to bed significantly later (r = 0.213, p < 0.001). Students who spent more screen time for study/work tended to sleep shorter (r = - 0.108, p < 0.015). There was no significant association between screen time and sleep quality (p = 0.103). The results show a need for educational interventions to promote healthy sleep behaviour and to limit screen time.

The mediating roles of coping styles and academic burnout in the relationship between stressors and depressive symptoms among Chinese postgraduates

Background

Since few studies have incorporated factors like stressors, coping styles, and academic burnout into the same model to analyze their impacts on depressive symptoms, this research attempts to establish an optimal structural model to explore the direct and indirect effects of these factors on depressive symptoms.

Methods

A total of 266 postgraduates completed questionnaires regarding coping styles, academic burnout, stressors, and depressive symptoms. The path analysis was applied for investigating the roles of coping styles and academic burnout in mediating the relationship between stressors and depressive symptoms.

Results

The total and direct effects of stressors on depressive symptoms were 0.53 and 0.31, respectively. The proportion of the direct effect of stressors on depressive symptoms to its total effect amounted to 58.50%. The indirect effects of academic burnout, positive coping style, and negative coping style on the association between stressors and depressive symptoms were 0.11, 0.04, and 0.03, taking up 20.75%, 7.55%, and 5.66% of the total effect, respectively. The serial indirect effect of positive coping style and academic burnout was 0.02, accounting for 3.77% of the total effect, while that of negative coping style and academic burnout was 0.02, taking up 3.77% of the total effect.

Conclusions

Coping styles and academic burnout chain jointly mediate the relationship between stressors and depressive symptoms among postgraduates. Thus, encouraging postgraduates to tackle stress positively may reduce the likelihood of the development of academic burnout and further reduce depressive symptoms.

Exploring the Relationship Between Stress and Satisfaction During Clinical Training Among Respiratory Therapy Students: A Nationwide Cross-Sectional Survey

Background

Although clinical training is an important component of healthcare education, it is nevertheless a significant source of stress for students. There is limited information on stress and satisfaction perceived by clinical-level undergraduate students studying respiratory therapy (RT) in Saudi Arabia.

Methods

A descriptive, cross-sectional study design with an online questionnaire was employed to conduct this study. Data collection occurred during the academic year 2022-2023 among RT students throughout Saudi Arabia. Patricians responded to demographic questions, the Students Stress Scale and Students Professional Satisfaction questionnaires. Descriptive, inferential, and correlational statistics were used to analyze the collected responses.

Results

A total of 1001 undergraduate RT students completed the online survey. RT students and interns had an overall moderate to high stress level (mean (SD); 3.55 (0.49)), while satisfaction was perceived as mild to moderate (mean (SD): 2.56 (0.65)). In addition, 38% of the study participants have considered quitting the RT program. Female students showed higher stress levels in the following domains: inadequate knowledge and training, adverse and embarrassing experiences, clinical supervision, patients' pain, and Education-reality conflict (p<0.005) compared to male students. Additionally, students who considered quitting the RT program revealed higher stress levels in all domains (p<0.005). There were negative correlations between satisfaction and stress domains: inadequate knowledge and training (r = -0.32; p = 0.001), adverse and embarrassing experience (r = -0.31; p = 0.025), close supervision (r = -0.24; p = 0.001), insufficient hospital resources (r = -0.30; p 0.002), patients' pain and suffering (r = 0.28; p = 0.04), and education - reality conflict (r = -0.30; p = 0.001).

Conclusion

During clinical training, respiratory therapy students experience moderate to high-stress levels and low satisfaction. There need to be tailored interventions to reduce stress and intention to quit and increase students' clinical experience satisfaction.

How often do medical students change career preferences over the course of medical school?

INTRODUCTION

During the preclinical years, students typically do not have extensive exposure to clinical medicine. When they begin their clinical rotations, usually in the third year, the majority of the time is spent on core rotations with limited experience in other fields of medicine. Students then must decide on their careers early in their fourth year. We aimed to analyze how often medical students change their career preferences between the end of their second and their fourth year.

METHODS

We conducted a retrospective, cohort study using the American Association of Medical Colleges Year 2 Questionnaire (Y2Q) and Graduating Questionnaire (GQ) from 2016 to 2020.

RESULTS

20,408 students answered both surveys, but 2,165 had missing values on the career choice question and were excluded. Of the remaining students, 10,233 (56%) changed their career choice between the Y2 and GQ surveys. Fields into which students preferentially switched by the GQ survey included anesthesia, dermatology, ENT, family medicine, OB/GYN, pathology, PM&R, psychiatry, radiology, urology, and vascular surgery. Many characteristics, including future salary, the competitiveness of the field, and the importance of work-life balance, were significantly associated with a higher likelihood of changing career choices. On the other hand, having a mentor and the specialty content were associated with a lower likelihood of change.

CONCLUSION

A majority of students switched their career preferences from the Y2Q to the GQ. Additional research should be focused on curricular design that optimizes student satisfaction with career decisions. This may include early integration of a variety of specialties.

Investigation of contemporary college students' mental health status and construction of a risk prediction model

BACKGROUND

Due to academic pressure, social relations, and the change of adapting to independent life, college students are under high levels of pressure. Therefore, it is very important to study the mental health problems of college students. Developing a predictive model that can detect early warning signals of college students' mental health risks can help support early intervention and improve overall well-being.

AIM

To investigate college students' present psychological well-being, identify the contributing factors to its decline, and construct a predictive nomogram model.

METHODS

We analyzed the psychological health status of 40874 university students in selected universities in Hubei Province, China from March 1 to 15, 2022, using online questionnaires and random sampling. Factors influencing their mental health were also analyzed using the logistic regression approach, and R4.2.3 software was employed to develop a nomogram model for risk prediction.

RESULTS

We randomly selected 918 valid data and found that 11.3% of college students had psychological problems. The results of the general data survey showed that the mental health problems of doctoral students were more prominent than those of junior college students, and the mental health of students from rural areas was more likely to be abnormal than that of urban students. In addition, students who had experienced significant life events and divorced parents were more likely to have an abnormal status. The abnormal group exhibited significantly higher Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scores than the healthy group, with these differences being statistically significant (P < 0.05). The nomogram prediction model drawn by multivariate analysis included six predictors: The place of origin, whether they were single children, whether there were significant life events, parents' marital status, regular exercise, intimate friends, and the PHQ-9 score. The training set demonstrated an area under the receiver operating characteristic (ROC) curve (AUC) of 0.972 [95% confidence interval (CI): 0.947-0.997], a specificity of 0.888 and a sensitivity of 0.972. Similarly, the validation set had a ROC AUC of 0.979 (95%CI: 0.955-1.000), with a specificity of 0.942 and a sensitivity of 0.939. The H-L deviation test result was χ2 = 32.476, P = 0.000007, suggesting that the model calibration was good.

CONCLUSION

In this study, nearly 11.3% of contemporary college students had psychological problems, the risk factors include students from rural areas, divorced parents, non-single children, infrequent exercise, and significant life events.

Critical Thinking, Generalized Anxiety in Satisfaction with Studies: The Mediating Role of Academic Self-Efficacy in Medical Students

BACKGROUND

The academic and emotional challenges faced by medical students can affect critical thinking and may also contribute to the development of increased generalized anxiety. Similarly, critical thinking and generalized anxiety can impact study satisfaction through the mediating mechanism of academic self-efficacy.

OBJECTIVE

The aim of this study was to assess the mediating role of academic self-efficacy between critical thinking and generalized anxiety in study satisfaction among medical students.

METHODS

A cross-sectional and explanatory study was conducted involving 259 Peruvian medical students aged between 18 and 35 (M = 20.29, SD = 2.84). The evaluation was based on self-reported questionnaires covering critical thinking, generalized anxiety, academic self-efficacy, and study satisfaction. Furthermore, a structural equation modeling (SEM) and mediation approach was employed to examine the relationships between variables.

RESULTS

The results showed an adequate fit of the model [χ2 (87) = 155, p < 0.001, CFI = 0.93, TLI = 0.92, RMSEA = 0.05 (CI: 0.04-0.07), SRMR = 0.07], demonstrating the impact of critical thinking and generalized anxiety. It was confirmed that academic self-efficacy has a positive effect on study satisfaction. Moreover, the mediating role of academic self-efficacy was confirmed between critical thinking and study satisfaction, as well as between generalized anxiety and study satisfaction.

CONCLUSIONS

Due to the high academic load on medical students, academic self-efficacy plays a mediating role in the relationship between critical thinking, generalized anxiety, and satisfaction with studies. The development of educational strategies will help to promote critical thinking and academic self-efficacy, as well as provide support to students with generalized anxiety, to enhance study satisfaction.

The Problematic Persistence of Tiered Grading in Medical School

Issue: The evaluation of medical students is a critical, complex, and controversial process. It is tightly woven into the medical school curriculum, beginning at the inception of the medical student's professional journey. In this respect, medical student evaluation is among the first in a series of ongoing, lifelong assessments that influence the interpersonal, ethical, and socioeconomic dimensions necessary for an effective physician workforce. Yet, tiered grading has a questionable historic pedagogic basis in American medical education, and evidence suggests that tiered grading itself is a source of student burnout, anxiety, depression, increased competitiveness, reduced group cohesion, and racial biases. Evidence: In its most basic form, medical student evaluation is an assessment of the initial cognitive and technical competencies ultimately needed for the safe and effective practice of contemporary medicine. At many American medical schools, such evaluation relies largely on norm-based comparisons, such as tiered grading. Yet, tiered grading can cause student distress, is considered unfair by most students, is associated with biases against under-represented minorities, and demonstrates inconsistent correlation with residency performance. While arguments that tiered grading motivates student performance have enjoyed historic precedence in academia, such arguments are not supported by robust data or theories of motivation. Implications: Given the evolving recognition of the deleterious effects on medical student mental health, cohesiveness, and diversity, the use of tiered grading in medical schools to measure or stimulate academic performance, or by residency program directors to distinguish residency applicants, remains questionable. Examination of tiered grading in its historical, psychometric, psychosocial, and moral dimensions and the various arguments used to maintain it reveals a need for investigation of, if not transition to, alternative and non-tiered assessments of our medical students.

A Cross-sectional Study on Factors of Well-being of UP College of Medicine Students from SY 2017-2018

Objectives

Psychological distress is more prevalent among medical students compared to the general population. This study describes the factors which contribute to the well-being of medical students enrolled in the UP College of Medicine, and their relationship with the students' demographic characteristics.

Methods

The modified Cardiff Medical School Well-being Questionnaire was administered to 598 students of the UP College of Medicine. The following domains were explored: acquisition of knowledge and skills, work-life balance, demands, travel and orientation, safety, culture, finances, perceived support in academics and perceived support in personal/health matters. Students also shared their insights regarding potential areas of change to enhance their engagement and performance. Demographics are presented as frequency and percentage; the relationship between the demographic characteristics and factors was analyzed through multiple linear regression.

Results

The mean age of the medical student participants was 22.6 years, with an almost equal male to female ratio. The majority were single, Roman Catholic, lateral entrants, having a high socioeconomic status, and with residence in the City of Manila while in training. Medical students were least concerned about culture, safety at work, travel and orientation, and perceived support for academics. However, they were most concerned about work-life balance, demands, finance, and perceived support on personal and health matters.

Conclusion

Medical students expressed more concern about work-life balance, demands, finance, and perceived support on personal and health issues, and marked less concern about culture, safety at work, travel and orientation, and perceived support for academics. Across all domains, there are areas for improvement and limitations which can be further explored in future studies.

The Relationship Between Social Media Use and Negative Emotions Among Chinese Medical College Students: The Mediating Role of Fear of Missing Out and the Moderating Role of Resilience

Objective

This study aimed to examine the mediating role of fear of missing out (FoMO) and the moderating role of resilience in the association between social media use and negative emotions among medical college students in China during the COVID-19 pandemic.

Participants and Methods

A cross-sectional study design was conducted, medical college students from Qiqihar Medical University, China participated in the study. A total of 470 medical college students were recruited voluntarily to complete questionnaires on social media use, FoMO, resilience, and negative emotions.

Results

Social media use was positively associated with FoMO and negative emotions among medical students (p < 0.01). The total effect of social media use on negative emotions was significant (β = 1.101, SE = 0.079, p < 0.001). Social media use had no significant direct effect on negative emotions (β = 0.168, SE = 0.096, p > 0.05), but it had an indirect effect on negative emotions via mediation of FoMO (β = 0.933, SE = 0.106, 95% CI: 0.731 to 1.149). Moreover, resilience had a significant moderating effect on the relationship between FoMO and negative emotions (β = -0.021, SE = 0.005, 95% CI: -0.032 to -0.012). FoMO had a significant positive predictive effect on negative emotions at both levels of resilience (low resilience individuals: β = 1.079, SE = 0.076, p < 0.001; high resilience individuals: β = 0.212, SE = 0.094, p < 0.05).

Conclusion

Social media use and FoMO may be risk factors for increased negative emotions, and resilience should be considered in prevention and intervention strategies designed to mitigate negative emotions among medical college students.

The impact of lecture playback speeds on concentration and memory

BACKGROUND

The information required to be learned and retained by medical students has continued to increase over the years. The stress that medical students face has already been highlighted in several studies, however, this in combination with a post-pandemic educational system subsequently generated a shift in medical education towards asynchronous streaming of daily lectures as part of the curriculum with variable playback speed options.

METHODS

This paper aims to study the effectiveness of playback speeds, principally that of 1.5x and 2x playback speeds. One objective of this study is to analyze the existing literature regarding how playback speeds may impact learning, and to highlight the need for additional research. It has become apparent that there is not enough literature to support the role that playback speeds have in concentration and/or long-term memory retention in medical students. Due to this lack of information on the topic, this paper additionally highlights a study conducted on second year medical students at one university to assess the associations that may exist between lecture playback speeds of 1.5x and 2x and concentration and long-term retention of memory.

RESULTS

Based on the data collected, it was found that there was no significant difference in student concentration or long-term memory retention with regards to lecture playback speeds.

CONCLUSIONS

Although more studies are needed to better understand the topic, it is the current recommendation of the authorial team that students are free to watch medical school lectures at their preferred speed without worry of changes in learning ability.

The Prevalence and Associated Factors of Academic Stress among Medical Students of King Khalid University: An Analytical Cross-Sectional Study

Medical students are the category of academic population with the highest levels of stress. This study aimed to assess the prevalence of academic stress among medical students in Saudi Arabia and to identify its associated factors. This cross-sectional study was conducted at the College of Medicine at King Khalid University, Abha. The Medical Student Stressor Questionnaire (MSSQ) was used to evaluate the stress caused by different factors. A total of 422 medical students participated in this study. Among the participants, 115 (27.3%) were male and 307 (72.7%) were female. The highest percentage of students were perceiving moderate to severe stress due to academic-related stressors (97.1%), followed by teaching- and learning-related stressors (93.9%) and group activities-related stressors (88.3%). The lowest domain in which students perceived moderate to severe stress was drive and desire-related stressors (65.8%). The mean percentage of students who perceived moderate-to-severe stress in all domains of stressors was 85.5%. We can conclude that medical students have a high degree of stress, and we emphasize the importance of implementing stress management programs to teach students how to handle stress in order to avoid negative effects on their health and academic performance.

Alcohol use disorder among healthcare professional students: a structural equation model describing its effect on depression, anxiety, and risky sexual behavior

BACKGROUND

Mental health problems such as depression, anxiety and alcohol use disorders are among the leading causes of disability worldwide. Among university students, alcohol use and poor mental health are associated with risky sexual behavior. Given the syndemic occurrence of these disorders most especially in young adults, we describe the relationship between them so as to guide and intensify current interventions on reducing their burden in this population.

METHODS

This was a cross-sectional study based on an online survey among healthcare professional university students that captured sociodemographic characteristics, risky sexual behavior, alcohol use disorder, generalized anxiety disorder, and depression. Structural equation modelling was used to describe the relationship between these variables using RStudio.

RESULTS

We enrolled a total of 351 participants of which 11% (37/351) had Alcohol Use Disorder, 33% (117/351) had depressive symptoms and 32% (111/351) had symptoms of anxiety. A model describing the relationship between these variables was found to fit well both descriptively and statistically [χ² = 44.437, df = 21, p-value = 0.01, CFI = 0.989, TFI = 0.980, RMSEA = 0.056]. All observed variables were found to fit significantly and positively onto their respective latent factors (AUD, anxiety, depression and risky sexual behavior). AUD was found to be significantly associated with risky sexual behavior (β = 0.381, P < 0.001), depression (β = 0.152, P = 0.004), and anxiety (β = 0.137, P = 0.001).

CONCLUSION

AUD, depression and anxiety are a significant burden in this health professional student population and there's need to consider screening for anxiety and depression in students reporting with AUD so as to ensure appropriate interventions. A lot of attention and efforts should be focused on the effect of AUD on risky sexual behavior and continued health education is still required even among health professional students.

Determinants of Poor Mental Health of Medical Students in Portugal-A Nationwide Study

Medical students are a population that is vulnerable to the development of anxiety, depression, and burnout. This observational cross-sectional study sought to assess the levels of distress and identify precipitating factors in all students enrolled in a Portuguese medical school during the academic year of 2022/23. Students (n = 768) were surveyed via validated instruments to measure anxiety, depression, and burnout. Sociodemographic information was also collected through a questionnaire. The study indicated that almost half of this population had depressive symptoms. No differences were found in distress levels between medical schools, and when comparing curricular years, higher levels of distress were found in the pre-clinical years in comparison to the clinical ones. Burnout, being a woman, the existence of physical health problems, homo- and bisexual orientations, affective family problems, problems with relationships in the academic community, difficulties in academic performance, and daily organization were identified as predictors of distress. On the other hand, satisfaction with the social support received and with academic ratings were identified as protective factors. In conclusion, there is a high prevalence of distress in medical students, which is associated with personal, physical, social, economic, and academic factors. The identification of predictive factors of distress may allow for the early identification of vulnerable students and for intervention and prevention strategies to be defined.