Burnout and Alcohol Abuse/Dependence Among U.S. Medical Students

Predictive factors of quality of life among medical students: results from a multicentric study

Background

Medical students have a worse perception of Quality of Life (QoL) and a high prevalence of psychosocial suffering when compared to the general population. The objective of this study was to investigate associated factors with Quality of Life of Brazilian medical students from an exploratory analysis in a cross-sectional study described in accordance with the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines.

Methods

This is a cross-sectional and multicenter study with national sample randomized by sex and year of the course. Data were collected between August 2011 and August 2012, using an electronic platform (VERAS platform). Our outcomes included: personal quality of life (QoLp) and quality of life related to medical course activities (QoLmc), both measured using a score ranging from 0 (worst) to 10 (best). Variables as predictors: the World Health Organization Quality of Life Assessment abbreviated version (WHOQOL-BREF); VERAS-Q (a questionnaire created to evaluate the QoL of students in health professions); Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maslach Burnout Inventory (MBI), Resilience Scale (RS-14), Interpersonal Reactivity Multidimensional Scale (IRMS) and Dundee Ready Education Environment Measure (DREEM).

Results

Our sample is comprised of 1350 (81.8%) medical students. When comparing predictors and both quality of life outcome measures, we found a negative correlation between QoL and the BDI, PSQI and ESS scores. Through a multiple linear regression mode we identified the median of significant predictors to higher QoL. We then run a tree regression model that demonstrated that the VERAS-Q—physical health domain (a domain assessing self-care, self-perception of health, sleep, leisure, physical activity and appearance) was the most important factor predicting QoL. Students with a VERAS-Q-physical health score ≥ 60.9 and a VERAS-Q-time management (address the management of the student's time, free time and whether he can dedicate himself to other activities besides the course) score ≥ 55.7 presented the best QoLmc (score: 8.08–9.63%). Students with a VERAS-Q-physical health score ≥ 79.7 presented the highest QoLp (score 8.93–8.74%).

Conclusion

Physical symptoms, self-perception of health and self-care assessed by the VERAS-Q physical domain had association with both final outcomes. Time management seems to have a protective role for better Quality of Life. These variables should be taken in consideration when designing interventions to improve Quality of Life among medical students.

Overlap of burnout-depression symptoms among Chinese neurology graduate students in a national cross-sectional study

BACKGROUND

The overlap of burnout and depression is a phenomenon that can effectively reflect the psychological state of a group. However, whether burnout is a type of depression is still debated in current research. The high incidence of burnout and depressive symptoms among medical students indicates that it is urgent to provide appropriate health services for them. However, the proportion of burnout and depression in the overlapping symptoms experienced by medical students, and the characteristics of the relative influencing factors, remain unclear. Therefore, we addressed these issues for neurology graduate students in China.

METHODS

Using data from a cross-sectional survey of Chinese neurology graduate students, a diagnostic model was established according to their burnout and/or depression symptoms. Burnout was assessed by using the Maslach Burnout Inventory. Depression symptoms were assessed with a two-item depression screening tool for primary care evaluation of mental disorders. Univariate analyses with chi-squared tests were conducted to assess associations between variables. Multinomial logistic regression models were used to analyze the effects of multiple factors on dependent variables. The factors included demographic information and three medical-study related problems.

RESULTS

In total, 32.2% of surveyed students evidenced overlapping burnout and depression symptoms. Students with depressive symptoms tended to be included in the burnout students' category. In the regression model, being unmarried, having children, and career choice regret were related to students who had only burnout, while the students with overlapping symptoms were affected by more factors such as family income, the consideration of dropping out once.

CONCLUSIONS

The symptoms and related factors of burnout and depression among Chinese neurology postgraduates have obvious overlap and show a significant trend. The occurrence of depressive symptoms among medical students is closely related to whether they are burned out. Students with only burnout were common, but students with only depressive symptoms were uncommon. Finally, burnout may be a pre-depression state.

Resilience and burnout in healthcare students and inpatient psychiatric nurses: A between-groups study of two populations

BACKGROUND

Stressful environments can have significant effects on an individual and lead to burnout. Psychological consequences of burnout include trauma reactions, depression, anxiety and substance use disorders. Resilience, a protective mechanism can mitigate the negative impact of burnout.

METHOD

This study utilizes an exploratory correlational design to determine whether or not there is 1) a similar correlation between resilience and burnout between psychiatric nurses working in a high stress environment and students who are naive to the high stress academic environment and 2) a higher level of resilience in the psychiatric nurses compared to the healthcare students.

RESULTS

A significant inverse relationship was observed with respect to resilience and burnout in both the professional nurse and student groups. However, the inpatient psychiatric nurse group was not found to have a higher level of resilience than the student group, when controlling for age.

CONCLUSION

This suggests that resilience to burnout is not related to the work environment but life experience (age) was found to be a factor related resilience in this sample.

Burnout, Psychological Capital and Health during COVID-19 Social Isolation: A Longitudinal Analysis

Background: Drawing on the impact of the COVID-19 global pandemic and its sanitary measures on coping strategies for preserving health, it is also necessary to add exposure to certain work stressors, such as burnout. The aim of the study was to assess the influence of the confinement situation caused by COVID-19 on the levels of self-perceived health and psychological capital in a sample of workers, as well as to analyze whether exposure to burnout before social isolation would help to explain the levels of health and psychological capital. Methods: Data were collected in a longitudinal design. Time 1 surveys (December 2019) were sent to a sample of 354 Spanish workers while in Time 2 (April 2020) the employees completed 235 questionnaires. Results: Our findings indicate a significant worsening of employees’ health perception (t = −4.13; p < 0.01) and psychological capital (4.10, p < 0.01) levels during mandatory confinement in Spain. Our results also revealed that emotional exhaustion is the only burnout dimension capable of explaining the variance of health while self-efficacy does regarding psychological capital. Conclusion: We conclude a significant reduction in self-perceived health and psychological capital during COVID-19 mandatory confinement, and that burnout acts as a predictor variable in both health and psychological capital variance.

Effectiveness of a Mindfulness-Based Programme on Perceived Stress, Psychopathological Symptomatology and Burnout in Medical Students

OBJECTIVES

Medical students display a high prevalence of psychopathological symptomatology, stress and burnout, which may continue in their time as resident and fully qualified doctors. The aim of this study is to evaluate and compare the effects of a mindfulness-based programme on these variables in an experimental group of medical students who underwent the intervention programme compared to a control group who did not.

METHODS

A quasi-experimental study of two independent groups (experimental and control) with two repeated measures (pre and post) was performed. Eight sessions of 2-h duration each were held over the course of 16 weeks. A total of 143 students participated in the study, 68 in the intervention group and 75 in the control group. A sociodemographic questionnaire was administered along with the Symptom Checklist-90-R (SCL-90-R), the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory-Student Survey (MBI-SS).

RESULTS

Our study revealed a clear improvement compared to the control group in perceived stress and psychopathological symptomatology, in the Global Severity Index, Positive Symptom Total and the primary symptom dimensions of somatization, obsessive compulsive, interpersonal sensitivity and anxiety of the SCL-90-R. The improvement was significant at both intra- and intergroup level. No impact was found on the level of burnout.

CONCLUSIONS

The mindfulness-based programme that was used resulted in an improvement in psychopathological symptomatology and stress, with no effect observed on BO score. This study can contribute to the design of a training programme to promote effective self-care and stress management strategies for both medical students and doctors.

MDMA Use by Paris Medical Students: Prevalence and Characteristics

3,4-Methylenedioxy-N-methylamphetamine (MDMA) is increasing being used by youth in Europe and in France, but characteristics of its use are unknown. Objectives: The aim was to characterize MDMA use in a sample of French medical students. Methods: Cross-sectional study of Paris VII medical students (N = 592) with an online self-reporting questionnaire. Results: 592 students completed the online questionnaire. 21.5% (n = 127) had experimented with MDMA. Use of MDMA was associated with male sex (p < 0.001), older age (p < 0.001), left the parent's home (p < 0.01), and belonging to a fraternity (p < 0.05). Most experimenters (90.7%) used MDMA in a club or during a music festival. Among users, 42.5% used it more than once a year and less than once a month. During the use, users drank alcohol (90.6%), smoked tobacco (70.9%), smoked cannabis (42.0%) or used cocaine (20.5%). In the days after the use, some smoked tobacco (40.9%), smoked cannabis (29.1%), drank alcohol (22.0%), used cocaine (1.6%) and also took benzodiazepines (5.5%). According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, criteria, the prevalence of MDMA use disorder was 8.5% in our sample and 40.9% among MDMA users. As compared with students who never experienced MDMA, fewer users thought that occasional intake could be dangerous (66.9% vs 83.9%, p < 0.001) and that MDMA could be addictive (74.0% vs 90.3%, p < 0.001). Conclusions: Other studies focusing on drug consumption among students are necessary to define specific public health strategies of prevention and harmful reduction.

Telepsychiatry and Medical Students: a Promising Mental Health Treatment for Medical Student Use Both Personally and Professionally

PURPOSE OF REVIEW

We review recent findings on the use of telepsychiatry while investigating medical students' perceptions and willingness to use it for their mental health needs. We explore the impact of COVID-19 on medical school curriculums. We also investigate current education in medical schools surrounding telemedicine.

RECENT FINDINGS

Medical students experience symptoms of anxiety at a greater rate than the general population. Major barriers to help-seeking behaviors are the refusal to seek treatment due to fear of incurring negative views from supervising faculty, time constraints, and the cost of counseling services. Those who do use telemental health resources have positive views and believe that it is an effective tool. Medical students are willing to use telepsychiatry for their personal mental health needs and recognize its value as a treatment modality that will be useful for their future patients. The telemedicine field is evolving but many medical school curriculums do not include education on telemedicine.

Rethinking gross anatomy in a compressed time frame: Clinical symptoms, not case studies, as the basis for introductory instruction

The goal of this observational study was to develop effective approaches to introduce first year medical students to gross anatomy/embryology in a compressed time frame. Pedagogical reorganization of anatomy instruction in the regions of Lower Extremity and Head and Neck was based upon core clinical conditions taught in second-year and USMLE Step 1 board review courses. These conditions were not presented as clinical problems, as many students had limited prior training in medical terminology, but focused upon clinical symptoms, allowing for direct correlation of structure and function. Instruction stressed vocabulary acquisition and was extended to prepare for laboratory dissections. Overall methodology was multimodal, including "flipped" and traditional lectures, study of prosections/radiographs and small group laboratory review sessions. Content was significantly reduced: knowledge of muscle actions and innervations was required, not muscle origins and insertions. Performance was evaluated by criterion-based written examinations that included a set of questions (34) asked repetitively over an 8 year period (n = 606 students) and by regional practical exams. Mean scores in all areas were sustained or numerically improved, despite the compression of instruction duration. Analysis showed no significant differences based upon question format or instructional modality. Despite the high performance levels, students needing assistance in learning could be identified by score distributions. A survey of students indicated that these changes effectively decreased stress and facilitated review for the USMLE Step 1 Board examination. These results suggest that training in gross anatomy can be modified to a compressed duration by instruction in the context of clinical symptomatology.

Outcomes of an Equine Assisted Learning Curriculum to Support Well-Being of Medical Students and Residents

Objectives of this study were to evaluate an equine assisted learning (EAL) curriculum designed for medical students and resident physicians, and to determine impacts of the curriculum on participant perceptions of burnout and well-being. The EAL curriculum incorporated evidence-based skills and concepts to increase happiness and/or resilience. A pre/post intervention design was used, with 18 EAL participants receiving the curriculum within their month-long community based primary care clerkship elective, and 10 control (CTL) participants who did not receive the curriculum within their clerkship elective. Three waves of surveys tested participant responses before, immediately after, and 3 months after the intervention. Patient Health Questionnaire-4 (PHQ-4) screened for depression and anxiety, and Maslach Burnout Inventory- Human Services Survey for Medical Personnel (MBI) addressed burnout. Analysis of covariance evaluated differences between EAL and CTL groups. EAL participants rated the curriculum highly (9.2 on a 10-point scale). The evaluations were overwhelmingly positive with participants able to identify key concepts that were most helpful, how they would apply those concepts to patient care and interactions with colleagues, and how the horses added value to their learning experience. Significant positive effects of EAL on burnout were identified in terms of improved MBI personal achievement scores, as well as a trend towards improved well-being scores. There was also a trend (P < .08) towards PHQ-4 depression scores to be lower in EAL group at T3. In conclusion, this study is the first to provide AU: quantitative evidence of positive outcomes associated with an EAL curriculum designed to strengthen well-being in medical students and resident physicians.

Mental Health Disturbances and Related Problems in Italian University Medical Students from 2000 to 2020: An Integrative Review of Qualitative and Quantitative Studies

Background and objectives: The presence of mental health problems in the population of medical students in Italy has been evaluated in several cross-sectional studies, which have used different methodologies and study designs. However, a global overview of the prevalence of mental health problems in Italian medical students is not available, although this would be essential for promoting preventive strategies and supportive treatments. Materials and Methods: An integrative review aiming to describe the prevalence of mental health problems in Italian medical students has been performed. Results: The most relevant findings are the high prevalence of substance use, in particular alcohol and nicotine, and of depressive and anxiety disorders in Italian medical students. In particular, substance use ranges from 13 to 86%, which is higher compared to Italian students coming from other faculties. Italian medical students show a high rate of smoking and of depressive symptoms of about 20%. Conclusions: Our findings highlight the need to develop appropriate supportive interventions for the medical student population, which are rarely provided and implemented among the routine activities of Italian medical universities. A relevant aspect to be considered is the stigma and anticipated discrimination attached to mental disorders, which reduce the help-seeking process in medical students.

Character Strengths Profiles in Medical Professionals and Their Impact on Well-Being

Character strengths profiles in the specific setting of medical professionals are widely unchartered territory. This paper focused on an overview of character strengths profiles of medical professionals (medical students and physicians) based on literature research and available empirical data illustrating their impact on well-being and work engagement. A literature research was conducted and the majority of peer-reviewed considered articles dealt with theoretical or conceptually driven 'virtues' associated with medical specialties or questions of ethics in patient care (e.g., professionalism, or what makes a good physician). The virtues of compassion, courage, altruism, and benevolence were described most often. Only a limited number of papers addressed character strengths of medical students or physicians according to the VIA-classification. Those articles showed that the VIA-character strengths fairness, honesty, kindness, and teamwork were considered most often by respondents to be particularly important for the medical profession. Available cross-sectional (time span: six years) and longitudinal (time span: three years) data regarding VIA-character strengths profiles of medical professionals were analyzed (N = 584 medical students, 274 physicians). These profiles were quite homogenous among both groups. The character strengths fairness, honesty, judgment, kindness, and love had the highest means in both samples. Noteworthy differences appeared when comparing medical specialties, in particular concerning general surgeons and psychiatrists, with the former reporting clearly higher levels of e.g., honesty (d = 1.02) or prudence (d = 1.19). Long-term results revealed significant positive effects of character strengths on well-being and work engagement (e.g., perseverance on physicians' work engagement) but also significant negative effects (e.g., appreciation of beauty and excellence on students' well-being). Further, hope was significantly associated both positively with physicians' well-being and negatively with students' work engagement, possibly indicating specific issues concerning medical education or hospital working conditions. According to the modern-day physician's pledge, medical professionals should pay attention to their own well-being and health. Therefore, promoting self-awareness and character building among medical professionals could be a beneficial strategy.

Association of Physician Burnout With Suicidal Ideation and Medical Errors

IMPORTANCE

Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression.

OBJECTIVE

To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study was conducted from November 12, 2018, to February 15, 2019. Attending and postgraduate trainee physicians randomly sampled from the American Medical Association Physician Masterfile were emailed invitations to complete an online survey in waves until a convenience sample of more than 1200 practicing physicians agreed to participate.

MAIN OUTCOMES AND MEASURES

The primary outcome was the association of burnout with suicidal ideation after adjustment for depression. The secondary outcome was the association of burnout and depression with self-reported medical errors. Burnout, depression, suicidal ideation, and medical errors were measured using subscales of the Stanford Professional Fulfillment Index, Maslach Burnout Inventory-Human Services Survey for Medical Personnel, and Mini-Z burnout survey and the Patient-Reported Outcomes Measurement Information System depression Short Form. Associations were evaluated using multivariable regression models.

RESULTS

Of the 1354 respondents, 893 (66.0%) were White, 1268 (93.6%) were non-Hispanic, 762 (56.3%) were men, 912 (67.4%) were non-primary care physicians, 934 (69.0%) were attending physicians, and 824 (60.9%) were younger than 45 years. Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation (odds ratio [OR], 1.85; 95% CI, 1.47-2.31). After adjusting for depression, there was no longer an association (OR, 0.85; 95% CI, 0.63-1.17). In the adjusted model, each SD-unit increase in depression was associated with 202% increased odds of suicidal ideation (OR, 3.02; 95% CI, 2.30-3.95). In the adjusted model for self-reported medical errors, each SD-unit increase in burnout was associated with an increase in self-reported medical errors (OR, 1.48; 95% CI, 1.28-1.71), whereas depression was not associated with self-reported medical errors (OR, 1.01; 95% CI, 0.88-1.16).

CONCLUSIONS AND RELEVANCE

The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.

Addressing the Covid-19 Burden on Medical Education and Training: The Role of Telemedicine and Tele-Education During and Beyond the Pandemic

Medical students are the future of sustainable health systems that are severely under pressure during COVID-19. The disruption in medical education and training has adversely impacted traditional medical education and medical students and is likely to have long-term implications beyond COVID-19. In this article, we present a comprehensive analysis of the existing structural and systemic challenges applicable to medical students and teaching/training programs and the impact of COVID-19 on medical students and education. Use of technologies such as telemedicine or remote education platforms can minimize increased mental health risks to this population. An overview of challenges during and beyond the COVID-19 pandemic are also discussed, and targeted recommendations to address acute and systemic issues in medical education and training are presented. During the transition from conventional in-person or classroom teaching to tele-delivery of educational programs, medical students have to navigate various social, economic and cultural factors which interfere with their personal and academic lives. This is especially relevant for those from vulnerable, underprivileged or minority backgrounds. Students from vulnerable backgrounds are influenced by environmental factors such as unemployment of themselves and family members, lack of or inequity in provision and access to educational technologies and remote delivery-platforms, and increased levels of mental health stressors due to prolonged isolation and self-quarantine measures. Technologies for remote education and training delivery as well as sustenance and increased delivery of general well-being and mental health services to medical students, especially to those at high-risk, are pivotal to our response to COVID-19 and beyond.

Burnout among medical students in Cyprus: A cross-sectional study

OBJECTIVES

The primary aim was to estimate the burnout prevalence among all medical students at the Medical School of the University of Cyprus. Secondary aims were to ascertain the predictors of burnout and its relationship with lifestyle habits, sleep quality and mental health.

BACKGROUND

Burnout in the healthcare sector has drawn significant scientific attention over the last few years. Recent research underscored the large burden of profession-related burnout among medical students.

MATERIALS AND METHODS

An anonymous questionnaire was administered to all 189 eligible candidates. This included demographic and lifestyle characteristics. Sleep quality was assessed via the Pittsburg Sleep Quality Index, mental health was assessed via the mental health (MH) domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory-Student Survey (MBI-SS).

RESULTS

Overall response rate was 96.3%. The burnout prevalence was 18.1%. There was a significant linear effect of between the year of studies and the burnout frequency [F(1) = 5.09, p = 0.024], implying that with increasing academic year there were more students with burnout, especially after the 4th year of education which signifies the beginning of clinical education. Students with burnout were more likely to have poor sleep quality (90.9% vs. 60.8%, odds ratio 4.33, p = 0.023) and worse mental health (MH score 40.2 ± 17.7 vs 62.9 ± 20.3, p<0.001). Alcohol consumers had more symptoms of cynicism and less feelings of efficacy than non-alcohol consumers. Moreover, less feelings of efficacy were significantly associated with more alcohol consumption among alcohol consumers.

CONCLUSIONS

Burnout is prevalent in medical students and increases significantly during the clinical years. Students with burnout have worse sleep and mental health and might use alcohol as a coping mechanism. Implementing prevention strategies of burnout may be beneficial.

Undergraduate Knowledge of Osteopathic Medicine: What Premedical Students Know About Osteopathic Medicine and Its Effect on Burnout

Context

Undergraduate student interest in becoming a physician continues to rise, but so too does the difficulty of earning acceptance to medical school. In this competitive environment, little is known about premedical students' knowledge of their medical school options. Moreover, as undergraduate students' emotional health continues to decline, little is known about whether premedical students experience or are at increased risk for the burnout symptoms reported by medical students and other physicians in training.

Objective

To examine premedical undergraduate students' knowledge of osteopathic medicine, assess how they learned of osteopathic medicine, and collect information about any reported feelings of burnout.

Methods

In this institutional review board-approved study, we electronically distributed an anonymous survey to 342 premedical undergraduate students at a midsize, public research undergraduate institution. The survey included 56 questions. Students were surveyed on their preference of medical schools, knowledge of osteopathic medicine, and experience with burnout via the Maslach Burnout Inventory which measures exhaustion, cynicism, and professional efficacy. Of those who completed the survey, only those who confirmed that they currently considered themselves to be premedical students were included in our analysis. A 2×2 factorial analysis of variance (ANOVA) test was applied to assess main and interaction effects amongst respondents who preferred osteopathic or allopathic programs, whether they learned of osteopathic medicine programs by their own research, and their scores on the 3 measures of the Maslach Burnout Inventory: exhaustion, cynicism, and professional efficacy. Bivariate and factorial analyses were completed using SPSS v26 software (IBM). All tests were 2-tailed and used a .05 standard P value.

Results

Of 342 students to whom the survey was sent, 160 (46.8%) responded, and only 92 (26.9%) considered themselves premedical students. Of the 160 students analyzed in our study, 80 (50%) reported first learning of osteopathic medicine through their own research. A 2×2 factorial ANOVA revealed a significant interaction effect for cynicism in respondents who reported learning of osteopathic medicine programs on their own. Conversely, when respondents reported learning of osteopathic medicine programs from another source, they also reported significantly lower cynicism (F[1,1]5.23, P=.03) and exhaustion (F[1,13] 5.79, P=.02) scores. Of the 92 respondents, only 2 students (2.2%) answered all questions regarding general osteopathic medical knowledge correctly.

Conclusion

The results of this study suggest that among premedical students, knowledge of osteopathic medicine may be incomplete and may be impeding medical school applications. Furthermore, respondents who reported interest in osteopathic medical schools and learned of this option through their own research seemed to experience greater burnout. Based on these findings, increased outreach and education have the potential to not only better inform students of the osteopathic profession, but also to reduce burnout.

Assessment of burnout in medical students using the Maslach Burnout Inventory-Student Survey: a cross-sectional data analysis

BACKGROUND

Medical student burnout can cause emotional and physical exhaustion and detachment. The objectives of this study were to evaluate burnout using the Maslach Burnout Inventory-Student Survey (MBI-SS), identify factors that may predict burnout, and assess wellness initiatives effectiveness at reducing burnout.

METHODS

The MBI-SS was administered to all medical students (Classes 2019 to 2022) at the University of Illinois College of Medicine (UICOM) from February to May 2019. Factor analysis and internal consistency of the MBI-SS were assessed. Mean MSBI-SS subscale scores for burnout were calculated for cynicism (CY), emotional exhaustion (EE), and academic efficacy (AE). Multiple regression analysis was used to identify student factors that may predict burnout.

RESULTS

A total of 273 (21.6%) UICOM students completed the survey and 110 (40.3%) respondents reported self-perceived burnout. MBI-SS subscale scores were significantly higher for CY and EE, and significantly lower for AE in students who reported suffering from burnout versus students who did not report burnout. Mean ± SD subscale scores for CY, EE, and AE in burnout students were 14.44 ± 5.59, 23.23 ± 4.74, and 24.81 ± 5.35, respectively. In comparison, mean ± SD subscale scores for CY, EE, and AE in non-burnout students were 7.59 ± 5.16, 14.96 ± 5.71, and 28.74 ± 3.21, respectively. Regression analysis denoted significant associations between burnout and being out-of-phase in the curriculum, the effectiveness of wellness initiatives, and strength of motivation for medical school (SMMS) in both the two- and three-dimensional MBI-SS models. Gender was significantly associated with burnout in only the two-dimensional model.

CONCLUSIONS

Self-reported burnout in medical students at UICOM was validated using the MBI-SS. Being out-of-phase in the curriculum, being female, rating wellness initiatives as less effective, and demonstrating lower motivation for continued medical school education may be used as predictors of medical student burnout. This investigation may act as a guide for measuring burnout in medical student populations and how the implementation of wellness initiatives may ameliorate burnout.

Impact of Workplace Climate on Burnout Among Critical Care Nurses in the Veterans Health Administration

BACKGROUND

Burnout is a maladaptive response to work-related stress that is associated with negative consequences for patients, clinicians, and the health care system. Critical care nurses are at especially high risk for burnout. Previous studies of burnout have used survey methods that simultaneously measure risk factors and outcomes of burnout, potentially introducing common method bias.

OBJECTIVES

To evaluate the frequency of burnout and individual and organizational characteristics associated with burnout among critical care nurses across a national integrated health care system using data from an annual survey and methods that avoid common method bias.

METHODS

A 2017 survey of 2352 critical care nurses from 94 sites. Site-level workplace climate was assessed using 2016 survey data from 2191 critical care nurses.

RESULTS

Overall, one-third of nurses reported burnout, which varied significantly across sites. In multilevel analysis, workplace climate was the strongest predictor of burnout (odds ratio [OR], 2.20; 95% CI, 1.50-3.22). Other significant variables were overall hospital quality (OR, 1.44; 95% CI, 1.05-1.99), urban location (OR, 1.93; 95% CI, 1.09-3.42), and nurse tenure (OR, 2.11; 95% CI, 1.44-3.10). In secondary multivariable analyses, workplace climate subthemes of perceptions of workload and staffing, supervisors and senior leadership, culture of teamwork, and patient experience were each significantly associated with burnout.

CONCLUSIONS

Drivers of burnout are varied, yet interventions frequently target only the individual. Results of this study suggest that in efforts to reduce burnout, emphasis should be placed on improving local workplace climate.

How to Cope with the Challenges of Medical Education? Stress, Depression, and Coping in Undergraduate Medical Students

OBJECTIVES

Up to 90% of medical students experience stress. Studies have observed a relationship between stress and depression. Coping strategies to deal with stress and depression are of great interest. This study aimed to evaluate the prevalence of stress and depression and the efficacy of coping strategies in undergraduate medical students.

METHODS

This survey was conducted with 589 second-year and sixth-year students in 2017 at the Medical University of Vienna. The questionnaire included a stress and coping questionnaire, depression screening, substance use questionnaire, and questionnaire concerning leisure time activities.

RESULTS

The coping strategies were included in a regression model to assess their predictive value for stress and depression screening scores. The most common stressor was performance pressure overload (92.1%). Overall, 52.4% of the participating students reached critical scores in the depression screening. Positive thinking and active coping were associated with lower stress scores. Positive thinking also was a protective factor against depressive symptoms. Less than 2% of all students reached high-risk values for substance use.

CONCLUSION

Accessible counseling for students in need of psychological care should be provided. Different interventions of positive psychology showed a positive impact on depression screening scores.

What Is the Prevalence of Burnout, Depression, and Substance Use Among Orthopaedic Surgery Residents and What Are the Risk Factors? A Collaborative Orthopaedic Educational Research Group Survey Study

BACKGROUND

Burnout and depression among healthcare professionals and trainees remain alarmingly common. In 2009, 56% of orthopaedic surgery residents reported burnout. Alcohol and illicit drug use are potential exacerbating factors of burnout and depression; however, these have been scarcely studied in residency populations.

QUESTIONS/PURPOSES

(1) What proportion of orthopaedic residents report symptoms of burnout and depression? (2) What factors are independently associated with an orthopaedic resident reporting emotional exhaustion, depersonalization, low personal accomplishment, and depression? (3) What proportion of orthopaedic residents report hazardous alcohol or drug use? (4) What factors are independently associated with an orthopaedic resident reporting hazardous alcohol or drug use?

METHODS

We asked 164 orthopaedic surgery programs to have their residents participate in a 34-question internet-based, anonymous survey, 28% of which (46 of 164) agreed. The survey was distributed to all 1147 residents from these programs, and 58% (661 of 1147) of these completed the survey. The respondents were evenly distributed among training years. Eighty-three percent (551 of 661) were men, 15% (101 of 661) were women, and 1% (nine of 661) preferred not to provide their gender. The survey asked about demographics, educational debt, sleep and work habits, perceived peer or program support, and substance use, and validated instruments were used to assess burnout (abbreviated Maslach Burnout Inventory), depression (Patient Health Questionnaire-2), and hazardous alcohol use (Alcohol Use Disorder Identification Test-Consumption). The main outcome measures included overall burnout, emotional exhaustion, depersonalization, low personal accomplishment, depression, and hazardous alcohol and drug use. Using the variables gathered in the survey, we performed an exploratory analysis to identify significant associations for each of the outcomes, followed by a multivariable analysis.

RESULTS

Burnout was reported by 52% (342 of 661) of residents. Thirteen percent of residents (83 of 656) had positive screening results for depression. Factors independently associated with high emotional exhaustion scores included early training year (odds ratio 1.15; 95% confidence interval, 1.01-1.32; p = 0.03) unmanageable work volume (OR 3.13; 95% CI, 1.45-6.67; p < 0.01), inability to attend health maintenance appointments (OR 3.23; 95% CI, 1.69-6.25; p < 0.01), lack of exercise (OR 1.69; 95% CI, 1.08-2.70; p = 0.02), and lack of program support (OR 3.33; 95% CI, 2.00-5.56; p < 0.01). Factors independently associated with depersonalization included early training year (OR 1.27; 95% CI, 1.12-1.41; p < 0.01), inability to attend health maintenance appointments (OR 2.70; 95% CI, 1.67-4.35; p < 0.01), and lack of co-resident support (OR 2.52; 95% CI, 1.52-4.18; p < 0.01). Low personal accomplishment was associated with a lack of co-resident support (OR 2.85; 95% CI, 1.54-5.28; p < 0.01) and lack of program support (OR 2.33; 95% CI, 1.32-4.00; p < 0.01). Factors associated with depression included exceeding duty hour restrictions (OR 2.50; 95% CI, 1.43-4.35; p < 0.01) and lack of program support (OR 3.85; 95% CI, 2.08-7.14; p < 0.01). Sixty-one percent of residents (403 of 656) met the criteria for hazardous alcohol use. Seven percent of residents (48 of 656) reported using recreational drugs in the previous year. Factors independently associated with hazardous alcohol use included being a man (OR 100; 95% CI, 35-289; p < 0.01), being Asian (OR 0.31; 95% CI, 0.17-0.56; p < 0.01), single or divorced marital status (OR 2.33; 95% CI, 1.47-3.68; p < 0.01), and more sleep per night (OR 1.92; 95% CI, 1.21-3.06; p < 0.01). Finally, single or divorced marital status was associated with drug use in the past year (OR 2.30; 95% CI, 1.26-4.18; p < 0.01).

CONCLUSIONS

The lack of wellness among orthopaedic surgery residents is troubling, especially because most of the associated risk factors are potentially modifiable. Programs should capitalize on the modifiable elements to combat burnout and improve overall wellbeing. Programs should also educate residents on burnout, focus on work volume, protect access to health maintenance, nurture those in the early years of training, and remain acutely aware of the risk of substance abuse. Orthopaedic surgery trainees should strive to encourage peer support, cultivate personal responsibility, and advocate for themselves or peers when faced with challenges. At a minimum, programs and educational leaders should foster an environment in which admitting symptoms of burnout is not seen as a weakness or failure.

LEVEL OF EVIDENCE

Level II, prognostic study.

Prevalence, Incidence, and Factors Associated With Substance Use Among Medical Students: A 2-Year Longitudinal Study

OBJECTIVES

Although there are a number of studies about substance use by medical students, the majority are still cross-sectional. We aimed to investigate prevalence, 2-year incidence, and factors associated with substance use during medical training.

METHODS

This longitudinal study included medical students in 4 different waves (with each wave equaling 1 semester). Socio-demographic data, Duke Religion Index (DUREL), DASS-21, and the "Alcohol, Smoking and Substance Involvement Screening Test" (ASSIST) were used.

RESULTS

A total of 327 (56.2%) medical students were followed for 2 years. Prevalence of lifetime substance use was 89.9% for alcohol, 34.5% for cannabis, and 17.1% for sedatives. Tobacco had the greatest incidence of use over the 2 years (16.4%), followed by alcohol (13.8%) and cannabis (13.8%). At least 24% of the students would need an intervention for alcohol use, 11.4% for tobacco, and 6.5% for cannabis. Alcohol use during wave 4 was associated with organizational religiosity, and alcohol and tobacco use at the baseline; tobacco use during wave 4 was associated with age, non-organizational religiosity, and cannabis and tobacco use at the baseline; and cannabis use during wave 4 was associated with cannabis and tobacco use at the baseline.

CONCLUSIONS

Our results indicate an increase in the incidence of lifetime substance use during medical training. Prior use of substance was associated with a higher chance of use after 2 years, while age and religiousness seem to reduce the chance of use.

Understanding the influence of high novelty-seeking on academic burnout: Moderating effect of physical activity

A large number of studies have shown a positive correlation between high novelty-seeking (HNS), substance/medication use (S/MU), high physical activity (HPA), and academic burnout (AB); however, the outcome of individuals with HNS in the terms of catching AB is doubtful. The present study was conducted to find out whether the personality traits such as HNS in medical students predisposes the AB or decreases its severity by increased physical activity (PA). This cross-sectional study, 227 medical students with HNS were selected from three major cities of Iran during February, 2019 to July, 2019 using convenience sampling and were assessed using demographic information form, Baecke's physical activity questionnaire, and Breso's academic burnout questionnaire. In this study, 126 male and 151 female participants were divided into four groups namely HNS + low physical activity (LPA) (n = 68); HNS + HPA (n = 73); HNS + S/MU + LPA (n = 72); and HNS + S/MU + HPA (n = 64). The study results indicated that the maximum and minimum mean scores of AB and its subscales were in the HNS + S/MU + LPA and HNS + HPA groups, respectively. In addition, the hierarchical multiple regression analysis results for the two groups of students with and without S/MU indicated that PA plays a moderating role in the relationship between AB and HNS. Given that the AB can be considered as an antecedent of depressive disorders, its lowered level could be effective in preventing major depressive disorder. Regarding the moderating role of PA in the relationship between HNS and AB, PA, as a relatively simple and inexpensive alternative to pharmacotherapy and psychotherapy, can be raised in the treatment and prevention of the AB.

Prevalence of medical students' burnout and its associated demographics and lifestyle factors in Hong Kong

BACKGROUND

Burnout causes personal suffering and adverse professional consequences. It is prevalent among medical students, although the relationship between burnout and lifestyle factors are understudied in Chinese medical students. Thus, this study aims to (i) estimate the prevalence of burnout among medical students in Hong Kong (HK) and (ii) delineate the relationship between burnout and various lifestyle factors.

METHOD

1,341 students were invited to complete a questionnaire from September to December 2017. Burnout was measured by the Maslach Burnout Inventory. Lifestyle factors including drinking habit, sleep habit and quality, and exercise level were assessed by validated instruments, including Alcohol Use Disorder Identification Test (AUDIT-C), Pittsburgh Sleep Quality Index (PSQI), and Godin-Shephard Leisure-Time Physical Activity (GSLTPA), respectively. Smoking status and use of self-medications were also inquired into, while demographic data was self-reported. Prevalence of burnout with confidence intervals was calculated. Difference in lifestyle and demographic data in students with or without burnout, were compared by t-test and Chi-square/Fisher's exact test. From this, all associations with significant p-value at p<0.1 were entered into the multiple logistic regression model.

RESULTS

731 students (55.6%) responded to the questionnaire. Prevalence of burnout was 27.9% (95%CI: 24.6%-31.5%). Only 3 students in the whole sample smoked; and 6.6% of students drank weekly but rarely drank more than 2 drinks per week. 6.3% and 2.3% self-medicated themselves with medications to improve their sleep and concentration, respectively. Using a multiple logistic regression model, only sleep quality and exercise level were significantly associated with the presence of burnout.

CONCLUSION

Around a quarter of medical students in HK suffered from burnout. Burnout was found to be significantly associated with sleep quality and physical exercise. The study also highlighted that HK medical students lived very different lifestyles from those from other countries. More research is needed to design and establish the effectiveness of lifestyle interventional programs that enhance exercise level and sleep quality.

Caring for others without losing yourself: An adaptation of the Mindful Self-Compassion Program for Healthcare Communities

OBJECTIVE

Two studies examined the efficacy of the Self-Compassion for Healthcare Communities (SCHC) program for enhancing wellbeing and reducing burnout among healthcare professionals.

METHOD

Study 1 (N = 58) had a quasi-experimental design and compared wellbeing outcomes for the SCHC group compared to a waitlist control group. Study 2 (N = 23) did not include a control group and examined the effect of SCHC on burnout.

RESULTS

Study 1 found that SCHC significantly increased self-compassion and wellbeing. All gains were maintained for three months. Study 2 found that in addition to enhancing wellbeing, SCHC significantly reduced secondary traumatic stress and burnout. Changes in self-compassion explained gains in other outcomes, and initial levels of self-compassion moderated outcomes so that those initially low in self-compassion benefitted more.

CONCLUSIONS

Findings suggest that the SCHC program may be an effective way to increase self-compassion, enhance wellbeing, and reduce burnout for healthcare professionals.

Health-related impediments to learning among dental and oral surgery students

Dental education is a challenging experience that places significant demands on students' intellectual, financial, and psychosocial well-being. Dental students who simultaneously experience physical illness, emotional upset, or interpersonal difficulty may be at greater risk of experiencing negative academic consequences. It is well documented that stress affects student learning, however, the impact of other health concerns on academic success is less understood. The purpose of this manuscript is to document the prevalence and perceived academic impact of 24 health concerns on the academic performance of a sample of 130 undergraduate dental students as measured by the National College Health Assessment (NCHA). Health concerns that were most prevalent among dental students were generally also perceived to be most detrimental to their learning. These included upper respiratory infections (cold, flu, sore throat), interpersonal concerns (concerns about a troubled friend or family member, and relationship difficulty), and mental health issues (depression/anxiety/seasonal affective disorder, and stress).

Are Medical Students Prepared to Model Healthy Behaviors for Their Future Patients? A Survey Comparing Aged-Matched Peers

BACKGROUND

Osteopathic medical students (OMS) who establish healthy behaviors for themselves are more likely to counsel their future patients on appropriate self-care. This study compared the lifestyle habits of OMS with those of age-matched peers in other areas of study, which served as the control group.

METHOD

In the fall of 2018, a survey was administered to OMS of the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) (group I) and graduate programs from the same school (group II), to assess their lifestyle habits. Questions on demographics were additionally included.

RESULTS

There were 398 total responses: 83.2% (N = 331) from group I and 16.9% (N = 67) from group II, with 25 being the mean age of the respondents. Group I (53.2%) reported to studying at least 5-10 h per day, while 20.1% reported to studying more than 10 h. Group II reported 37.3% and 9.0%, respectively, of study time. Group I exercised more times per week (2-3 times) than group II and for a longer duration (30-60 min). Group I slept more than group II (6-8 h), yet reported to using more substances to stay awake.

CONCLUSIONS

OMS studied, exercised, and slept more than age-matched peers, but used more substances to stay awake. Aspects of this study are encouraging, but suggest that further evaluation is needed for schools to assist students establish lifelong habits to encourage the wellness of their future patients.

Medical Student Spirituality and Substance Use

OBJECTIVES

Although medical students report relatively high levels of substance use, little is known about the risk and protective factors associated with substance use in this population. This study sought to examine the link between spirituality and substance use among medical students.

METHODS

As part of a larger study, medical students from all 9 medical schools in the state of Florida were invited to complete an anonymous survey pertaining to distress and well-being. Responses to items assessing self-reported spirituality and substance use were examined and descriptive statistics were analyzed.

RESULTS

Data from 868 medical students (57% female) were included. Of these, 22.6% described themselves as "non-spiritual," 31.0% described themselves as "spiritual," 18.5% engaged in informal spiritual practices, and 27.9% reported formal spiritual/religious practices. Students who reported stronger spirituality also reported lower rates of substance use. Though 31% of respondents across all levels of spirituality reported that their alcohol consumption increased since starting medical school, rates of binge drinking after exams were inversely related to level of spirituality.

CONCLUSIONS

Self-reported spirituality appears to be associated with decreased risk of substance use in medical school. Future studies should examine this relation in greater depth.

Promoting Resilience in Medicine: The Effects of a Mind-Body Medicine Elective to Improve Medical Student Well-being

Background

Poor mental health is common among medical students. In response, some medical schools have implemented wellness interventions. The University of Florida College of Medicine recently introduced a mind–body medicine elective, Promoting Resilience in Medicine (PRIMe), based on the Georgetown University School of Medicine course. PRIMe teaches meditation techniques including mindfulness, biofeedback, art, and journaling in a faculty-facilitated small group setting.

Methods

First- and second-year medical students (N = 24) who participated in the 11-week elective (3 cohorts over 2 years) completed anonymous surveys regarding their experiences. Measures included the Freiberg Mindfulness Inventory (FMI), Perceived Stress Scale-10 item (PSS-10), and a series of multiple-choice and free-response questions developed for this study. The study was approved by the University of Florida Institutional Review Board.

Results

Among students with available pre- and posttest scores, the average PSS-10 score at pretest was 14.4 (SD = 6.17, range = 3–26) and at posttest was 14.2 (SD = 4.17, range = 8–22), suggesting no change in perceived stress. However, average scores on the FMI improved from 34.4 (SD = 6.10, range = 24–47) at pretest to 41.8 (SD = 4.81, range = 33–49) at posttest. The overwhelming majority of participants (95.8%) described the course as “definitely” worth it. The greatest improvements were noted in mindfulness, relationships with peers, and having a safe place in medical school to receive support. Learning mindfulness/meditation skills and increasing social support were noted as the primary factors impacting student well-being.

Conclusion

A mind–body medicine elective course may be a practical method to improve medical student well-being and improve ability to care for patients. Future studies should include follow-up testing to determine if benefits are sustained over time. In addition, more work is needed to understand the cost–benefit of providing instruction in mind–body medicine techniques to all medical students.

A qualitative analysis of the coping reservoir model of pre-clinical medical student well-being: human connection as making it 'worth it'

BACKGROUND

By all indications, well-being among physicians is poor, which manifests in various outcomes, including burnout, depression/anxiety, low life satisfaction, alcohol/substance misuse, suicide ideation, and suicide. Despite the vast literature on physician burnout, there is relatively little research on how pre-clinical experiences in medical school may be an antecedent to subsequent poor health among physicians. Here we focus on two neglected areas within the literature by focusing on the pre-clinical stage of medical school and the positive, as opposed to exclusively the negative, aspects of the medical school experience as it affects well-being.

METHODS

This study utilizes the metaphor of the Coping Reservoir Model as a theoretical and analytical framework for understanding medical student well-being by identify the 'depleting' and 'replenishing' inputs that are deposited into students' coping reservoirs. We analyze 105 medical students' reflective writings using a data analytic process consistent with an interpretive description approach, engaging in a hierarchical 3-step coding process to identify the main replenishing inputs deposited into students' coping reservoirs.

RESULTS

The main depleting inputs that we identify are consistent with those identified by The Coping Reservoir Model. In addressing our main research question regarding the replenishing inputs, results show the main positive factors are psycho-social resources, intellectual stimulation, and social support/relationships. Most importantly, relationships with patients shape all three of these positive factors and provide the main source of hope that the stress of medical school will get better.

CONCLUSIONS

What allows students to frame their experiences with hope and optimism are the connections they form with each other and with patients. The prolonged stress of medical school is made "worth it" in hopes that it will "get better" with more meaningful patient interaction in the future. These results that emphasize the positive aspects of medical school are discussed in context of their theoretical contributions to The Coping Reservoir Model and the practical implications for medical education to improve medical student well-being by facilitating human connection.

Redesigning the Learning Environment to Promote Learner Well-Being and Professional Development

There is a high prevalence of burnout and depression among medical students and residents (or learners), which can negatively impact them personally, their professional development, and the patients to whom they provide care. Educators have a responsibility for the system-level factors that influence learners' well-being. In this Invited Commentary, the authors outline strategies institutions and affiliated training sites responsible for educating learners can take to pursue the recommended goal related to learners, their well-being, and the learning environment in the National Academies of Sciences, Engineering, and Medicine consensus study report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.

Patterns of Alcohol Consumption and Drinking Motives Among Korean Medical Students

BACKGROUND Physicians who have healthy lifestyles can provide quality healthcare to their patients and keep themselves healthy. There is little data on the prevalence of drinking behaviors and problems among East Asian medical students. Here, we explored alcohol use and drinking motives among medical students in Korea. MATERIAL AND METHODS A questionnaire-based, multicenter, cross-sectional study was carried out in 323 students from 5 medical colleges in Korea between July and October 2016. We used the Korean version of the Alcohol Use Disorders Identification Test (AUDIT) and an anonymous, self-administered questionnaire that included demographic characteristics, smoking status, consumption of alcohol, and drinking motives. RESULTS The mean AUDIT score was 9.8±7.5 for males and 6.3±5.4 for females. Heavy drinking (75.9%) and binge drinking (56.0%) were very high among Korean medical students. Female medical students drank as much as male students, and much more than other women. The probability that a student would be a binge drinker was 2.72 times higher for a smoker than a non-smoker. The scores for drinking frequency, alcohol intake at one time, heavy drinking, binge drinking, and alcohol dependence symptoms were highest in the group who had "enhancement drinking motives". CONCLUSIONS Heavy drinking and binge drinking are common among both male and female medical students in Korea and this behavior is associated with smoking and enhancement drinking motives. Medical schools should consider implementing effective interventions to prevent and reduce problem drinking among medical students.

Reducing Burnout and Promoting Health and Wellness Among Medical Students, Residents, and Physicians in Alberta: Protocol for a Cross-Sectional Questionnaire Study

Background

Burnout is an increasingly common and insidious phenomenon experienced by workers in many different fields, although it is of particular concern among physicians and trainees due to the nature of their work. It is estimated that one-third of practicing physicians will experience burnout during their career, and this rate is expected to continue to increase. Burnout has significant implications, as it has been identified as a contributor to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide.

Objective

This study will evaluate the prevalence and impact of burnout on physicians, residents, and medical students in Alberta.

Methods

Quantitative and qualitative data collected through self-administered, anonymous, online questionnaires will be used in this cross-sectional provincial study design. Data collection tools were developed based on published literature and questions from previously validated instruments. The tools capture relevant demographic information, mental health status, and rates of burnout, as well as factors contributing to both burnout and resilience among respondents. We anticipate a sample size of 777 medical students, 959 residents, and 1961 physicians to represent the respective ratios of trainees and practicing physicians in the province of Alberta.

Results

Study recruitment will begin in September 2020, with 4 weeks of data collection. The results of this study are anticipated within 12 months from the end of data collection. It is expected that the results will provide an overview of the prevalence of burnout among those training and working in medicine in Alberta, identify contributors to burnout, and help develop interventions aimed at reducing burnout.

Conclusions

This study’s aim is to examine burnout prevalence and contributing factors among medical trainees and physicians in Alberta. It is expected that the results will identify and examine individual and organizational practices that contribute to burnout and help develop strategies and interventions focused on mitigating burnout and its sequelae.

International Registered Report Identifier (IRRID)

PRR1-10.2196/16285

Determining the feasibility and effectiveness of brief online mindfulness training for rural medical students: a pilot study

BACKGROUND

We sought to determine the feasibility and effectiveness of a mindfulness training program, delivered online to medical students at a Rural Clinical School.

METHODS

An 8-week online training program was delivered to penultimate-year medical students at an Australian Rural Clinical School during 2016. Using a mixed methods approach, we measured the frequency and duration of participants' mindfulness meditation practice, and assessed changes in their perceived stress, self-compassion and compassion levels, as well as personal and professional attitudes and behaviours.

RESULTS

Forty-seven participants were recruited to the study. 50% of participants were practising mindfulness meditation at least weekly by the end of the 8-week program, and 32% reported practising at least weekly 4 months following completion of the intervention. There was a statistically significant reduction in participants' perceived stress levels and a significant increase in self-compassion at 4-month follow-up. Participants reported insights about the personal and professional impact of mindfulness meditation training as well as barriers to practice.

CONCLUSIONS

The results provide preliminary evidence that online training in mindfulness meditation can be associated with reduced stress and increased self-compassion in rural medical students. More rigorous research is required to establish concrete measures of feasibility of a mindfulness meditation program.

Army Physician Career Satisfaction Based on a Medical Corps Survey

Introduction

It is critical the U.S. Army retains skilled physicians in the Medical Corps (MC) to ensure direct support to military operations and medical readiness. The purpose of this study was to examine U.S. Army physicians’ opinions concerning: readiness to perform required duties, work environment, support and recognition they receive, military career intentions, and how these factors may relate to Army physician job satisfaction.

Materials and Methods

A cross-sectional study of Army physicians was conducted using a 45-item web-based survey tool, “Army Medicine Medical Corps (MC) Engagement/Satisfaction Survey 2018.” The survey used a combination of multiple choice (Likert-scaled and categorical) and open text statements and questions. Satisfaction with their Army physician career was measured using a 5-point unipolar Likert scale response on level of satisfaction. Chi-square tests of independence were conducted on all demographic characteristics to examine if levels of satisfaction with Army physician career were associated with a particular demographic profile. Agreement opinions expressed on 20 statements about professional readiness, work environment, and job recognition were summarized and rank-ordered by percentage of “strongly agree” responses. Categorical responses to several questions related to career intentions were summarized overall and by career satisfaction level. Multivariate logistic regression was performed to identify demographic factors, which may influence career satisfaction as an Army physician.

Results

Approximately 47% (2,050/4,334) of U.S. Army physicians participated in the MC 2018 survey. Career satisfaction percentages overall were: “extremely satisfied” (10.0%), “quite satisfied” (24.8%), “moderately satisfied” (33.9%), “slightly satisfied” (22.6%), and “not at all satisfied” (8.3%). Respondents were in least agreement to statements about sufficient administrative support and recognition of doing good work. Logistic regression results showed military rank as a significant predictor of negative career satisfaction as an Army physician. For Captains, the odds for being “not at all satisfied” with their military career were almost nine times that of Colonels. Also, compared to their baseline group, physicians who completed their graduate medical education training, mission critical surgeons, and physicians who worked in military treatment facilities that were either a hospital (not a medical center) or a clinic-ambulatory surgery center had a greater risk of being “not at all satisfied” with their career as an Army physician.

Conclusions

There is significant room for improvement in MC officer career satisfaction. The drivers of satisfaction are multiple and apply differently among MC officers of varied ranks and experience. Senior officers are the ones who are the most satisfied with their military career. Results of this novel MC officer study may serve as an impetus to identify existing shortcomings and make necessary changes to retain skilled Army physicians. Army leaders should invest resources to develop and sustain initiatives that improve military career satisfaction and retention of MC officers.

Socioeconomic Factors Associated With Burnout Among Oncology Trainees

PURPOSE:

Burnout in the medical workforce leads to early retirement, absenteeism, career changes, financial losses for medical institutions, and adverse outcomes for patients. Recent literature has explored burnout in different specialties of medicine. This article examines burnout among medical oncology trainees and identifies factors associated with burnout and professional dissatisfaction, including socioeconomic factors.

METHODS:

US medical oncology programs were sent a survey that included the Maslach Burnout Index–Human Services Survey as well as demographic, socioeconomic, and program-specific questions tailored to medical oncology fellowship. Primary binary end points included burnout, satisfaction with being a physician, and satisfaction with being a medical oncologist. Binomial logistic models determined associations between various characteristics and end points.

RESULTS:

Overall, 261 US fellows completed the survey. Seventy percent of international medical graduates reported no educational debt, whereas only 36% of US graduates reported no educational debt. Eighty-two percent of survey respondents reported their mother had at least a bachelor’s degree, and 87% of respondents reported their father had at least a bachelor’s degree. At least 27% of respondents had symptoms of burnout. Factors inversely associated with burnout on multivariable analysis included having a mother who graduated college (odds ratio [OR], 0.27), reporting an adequate perceived balance between work and personal life (OR, 0.22), feeling that faculty care about educational success (OR, 0.16), and being in the final year of training (OR, 0.45). Having debt ≥ $150,000 (OR, 2.14) was directly associated with burnout.

CONCLUSION:

Symptoms of burnout are common among medical oncology fellows and are associated with educational debt and socioeconomic factors.

Who attempts suicide among medical students?

OBJECTIVE

To identify factors associated with a history of suicide attempt in medical students.

METHODS

A Web-based survey was sent out to a sample of medical students. A multi-predictor Poisson regression was performed to identify factors associated with a history of suicide attempt. In addition, an elastic net regularization was used to build a risk calculator to identify students at risk for attempted suicide.

RESULTS

A total of 4,840 participants were included in the study. Prevalence of suicide attempts in the sample was 8.94%. Risk factors associated with past suicide attempt in the multi-predictor Poisson regression were as follows: female gender (P < 0.001); homosexuality (P < 0.001); low income (P = 0.026); bullying by university peers (P = 0.006); childhood (P = 0.001) or adult (P = 0.001) trauma; family history of suicide (P = 0.005); suicidal ideation within the last month (P < 0.001); daily tobacco use (P = 0.037); and being at severe risk for alcohol abuse (P = 0.023). Our elastic net model performed well with an AUC of 0.83.

CONCLUSIONS

This study identifies a number of key factors associated with a history of suicide attempts among medical students. Future longitudinal studies should assess the causal relationship between these factors and suicide attempts. Additionally, these results demonstrate that current available data on suicide attempts among medical students can be used to develop an accurate risk algorithm.

Development of Cynicism in Medical Students: Exploring the Role of Signature Character Strengths and Well-Being

Reports of medical students experiencing burnout-related symptoms (e.g., cynicism) have increased in recent years. Little is known about the developmental process of this phenomenon and its relations with signature character strengths and well-being. The aim of this longitudinal analysis was to explore changes in the level of cynicism of medical students while in preclinical education. We further examined how the applicability of signature character strengths and well-being are related to this developmental process. Medical students (N = 99) participated in three online surveys over 3 years during medical school. Latent growth modeling, latent class growth modeling, general mixed modeling was conducted, and post hoc mixed ANOVA, Friedman test and Welch test analyses were examined. The results showed an increase in cynicism among medical students from first to last measurement. Two groups with distinct developmental trajectory patterns of cynicism were identified. Students with high levels of cynicism (high-level group) and students with changing levels of cynicism (increasing group) perceived higher applicability of signature character strengths in private life compared to the study context. Moreover, the high-level group experienced significantly lower psychological well-being (in particular mastery, optimism, and relationship) in their first year of medical education. This explorative study offers a comprehensive understanding of cynicism development in medical students during medical school and its relations to the applicability of signature character strengths and well-being. Prospective replication studies are needed to replicate the results obtained in this study.

Time for change: Overcoming perpetual feelings of inadequacy and silenced struggles in medicine

Focusing on support of psychological wellness in medical students, residents and physicians, this commentary highlights the need for cultural change and the accompanying importance of leadership.

Work Addiction, Obsessive-Compulsive Personality Disorder, Burn-Out, and Global Burden of Disease: Implications from the ICD-11

Occupational stress and high workload are being increasingly recognized as significant contributors to the diseases and disorders constituting major components of the global burden of disease. A more detailed definition of burn-out was recently included by the World Health Organization (WHO) in the eleventh revision of the International Classification of Diseases (ICD-11) which reflects a growing acknowledgment of the role of professional work in mental health. One of the symptoms of obsessive-compulsive personality disorder/anankastic personality disorder (OCPD/APD) is an undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships. This compulsive overworking is closely related to the concept of work addiction, and OCPD/APD was suggested to be its major risk factor. OCPD/APD is the most prevalent personality disorder and one that appears to produce the highest direct and indirect medical costs. At the same time, it is vastly understudied. In recent years, it has been repeatedly emphasized that it requires consistent conceptualization and clarification of its overlapping with similar conditions. Even though the limited existing studies suggest its strong relationship with burn-out and depression among employed individuals, there has been no systematic effort to investigate its role in the consequences of occupational stress and high workload. This paper identifies several substantial gaps in the current understanding of the relationships between work addiction, OCPD/APD, burn-out, and the global burden of disease within the context of the WHO's plan of developing evidence-based guidelines on mental wellbeing in the workplace.

Understanding the influence of high novelty-seeking on academic burnout: Moderating effect of physical activity

A large number of studies have shown a positive correlation between high novelty-seeking (HNS), substance/medication use (S/MU), high physical activity (HPA), and academic burnout (AB); however, the outcome of individuals with HNS in the terms of catching AB is doubtful. The present study was conducted to find out whether the personality traits such as HNS in medical students predisposes the AB or decreases its severity by increased physical activity (PA). This cross-sectional study, 227 medical students with HNS were selected from three major cities of Iran during February, 2019 to July, 2019 using convenience sampling and were assessed using demographic information form, Baecke’s physical activity questionnaire, and Breso’s academic burnout questionnaire. In this study, 126 male and 151 female participants were divided into four groups namely HNS + low physical activity (LPA) (n = 68); HNS + HPA (n = 73); HNS + S/MU + LPA (n = 72); and HNS + S/MU + HPA (n = 64). The study results indicated that the maximum and minimum mean scores of AB and its subscales were in the HNS + S/MU + LPA and HNS + HPA groups, respectively. In addition, the hierarchical multiple regression analysis results for the two groups of students with and without S/MU indicated that PA plays a moderating role in the relationship between AB and HNS. Given that the AB can be considered as an antecedent of depressive disorders, its lowered level could be effective in preventing major depressive disorder. Regarding the moderating role of PA in the relationship between HNS and AB, PA, as a relatively simple and inexpensive alternative to pharmacotherapy and psychotherapy, can be raised in the treatment and prevention of the AB.

Stress among Portuguese Medical Students: the EuStress Solution

There has been an increasing attention to the study of stress. Particularly, college students often experience high levels of stress that are linked to several negative outcomes concerning academic functioning, physical, and mental health. In this paper, we introduce the EuStress Solution, that aims to create an Information System to monitor and assess, continuously and in real-time, the stress levels of the students in order to predict burnout. The Information System will use a measuring instrument based on wearable device and machine learning techniques to collect and process stress-related data from the students without their explicit interaction. In the present study, we focus on heart rate and heart rate variability indices, by comparing baseline and stress condition. We performed different statistical tests in order to develop a complex and intelligent model. Results showed the neural network had the better model fit.

Burnout among nursing students: predictors and association with empathy and self-efficacy

ABSTRACT Objective: to analyze burnout, its predictors and association with empathy and self-efficacy among nursing students. Method: cross-sectional analytical study with 284 students from five state universities in the state of Parana, Brazil. The instruments applied were: social and academic questionnaire, Maslach Burnout Inventory, Interpersonal Reactivity Index and Occupational Self-Efficacy Scale (Short Form). Spearman’s correlation and univariate and multivariate logistic analysis were used. Results: 6.0% of the students presented high burnout, 36.3% presented high emotional exhaustion, 37.7% presented high depersonalization and 28.2% presented low personal accomplishment. The burnout predictors were: absence of physical activity; weekly workload >24 hours; low empathic concern. There were negative correlations between empathy (empathic concern and perspective taking) and depersonalization; self-efficacy and emotional exhaustion; and positive correlations between personal accomplishment and empathy and self-efficacy. Conclusion: Personal factors and an academic variable were burnout predictors among nursing students. The correlations suggest that self-efficacy and empathy can prevent burnout.

Evaluation and Durability of a Curriculum-Based Intervention for Promoting Mental Health among Graduate Students

Background

Graduate school environments are recognized for contributing to elevated stress levels among student populations.

Purpose

The objective was to test whether a behavioral intervention, delivered through an online course on behavior change, is effective in preventing declining mental health.

Methods

Data were collected via a quasi-experimental longitudinal study to observe the effect of self-directed behavioral interventions on mental health. Participants included students enrolled in a course on Health Behavior Change at the Yale School of Public Health (n = 45) and a control group (n = 33) of students in the same graduate program. Analyses were conducted to evaluate differences at post-intervention and at a 12-week follow-up assessment in indicators of mental and general health.

Results

Enrolled students reported significantly improved mental health outcomes as compared to the control students. At follow-up, multiple differences persisted, with participants who had completed the course reporting sustained improvements in general and mental health.

Discussion

Self-directed behavior change interventions are effective in promoting mental and physical health among graduate student populations.

Translation to Health Education Practice

This curriculum-based intervention can support student wellbeing in a variety of academic programs.

Burnout Syndrome Amongst Medicine Students in Lithuania and Germany

Summary Background

The research provides comparative analysis of the burnout syndrome among medical students in Lithuania and Germany and determines relations between burnout and lifestyle, health complaints and seeking for psychological help.

Materials and methods

The research was conducted in April 2019 using an anonymous self-administered e-based questionnaire. The sample size was 261 medical students (age mean 20,5 ± 1,8, 46 males, 215 females): 131 from Vilnius University (VU), 67 from Lithuanian University of Health Science (LSMU) and 63 from Heidelberg University (HU), Germany. The 15 items MBI-SS scale was used to identify burnout syndrome among students (Cronbach α =0,74). Emotional exhaustion (>14), cynicism (>6), and professional efficacy (<23) scores were calculated for academic burnout. The participants were also asked additional questions related to lifestyle and well-being. Descriptive statistics were analysed using MS Office Excel, SPSS and R Commander, results were statistically significant when p<0,05.

Results

51 (38,9%) VU, 25 (37,3%) LSMU and 10 (15,9%) HU students were ascertained as burnt-out (p=0,004). 76 (90,6%) respondents complained of feeling study induced mental stress (p=0,0002). Furthermore, 67 (77,9%) respondents indicated having a bad mood (p=0,043), 54 (62,7%) general weakness (p=0,024), 44 (51,1%) digestive problems (p=0,003). Sleep duration was strongly associated with burnout (p=0,002) with over half (n=51, 59,3%) of the burnout respondents sleeping <7 hours a day. 87 (33,3%) students considered consulting a psychologist, but only 24 (9,2%) reached out for help.

Conclusions

More than 1/3 of medical students in the research group had signs of burnout. The highest prevalence of burnout was among VU and lowest among HU students. Burnt-out respondents complained of mental stress, weakness, bad mood, digestive problems. The university studies and the duration of sleep can impact the occurrence of burnout syndrome. Only every forth student, willing to consult a psychologist, sought assistance.

Burnout in Pediatric Residents: Three Years of National Survey Data

BACKGROUND

We aimed to describe the national epidemiology of burnout in pediatric residents.

METHODS

We conducted surveys of residents at 34 programs in 2016, 43 programs in 2017, and 49 programs in 2018. Survey items included the Maslach Burnout Inventory, demographics, program characteristics, personal qualities, experiences, and satisfaction with support, work-life balance, and learning environment. Analyses included cross-sectional comparisons and cross-sectional and longitudinal regression.

RESULTS

More than 60% of eligible residents participated; burnout rates were >50% in all years and not consistently associated with any demographic or residency characteristics. Cross-sectional associations were significant between burnout and stress, sleepiness, quality of life, mindfulness, self-compassion, empathy, confidence in providing compassionate care (CCC), being on a high-acuity rotation, recent major medical error, recent time off, satisfaction with support and career choice, and attitudes about residency. In cross-sectional logistic regression analyses, 4 factors were associated with an increased risk of burnout: stress, sleepiness, dissatisfaction with work-life balance, and recent medical error; 4 factors were associated with lower risk: empathy, self-compassion, quality of life, and CCC. Longitudinally, after controlling for 2017 burnout and 2018 risk factors (eg, recent error, sleepiness, rotation, and time off), 2017 quality of life was associated with 2018 burnout; 2017 self-compassion was associated with lower 2018 stress; and 2017 mindfulness, empathy, and satisfaction with learning environment and career choice were associated with 2018 CCC.

CONCLUSIONS

A majority of residents met burnout criteria. Several identified factors (eg, stress, sleepiness, medical errors, empathy, CCC, and self-compassion) suggest targets for interventions to reduce burnout in future studies.

Teaching Millennials and Generation Z

Each generation is defined not solely by the date of their birth, but also for their beliefs, their priorities, and their motivations. Many factors play heavily into the development of each generation's collective identify, including parenting styles, significant political and current events, changing gender roles, and other formative experiences. These factors significantly and uniquely influence how each generation lives, learns, and interacts with others (Gerhardt, 2016). While most medical educators today are baby boomers, the majority of medical students are millennial and generation Z individuals, who communicate, learn, and interact very differently than their instructors. As a result, effective medical educators are challenged to update their methods of instruction to best suit these newer generations of learners for better assimilation, clinical application, and long-term retention of material, to maintain delivery of high-quality healthcare in the country for future generations (Desy et al., 2017; Waljee, 2018).

Improved quality of life and reduced depressive symptoms in medical students after a single-session intervention

OBJECTIVE

Anxiety and depression are prevalent among medical students. Brazilian medical students have higher levels of depression and lower quality of life than their U.S. counterparts, and no preventive intervention exists for this risk group in Brazil. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral treatment protocol for neuroticism, was recently adapted into a single-session, preventive intervention. This study tested the impact of this protocol on psychiatric symptoms and quality of life in Brazilian medical students.

METHODS

In this open trial, the intervention protocol was translated and adapted to Brazilian Portuguese. Medical students over 18 years of age without psychotic symptoms, severe depressive episodes, or acute psychiatric risk were included, undergoing a psychiatric clinical interview (Mini-International Neuropsychiatric Interview [MINI]) and evaluation at baseline and at 7 and 30 days after a single-session UP that included experimental avoidance, quality of life, self-esteem, empathy, and anxiety symptom scales. A new evaluation was performed 90 days after the intervention.

RESULTS

Sixty-two students participated. Ninety days after the intervention, there were significant reductions in the number of students who met the criteria for social anxiety disorder (p = 0.013) or panic disorder (p = 0.001). There were also significant improvements in depressive symptoms (Beck Depression Inventory, p < 0.001) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire, p < 0.001).

CONCLUSION

UP improved anxiety and depressive symptoms in medical students. The single-session group format could reduce costs and facilitate application. Future placebo-controlled studies are necessary to confirm these findings.

A review of the factors related to burnout at the early-career stage of medicine

Background: Globally, burnout is an increasingly prevalent problem amongst young medical professionals. This review aims to understand the factors related to burnout in the early-career stage of medicine. Drawing on the widely used Job Demands-Resources Model, the antecedents of burnout were distinguished from its outcomes.Methods: The review adopted the PRISMA guidelines. Using specific search terms, peer-reviewed articles were obtained from a range of databases and assessed against selection criteria. To meet inclusion requirements, the study had to be published between 2000 and 2018, include a validated measure of burnout, and undertake empirical assessment of factors related to burnout in medical students and/or junior medical officers/residents. Additional studies were obtained and reviewed from the reference lists of selected articles.Results: Out of the 3796 studies that were initially found, 585 were assessed against the eligibility criteria leaving 113 studies for review. These studies highlighted the negative consequences of burnout in the early medical career. Also identified were work-specific and person-specific demands that likely lead to burnout and, work and person resources that appear to reduce burnout.Conclusion: This review provides a framework to explain the growing problem of burnout amongst early-career medical professionals. However, further research is necessary to overcome the current reliance on cross-sectional designs and small sample sizes.

Fostering Meaning in Residency to Curb the Epidemic of Resident Burnout: Recommendations From Four Chief Medical Residents

Burnout has become commonplace in residency training, affecting more than half of residents and having negative implications for both their well-being and their ability to care for patients. During the authors' year as chief medical residents at Brigham and Women's Hospital in 2017-2018, they became intimately familiar with the burnout epidemic in residency training. The authors argue that addressing resident burnout requires residency programs and teaching hospitals to focus not on the individual contributors to burnout but instead on fostering meaning within residency to help residents find purpose and professional satisfaction in their work. In this Perspective, they highlight 4 important elements of residency that provide meaning: patient care, intellectual engagement, respect, and community. Patient care, intellectual engagement, and community provide residents with a focus that is larger than themselves, while respect is necessary for a resident's sense of belonging. The authors provide examples from their own experiences and from the literature to suggest ways in which residency programs and teaching hospitals can strengthen each of these elements within residency and curb the epidemic of burnout.