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Roze des Ordons AL, Ellaway RH. Storylines of Trauma in Health Professions Education: A Critical Metanarrative Review. TEACHING AND LEARNING IN MEDICINE 2024:1-13. [PMID: 38635478 DOI: 10.1080/10401334.2024.2342443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/29/2024] [Indexed: 04/20/2024]
Abstract
PHENOMENON Learners in medical education are often exposed to content and situations that might be experienced as traumatic, which in turn has both professional and personal implications. The purpose of this study was to synthesize the literature on how trauma has been conceptualized and approached within medical education, and the implications thereof. APPROACH A metanarrative approach was adopted following the RAMESES guidelines. Searches of 7 databases conducted in January 2022 with no date limitations yielded 7,280 articles, of which 50 were identified for inclusion through purposive and theoretical sampling. An additional 5 articles were added from manual searches of reference lists. Iterative readings, interpretive and reflexive analysis, and research team discussions were performed to identify and refine metanarratives. FINDINGS Five metanarratives were identified, including the concept of trauma, the trauma event, the person with trauma, the impact of trauma, and addressing trauma, with each metanarrative encompassing multiple dimensions. A biomedical concept of trauma predominated, with lack of conceptual clarity. Theory was not integrated or developed in the majority of articles reviewed, and context was often ambiguous. Trauma was described in myriad ways among studies. Why certain events were experienced as trauma and the context in which they took place were not well characterized. The impact of trauma was largely concentrated on harmful effects, and manifestations beyond symptoms of post-traumatic stress were often not considered. Furthermore, the dominant focus was on the individual, yet often in a circumscribed way that did not seek to understand the individual experience. In addressing trauma, recommendations were often generic, and earlier research emphasized individually-focused interventions while more recent studies have considered systemic issues. INSIGHTS Multiple dimensions of trauma have been discussed in the medical education literature and from many conceptual standpoints, with biomedical, epidemiologic, and individualized perspectives predominating. Greater precision and clarity in defining and understanding trauma is needed to advance research and theory around trauma in medical education and the associated implications for practice. Exploring trauma from intersectional and collective experiences and impacts of trauma and adapting responses to individual needs offers ways to deepen our understanding of how to better support learners impacted by trauma.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine, Division of Palliative Medicine, Department of Oncology, Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Hu B, Yang X, Tuo X. The prevalence of post-traumatic stress disorder in college students by continents and national income during the COVID-19 pandemic: a meta-analysis. Front Psychol 2023; 14:1129782. [PMID: 37251043 PMCID: PMC10217783 DOI: 10.3389/fpsyg.2023.1129782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction The present study aimed to provide a more accurate representation of post-traumatic stress disorder (PTSD) in college students during COVID-19 by performing meta-analyses by continents, national income, and study majors, and comparing the results with estimated pooled prevalence. Methods Based on the guideline of PRISMA, literature was searched in PubMed, Web of Science, and Embase. The prevalence of PTSD was estimated through a random model based on the different continents and levels of national income, as well as study majors, and compared with the pooled prevalence of PTSD among college students. Results Totally 381 articles were retrieved from electronic databases and 38 articles were included in the present meta-analysis. The results showed that the pooled prevalence of college students' PTSD was 25% (95% CI: 21-28%). Prevalence estimates of PTSD among college students were statistically significant (p < 0.00001) when stratified with geographical regions, income levels, and study majors. In comparison with the pooled prevalence of PTSD (25%), subgroups of Africa and Europe, lower-middle-income countries, and medical college students possessed higher prevalence estimates. Discussion The findings of the study showed that the prevalence of PTSD in college students worldwide during COVID-19 was relatively high and varied in different continents and countries with different income levels. Therefore, healthcare providers should pay attention to the psychologically healthy condition of college students during COVID-19.
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Affiliation(s)
- Biao Hu
- School of Marxism, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiling Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaoqian Tuo
- Department of Gynecology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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Peng P, Hao Y, Liu Y, Chen S, Wang Y, Yang Q, Wang X, Li M, Wang Y, He L, Wang Q, Ma Y, He H, Zhou Y, Wu Q, Liu T. The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis. J Affect Disord 2023; 321:167-181. [PMID: 36341802 PMCID: PMC9613786 DOI: 10.1016/j.jad.2022.10.040] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This meta-analysis and systematic review aimed to evaluate the global prevalence and risk factors of mental problems (i.e., depression, anxiety, stress, sleep disorder, posttraumatic stress disorder (PTSD), burnout, psychological distress, and suicidal ideation) among medical students during the COVID-19 pandemic. METHOD We searched PubMed, Embase, Web of Science, psycARTICLES, PsycINFO, CNKI, and Wan Fang for studies on the prevalence of mental problems among medical students from January 1, 2020, to April 1, 2022. The pooled prevalence was calculated by random-effect models. We performed a narrative review to identify the risk factors. RESULTS The meta-analysis included 201 studies (N = 198,000). The prevalence of depression (41 %, 95 % CI, 37-45 %,), anxiety (38 %,95 % CI, 34 %-42 %), stress (34 %, 95 % CI, 27 %-42 %), sleep disorder (52 %, 95 % CI, 44 %-60 %), psychological distress (58 %, 95 % CI, 51 %-65 %), PTSD (34 %, 95 % CI, 22 %-46 %), suicidal ideation (15 %, 95 % CI, 11 %-18 %) and burnout (38 %, 95 % CI, 25 %-50 %) was high. The major risk factors were being female, being junior or preclinical students, exposure to COVID-19, academic stress, psychiatric or physical disorders history, economic trouble, fear of education impairment, online learning trouble, fear of infection, loneliness, low physical activity, low social support, problematic internet or smartphone use, and young age. LIMITATIONS Most studies were cross-sectional. Few studies provided a reasonable response rate, suggesting potential selection bias. CONCLUSIONS The study demonstrated a high prevalence and risk factors for mental problems during COVID-19, calling for mental health services. Our findings are valuable for college and health authorities to identify high-risk students and provide targeted intervention.
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Affiliation(s)
- Pu Peng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuzhu Hao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yueheng Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Shubao Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yunfei Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Qian Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Manyun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yingying Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Li He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Qianjin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuejiao Ma
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Haoyu He
- Department of Psychology, College of Education, Hunan First Normal University, Changsha 410205, China
| | - Yanan Zhou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China,Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Qiuxia Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Tieqiao Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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The Consequences of the Pandemic on Medical Students’ Depressive Symptoms and Perceived Stress: A Repeated Cross-Sectional Survey with a Nested Longitudinal Subsample. J Clin Med 2022; 11:jcm11195896. [PMID: 36233763 PMCID: PMC9572955 DOI: 10.3390/jcm11195896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to explore the impact of the pandemic on medical students’ mental health in Italy using a repeated cross-sectional survey with a nested longitudinal subsample (first timepoint: 2018; second: 2020/2021). Three research questions (RQs) were investigated. Study 1 (longitudinal sub-sample) explored whether medical students had higher levels of depressive symptoms and stress during the pandemic compared with a pre-pandemic period (RQ1) and what variables were associated with these conditions during the pandemic adjusting for baseline levels (RQ2). Study 2 (repeated cross-sectional data) aimed to examine whether medical students had higher levels of these conditions during the pandemic compared with their same-year peers during a pre-pandemic period (RQ3). In Study 1, higher levels of depressive symptoms and stress were shown during the pandemic (RQ1). Multivariable models highlighted associations between poor mental health and worsening of the judgment of medical school choice, worsened psychological condition due to the pandemic, economic repercussions due to the pandemic, and baseline levels of symptoms (RQ2). In Study 2, our findings reported higher levels of depressive symptoms and stress during the pandemic, also adjusting for other variables (RQ3). In conclusion, depressive symptoms and stress were greater during the pandemic. The most relevant variables were pandemic-related items and medical school choice judgment.
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