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

An initial preparation for human cadaveric dissection ameliorates the associated mental distress in students

It is universally recognized that cadaveric dissection is an essential part of anatomy training. However, it has been reported to induce mental distress in some students and impair their intrinsic motivation (IM) to study. One of the postulated reasons for this behavior is the lack of adequate information and preparation of students for cadaveric dissection. Therefore, it is hypothesized that providing relevant information prior to cadaveric dissection will ameliorate the mental distress, enhance the IM of students, and improve their academic performance. A cohort of occupational therapy students enrolled in an anatomy course were psychologically prepared for cadaveric dissection. Students were provided with a curated list of YouTube videos and peer-reviewed journal articles related to cadaveric dissection prior to the commencement of the anatomy course. All students were also required to attend an oral presentation immediately before commencing dissection. The control group included students who had not been provided with any resources in preparation for cadaveric dissection. Compared to the control group, students who had been prepared demonstrated better quality of cadaveric dissection, improved academic performance, reported less mental distress and greater IM. Moreover, students reported the oral presentation to be most relevant and journal articles to be least useful in their preparation. Therefore, this is an effective approach in the amelioration of mental distress and improvement of performance in anatomy students. Consequently, this study represents a paradigm shift in the pedagogy of anatomy, and could represent a vital element in the evolution of a revitalized anatomy curriculum.

Medical student perceptions of reflective practice in the undergraduate curriculum

Introduction: Reflective practice (RP) forms a core component of medical professionalism but, despite its benefits, it remains largely undervalued among medical students. The aim of this study was to explore medical students’ attitudes and barriers to engagement with RP in the undergraduate programme at a UK based medical school. Methods: This was a qualitative study based on the methodology of phenomenology. All penultimate year medical students at University College London Medical School (n=361) were approached for this study and altogether thirteen participants were recruited, with data collected through two focus group discussions. Thematic analysis was used to generate the coding framework. Results: Five key themes emerged around student attitudes to RP, which were grouped into three domains: ‘value of RP’, ‘barriers to engagement’, and ‘strategies for enabling RP’. ‘Value of RP’ centred on the themes of humanising medicine and developing empathy, developing professionalism and RP as a tool for sense-making. ‘Barriers to engagement’ centred on the purpose and tokenism of RP and in the third domain, ‘strategies for enabling RP’, the theme of student agency in RP emerged strongly. Conclusion: Overall, the value of RP was not fully appreciated until students began their clinical placements. Potential strategies identified by participants for optimising engagement included student co-design and positioning RP within a broader pastoral role early in the undergraduate curriculum.

Medical students describe their wellness and how to preserve it

BACKGROUND

Despite widespread efforts to create wellness programming in medical schools, there is a paucity of literature examining students' perception of wellness and perceptions of these programs. With the inaugural class at the Arizona campus of Mayo Clinic Alix School of Medicine (MCASOM-AZ), an opportunity arose to establish an empirically evaluated wellness curriculum that most inclusively and effectively enables medical students to flourish for years to come. The initial wellness offerings included mental health, academic success, and disability services, curriculum-embedded seminars, wellness committee driven programming, and student-proposed wellness activities. We aimed to improve the relevance and impact of medical school wellness curricula by soliciting in-depth and longitudinal perspectives of medical students themselves. As MCASOM-AZ opened in 2017, the student body at the time of study consisted of first- and second-year medical students.

METHODS

Employing a mixed methods analysis of qualitative and longitudinal quantitative data, first- and second-year students at a MCASOM-AZ were invited to respond to an anonymous, online year-long survey (baseline, six months and 12 months) during the 2018-2019 academic year and participate in a structured, in-depth and in-person, peer-to-peer interview about their conceptions of wellness and the MCASOM-AZ wellness curriculum and resources. Qualitative data was coded for themes using thematic analysis strategies by independent raters.

RESULTS

Nearly half of eligible students completed the baseline survey,1/3 completed all 3 time-points, and 1/5 participated in an in-depth interview. Participant age, gender, and year of school were representative of the larger student body. Although individual conceptions varied, Wellness was consistently highly valued. Family, Academic Performance, and Friends emerged as most important to well-being across time-points. Academic work arose as the largest barrier to wellness. Analysis of qualitative data revealed five themes. Despite individual differences in approaches to wellness, wellbeing was interrelated to the learning environment; mandatory wellness efforts that didn't address the medical culture met with skepticism.

CONCLUSIONS

Interview responses provided understanding and context by which to interpret questionnaire responses. Academics was critical to students' identity and wellness, while also the largest barrier. Suggested curricular improvements include restructuring academic work, seamlessly integrating wellness within coursework, and offering optional individualized approaches.

Promoting resilience in healthcare students through psychological interventions

Given the impact of well-known chronic stressors on health and social care students, the concept of resilience has gained importance in the field of health professional education. Many interventions have been tested that are aimed at fostering students’ resilience, but the underlying evidence has not been rigorously assessed. This was the aim of the review in this issue's Cochrane Corner. In this Round the Corner section, we discuss those findings and put them into further context.

Stress and its association with involvement in online classes: a cross-sectional study among undergraduate students of a medical college in South India

Background: With the implementation of lockdown and all students restricted to their houses, medical education has shifted towards the online mode. The objective of this study was to assess stress during the pandemic and the association between stress and involvement in online classes among students of a medical college in Mangalore, Karnataka, South India. Methods: A cross-sectional study was conducted among 324 undergraduate students at a medical college in Mangalore, Karnataka, South India. The extent of stress was assessed using a perceived stress scale (PSS), and a questionnaire was used to identify different stressors and to understand the participant's involvement in online classes. Results: In this study, the mean perceived stress score was 21.66 ± 4. Moderate stress was observed in 262 (85%) students. The main stressors noted were inability to focus (173 (56.4%)) and fear of exams (153 (49.8%)). A significant association was noted between stress and involvement in online classes. Conclusions: This study thereby highlights the need for more attention to the various stressors among students and for making online classes student friendly.

Wellness in Physician Assistant Education: Exploring Mindfulness, Well-Being, and Stress

PURPOSE

The current study examined stress reduction activities most commonly used by matriculating physician assistant (PA) students to better understand how students are approaching self-care and management of stress. In particular, the study examined levels of mindfulness and well-being to understand how these relate to various stress reduction approaches at the time of matriculation.

METHODS

Newly matriculated students at 9 PA programs located across the nation were surveyed (n = 294). Validated survey instruments assessed levels of mindfulness and general well-being. Stress reduction activities were also assessed. Univariate and multivariate analyses were used to examine levels of mindfulness and levels of well-being to see how these relate to various stress reduction approaches.

RESULTS

The survey response rate was 72%. Nearly one-third of respondents (32%) identified meditation as one of their stress reduction activities, and more than half (53%) reported having participated in mindfulness practice at least once in the past year. Sixty-four percent of students reported awareness of mindfulness practices, while only 16% reported frequent practice within the year prior to matriculation. When looking at variables of interest, decentering and psychological flexibility were significant in accounting for student-reported perceived stress and life satisfaction.

CONCLUSION

PA students are likely receptive to mindfulness-based interventions that have the potential to improve well-being and reduce stress. There is opportunity for programs to incorporate reliable and structured training within curricula that effectively increases levels of mindfulness and, in doing so, can lead to improvement in perceived stress and life satisfaction. Further research may assist educators in the development of strategies to promote student and clinician wellness.

Psychometric validation and cultural adaptation of the Italian medical student stressor questionnaire

Medical students encounter specific stressors that can lead to higher levels of psychological distress compared to their similar aged counterparts who study other subjects. The Medical Student Stressor Questionnaire (MSSQ) was developed to specifically identify stressors among medical students as well as measure the intensity of stress caused by the stressors. However, no Italian version has been validated to date. The aim of this study was to develop an Italian version of the MSSQ (MSSQ-I) and to assess its psychometric properties. The MSSQ has been translated and culturally validated into Italian. All medical students from the University of Brescia were asked to participate in a web-survey in which they were asked to complete the MSSQ-I. For the analysis of the stability over time, participating students were asked to complete again the MSSQ-I after about one month. Among 1754 medical students, 964 completed the MSSQ-I for the validation analyses. A first Confirmatory Factor Analysis and a subsequent Explanatory Factor Analysis outlined a slightly modified factor structure of the scale with five factors instead of six as in the original scale. The internal consistency on the overall scale was high (α = 0.94), as well as the internal consistency of each of the new factors: (α > 0.83 for the first four factors and α = 0.67 for the fifth). External validity analysis confirmed moderate/high concurrent validity. These results suggest that the MSSQ-I can be used as a tool to identify stressors among Italian medical students, although further research is needed to confirm its individual test-retest reliability.

Trauma-Informed Care in the Classroom: Our Experience with a Content Warning in a Medical School Course

Trauma is now recognized as a common human experience that has consequences, including adverse effects on learning outcomes. Principles of trauma-informed care include awareness of the impact of trauma and use of strategies to prevent retraumatization. While well-described in medical and mental health care, these principles have been inconsistently applied in the medical education classroom. Content warnings can be part of a trauma-informed classroom approach that notifies learners about potentially distressing topics, allows individuals to employ self-care, and seeks to resist retraumatization. This article describes our experience integrating a content warning about reproductive topics in a second-year medical school course.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01559-0.

Current Approaches to Yoga in U.S. Medical Schools: Scoping Review of the Literature

Background: Yoga is described as a system of physical and mental practices originating from India that connects mind, body, and spirit with techniques such as physical exercises, breathing, and meditation to promote health and well-being. Medical students experience an immense amount of stress that unfortunately continues throughout their residency and careers. Yoga represents a tool to reduce stress and support medical student resilience. Objective: This study aims to evaluate the current approaches to yoga in U.S. medical schools. Methods: A scoping literature review was conducted using search terms such as "medical school," "medical student," "medical education," "yoga," "asana," "pranayama," and "mindfulness." The primary aim of the review was to examine if U.S. medical schools offer accessible yoga to medical students and the characteristics of those yoga programs. Results: The search yielded 1313 primary articles. All titles and abstracts were screened for eligibility. Duplicate articles were removed, and 156 articles were reviewed independently by two authors. A total of eight articles met all the criteria. Yoga is offered in medical schools through three main models: recreational, research, and educational. All of the studies indicated various positive effects on medical students from these yoga programs, including in psychological states, perceived stress, and scores on medical knowledge assessments. Conclusions: Yoga aligns well with the objectives of medical education by combining physician resiliency, mindfulness, and education that can ultimately serve patients. Greater opportunities should be created to engage medical students in yoga through the length of their entire undergraduate and graduate medical training.

How Financial Aid Policy Shortchanges American Healthcare

Issue: Medical school debt is increasing. This trend may reduce access to medical school at a time of historic recognition of the need for greater openness and diversity in medical education by disadvantaging candidates who are underrepresented in medicine. The effects of high education-related debt for medical school needs greater consideration. Evidence: The implementation staircase model is employed as lens for understanding the impact of debt on trainees who are underrepresented in medicine and the healthcare system overall. Higher debt burdens are associated with worse mental health outcomes and increased odds of attrition in medical school. Trainees cite debt as a concern in considering primary care careers. Those with greater debt are less likely to pursue or remain in academic careers. Implications: The current financial aid system's reliance on high debt burden undermines goals to improve the representation of underrepresented candidates in primary care and academic medicine. Alternative models requiring less debt could facilitate the creation of a more diverse workforce in healthcare.

Impact of role conflicts and self-efficacy on academic performance of graduate-entry healthcare students: A lagged study

Graduate entry healthcare students experience many challenges during their academic journey. The impact of these challenges needs to be considered to support students through their training and education. In this study, we examined the impact of experiencing these role conflicts (at the outset of the academic year), for example, family and caring responsibilities, activities with family/friends, and daily tasks/chores, on the academic performance (at the end of the academic year) of graduate‐entry healthcare students. We also investigated the potential of students' self‐efficacy for learning to mitigate the extent to which such role conflicts impact academic performance. Findings demonstrate that the more graduate entry healthcare students experienced conflicts between their life responsibilities and their academic responsibilities, the worse their academic performance was across the year. This negative relationship was somewhat mitigated by high self‐efficacy for learning. The practical implications of our research suggest the need to provide specific mitigation strategies to support healthcare students regarding conflicts between their life/family responsibilities and their academic work.

An exploratory study on the challenges faced and coping strategies used by preclinical medical students during the COVID-19 crisis

PURPOSE

The impact of the coronavirus disease 2019 crisis on medical education includes reduced clinical training, a significant loss of learning time and a probable decline in confidence of being a doctor. These recent changes will have significant effect on the well-being of medical students and interventional support needs to be given early. This study explores the challenges faced and coping strategies used by preclinical medical students during the crisis.

METHODS

A qualitative study involving 13 preclinical medical students was conducted between August and September 2020 at a medical school in Malaysia. An in-depth individual interview via Microsoft Teams (Microsoft Corp.) with semi-structured questions was conducted. The recorded interview data were thematically analyzed using the six phases of Braun and Clarke's Thematic Analysis.

RESULTS

The challenges faced were identified under three themes: psychosocial impact of lockdown, significant lifestyle changes, and impact on professional progression. Meanwhile, four themes emerged in coping strategies that include behavioral strategies, re-appraisal of the uncertainties of situation, active coping mechanisms, and regulation of emotion with coping reserve. There are indications that personality traits determine strategies to cope with challenges faced during the crisis which may either lead to resilience building or experiencing burnout.

CONCLUSION

The findings of the study highlighted the urgent need to develop early preventive and intervention strategies to address the mental health of medical students to mitigate stress and promote positive well-being in times of crisis.

Stress among Medical Students Presented with an EEG at Suranaree University of Technology, Thailand

Purpose

A high level of stress among medical students is perceived as stress caused by strenuous medical programs and medical school is an extremely stressful environment, to begin with. For this reason, identifying stressors facing medical students is expected to enhance medical school lecturers’ understanding, leading to a provision of assistance for adequate supervision. The purposes of this study were to investigate stress levels in daily life and the electroencephalogram (EEG) characteristics during daily life and pre-examination period of 2nd-year medical students at Suranaree University of Technology (SUT), Thailand, and to compare the EEG characteristics between these two periods.

Methods

Medical Student Stressor Questionnaire (MSSQ) was used as a research instrument to collect data from sixty medical students. After that, EEG was administered in two periods for these studies (in daily life (baseline) and pre-examination 1 week). Paired t-test was used for analyzing the difference in the EEG characteristics in the 2 periods.

Results

The results indicated that the stress levels among medical students were mild (3.33%), moderate (53.33%), and high (43.33%). Academic Related Stressor (ARS) was found to be the main cause of stress among the subjects. All had a beta wave in 2 periods.

Conclusion

In conclusion, stress among medical students can alter brain function as measured by EEG. The findings could assist medical schools in better understanding medical students’ stress levels and planning how to teach in order to improve student achievement.

"Fun slipping into the doctor's role"-The relationship between sonoanatomy teaching and professional identity formation before and during the Covid-19 pandemic

The various psychological dimensions of professional identity formation (PIF) are an important aspect of the study course for undergraduate medical students. Anatomical learning environments have been repeatedly shown to play a critical role in forming such an identity; however, relevance of PIF during sonoanatomical training remains underexplored. At the end of their basic anatomy studies, third-semester medical students took part in a four-day block course on anatomy and imaging. Anatomical content was revised in small groups using peer teaching and imaging methods, including one hour of hands-on sonoanatomy sessions each day. On-site sonoanatomy was identified as an excellent format to support students' transition from the pre-clinical to clinical phase as medical experts-to-be. Students enjoyed practical exercises and the clinical input, which increased their interest in the medical profession and their academic studies. This study further examined the effects of the transition into an online-only format, necessitated by the current Covid-19 pandemic. A comparison was made between the quantitative and qualitative evaluation data, and the written results of examinations of several on-site (n = 1096, mean age = 22.4 years ± 2.18), and online-only cohorts (n = 230, mean age = 22.6 years ± 2.21). The online-only transition led to a reduction of all PIF-related variables measured, losing identity-related variables, increasing students' stress levels, and reducing their long-term academic performance. Together, this study demonstrates presence of PIF in undergraduate sonoanatomy teaching, and cautions against the uncritical online-only substitution of hands-on learning environments.

Introduction to Cognitive Restructuring for Medical Students

INTRODUCTION

Medical students list stigma and lack of time as reasons to avoid seeking mental health care. Many patients do not receive appropriate mental health care due to a lack of knowledge regarding available treatments among their medical providers. We created this activity to enhance medical student knowledge and well-being by introducing cognitive restructuring principles and skills in a highly interactive module.

METHODS

We administered a 90-minute learning activity, which included a short videotaped lecture, clinical case vignette, small-group discussion, and application exercise. Immediately following the learning activity, students and faculty completed anonymous evaluations.

RESULTS

A total of 139 first-year medical students and 152 second-year medical students completed the activity. For the first-year cohort, upwards of 80% of students and 100% of faculty respondents rated the session either good or excellent. For the second-year cohort, over 80% of students and over 90% of faculty rated the session either good or excellent. Approximately 90% of first- and second-year medical students and 100% of faculty recommended offering the session to future students. Open-ended feedback from students was overwhelmingly positive.

DISCUSSION

The resources included in this module allow educators at any institution to implement this learning activity, as no specific content knowledge/expertise is required of faculty. As the activity was well received by students and faculty, the investment of curricular time appears to have been well spent.

Risk factors associated with student distress in medical school: Associations with faculty support and availability of wellbeing resources

Background

It is estimated that over half of medical students experience severe distress, a condition that correlates with low mental quality-of-life, suicidal ideation and serious thoughts of dropping out. While several risk factors for the development of severe distress have been identified, most focus on individual student characteristics. Currently, little is known about the impact medical schools have on student wellbeing.

Methods

Prospective, observational survey study from 2019–2020 from a national cohort of US medical students. Student wellbeing, school characteristics, and wellbeing resource availability was measured with a 30-question electronic survey. Medical student distress was defined as a Medical Student Wellbeing Index (MS-WBI) of ≥4. Risk factors for the development of severe distress were evaluated in a multivariate logistic regression model. The impact of the number of wellbeing resources available on student wellbeing was measured along multiple wellbeing domains. Independent reviewers categorized free text analysis of survey responses about desired wellbeing resources into themes.

Results

A total of 2,984 responses were included in the study, representing 45 unique medical schools. Medical school characteristics independently associated with severe distress included low faculty support (OR 4.24); the absence of mentorship resources (OR 1.63) and the absence of community building programs (OR 1.45) in a multivariate model. Increased availability of wellbeing resources was associated with lower average MS-WBI (4.58 vs. 3.19, p<0;05) and a smaller percentage of students who had taken or considered taking a leave of absence (40% vs. 16%, p<0.05). The resources most desired by students were mental health services and scheduling adjustments.

Conclusions

The majority of medical school characteristic that contribute to student distress are modifiable. Improving faculty support and offering more and varied wellbeing resources may help to mitigate medical student distress. Student feedback is insightful and should be routinely incorporated by schools to guide wellbeing strategies.

How do medical students learn conceptual knowledge? High-, moderate- and low-utility learning techniques and perceived learning difficulties

BACKGROUND

Acquiring medical knowledge is a key competency for medical students and a lifelong requirement for physicians. Learning techniques can improve academic success and help students cope with stressors. To support students' learning process medical faculties should know about learning techniques. The purpose of this study is to analyse the preferred learning techniques of female and male as well as junior and senior medical students and how these learning techniques are related to perceived learning difficulties.

METHODS

In 2019, we conducted an online survey with students of the undergraduate, competency-based curriculum of medicine at Charité - Universitätsmedizin Berlin. We chose ten learning techniques of high, moderate and low utility according to Dunlosky et al. (2013) and we asked medical students to rate their preferred usage of those techniques using a 5-point Likert scale. We applied t-tests to show differences in usage between female and male as well as junior and senior learners. Additionally, we conducted a multiple regression analysis to explore the predictive power of learning techniques regarding perceived difficulties.

RESULTS

A total of 730 medical students (488 women, 242 men, Mage = 24.85, SD = 4.49) use three techniques the most: 'highlighting' (low utility), 'self-explanation' (moderate utility) and 'practice testing' (high utility). Female students showed a significantly higher usage of low-utility learning techniques (t(404.24) = -7.13, p < .001) and a higher usage of high-utility learning techniques (t(728) = -2.50, p < .05) than male students (M = 3.55, SD = .95). Compared to junior students (second to sixth semester; M = 3.65, SD = .71), senior students (seventh semester to final clerkship year; M = 3.52, SD = .73) showed a lower use of low-utility learning techniques (t(603) = 2.15, p < .05). Usage of low-utility techniques is related to more difficulties (β = .08, t(724) = 2.13, p < .05). Usage of moderate-utility techniques is related to less learning difficulties (β = -.13, t(599) = -3.21, p < .01).

CONCLUSIONS

Students use a wide range of low-, moderate- and high-utility learning techniques. The use of learning techniques has an influence on the difficulties perceived by students. Therefore, they could benefit from knowing about and using high-utility learning techniques to facilitate their learning. Faculties should inform their students about effective learning and introduce them to useful learning techniques.

Experiences of Clinical Clerkship Students With Mindfulness-Based Stress Reduction: A Qualitative Study on Long-Term Effects

Purpose

To explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction (MBSR) training.

Method

A qualitative study was performed by semi-structured in-depth interviews with 16 clinical clerkship students selected by purposive sampling. Students had participated in a MBSR training 2 years before and were asked about their current mindfulness practice, and the long-term effects of the MBSR training. Thematic analysis was conducted using the constant comparison method. Data saturation was reached after 16 interviews.

Results

Most interviewees were still engaged in regular, predominantly informal, mindfulness practice, although some discontinued mindfulness practice and reported an “unchanged lifestyle.” Three main themes came forward; (1) “focused attention and open awareness” during daily activities as core elements of long-term mindfulness practice; (2) “changes in behavior and coping” that resulted from taking a pause, reflecting, recognizing automatic behavioral patterns and making space for a conscious response; (3) “integration in personal and professional life” by enhanced enjoyment of daily activities, improved work-life-balance and making different career choices. Barriers and facilitators in starting and maintaining mindfulness practice were (1) understanding and intention as “pre-conditions”; (2) practical, personal, and professional factors of students in maintaining practice.

Conclusion

Two years after participation in a MBSR training, many interviewees were still engaged in (mostly informal) mindfulness practice contributing to both personal and professional changes. In light of the high clerkship demands, MBSR training could be a valuable addition to medical curricula, supporting medical students in developing necessary competencies to become well-balanced professionals.

Investigating the risk factors for academic difficulties in the medical programme at a South African university

BACKGROUND

The National Benchmark Test (NBT) that determines academic readiness is widely used by Faculties as an additional measure to select students for the study of medicine. Despite this, many students continue to experience academic challenges that culminate in delayed graduation and sometimes academic exclusion or discontinuation of studies.

AIM

This study aimed to understand academic and non-academic variables linked with academic difficulties in the first three years of medical education.

METHODS

The study sample consisted of six cohorts of medical students for the period 2011 to 2016 (n = 1392). Only the first three of the six-year medical programme were selected for analysis. Survival analysis and Cox Proportional Hazard (CPH) was used to identify academic and non-academic variables associated with academic difficulties.

RESULTS

A total of 475 students (34%) experienced academic difficulty; 221 (16%) in the first year of study, 192 (14%) in the second year and 62 (5%) in the third year of study. The results show that Intermediate Upper, Lower and Basic levels for all NBT domains, living in university residence, rurality and male gender were risk factors for academic difficulty.

CONCLUSION

In mitigating these factors, the NBT must inform the type of support programmes to augment the students' skills and promote academic success. Additionally, existing support programmes should be evaluated to ascertain if they reach students at risk and whether participating in these programmes yield positive academic outcomes.

Examining anxiety and stress regarding virtual learning in colleges of health sciences: A cross-sectional study in the era of the COVID-19 pandemic in Saudi Arabia

Background

Stress and anxiety are relatively common, particularly in females and college students. Stress can impact students' overall performance and their physical and mental health. The COVID-19 pandemic has affected all aspects of life and is associated with high levels of psychological distress. It has considerably affected the education sector, not only locally but worldwide, forcing a shift in the education system from on-site to virtual learning. This cross-sectional study was undertaken to evaluate the prevalence of anxiety and stress regarding virtual learning among health sciences college students in the Kingdom of Saudi Arabia (KSA) after introducing blended virtual classes and exams and in-person laboratory training. The study was carried six months after the COVID-19 outbreak.

Methodology

Participants were recruited by convenient sampling and snowballing strategies. Our study was conducted between November 18 and December 6, 2020. Questionnaires were employed; they included the General Anxiety Disorder-7 (GAD-7) scale and focused on the participants' attitudes toward virtual learning. The present research was validated by a pilot study, followed by implementing some amendments.

Results

A total of 418 health sciences college students, aged 18-27 (M = 20.88, SD = 1.97), participated in the study. Our analysis indicated that more than half the sample (51.44%) reported a risk of moderate to severe GAD. Anxiety was recognized more frequently in women (72.09%) than in men (27.91%). Interestingly, our Χ2 analysis revealed an association between marital status and anxiety, with a higher risk of GAD found in single people (compared with married). In addition, we found that the risk of anxiety increased in junior students (1st-3rd year) compared to senior students (4th-6th year).

Conclusion

Our study highlights the need to establish gender-based tailored mental health support systems that provide preventive measures. The study findings also recommend that institutions develop programs and platforms that safely support students to interact and seek guidance, particularly those at higher risk of stress, such as females and first-year students. Overall, our study underlines the need to pursue an understanding of the complicated nature of anxiety disorders..

Cross-Country Student Perceptions about Online Medical Education during the COVID-19 Pandemic

(1) Introduction: Most educational institutions around the world have shifted from traditional face-to-face to online education amid COVID-19. This change may particularly impact medical students, whose education is heavily influenced by clinical learning experiences. Accordingly, we investigated medical students' perceptions about positive and negative aspects of online medical education in Japan and overseas during the COVID-19 pandemic. (2) Methods: In-depth online interviews were conducted among 13 Japanese medical students and five medical students from Slovakia, Norway, and Hungary. Interviews were conducted from 23rd September to 3rd October 2020 using the snowball sampling method. Questions were focused on five main areas: Q1 the type of online education; Q2 advantages and disadvantages of online education; Q3 any changes in the relationship with teachers, friends, and family; Q4 any opinions about further improvements in online education; and Q5 any needs for affiliation with a particular university. Then thematic analysis was conducted. (3) Results: The results of the thematic analysis revealed the following four themes that represent the positive and negative aspects of online medical education; Theme 1: Timesaving and Flexibility; Theme 2: Technical problems and lack of digital skills; Theme 3: Unstandardized teaching skills; Theme 4: Lack of experience beyond medical school lectures. (4) Conclusions: While online education was found useful in terms of saving time and creating a flexible learning environment, many important drawbacks were noted such as internet and computer problems and unstandardized teaching skills, and lack of quality assurance. In addition, experiences outside the classroom such as making relationships with faculty and friends, conducting research and participating in extracurricular activities were missed, which they normally enjoy in college life.

Symptoms of depression and anxiety in Indonesian medical students: association with coping strategy and resilience

BACKGROUND

Depression and anxiety are prevalent mental health issues among medical students due to the various challenges during medical education. These issues affect not only their quality of life, but also their academic and professional development. Coping strategy and resilience are two factors that may influence students' mental health outcomes. Data of medical student mental health in Indonesia is scarce, hampering efforts to systematically address the problem. Hence, this study aims to estimate the prevalence of depressive and anxiety symptoms in Indonesian medical students, and their association with coping strategy and resilience.

METHODS

Undergraduate medical students from each year of study (Preclinical Year 1 to 4, Clinical Year 1 and 2) in the Faculty of Medicine Universitas Indonesia were randomly selected to participate in this cross-sectional study. The study questionnaire included sociodemographic characteristics, Depression Anxiety Stress Scale (DASS) to measure symptoms of depression and anxiety, Brief COPE to measure coping strategy, and Connor-Davidson Resilience Scale (CD-RISC) to measure resilience. Scores of depression and anxiety symptoms were analyzed by comparing them between different sociodemographic groups and by measuring their correlation with coping strategies and resilience. Multiple regression analyses were conducted to identify predictors of depression and anxiety symptoms.

RESULTS

Among 532 respondents, 22.2% reported symptoms of depression and 48,1% reported anxiety, including 3.0% and 8.1% with extremely severe depression and anxiety, respectively. Students not living with immediate family had higher depression score; female students and those in Preclinical Year 1 and Clinical Year 1 showed higher anxiety scores. Dysfunctional coping strategies and lower resilience are predictors of higher depression and anxiety symptoms.

CONCLUSIONS

Students show different levels of depressive and anxiety symptoms, signifying different levels of mental health support needs from universal mental health promotion to psychiatric treatment. Prevention programs can be targeted towards students with risk factors, such as not living with immediate family, undergoing first year of preclinical studies or clinical rotations, coping with dysfunctional strategies, and having low resilience. Additionally, medical educators must be aware of other, non-student factors that may impact student mental health, such as curriculum design and learning experience.

Considerations for Organizing Longitudinal Delivery of Pharmacology: the Impact of Content Delivery in Context

At Virginia Tech Carilion School of Medicine, we implemented a new strategy to organize the longitudinal delivery of pharmacology, leveraging elements of spaced repetition and spiral design. Our innovative model focused on generating cognitive frameworks in large group sessions, providing a scaffold to associate key aspects of individual drugs using specific objectives in problem-based learning. The design enhanced both student satisfaction and summative performance on pharmacology content on end of Block National Board of Medical Examiners exams. By taking a new approach, we were able to focus student learning, reduce the extraneous load and retain rigor and content volume.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01461-1.

Using Accreditation to Transform Diversity, Equity, and Inclusion Efforts Into Diversity, Equity, and Inclusion Systems

The Liaison Committee on Medical Education accreditation process is an important component of professional regulation and is used by medical schools to strengthen their medical education programs. Accreditation-related consultations with schools often include a review of relevant documents, stakeholder interviews, and mock site visits. A review by the author of this commentary of these consultations at 17 schools showed variability in how information regarding diversity, equity, and inclusion (DEI) was incorporated and discussed in accreditation-related materials and interviews. At all schools, DEI information emerged in materials related to the accreditation standards that specifically inquire into DEI. However, at some schools, DEI emerged more broadly across a variety of standards. These differences suggest that considering the totality of the Liaison Committee on Medical Education standards and elements may be a useful tool for enabling schools to analyze and describe their DEI efforts, consider additional ways to engage in continuous quality improvement related to DEI, and achieve institutional DEI goals. In addition, a small number of the reviewed schools appeared to have had particular success in meeting institutional DEI goals. An appreciative inquiry-informed review suggested that these exemplar schools had both area-specific and cross-functional systems focused on achieving DEI goals. In addition, senior leadership demonstrated a commitment to DEI, DEI champions were empowered, and leaders displayed legislative-style and systems leadership skills. Schools that nurture these characteristics may be better positioned to advance DEI. Scholarly evaluation of these observations is necessary.

Associations of university student life challenges with mental health and self-rated health: A longitudinal study with 6 months follow-up

BACKGROUND

Mental health problems are highly prevalent among university students. Stress due to student life challenges may be a risk factor for poorer health. This study investigates to what extent student life challenges and changes therein are associated with mental health and self-rated health.

METHODS

In a longitudinal study with 568 Italian university students mental health was assessed using the Mental Health Inventory-5 (MHI-5) and self-rated health with a single item from the Short Form 36 Health Survey (SF36) (score ranges: 0-100) at baseline and at six months follow-up. Student life challenges were investigated using six subscales (score ranges: 1-4) of the Higher Education Stress Inventory (HESI). A between-within linear regression model was used to investigate whether a higher exposure to life challenges was associated with poorer health (between individuals) and whether changes in student life challenges were associated with changes in health (within individuals).

RESULTS

Higher exposure to student life challenges was associated with poorer mental health (b ranging from -5.3 to -10.3) and self-rated health (b ranging from -3.1 to -9.6). An increase in student life challenges within individuals was associated with poorer mental health and self-rated health, in particular for high workload (b up to -5.9), faculty shortcomings (b up to -5.7), and unsupportive climate (b up to -5.6).

DISCUSSION

Exposure to student life challenges and changes therein are associated with university students' health. Our findings suggest that student life challenges may be a target for interventions to improve mental health and self-rated health among university students.

Resilience matters: Student perceptions of the impact of COVID-19 on medical education

Introduction

We assessed students' perception of the impact of the pandemic on their well-being, education, academic achievement, and whether grit and resilience alter students’ ability to mitigate the stress associated with disruptions in education. We hypothesized that students would report a negative impact, and those with higher grit and resilience scores would be less impacted.

Methods

A multidisciplinary team of educators created and distributed a survey to medical students. Survey results were analyzed using descriptive statistics, ANOVA, and multivariate linear regressions. A p-value <.05 was considered statistically significant.

Results

A total of 195 students were included in the study. Approximately 92% reported that clinical education was negatively affected, including participants with higher grit scores. Students with higher resilience scores were more optimistic about clinical education. Those with higher resilience scores were less likely to report anxiety, insomnia, and tiredness.

Conclusion

More resilient students were able to manage the stress associated with the disruption in their education. Resiliency training should be year-specific, and integrated into the UME curriculum due to the different demands each year presents.

Need Fulfillment and Resilience Mediate the Relationship between Mindfulness and Coping in Medical Students

Theory: Medical programs have turned to mindfulness-based initiatives to help reduce student distress and promote healthy coping within the learning environment. However, little attention has been paid to how fulfillment of medical students' basic psychological needs (autonomy, competence, and relatedness) impacts their capacity to be mindful and cope with stress. Self-Determination Theory (SDT) posits that mindfulness facilitates adaptive coping and wellness, in large part because of need fulfillment. Hypotheses: Using SDT as a lens, it is hypothesized that medical students' resilience and, to a greater extent, need fulfillment in medical school, will mediate the relationship between their mindfulness and coping reactions to stress. Method: One-hundred-ninety-seven medical students from the University of Saskatchewan were recruited to participate in this study: 71 first year, 58 second year, and 36 third and fourth year, each. Students completed an anonymous survey, measuring need fulfillment in medical school, mindfulness, resilience, and frequent use of various adaptive and maladaptive coping strategies. We assessed the extent that need fulfillment and resilience mediated the relationship between mindfulness and coping styles. Results: Need satisfaction and resilience fully mediated the relationship between mindfulness and adaptive coping. Conversely, need frustration and resilience partially mediated the relationship between mindfulness and maladaptive coping. Need fulfillment was a stronger mediator than resilience in both coping models. Conclusions: Findings suggest that increased supports for medical students' resilience and basic psychological needs may promote their mindfulness, and in turn, their ability to respond more adaptively and less maladaptively to stressors they face in medical school.

Gender Disparities in Symptoms of Depression After Medical School Exams and Student Coping Strategies for Postexam Depression Symptoms

CONTEXT

Little research exists to determine if medical students experience symptoms of depression after examinations and if symptoms vary by gender.

OBJECTIVES

Determine if is there a difference between male and female medical students in the number of symptoms of major depressive disorder (MDD) experienced after exams, as well as which coping strategies are used by students to alleviate depression symptoms.

METHODS

An anonymous and secure survey was sent via university email to first, second, and third-year medical students after exams for 2 consecutive exam periods. Surveys that were not fully completed were excluded from the analysis.

RESULTS

A total of 162 out of 550 students completed the survey for a response rate of 30%. Overall, a greater proportion of female students experienced more symptoms of depression compared to males. This was statistically significant for the Diagnostic and Statistical Manual of Mental Disorders 5th Edition symptoms of MDD: depressed mood, anhedonia, changes in sleep, fatigue, and difficulty with concentration after exams compared to their male counterparts. Male first-year medical students experienced higher rates of depression compared to their third-year counterparts. Most students exhibited coping strategies that helped them feel less depressed. The 3 most common coping strategies reported were: reaching out to social support networks, physical activity/exercise, and engaging in hobbies.

CONCLUSIONS

Both gender and year in a medical school play a role in the number of symptoms of depression experienced after medical school exams. Recognizing that examinations can be a trigger of depressive symptoms in medical students, particularly female and first-year students, has important implications on student mental health. Helping students recognize these symptoms and employ healthy coping strategies may further help alleviate these symptoms. Long-term consequences of experiencing symptoms of depression after recurrent exams in medical school are unknown and require further research.

Stress and its correlates among medical students in six medical colleges: an attempt to understand the current situation

Abstract

Background

Medical students encounter various stressors during their studies. The study aimed to assess stress levels, sources, and associated determinants among Sudanese medical students. An online questionnaire-based study was conducted among 617 undergraduate medical students of 6 different universities in Sudan. A 19-item questionnaire was utilized to assess stress sources, in addition to demographics, stress manifestations, and coping strategies.

Results

The overall prevalence of stress was 31.7% (p < 0.01). The main sources of stress were time pressure, heavy workload, fear of failure, and examination frequency. One-third of students indicated that they experienced at least one source of psychosocial- and teaching-related stress. Female medical students were more significantly stressed due to academics than males. Also, fourth- and fifth-year students were academically more stressed in comparison to the first-year students. Poisson regression analysis model showed that first-year students were less stressed than the final-year students in relation to academics (odds = 0.888, P = 0.003). Male medical students, across all study years, were far less stressed than females (odds = 0.901, P = 0.000153). Expectedly, ‘studying medicine by choice’ was associated with decreased odds for psychosocial stressors (odds = 0.885, P = 0.00781), and improved model-fit (chi-squared = 6.8952, P = 0.008643). Also, the year of study was a predictor of teaching-related stress development.

Conclusions

Female medical students were more stressed due to academics than males. On the other hand, final-year students were more academically stressed than first-year students. Female medical students were likely having stress related to academic stress development, while being first-year medical student was a predictor of not developing academic stress. Studying medicine by choice’ was associated with ability to cope against stress.

Factors Associated with Psychological Distress in French Medical Students during the COVID-19 Health Crisis: A Cross-Sectional Study

BACKGROUND

The purpose of this study was to assess the prevalence of psychological distress in medical students during the COVID-19 health crisis and to identify factors associated with psychological distress.

METHODS

A cross-sectional observational study was presented to 1814 medical students (from first to sixth year) in a French university hospital center. Sociodemographic, occupational and medical information (psychological distress measured on the French GHQ12 scale) were collected via an online anonymous self-administered questionnaire. Variables associated with psychological distress were investigated using univariate analysis and multivariate analysis (modified Poisson regression).

RESULTS

In total, 832 medical students responded (46%) and 699 completed the questionnaire in full (39%); 625 (75%) showed signs of psychological distress and 109 (15%) reported suicidal ideation. Female gender, psychological trauma during the COVID-19 health crisis, change in alcohol consumption, and difficulties with online learning emerged as risk factors for psychological distress, whereas a paid activity, a feeling of mutual aid and cooperation within the studies framework, and recognition of work appeared to be protective factors.

CONCLUSIONS

Mental health care or suicide prevention should be provided to students at risk in the aftermath of the pandemic. Knowing the educational and medical factors associated with psychological distress enables areas for prevention to be identified.

Medical student wellness in Canada: time for a national curriculum framework

There is substantial evidence showing that medical student wellness is a worsening problem in Canada. It is apparent that medical students' wellness deteriorates throughout their training. Medical schools and their governing bodies are responding by integrating wellness into competency frameworks and accreditation standards through a combination of system- and individual-level approaches. System-level strategies that consider how policies, medical culture, and the "hidden curriculum" impact student wellness, are essential for reducing burnout prevalence and achieving optimal wellness outcomes. Individual-level initiatives such as wellness programming are widespread and more commonly used. These are often didactic, placing the onus on the student without addressing the learning environment. Despite significant progress, there is little programming consistency across schools or training levels. There is no wellness curriculum framework for Canadian undergraduate medical education that aligns with residency competencies. Creating such a framework would help align individual- and system-level initiatives and smooth the transition from medical school to residency. The framework would organize goals within relevant wellness domains, allow for local adaptability, consider basic learner needs, and be learner-informed. Physicians whose wellness has been supported throughout their training will positively contribute to the quality of patient care, work environments, and in sustaining a healthy Canadian population.

Digital mental health literacy -program for the first-year medical students' wellbeing: a one group quasi-experimental study

BACKGROUND

Medical students are prone to mental disorders, such as depression and anxiety, and their psychological burden is mainly related to their highly demanding studies. Interventions are needed to improve medical students' mental health literacy (MHL) and wellbeing. This study assessed the digital Transitions, a MHL program for medical students that covered blended life skills and mindfulness activities.

METHODOLOGY

This was a one group, quasi-experimental pretest-posttest study. The study population was 374 first-year students who started attending the medical faculty at the University of Turku, Finland, in 2018-2019. Transitions was provided as an elective course and 220 students chose to attend and 182 agreed to participate in our research. Transitions included two 60-minute lectures, four weeks apart, with online self-learning material in between. The content focused on life and academic skills, stress management, positive mental health, mental health problems and disorders. It included mindfulness audiotapes. Mental health knowledge, stigma and help-seeking questionnaires were used to measure MHL. The Perceived Stress Scale and General Health Questionnaire measured the students' stress and health, respectively. A single group design, with repeated measurements of analysis of variance, was used to analyze the differences in the mean outcome scores for the 158 students who completed all three stages: the pre-test (before the first lecture), the post-test (after the second lecture) and the two-month follow-up evaluation.

RESULTS

The students' mean scores for mental health knowledge improved (-1.6, 95% Cl -1.9 to -1.3, P<.001) and their emotional symptoms were alleviated immediately after the program (0.5, 95% Cl 0.0 to 1.1, P=.040). The changes were maintained at the two-month follow up (-1.7, 95% Cl -2.0 to -1.4, P<.001 and 1.0, 95% Cl 0.2 to 1.8, P=.019, respectively). The students' stress levels reduced (P=.022) and their attitudes towards help-seeking improved after the program (P<.001), but these changes were not maintained at the two-month follow up. The stigma of mental illness did not change during the study (P=.13).

CONCLUSIONS

The digital Transitions program was easily integrated into the university curriculum and it improved the students' mental health literacy and wellbeing. The program may respond to the increasing global need for universal digital services, especially during the lockdowns due to the COVID-19 pandemic.

TRIAL REGISTRATION

The trial was registered at the ISRCTN registry (26 May 2021), registration number 10.1186/ ISRCTN10565335 ).

Introducing Lifestyle Medicine Within the Mayo Clinic Alix School of Medicine in Arizona

Purpose: High-value care is becoming increasingly important as the United States shifts toward a more sustainable health care system. Lifestyle medicine (LM) may be the highest-value model of care. Surprisingly, however, it is taught in a minority of medical schools. In this article, we describe a pilot project of introducing a brief LM course taught within the Mayo Clinic Alix School of Medicine in Arizona. The main purpose of the course was to introduce the students to LM as a specialty practice and to provide students with foundational knowledge of the pillars of LM. Results: Students reported improved personal health habits and increased confidence in LM competencies.

It's what you do, not the way you do it - online versus face-to-face small group teaching in first year medical school

BACKGROUND

Major disruptions imposed on medical education by the COVID-19 pandemic and the rapid shift to online teaching in medical programs, necessitated need for evaluation of this format. In this study we directly compared knowledge outcomes, social outcomes, and wellbeing of first year student small group teaching in either face to face (f2f) or online format.

METHODS

At the end of the first course of our medical program, students were invited to participate in an online questionnaire with 10 quantitative items and 1 qualitative item. These were analysed using Factor Analysis Pattern Matrix and linear regression to group items and assess relatedness. Qualitative responses were thematized using Qualtrics software (Qualtrics, Provo, UT, USA). Summative assessment results were compared, both between current cohorts to historical cohorts.

RESULTS

From a cohort of 298 students there was a 77% response rate. Overall, there were no differences in knowledge gains, either between groups or when compared to historical cohorts. Questionnaire items fell reliably into groups that related to either learning outcomes, social outcomes, or wellbeing. Independent T tests showed that format for teaching (online versus f2f) had an impact on social outcomes but no direct impact on learning outcomes. Linear regression revealed that the social outcomes have a direct impact on wellbeing and almost the double the impact on learning outcomes than mode of learning i.e.. F2f or online (β = .448 and β = .232 respectively).

CONCLUSION

In this study, we were able to show with statistical strength that social outcomes for students such as engaging with peers and facilitator, contributing to the group, and making friends have a direct impact on wellbeing and indirectly impact learning outcomes (such as motivation, satisfaction, integration of knowledge). In a rapidly changing educational landscape, in our opinion, it is vital that these aspects are a focus of design and delivery of medical education. The data from this study supports the notion that activity design and the expertise of the teacher in facilitating the small group activities, has greater impact than the mode of educational delivery itself on students' learning processes.

Relationship between medical students' negative perceptions of colleagues' work-life and burn-out during clerkships: a longitudinal observational cohort study

OBJECTIVE

Because work and educational environments are closely related and can affect each other, this study examined whether medical students' negative perceptions of their colleagues' work-life balance (NWLB) during their clinical rotations would be related to burn-out in clerkships and investigated the effect of students' gender on this relationship.

DESIGN

A longitudinal, prospective 2-year cohort study conducted between September 2013 and April 2015.

SETTING

Medical students from a university school of medicine in Taiwan.

PARTICIPANTS

One voluntary cohort of undergraduate medical students in clerkships was invited to participate. Among 190 medical students recruited in September 2013, a total of 124 students provided written informed consent. Participants were free to decide whether to complete each survey; therefore, varying numbers of responses were obtained during the study period. Those who responded to our survey for more than 6 months were included in our analyses. Overall, 2128 responses from 94 medical students were analysed, with each student providing an average of 23 responses for 2 years.

PRIMARY OUTCOME MEASURE

Burn-out was measured using the Professional Quality of Life Scale.

RESULTS

Our study found that a strong NWLB was related to high burn-out levels among medical students during their clerkships (p<0.001). However, the gender of the student had no effect on this relationship (p>0.05). In addition, our study indicated that medical students living with a companion had decreased burn-out levels than did those living alone during their clerkships.

CONCLUSIONS

The significance of policies promoting employee work-life balance should be emphasised because of the potential for social contagion effects on medical students. Clerkship trainees might be vulnerable to such negative contagion effects during the transition to their early clinical workplace training and may, therefore, require advanced socialisation and mentoring.

Relationship between web-based illness scripts and the performance of medical students in orthopedic surgery placements

OBJECTIVES

We aimed to explore the relationship between web-based orthopedic illness scripts and medical students' performance as assessed through examination results.

METHODS

This was a retrospective cohort study with 83 fifth-year medical students in an academic hospital. During a one-month placement, they were instructed to do web-based illness scripts. Their performances were assessed by examination in the last week. All recorded data about illness scripts and examination results were retrieved. The students were separated into high and low response groups based on completed illness scripts. The characteristics of the students between the two groups were compared. Pearson correlation coefficients and regression analysis were used to identify the relationship between illness scripts and examination results.

RESULTS

There were 56 students in the high-response and 27 in the low-response groups. The characteristics and examination scores were not significantly different between the groups, while there was a significant difference in script completion (t₍₂₇₎=13.72, p<0.001). Using Pearson correlation, we found weak correlations without significance between completed scripts, illness script scores, and examination scores. We found no relationship between illness script scores and examination scores, even in the high response group, by regression analysis.

CONCLUSIONS

The use of web-based orthopedic illness scripts did not correlate to the examination performance of medical students. A high number of scripts without variety and limited time for practicing may have obscured potential positive relationships. Illness scripts should be adjusted as appropriate for each school before being assigned. A further multi-center, prospective study is suggested to identify the correlations and investigate the influencing factors.

Prevalence of fibromyalgia in medical students and its association with lifestyle factors - a cross-sectional study

Objectives

Fibromyalgia (FM) is a chronic widespread pain syndrome, known to be associated with several other symptoms. Chronic stress is suspected to be a contributing factor in the pathogenesis of FM. It is known that medical students are under a constant state of stress originating from personal and social expectations. The aim of the study was to assess the prevalence of FM in this population and identify lifestyle parameters influencing FM severity.

Material and methods

An online survey of first- and final-year medical students was conducted using the ACR modified 2016 criteria and FANTASTIC checklist. The survey acquired demographic information such as age, gender, year, and division of studies. A subgroup analysis based on gender, year of studies, and division of studies was performed.

Results

439 medical students (71% females) completed the survey. The overall prevalence of FM in our cohort was 10.48%. The ratio of females to males was 3 : 1. A significant negative correlation between better quality of lifestyle and worse FM severity was observed in all subgroups. The “insight”, “sleep and stress”, “behavior” and “career” domains of lifestyle were found to have a significant negative correlation with FM severity on univariate analysis.

Conclusions

The prevalence of FM in medical students seems to be considerably higher than in the general population. Chronic stress levels, sleep problems, social support, and behavior seem to be the major factors influencing FM severity in this population. Our findings suggest that medical students must be considered a “high-risk” group for FM, and hence must be identified, educated, and managed accordingly. It is, therefore, important for medical universities to implement programs educating students about FM, the importance of a healthy lifestyle, and stress coping strategies, while also making systemic changes to curb stressors in medical training.

[Influencing factors on stress management in medical students-with special consideration of depression]

BACKGROUND

Due to high levels of stress, a practical course on stress management in medical school was offered to preclinical medical students at the Justus-Liebig University in Giessen up to 2019. In addition to autogenic training with specific resolution formulas, learning strategies, examination anxiety, and stress management were taught.

OBJECTIVE

The aim was to determine the factors influencing the efficacy of the course as well as predictive factors favoring the success of preventive strategies for medical students.

METHODS

A total of 81 medical students with an average age of M = 25.4 years participated in this study, with 32.1% being male. The pre-post surveys were conducted anonymously with PSQ, BDI, PHQ‑9, HADS, SF-12 and the STQL‑S.

RESULTS

With respect to satisfaction, stress, anxiety, and depression, a significant improvement was achieved at high effect levels (Cohen's d > 1). Initially, 35% of the students suffered from clinically relevant depression; these also showed a significantly higher stress level at the end of the course. This also applies to students with low study or life satisfaction. There were significant interactions of stress reduction depending on the existence of adequate learning techniques as well as anxiety symptoms but less often due to the existence of adequate stress management strategies.

CONCLUSION

As predictive factors against a high stress level in medical students, a high study satisfaction and a high life satisfaction as well as low depression values could be confirmed. Relevant factors contributing to the efficacy of the course are learning strategies and coping with examination phobia. Theoretical information concerning stress management was found to be less helpful.

Prevalence of stress, stressors, and coping strategies among medical undergraduate students in a medical college of Mumbai

BACKGROUND

Stress is a subjective experience which creates an obstacle in a person's path of achieving his or her goals. It creates negative outcomes among the population. Medical curriculum is very vast and stressful. As doctors are the very important part of society, medical students must be allowed to learn their trade in a stress-free environment. The present study aimed to assess the perceived stress, various sources of stress among medical undergraduate students, and the coping strategies adopted.

MATERIALS AND METHODS

This was a cross-sectional study conducted among medical under-graduate students studying at a tertiary care hospital situated in Mumbai city of Maharashtra between January and June 2018. Using purposive sampling technique, a total of 450 medical students from 1^st year to final year were invited to participate in the study. A self-administered questionnaire consisting of sociodemographic details and perceived stress scale questions was used. Logistic regression analysis was carried out to assess the determinants of stress. Odds ratio, 95% confidence interval was calculated. P < 0.05 was considered statistically significant.

RESULTS

The overall response rate was 79.11%, with 356 out of 450 students returning the questionnaire. Among 356 participants, 324 participants (91%) were suffering from high levels of stress. Factors such as curriculum vastness, frequency of examination, competition with peer, performance in examinations, worry about future, loneliness, relation with opposite sex, and quality of food played a major role in creating additional stress.

CONCLUSIONS

The perceived stress was higher among female medical students. Academic factors are greater perceived cause of stress in medical students in this study. A substantial proportion of medical undergraduate students were found to be stressed which necessitates appropriate and timely interventions. Reframing the academic curriculum along with examination and evaluation patterns, incorporating extracurricular activities, and establishment of counselling cells in the institution is the need of the hour.

A longitudinal investigation of mental health, perceived learning environment and burdens in a cohort of first-year German medical students' before and during the COVID-19 'new normal'

BACKGROUND

Medical students' propensity to develop mental morbidity has been described for decades but remains unresolved. To assess student mental health person-centred and longitudinally, we have been investigating a cohort of German students since October 2019. After their first semester under 'normal' conditions, rapid changes became necessary due to the COVID-19 situation. In line with the initial aim, we investigated students' change of mental health, perceived learning environment and burdens in the 'new normal'.

METHODS

Students in a newly founded German medical study programme (n = 63) answered a questionnaire each semester (October 2019 = entering medical school; December 2019 = 'old normal'; June 2020 = 'new normal'; December 2020 = 'new normal') on their well-being (FAHW-12), burnout (Maslach Inventory), depression (PHQ-9), perception of the learning environment (DREEM), burdens and protective attitudes in the 'new normal' (items designed for the study).

RESULTS

Friedman tests reveal overall significant differences (all p < .001) in depression and burnout (emotional exhaustion, depersonalisation, personal accomplishment); changes in well-being were identified as just non-significant (p = .05). The effects were explained by a significant increase in burnout and depression identified post-hoc from October 2019 to December 2019. No increase in severity was identified in the 'new normal' semesters. The learning environment was perceived positively even with a significant improvement for June 2020 (repeated measures ANOVA p < .001). Study-related burdens (e.g. procrastination of online-learning material) took on greater relevance than burdens related to physicians' occupation (e.g. potential for students' recruitment to the healthcare system during their studies).

CONCLUSIONS

The 'new' when entering medical school had a greater impact on our students' mental health than the 'new normal'. The readiness for change in the context of a newly designed study programme may have been beneficial with regard to students' positively perceived learning environment during the virtual semesters. Monitoring medical students' mental health longitudinally should be a concern regardless of a pandemic.

Should Medical Educators Help Learners Reframe Imposterism?

Issue: Impostor syndrome, impostor phenomenon, or imposterism, is a very common, likely ubiquitous, psychological construct in the general population and certainly among health care providers. It has been the subject of many, mostly descriptive, articles and blogs in the medical literature as well as in the lay press and on social media. Evidence: Imposterism has been associated with, but not demonstrated to be causative of, psychological conditions including stress, shame, guilt, and burnout, and behaviors such as "hiding out," which impede career development. The authors argue that to avoid these more serious potential manifestations of imposterism, the approach to imposterism should be reframed, and medical students, residents, and physicians should be helped to view episodic feelings of imposterism as appropriate situational responses. Implications: As feelings of imposterism are virtually universal for those on the journey from medical/graduate student through practicing physician/scientist, handling them appropriately could hopefully channel them into positive responses that mitigate potential psychological and behavioral consequences and improve emotional health.

Do Orthopaedic Residency Programs Have the Least Time Between Invitation and Interview?

BACKGROUND

The cost and stress of applying to residency programs are increasing. Planning for interviews with limited lead time can cause additional burden to residency applicants.

OBJECTIVE

We sought to determine if the specialty of orthopaedics was affording the same lead time between interview invitation and interview dates as its surgical and medical counterparts.

METHODS

Dates for the first interview invitation and last possible interview were gathered for each program in orthopaedic surgery, general surgery, otolaryngology, vascular surgery, plastic surgery, neurological surgery, internal medicine, psychiatry, pediatrics, and family medicine. Interview lead time was calculated for each specialty. Mann-Whitney U and independent sample Kruskal-Wallis tests were used for nonparametric data with P < .05 considered as significant.

RESULTS

Orthopaedic surgery lead time is significantly different when compared individually and pairwise to other specialties (P < .05 for all comparisons), with a median lead time of 57 days. The next lowest lead time specialty is otolaryngology with a 70-day lead time. The specialty with the longest is pediatrics (median 106 days).

CONCLUSIONS

Residency programs (orthopaedic surgery in particular) vary widely in the amount of lead time given to schedule and attend interviews. The authors propose that interview invitations be extended into mid-October.

Creating a Lactation-Friendly Learning Environment for Medical Students and Residents: A Northern Canadian Perspective

Background: Lactation is a normal postpartum physiological process that can continue in excess of 3 years and is often the sole nutritional source for infants in the first 6 months of life. Breastfeeding not only provides infant nutrition, but also facilitates maternal-infantile bonding. Lactating mothers separated from their children face multiple challenges in finding and accessing appropriate spaces and time for milk expression. Maternal employment is a great barrier to breastfeeding and accordingly has led to multiple advancements in the area of breastfeeding policy. One example of a policy is the Baby-Friendly Initiative. This initiative focused on breastfeeding promotion, support, and protection. However, the impact of such campaigns on lactating medical students and residents is thought to be low. Furthermore, breastfeeding rates differ vastly according to geographic locations in North America. Trends indicate decreased rates of breastfeeding in northern rural areas in comparison with southern urban counterparts. This highlights the need for increased protection, support, and creation of safe-lactation spaces for all working mothers including medical students and residents, and especially those in rural areas. Goals: To review challenges of breastfeeding as a medical trainee and delineate the creation of a lactation policy for medical learners and residents. Methodology: We conducted a literature review of breastfeeding policy and experiences of breastfeeding while in the learning environment. Results: Challenges of breastfeeding in medical school and residency include the complex, high-paced medical working environment where taking breaks or time off is often difficult. Few medical schools across North America have any breastfeeding policy. Conclusion: The Northern Ontario School of Medicine's lactation policy serves as a possible solution to the barriers medical students and residents face when breastfeeding in the academic environment. This policy creates lactation-friendly medical learning spaces through the entitlement of dedicated space and time for milk expression.

From Grading to Assessment for Learning: A Qualitative Study of Student Perceptions Surrounding Elimination of Core Clerkship Grades and Enhanced Formative Feedback

Problem: Medical students perceive honors grading during core clerkships as unfair and inequitable, and negatively impacting their learning and wellbeing. Eliminating honors grading, a powerful extrinsic motivator, and emphasizing formative feedback may address these problems and promote intrinsic motivation and learning. However, it is unknown how transitioning from honors to pass/fail grading with enhanced formative feedback in the core clerkship year may affect student learning experiences, wellbeing, and perceptions of the learning environment. Intervention: Core clerkship grading was transitioned from honors/pass/fail to pass/fail at one US medical school. In addition, the requirement for students to obtain formative supervisor feedback was formalized to twice per week. Context: This qualitative study utilized semi-structured interviews to explore the perceptions among core clerkship students of learning and assessment. Interview questions addressed motivation, wellbeing, learning behaviors, team dynamics, feedback, and student and supervisor attitudes regarding assessment changes. The authors analyzed data inductively using thematic analysis informed by sensitizing concepts related to theories of motivation (goal orientation theory and self-determination theory). Impact: Eighteen students participated, including five with experience in both honors-eligible and pass/fail clerkships. The authors identified three major themes in students' descriptions of the change in approach to assessment: student engagement in clerkships, wellbeing, and recognition of learning context. Student engagement subthemes included intrinsic motivation for patient care rather than performing; sense of agency over learning, including ability to set learning priorities, seek and receive feedback, take learning risks, and disagree with supervisors, and collaborative relationships with peers and team members. Positive wellbeing was characterized by low stress, sense of authenticity with team members, prioritized physical health, and attention to personal life. Learning context subthemes included recognition of variability of clerkship contexts with pass/fail grading mitigating fairness and equity concerns, support of the grading change from residents and some attendings, and implications surrounding future stress and residency selection. Lessons Learned: Students perceive a transition from honors grading to pass/fail with increased feedback as supporting their engagement in learning, intrinsic motivation, and wellbeing. Drivers of wellbeing appear to include students' feelings of control, achieved through the ability to seek learning opportunities, teaching, and constructive feedback without the perceived need to focus on impressing others. Ongoing evaluation of the consequences of this shift in assessment is needed.

A journey through roses and thorns: becoming a physician by learning from patients with life-threatening illnesses. A qualitative study with international medical students

The medical students' well-being may be threatened by various stressors associated with providing care to different kinds of patients. This study aims to explore students' clinical experiences with patients who suffer from life-threatening illnesses, focusing on potential risk and protective factors. Audio-recorded and face-to-face interviews were conducted and transcribed verbatim. The "Interpretive Description" approach was used to analyse data. Overall, ten medical students with a mean age of 28 years old were interviewed. Well-being promoting factors were the following: therapeutic relationships, work-life balance, social support and communication, perception of improvement in knowledge and availability of advanced directives. Whilst factors that may reduce well-being included death exposure, managing emotions, communication difficulties, internal conflicts and disagreements, lack of knowledge and subjective concerns. These findings shed light on facets that are inherent parts of clinical experience with patients suffering from a life-threatening illness and that may turn in risk or protective factors for the medical students. Understanding the students' subjective experiences may aid in the improvement of the current educational programs, as well as in the development of tailored supportive and preventative interventions to promote well-being and professional competencies among this kind of students.

How medical students cope with stress: a cross-sectional look at strategies and their sociodemographic antecedents

BACKGROUND

Medical training can be highly stressful for students and negatively impact their mental health. Important to this matter are the types of coping strategies (and their antecedents) medical students use, which are only characterized to a limited extent. A better understanding of these phenomena can shed additional light on ways to support the health and well-being of medical students. Accordingly, we sought to determine medical students' use of various coping reactions to stress and how their gender and year of study influence those behaviours.

METHODS

A total of 400 University of Saskatchewan medical students were invited to complete an online survey. Using the Brief COPE inventory, we assessed students' reported use of various adaptive and maladaptive coping strategies. Descriptive and comparative statistics were performed, including multivariate analysis of variance, to explore how gender and year influenced coping strategies.

RESULTS

The participation rate was 49% (47% males and 53% females). Overall, the students' coping strategies were mostly adaptive, albeit with a few exceptions. Females used more behavioural disengagement, while males used less emotional and instrumental support. Additionally, third years used more denial to cope with stress than students in any other year.

CONCLUSIONS

While few studies report significant sociodemographic effects on medical student coping, our findings raise the possibility that males and females do engage in different coping strategies in medical school, and that the clinical learning environment in third year may provoke more dysfunctional coping, compared to pre-clinical stages of training. Potential explanations and implications of these results are discussed.

Using the Five-Microskills Method in Veterinary Medicine Clinical Teaching

Effective clinical teaching is essential for the development of veterinary learners. Teaching clinical reasoning is a challenge for veterinary instructors as many lack adequate training in clinical teaching. In this paper, we propose the use of the five-microskills (FMS; also known as the one-minute preceptor) model of clinical teaching as a tool that can be used not only in teaching during clinical encounters but also during traditional teaching sessions (e.g., practicals). The FMS model assists the instructor in estimating the level of knowledge and development of the learner and allows for providing feedback. The FMS model is applicable in the busy clinical or teaching schedule of the instructor and requires training only of the instructor, not the learner. We provide two examples of the use of the FMS model, one of a clinical encounter and the other a biochemistry practical. From the examples, readers should be able to extract the basis of the model and start using it in their day-to-day practice. For proper use of the model, 1-4 h of training is usually recommended.

COVID-19 mental health consequences on medical students worldwide

Background: The COVID-19 epidemic has impacted medical education for medical students worldwide. As medical students are already vulnerable to poor psychological well-being, the mental health of medical students may be significantly affected by the changes caused by COVID-19. Objective: In this article, we discuss the curriculum and mental health ramifications of the COVID-19 epidemic on the international medical school population Methods: In this review, we analyzed 13 studies evaluating the impact of COVID-19 on medical school curriculum, medical student mental health, and subsequent medical student coping strategies. Results: Early in the COVID-19 outbreak, the Association of American Medical Colleges recommended to pause all student clinical rotations, while in-person curriculum moved to virtual modalities. Students expressed concern over their abilities to explore specialties of interest and their confidence in becoming a competent doctor. Medical students also reported higher levels of anxiety, stress, and exhaustion, with female students reporting this more than male students. Students have been coping with these challenges in quarantine through engaging in physical activity, spending time outdoors, and video chats. Conclusion: Medical education institutions must address the effects of COVID-19 on the mental health of their students in order to mitigate related consequences.