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

Beyond the Smile: Exploring the Mental Well-Being of Dental Students Across Institutions

INTRODUCTION

A high frequency of mental issues has been reported amongst dental students in recent years. The aim of this study was to explore the frequency of depression, stress, and anxiety amongst undergraduate dental students in a developing country and identify factors which may contribute to the poor mental health of dental students.

MATERIALS AND METHODS

After obtaining ethical approval, undergraduate dental students from 14 dental institutions were invited to participate in an online study. Data were collected using two globally validated scales for screening mental health. The survey inventory also included two open-ended items and was administered using Google forms.

RESULTS

Complete responses were received from 639 participants, which included 71.67% (n = 458) females and 28.33% (n = 181) males. The overall response rate was 43%. The modal age group was 18-21-year-olds (63.54%, n = 406), followed by 22-25-year-olds (35.52%, n = 227). The mean score on PHQ-9 was 10.37 (SD ± 6.13) and 48.67% of participants showed moderate to severe depression. The mean DASS-21 score was 20.81 (SD ± 14.64) and 48.21% of participants were screened positively for moderate to extremely severe depression, 49.30% for moderate to extremely severe anxiety, and 30.36% of participants showed features of moderate to extremely severe stress. Significantly positive correlations were observed for the whole sample and demographic factors for participant scores on PHQ-9 for Depression, and Depression, Anxiety, and Stress scores on DASS-21. Academic workload, social interactions, personal factors, academic environment, and financial difficulties were reported as the main causes of poor mental health.

DISCUSSION

This study shows a high prevalence of depression, anxiety, and stress amongst undergraduate dental students in a country with a unique socio-cultural landscape. The study also identified underlying factors which adversely affect the mental health of dental students and provides recommendations to address these challenges.

Inappropriate use of propranolol among medical students in Palestine: cross-sectional study

INTRODUCTION

Medical students' inappropriate propranolol use, driven by exam stress, is a developing concern. This study examined propranolol misuse among Palestinian medical students at An-Najah National University.

METHODOLOGY

This is a cross-sectional study that included second to sixth-year medical students at An-Najah National University in Palestine. An online self-administrated Arabic questionnaire was developed by researchers. This 29-question, three-section questionnaire was sent to eligible participants via university email and student Facebook groups. The data collection period extended from August to September 2023.

RESULTS

A total of 401 students participated in the survey. The majority of the respondents were females (227, 57%) and final-year medical students (137, 34%). The utilization of propranolol was identified in 12% in our study. About 60% engaged in self-prescribing doses ranging between 10 and 20 mg, with 56% falling within this range. The main motivation for self-prescribing was to alleviate anxiety symptoms (88%), particularly before objective structured clinical examinations (OSCEs) (89%) or presentations (39%). 68% of students expressed awareness of the potential side effects. Statistical analysis revealed significant associations between propranolol use and factors such as age (p < 0.001), academic year (p < 0.001), the presence of chronic diseases (p = 0.011), and psychoactive drug use (p = 0.045).

CONCLUSION

Propranolol was used by 12% of the surveyed medical students, with 89% of its users taking it before OSCEs. Despite being aware of its potential side effects, many students still chose to self-medicate, highlighting the role of stress-induced behavior. This emphasizes the importance of stress management strategies before difficult occasions in medical students' journey.

Epidemiology of sleep disturbances among medical students in the Middle East and North Africa: a systematic review and meta-analysis

Background

Sleep disturbances and their associated health issues are common among medical students. Despite this, the epidemiology of sleep disturbances among medical students in the Middle East and North Africa (MENA) region remains inadequately understood. Our objective was to synthesise the prevalence of sleep disturbances, including poor sleep quality, insufficient sleep duration, and excessive daytime sleepiness (EDS), and their variation in relation to academic performance and stress levels.

Methods

We performed a systematic review and meta-analysis. Two independent reviewers searched PubMed, Web of Science, Google Scholar, and the reference lists of relevant studies and reviews up to May 2024. We assessed the quality of the included studies using a risk of bias tool. We performed meta-analyses using random-effects models and used Cochran's Q between-subgroups statistic to test for differences across subgroups. We used the I2 statistic to assess the statistical heterogeneity. Further, we assessed the publication bias using Doi plots.

Results

We included 150 studies conducted in 16 MENA countries. We found that 59.1% of medical students suffer from poor sleep quality (Pittsburgh Sleep Quality Index mean (x̄) = 8.5; 95% confidence interval (CI) = 7.0-10.1), 59.8% have insufficient sleep duration (<7 hours per night) averaging 6.1 hours per night (95% CI = 5.4-6.9), and 38.4% experience EDS (Epworth Sleepiness Scale x̄ = 8.6; 95% CI = 8.0-9.1). Our results indicate a significantly higher prevalence of poor sleep quality among students with moderate or high stress levels during the preclinical training period and in low-income MENA countries. A significantly higher prevalence of insufficient sleep duration was found among students during preclinical academic years. A significantly higher prevalence of EDS was found among students in public medical schools and those in low-income MENA countries. We observed no differences in poor sleep quality and EDS between students with poor and good academic performance.

Conclusions

Our findings highlight the substantial prevalence of sleep disturbances among MENA medical students. Medical schools must address this critical issue with targeted, locally informed, and culturally appropriate interventions. Further research is needed to assess the association between sleep disturbances and identify factors for tailored interventions that mitigate the adverse consequences on medical students' health and well-being.

Registration

Open Science Framework BF2A6.

The Historical Roots of Tiered Grading in U.S. Medical Education

Evaluation of medical students remains one of the most complex and challenging issues in academic medicine. Evaluation occurs in an educational environment that must cultivate a diverse, collaborative, and resilient physician workforce imbued with skills, drive, and stamina for a lifelong commitment to patient care, self-care, and professional development. Additionally, evaluation must not only be valid and reliable but also relevant to the public who medical students will eventually serve. In U.S. medical education, evaluation, and the assessments on which evaluation is based, has evolved over several centuries. Understanding the history of how, when, and why U.S. medical students have been assessed and subsequently evaluated can inform contemporary dialogue on curricular reform. In exploring this history, several important considerations emerge. First, tiered grading arose through the historical assimilation of U.S. medical schools into universities rather than as a mechanism for assessing clinical competence or acumen. Second, even before influences of university academia suffused medical education, imprudent academic emphasis on the memorization of facts over deeper understanding of, and reflection on, medical sciences and practice was already entrenched. Evaluation systems like tiered grading served to validate-if not accelerate-overreliance on the memorization and recall of scientific facts. As a result, other professional attributes important for medical practice, including intrinsic motivation, group cohesiveness, and diversity of the physician workforce were, and remain, adversely affected. Finally, despite early observations that tiered grading is associated with medical student stress and anxiety, there has been insufficient attention to and mitigation of these effects on medical student wellbeing over the last century. Our collective response to controversies surrounding tiered grading should account for the historical rationality of the adoption of this form of evaluation and its enduring effects on contemporary medical education.

When Push Comes to Shove: Unravelling the Developmental and Longitudinal Dynamic Relationship between Bullying and Empathy in Chinese School Children

While bullying has significant long-term impacts on mental health, the developmental relationship between empathy and bullying behaviors remains unclear. Specifically, it is uncertain whether bullying perpetration and victimization predict changes in empathy over time or if empathy influences these behaviors. This study addresses this gap by examining the longitudinal dynamic relationship between empathy, bullying perpetration, and victimization. The sample comprised 3337 Chinese school children (Mage = 11.23 years, SD = 1.60; 47.7% female), followed over six waves across three years. Random intercept cross-lagged panel models (RI-CLPMs) were employed to separate between-person and within-person effects. Results indicated that at the between-person level, empathy, bullying perpetration, and victimization followed decreasing trajectories, with initial empathy negatively associated with both bullying perpetration and victimization. At the within-person level, fluctuations in bullying perpetration and victimization predicted subsequent declines in empathy, while empathy did not significantly predict later changes in bullying perpetration and victimization behaviors. These findings suggest that bullying experiences, whether as a perpetrator or victim, can impair empathy development and that empathy alone may not be sufficient to reduce bullying. This challenges current intervention models focused on empathy enhancement and calls for more nuanced approaches that address the complex dynamics between empathy and bullying.

Comfort Foods in the Twenty-First Century: Friend or Foe?

The comfort food (CF) concept emerged during the latter half of the twentieth century. Although not well defined, CF can be described as familiar foods that elicit feelings of well-being and play a role in social interactions and psychological health. These foods are often calorically dense and nutrient-poor, and overconsumption of some CF may contribute to negative metabolic health outcomes. This is particularly relevant when considering the global increase in obesity, leading to the development of therapeutics for improved weight control and metabolic health. In this review, we aim to (a) provide a historical perspective of the CF concept, (b) detail some genetic, developmental, and cultural factors that determine food preference, (c) discuss the influence of diet on the gut-brain connection, hormones, nutrient absorption, and microbiome diversity, and (d) provide a perspective detailing possible future directions in which food technology may enable a new generation of CF with enhanced palatability and nutrient profiles while contributing to well-being and environmental sustainability.

Academic burnout and its association with psychological factors among medical students in Guangxi, China

BACKGROUND

Academic burnout is prevalent among medical students and is directly related to psychological distress. However, little is known about academic burnout among medical students in Guangxi and its associations with psychological health. This study aimed to determine the associations between psychological factors and academic burnout among medical students.

MATERIALS AND METHODS

A cross-sectional study was conducted among 1067 medical students at Guangxi Medical University from November 2023 to April 2024, with a stratified sampling method. Data were collected using web-based online software. Hierarchical linear regression analyses were used to examine the association between psychological factors and academic burnout.

RESULTS

Most of the students were female (55.3%), with a mean age of 20.6 years (SD = 1.4), and the mean overall academic burnout (OAB) was 57.3 (SD = 9.3). More than half (53.1%) reported a learning duration of 8 hours or more per day, and 66.2% reported sufficient reward promotion. Perceived stress was positively associated with OAB (β = 0.203, P < 0.001), whereas self-efficacy and self-esteem were negatively associated with OAB (β = -0.598, P < 0.001 for self-efficacy; β = -0.192, P < 0.001 for self-esteem), after adjusting for all predictors.

CONCLUSION

Academic burnout was influenced by psychological factors such as perceived stress, self-efficacy, and self-esteem. Thus, consideration of these factors could be useful to identify medical students who are susceptible to burnout and poor mental health and design appropriate interventions or university strategies of learning motivation and educational environment to reduce and prevent burnout in this population.

The impact of affective and cognitive empathy on stress in medical students

OBJECTIVE

To analyze the relationship between empathy and its domains (i.e., affective and cognitive) and stress in medical students.

METHODS

An online cross-sectional study with 543 medical students as respondents divided in three groups: pre-clinical cycle (n = 173), clinical cycle (n = 197), and internship (n = 173). The participants completed the sociodemographic questionnaire, the Interpersonal Reactivity Index, and the Perceived stress scale.

RESULTS

The participants were mostly female (71.5%) with an average age of 23.54 (± 4.54) years old. Medical students in the clinical cycle, when compared to the ones in their pre-clinical cycle and internship, showed higher stress levels. Pre-clinical students presented higher levels of total empathy and its affective domain. The highest levels of empathy, especially affective empathy, were associated with higher stress levels in all three groups. Regarding cognitive empathy, there was no observed association with stress among the groups.

CONCLUSIONS

The levels of empathy and its affective domain correlated significantly with the stress indicators among students of different cycles (i.e., pre-clinical, clinical cycle, and internship).

Associations between adverse childhood experiences and medical students' interest in careers: a single-setting study

Background

Adverse childhood experiences (ACEs) are pervasive across communities, including medical students and physicians. Exposure to childhood trauma influences career decisions, such as social workers and nurses. However, the impact of ACEs on medical students' career interests remains unexplored.

Methods

From August to October 2022, a survey was designed and administered to medical students at UT Health San Antonio School of Medicine (Texas, USA). Ten household-level and four community-level ACEs were assessed. Associations between ACE distribution and interest in medical specialties, academia, and primary care were analyzed by Mann-Whitney U test.

Results

Four hundred nineteen (47.0%) of 891 total students completed the survey, of which 310 (74.3%) reported at least one ACE and 107 (25.7%) reported four or more. The most common ACE was living with a household member with mental illness (154, 36.9%). Students interested in psychiatry (p<.01) or academic medicine (p=.02) had significantly higher ACE scores than those not interested in these fields. No associations were observed between ACEs and students' interest in primary care.

Discussion

The prevalence of medical students living with a household member with mental illness was approximately double than reported in population-based studies. Childhood trauma exposure may influence medical students' interests in psychiatry and academic medicine careers. Further research is needed to investigate how ACEs influence medical students' career considerations. Research exploring ACEs exposure in academic physicians and psychiatrists may further illuminate the associations found in this brief report. Importantly, advancements in trauma-informed approaches to medical education are necessary to facilitate safe learning environments.

Examination of factors associated with physical activity among medical students pre and post-COVID-19 in Serbia

The association of physical activity (PA) with the prevention and treatment of various diseases is well known. The issue of insufficient physical activity among university students has worsened due to the effects of the COVID-19 pandemic. The aim of this research is to examine the social, lifestyle, and health factors associated with moderate and high levels of PA in two cross-sectional studies conducted before and after COVID-19 involving 1,266 medical students from five universities in Serbia. Two cross-sectional studies were conducted on the population of fifth-year medical students from five different universities in Serbia before and after the COVID-19 pandemic (in 2019 and 2023). The research instrument was a questionnaire specially designed based on similar research. The mean energy expenditure in MET-minutes per week increased from 2,265.26 ± 1,930.67 in 2019 to 2,871.65 ± 2,301.99 in 2023 (p < 0.001). Multivariate logistic regression analysis with high PA as an outcome variable for the entire sample showed the association of high PA with the University of Kosovska Mitrovica and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2019 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2023 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. The average energy expenditure was significantly higher in 2023. Factors such as studying in Kosovska Mitrovica, scores on the Zung Anxiety Scale, alcohol consumption, binge drinking in the past month, and the number of meals consumed per day were associated with either moderate or high levels of PA or both.

Implications for developing global health education in China: evidence from an undergraduate teamwork with role-play

BACKGROUND

Since 2012, China has had one degreed undergraduate programme in global health for domestic students. The International Health Project Management course is a core component of this programme's curriculum, bridging theoretical knowledge to practice in global health engagement. This study aims to evaluate whether introducing a teamwork and role-play module would meet the learning objectives, including improving students' perception of global health, enhancing their understanding of the management processes for global health projects, and eventually developing competencies for effective global health involvement.

METHODS

The teamwork role-play module was used in a scenario assuming that all students played a specific role in project management in the 'Health System Enhancement for Pandemic Preparedness in Southeast and South Asian Countries' programme. This programme called for proposals to implement a project in at least one country in Southeast or South Asia. We conducted a content analysis using two types of materials from the students: (1) concept note and proposal presentations and (2) students' responses to the open-question feedback survey with four questions.

RESULTS

Students addressed the colonial origins of global health and its evolving definition, emphasising the need for a broader interdisciplinary approach. They perceived China's role in global health as evolving from a recipient to a donor, collaborator or participator, with a focus on enhancing soft power. However, their inadequate background knowledge of global health issues hindered their ability to undertake the tasks in depth. Students provided positive feedback on the teamwork with the role-play module, highlighting improved efficiency, broader and deeper learning through communication, increased participation, etc. Challenges such as poor leadership in teamwork, communication breakdowns and unequal workload distribution were identified.

CONCLUSIONS

Students showed a comprehensive understanding of managing a global health project through their teamwork tasks. Introducing teaching assistants to support teamwork, providing more hands-on opportunities, and integrating a broader range of disciplines into the curriculum will be crucial for the continued development of effective global health education programmes.

Impact and reception of point-of-care ultrasound training across medical education levels

BACKGROUND

Point-of-care ultrasound (POCUS) is a versatile and cost-effective technology that can significantly enhance medical education and clinical practice. This study examines the acceptance of POCUS among medical students and explores strategies to optimize its integration into their training.

MATERIALS AND METHODS

A total of 318 medical students, spanning both preclinical and clinical semesters, participated in seminars that included POCUS demonstrations and hands-on practice. Their perceptions were assessed through a voluntary questionnaire based on the Technology Acceptance Model (TAM), which furthermore explored the ideal timing and potentially suitable subjects for integrating POCUS into the curriculum, with an emphasis on its role in developing clinical skills and supporting decision-making.

RESULTS

Among preclinical students, 60.7% had no prior ultrasound exposure, while 97% of clinical students reported some experience, albeit often limited. Despite the majority of senior students having some ultrasound experience, many lacked confidence in its use. Confidence in sonography skills was generally low across both groups, with 95.9% of preclinical and 79.4% of clinical students expressing a lack of confidence. Importantly, both preclinical and clinical students recognized the high usefulness of POCUS skills and rated the technology as user-friendly, with clinical students perceiving it as slightly easier to use. When asked to identify the most suitable subjects for POCUS training, students most frequently cited anatomy (35.2%) and internal medicine (16.7%). Additionally, a majority of students (57.7%) advocated for POCUS education to begin as early as the first semester.

CONCLUSION

This study highlights a significant gap in ultrasound training among medical students, while also underscoring their strong motivation to learn and their positive perception of POCUS as a valuable tool for enhancing clinical skills and decision-making. The findings emphasize that early integration of sonography into the medical curriculum is both highly desired by students and essential for advancing medical education. This is particularly timely and important given the growing role of artificial intelligence in ultrasound technology and the opportunities expected to emerge from this integration.

Predictors of Psychological Well-being among Veterinary Medical Students in Clinical Training

The psychological well-being of veterinary medical students in clinical training was the focus of this investigation. Psychological well-being was evaluated in six subscales: personal growth, purpose in life, positive relationships with others, self-acceptance, environmental mastery, and autonomy. Comparisons between pre-clinical and clinical veterinary medical students identified that both groups experienced moderate to high levels of psychological well-being. Clinical students were more likely to endorse stress associated with financial concerns, school/life balance, heavy workload, unclear expectations, and relationship conflict than pre-clinical students. Additionally, clinical students experienced a lower sense of environmental mastery when compared to pre-clinical peers. Increased number of daily meals (more than 2), frequency of significant other and faculty mentor support, and fewer comparisons with peers predicted elevated well-being among clinical students. This accounted for 34% of the variance in psychological well-being of clinical students. These findings were discussed considering potential interventions to support clinical student psychological well-being.

Disparities in well-being outcomes among medical students: a comparative study between medical students with and without disability

BACKGROUND

The strenuous demands of medical education often lead to adverse mental health outcomes among students. Despite extensive research on medical student distress, the unique challenges faced by students with disabilities remain understudied. This study aims to investigate the well-being of medical students with and without disabilities, by comparing levels of distress, risk and protective factors, and modifiable variables' impact on distress.

METHODS

From September 2019 to February 2020, we implemented an exploratory observational study to survey medical students across the US, US territories, and Caribbean. Participants completed the Medical Student Wellbeing Survey (MSWS), which was used to assess well-being and capture extensive demographic data on these students. We retrospectively sorted participant data into cohorts based on disability status, then compared them using rates of well-being outcomes, logistic regression, and interaction analyses. We conducted logistic regression analyses to identify significant predictors of severe distress, burnout, and depression.

RESULTS

Of the 3162 medical student participants, 277 identified as having a disability. Respondents with disabilities reported significantly higher rates of severe distress (65%) compared to their non-disabled peers (51.3%). Additionally, burnout and depression rates were higher among disabled students, with 80.41% experiencing burnout and 54.84% experiencing depression. Logistic regression revealed that certain identities, as well as high debt and tuition costs, were significant predictors of severe distress across cohorts. Uniquely, marital status emerged as a protective factor specifically for students with disabilities.

CONCLUSION

Medical students with disabilities exhibit higher levels of severe distress, burnout, and depression than their non-disabled counterparts. Current interventions and modifiable factors are insufficient in lessening severe distress for these students. These findings highlight the necessity for tailored support strategies and structural interventions to improve the well-being of medical students with disabilities, especially for those with intersecting vulnerable identities.

TRIAL REGISTRATION

This study does not report the results of a health care intervention on human participants, so trial registration is not required.

Navigating the medical journey: Insights into medical students' psychological wellbeing, coping, and personality

BACKGROUND AND AIMS

In recent years, increased awareness of the psychological wellbeing of healthcare professionals and students has become a pressing public health issue affecting care delivery. Medical students undergo rigorous training programs that can affect their psychological wellbeing. Despite increased awareness of mental health issues among medical students, research often focuses on negative aspects, overlooking potential positive contributors to wellbeing. This study aims to explore both negative and positive factors influencing medical students' psychological wellbeing, considering coping strategies and personality traits to inform targeted support measures for diverse student needs.

METHODS

A mixed-methods approach was employed to investigate medical students' psychological wellbeing, coping strategies, and personality traits. Quantitative data was gathered via self-report questionnaires and analysed using regression models. Additionally, qualitative insights were obtained from semi-structured interviews and analysed thematically to capture students' perceptions and experiences.

RESULTS

The analysis revealed moderate to high levels of stress, anxiety, and depression among medical students, along with decreased life satisfaction. Regression analysis showed that problem-focused coping positively impacted medical students' psychological wellbeing, whereas emotion-focused and avoidance coping showed less favourable effects. Notably, problem-focused coping partially mediated the relationship between stress and depression. Furthermore, personality traits, particularly agreeableness and conscientiousness, played a pivotal role in shaping medical students' coping strategies and mental health outcomes. Based on thematic analysis, codes gave rise to three overarching themes and corresponding subthemes.

CONCLUSIONS

The study underscores the significance of addressing both positive and negative factors impacting medical students' wellbeing and highlights the need for tailored support considering individual personality traits that influence coping strategies and mental health. It also identifies challenges within medical education, emphasising the necessity for stress management programs, mental health support, and curricula promoting problem-solving skills. Prioritising medical students' wellbeing may not only foster good mental health among future professionals but may also enhance future healthcare quality.

A Psychiatry Clerkship Orientation Based on Bite-Sized Teaching and Chalk Talks

OBJECTIVE

Chalk talks are a subtype of bite-sized teaching with potential benefits over conventional teaching methods, including their use of visuals, adaptability, and potential to be more engaging. The objective of this study was to develop and evaluate the effectiveness of an orientation curriculum for medical students during the psychiatry clerkship based on bite-sized teaching and chalk talks.

METHODS

A series of brief (10 min) lectures were developed covering fundamental skills in psychiatry, including psychiatric interview, mental status exam, and differential diagnosis. Talks were presented to medical students by the study author on the first day of their psychiatry clerkship in 60-min group educational sessions with 10-15 students per group. Data was gathered in pre- and post-session surveys that measured response to 4 knowledge-based questions on mental status exam terminology, 3 questions assessing confidence in completing skills associated with the talks, and 3 questions assessing beliefs regarding these skills.

RESULTS

Fifty-six medical students participated in the educational sessions and completed pre- and post-session surveys. Students showed significant improvement from pre- to post-session in answering knowledge questions and perceived confidence in all skills, and indicated significant change in their beliefs regarding these topics.

CONCLUSIONS

Although this is a small study without a control group, the results provide initial evidence that approaches to teaching foundational psychiatry topics based on bite-sized teaching and chalk talks may be an acceptable and more time-efficient alternative to a traditional lecture-based curriculum, and can produce significant changes in knowledge and attitudes.

Could Empathy Be Taught? The Role of Advanced Technologies to Foster Empathy in Medical Students and Healthcare Professionals: A Systematic Review

The physician-patient relationship relies mostly on doctors' empathetic abilities to understand and manage patients' emotions, enhancing patient satisfaction and treatment adherence. With the advent of digital technologies in education, innovative empathy training methods such as virtual reality, simulation training systems, mobile apps, and wearable devices, have emerged for teaching empathy. However, there is a gap in the literature regarding the efficacy of these technologies in teaching empathy, the most effective types, and the primary beneficiaries -students or advanced healthcare professionals-. This study aims to address this gap through a literature review following PRISMA guidelines. A comprehensive literature search was conducted in the PsychINFO, Scopus, PubMed, and Web of Science databases using specific keywords. Inclusion criteria for articles were established, and two researchers independently rated the selected articles, resolving any disagreements by consensus. Out of 1137 articles screened, a total of 14 articles were included in this review with a total of 1285 participants, who received empathic training integrated with the use of digital technologies. Only 9 articles defined the construct of empathy, focusing on cognitive, affective, clinical, or cultural aspects. Empathy was assessed with various methods and promoted through various digital technologies, including wearables (e.g. HMDs, SymPulse™ armband) and non-wearable devices (computer monitors, Mobile Apps, Kinect System). Participants were primarily medical students (68.1%), with few healthcare workers (31.9%) and nurses (2.9%). All digital technologies effectively promoted empathy among the target population except for 3 studies that involved advanced career healthcare workers. This review highlights the potential efficacy of digital technologies in fostering empathy among medical students, though not as effectively among advanced healthcare professionals. These insights have implications for designing targeted educational programs that address the distinct needs of healthcare professionals at varying career stages. Limitations and future research directions are also discussed.

Schwartz Rounds in Higher Education Settings: A Systematic Review of the Research with Recommendations

BACKGROUND

Higher education institutions (HEIs) have recently integrated Schwartz Rounds (Rounds) as innovative ways of supporting health professional students' reflective practice, interprofessional learning and compassionate care. Emerging evidence suggests that Rounds benefit students' shared sense of belonging and insight into emotional aspects of training and care, providing safe places to share experiences and reflect. Our review examines the current literature regarding health students' evaluation of Rounds in HEIs, exploring experiences and perceived benefits of participating. We consider methodological issues with the existing literature and propose ways of addressing these in future research.

METHODS

Systematic searches were conducted on EBSCO, PsycINFO, PubMed and ASSIA to identify available literature relating to Schwartz Rounds in higher education. Eight studies - six with a mixed method design and two qualitative - were included in the review. Study quality and risk of bias were assessed. Evaluation survey data and themes generated from qualitative responses were considered together and a narrative synthesis was constructed.

RESULTS

Despite challenges with differing measurements and scale usage, five themes were identified reflecting the experience and perceived benefits for students attending Rounds. Students highlighted the value of peer connection and communication; normalisation of emotions; collaborative reflection and self-awareness; and the relevance of Rounds in their daily work and patient care. Students also commented on barriers to participation including Rounds' multidisciplinary nature, their group size, and the presence of staff. The majority of students rated Rounds as excellent or exceptional and agreed they should be integrated into the curriculum.

CONCLUSIONS

Our findings on Schwartz Rounds in higher education suggest they support student reflective practice and confidence in providing compassionate, high-quality patient care. However, the quality of research in this area is mixed, reflecting the relatively recent integration of Rounds in Higher education, and the challenges of implementing and evaluating new interventions in educational settings.

Is medical training solely to blame? Generational influences on the mental health of our medical trainees

INTRODUCTION

The negative impact of medical training on trainee mental health continues to be a concern. Situated within a sociocultural milieu, Generation Z and Generation Y, defined by their highly involved parents and the widespread use of technology, currently dominate undergraduate and graduate medical education respectively. It is necessary to explore medical trainees' generational characteristics and job-related factors related to stress, burnout, depression, and resilience. This might provide different perspectives and potential solutions to medical trainees' mental health.

METHODS

A cross-sectional study was conducted among medical trainees (students and residents) from two institutions in Qatar. A self-administered online survey included measures for trainees' social media overuse, their parent's parenting style, the educational support by the clinical teacher, job (demands, control, and support), and work-life balance and their relation with their stress, burnout, depression, and resilience. Relationships were tested with multiple linear regression analyses.

RESULTS

Of the 326 medical trainees who responded, 142 (44%) trainees - 93 students and 49 residents - completed all items and were included in the analysis. Social media overuse and inability to maintain a work-life balance were associated with higher levels of stress, depression, and student burnout. Higher levels of job support were associated with lower levels of stress, depression, and resident burnout, and a higher level of resilience. Job control was associated with lower burnout levels. Parenting style was unrelated to trainees' mental health.

DISCUSSION

The two generations 'Y' and 'Z' dominating current medical training showed more stress-related complaints when there is evidence of social media overuse and failure to maintain a work-life balance, while job support counterbalances this, whereas parenting style showed no effect. Measures to enhance medical trainees' mental health may include education about the wise use of social media, encouraging spending more quality social time, and enhancing job support and job control.

The psychosomatic impact of Yoga in medical education: a systematic review and meta-analysis

Non-clinical approaches such as meditation, yoga, and mindfulness are popular traditional therapeutical interventions adopted by many educational institutions to improve the physical and mental well-being of learners. This study aimed to evaluate the effectiveness of yoga intervention in improving cardiopulmonary parameters such as blood pressure, heart rate, pulmonary function tests and psychosomatic symptoms such as depression, anxiety and stress in medical and dental students. Using the PRISMA protocol, a search from databases such as PubMed, Scopus, and Embase resulted in 304 relevant articles. After screening the title and abstracts, 47 papers were analyzed thoroughly and included in the qualitative analysis. 18 articles with homogenous statistical data on physiology and psychological parameters were included for meta-analysis. In comparison to the control group, the study showed a significant reduction of systolic blood pressure (SBP: 6.82 mmHg, z = -3.06, p = 0.002), diastolic blood pressure (DBP: 2.92 mmHg, z = -2.22, p = 0.03), and heart rate (HR: 2.55 beats/min, z = -2.77, p = 0.006). Additionally, data from 4 studies yielded a significant overall effect of a stress reduction of 0.77 on standardized assessments due to the yoga intervention (z = 5.29, p < 0.0001). Lastly, the results also showed a significant (z = -2.52, p = 0.01) reduction of 1.2 in standardized anxiety tests in intervention group compared to the control. The findings offer promising prospects for medical educators globally, encouraging them to consider reformation and policymaking in medical curricula to enhance academic success and improve the overall quality of life for medical students worldwide.

The experiences of students with mental health difficulties at medical school: a qualitative interview study

BACKGROUND

High rates of burnout, anxiety, and depression in medical students are widespread, yet we have limited knowledge of the medical school experiences of students with mental health issues. The aim of the study is to understand the impact of mental health issues on students' experience and training at medical school by adopting a qualitative approach.

METHODS

Qualitative study using in-depth semi-structured interviews with 20 students with mental health issues from eight UK medical schools of varying size and location. Students were purposefully sampled to gain variety in the type of mental health issue experienced and demographic characteristics. Reflexive thematic analysis was employed using NVivo software.

RESULTS

Three themes were identified. 1) Culture of medicine: medical culture contributed to causing mental ill-health through study demands, competitiveness with peers, a 'suck it up' mentality where the expectation is that medical school is tough and medical students must push through, and stigma towards mental ill-health. 2) Help-seeking: students feared others discovering their difficulties and thus initially tried to cope alone, hiding symptoms until they were severe. There were multiple barriers to help-seeking including stigma and fear of damage to their career. 3) Impact on academic life: mental health issues had a detrimental impact on academic commitments, with students' unable to keep up with their studies and some needing to take time out from medical school.

CONCLUSION

This study provides insight into how medical culture contributes both to the cause of mental health difficulties and the reluctance of medical students to seek help. Mental health issues had a considerable negative impact on medical students' ability to learn and progress through their degree. Addressing the medical culture factors that contribute to the cause of mental health issues and the barriers to help-seeking must be a priority to ensure a healthier medical workforce.

Medical students' perception of a unique humanistic mentoring program in a religious university: a convergent parallel mixed methods study

BACKGROUND

The medical school of Tzu Chi University in Taiwan offers a unique, group-based, humanistic mentoring program as a complement to the programs mentored by faculty members and school counselors. The humanistic mentors are senior volunteers who are subject-matter experts in various fields and who embody the spirit of humanism in their lives. The average mentee-to-mentor ratio is around 3. This study explored medical students' perceptions of this unique program and focused on three major themes: guidance/support, mentor-mentee interaction/relationship, and cultivation of humanistic literacy.

METHODS

During the 2018-2019 academic year, we conducted a mixed methods study with a convergent parallel design targeting clerks and graduates undertaking post-graduate year training as the study population. The content validity index and Cronbach's alpha were used to assess the validity and reliability of the questionnaires. Data comparisons between two subgroups were assessed using the Chi-square test. Quantitative data from 86 respondents based upon convenience sampling were collected by using a validated self-administered questionnaire (20 items each utilizing a Likert scale). Qualitative data from 20 interviewees based upon purposive sampling were collected through one-to-one interviews based on a semi-structured interview guide. Data were analyzed in parallel using thematic analysis and merged at the point of interpretation, allowing for triangulation and validation of results.

RESULTS

Regarding the functional roles of three focused themes both quantitative and qualitative data revealed that participants viewed the program positively. The three quantitative items with the highest percentages of positive responses were related to mentors' endeavors to provide support (72%), to stay connected (69%), and to share their career and life experiences (72%). Interviewees perceived that their mentors provided timely guidance and support in response to their physical or mental needs and empowered them to cultivate humanistic literacy, both of which were mediated through a trusting, caring mentor-mentee relationship.

CONCLUSION

The participants had positive perceptions regarding this unique humanistic mentoring program. As an educational strategy for medical students this type of humanistic mentoring holds great potential.

Prevalence of depression and anxiety among university students in Jeddah, Saudi Arabia: exploring sociodemographic and associated factors

Introduction

Previous studies have shown that mental health issues such as depression and anxiety are on the rise globally, particularly among university students. The aim of this study is to assess the prevalence of depressive and anxiety symptoms among university students, and the associated potential risk factors, in Jeddah, Saudi Arabia.

Methods

A cross-sectional questionnaire study was conducted in a sample of 728 students who anonymously completed three sets of questionnaires: a sociodemographic and lifestyle information questionnaire, the Patient Health Questionnaire-9 (PHQ-9) to screen for depressive symptoms and the Generalized Anxiety Disorder-7 (GAD-7) scale to screen for anxiety symptoms.

Results

In a survey of 728 students, 81.5% reported depression and 63.6% anxiety, with no difference between medical and non-medical majors. Regular exercise, a history of psychological disorders, a diagnosis of chronic illness, and the use of antidepressant medications were significant indicators of depression. Significant anxiety markers included female gender, a diagnosis of chronic illness, a history of psychological disorders, the use of antidepressant medications, and smoking. Surprisingly, we did not observe any significant differences between the prevalence of depression or anxiety symptoms and common risk predictors, such as poor academic performance, low family income, and year of study.

Conclusion

Depression and anxiety had a high prevalence among undergraduates, regardless of their field of study; therefore, we recommend the implementation and expansion of community-based mental health prevention programs and mentorship programs. Universities with counseling programs should identify and eliminate factors that contribute to depression and anxiety.

Library as a Therapeutic Landscape Promoting Health and Well-Being to Chiropractic Students: A Descriptive Report

Objective

The purpose of this paper is to describe a bibliotherapy-based wellness initiative that was developed at the health science library at Canadian Memorial Chiropractic College.

Methods

A comprehensive literature review and consultations with stakeholders were completed. A bibliotherapy program, which included the practice of using books and reading to promote mental health, well-being, and resilience for chiropractic students, was developed and launched in January 2020. The program included shared reading, reflection, and a guided group discussion. Short readings of various genres (i.e., poetry, fiction, nonfiction) were tailored specifically to address psychological, emotional, and social challenges facing students.

Results

The program participant feedback showed that shared reading helped students cope with anxiety, worries, and loneliness and isolation caused by the pandemic, as consistent with bibliotherapy research.

Conclusion

The bibliotherapy program at this 1 location seemed to be well-received by chiropractic students. The program was recognized by faculty and college administrators as a valuable addition to other mental health and wellness support services available on campus. These findings suggest future research to evaluate the potential efficacy of bibliotherapy for the mental health, well-being, and resilience of chiropractic students.

Correlates and Barriers of Exercise, Stress, and Wellness in Medical Students

Medical students report higher stress and increased mental illness than peers of similar age. Burnout and depression among medical students and physicians have also been correlated with increased risk of medical errors and decreased importance of altruistic values, such as providing care to medically underserved populations. This study works to analyze the effects of exercise, nutrition, sleep, and other factors affecting wellness and performance of medical students, as well as identifying barriers to exercise and possible solutions. A survey was distributed to medical students in the Midwest to evaluate exercise habits, dietary intake, sleep, and other factors affecting wellness. An investigation of the correlation of variables and comparison of year in school for the variables was conducted. Satisfaction with social relationship and performance in school correlated with exercise, stress, and sleep variables. Several variables, including satisfaction with exercise, social life, and performance in school, showed significant differences based on year in school. No significant findings were noted between students from the various medical institutions at which the survey was distributed regarding satisfaction with exercise, academic performance, social life, personal relationships, hours spent in clerkship/class, hours spent studying, and stress. Students tended to have higher satisfaction with school and social relationships if they engaged in exercise more often, exercised with greater intensity, and slept better. Students identified barriers to exercise including cost, availability, and lack of time. Potential solutions include a workout facility in school buildings/hospitals, allocated wellness periods for exercise, and a more consistent schedule.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02134-5.

Impact of Learning Adjustment Dimensions on Depressive Symptoms Among Chinese Nursing Freshmen: The Mediating Role of Psychological Capital

Purpose

To examine the influence of learning adjustment dimensions (motivation, attitude, ability, teaching pattern, and environment) on depressive symptoms in Chinese nursing freshmen, and the mediating role of psychological capital.

Methods

A cross-sectional survey was conducted among 471 nursing freshmen at a university in May 2024. The anonymous self-reported questionnaire included the Patient Health Questionnaire, the Learning Adjustment Questionnaire, and the Psychological Capital Questionnaire. Data were analyzed using SPSS v25.0 and PROCESS v4.1 macro, including correlation and mediation analysis.

Results

Learning adjustment had a significant direct effect on depressive symptoms among nursing freshmen (β = -0.565, p <0.001), and psychological capital partially mediated this relationship (β= -0.156, 95% Boot CI [-0.107, -0.135]), suggesting psychological capital explains part of the link between poor learning adjustment and depressive symptoms.

Conclusion

More attention should be paid to the mental health issues of freshmen. Addressing learning adjustment issues and fostering psychological capital among nursing freshmen may alleviate depressive symptoms, which will require relevant educational interventions and mental health support from university educators and counselors.

A holistic approach to sustain and support lifelong practices of wellness among healthcare professionals: generating preliminary solid steps towards a culture of wellness

BACKGROUND

The COVID-19 pandemic has served as a catalyst for recognizing the challenging environments in which healthcare workers operate, underscoring the urgent need to enhance their wellness to better support themselves and others. The implementation of a culture of wellness within the context of healthcare education, with a particular emphasis on individual-level strategies, allows for the realization of its intrinsic value and significance as a foundation for broader organizational strategies. This approach facilitates the establishment of a sustainable culture of wellness that benefits both current and subsequent generations of healthcare professionals.

METHODS

We implemented our wellness program using a pragmatic pre-post study design for different settings. Our wellness intervention program was tested in three ways by creating combinations of different intensities (high, moderate, or low), delivery methods (face-to-face vs. virtual), different motivations (incentive, mandatory, or volunteer participation), and different timings (during medical programs or before entering into healthcare programs) among medical and nursing students. The effects of the wellness program were measured on quality of life, emotional intelligence, and efficacy scores among healthcare students. Statistical methods included repeated measures analysis of variance and paired t-tests.

RESULTS

A total of 224 students (13 in high, 145 in moderate, and 66 in low-dose interventions) participated in our study program. Most scores were significantly improved except for a few factors in the high-dose face-to-face Well-Teach intervention cohort. Among quality of life components, the average psychological scores were markedly increased after high (13.2 vs. 14.7, p = .018), moderate (13.9 vs. 14.8, p < .001), and low (12.8 vs. 13.4, p < .001) intensity intervention cohorts. The moderate and low intensity of wellness intervention cohorts had the highest impact on the total emotional intelligence scores (mean difference = 3.021, 95%CI:0.553-5.488, p = .008) and (mean difference = 5.197, 95%CI:3.057-7.337, p = < 0.001), respectively. The low-dose healthcare intervention program yielded improvements in all components of all scores to a greater extent than moderate-dose or high-dose with face-to-face intervention programs.

CONCLUSIONS

This study demonstrates that our multifaceted Well-Teach model can be used to improve the quality of life, emotional intelligence, and self-efficacy of healthcare students. Low- or moderate-intensity intervention programs integrated into the curriculum may be more practical in health sciences education to sustain and promote lifelong wellness practices as solid steps toward attaining a "culture of wellness". Our model should be considered to be beneficial, sustainable, cost-effective, comprehensive, and effective for current and future generations of healthcare providers.

Psychological resilience and perceived stress among Chinese medical students: mediation between optimistic intelligence quotient and adversity quotient

BACKGROUND

Chinese medical students face rigorous academic demands and exacting professional challenges, which lead to significant psychological stress. Understanding perceived stress and psychological resilience is key to enhancing emotional regulation and empathy. This study explores the hypothesis that psychological resilience impacts the perceived stress of medical students, with the Optimistic Intelligence Quotient (OQ) and the Adversity Quotient (AQ) acting as serial mediators, thereby promoting students' mental health.

METHODS

A questionnaire survey was conducted to assess psychological resilience, perceived stress, OQ, and AQ among students from the top 20 medical colleges in mainland China. Using random sampling, 60 students per institution were selected, yielding 1,024 valid responses from 1,200 distributed questionnaires. Data were analyzed using correlation and mediation analysis.

RESULTS

The results showed a significant negative correlation between psychological resilience and perceived stress. OQ was significantly associated with reduced stress and enhanced overall well-being, while AQ was related to stress management skills.A serial mediation pathway was identified from psychological resilience to OQ and AQ, forming a chain influencing perceived stress.

CONCLUSIONS

This study highlights the current psychological stress among Chinese medical students and the serial mediating roles of OQ and AQ. Tailored interventions in medical education should focus on enhancing psychological resilience to reduce perceived stress. Future research should explore alternative frameworks in positive psychology and develop new stress management intervention models.

Motivation and socialization during summer predict medical students' success: An artificial intelligence study

PURPOSE

The latest reform of French medical studies has moved the National Ranking Examination before residency to the beginning of the sixth-year for undergraduate medical students, thus placing unprecedented workload during the preceding summer. The main objective was to determine whether study conditions and psychosocial factors were associated with student success in this model of intense workload.

MATERIALS AND METHODS

An online survey designed with six student-partners was sent at a French Medical School after the examination in 2023. The primary outcome was student success in achieving their main goal (Ranking, Knowledge, Well-being). A machine-learning model (eXtreme Gradient Boosting) was developed and explained using Artificial Intelligence. An AI-guided multivariate logistic regression was performed, Odd Ratios were calculated.

RESULTS

Out of 123 responses, 75 (61%) of the students achieved their main goal. Motivation and socialization during the summer were the two most important variables for predicting student success. In guided multivariate logistic regression, summer motivation (Odd Ratio = 4.12, 95%CI[1.75-10.30]), summer loneliness (Odd Ratio = 0.35, 95%CI[0.14-0.86]), and student's main goal (Ranking, Odd Ratio = 2.94, 95%CI[1.15-7.79]) were associated with student success.

CONCLUSIONS

Motivation and socialization during the summer preceding high-stakes examinations are strongly predictive of undergraduate medical students' success. This study highlights the importance of well-being during summer for student success.[Box: see text].

Sustained Impact of an Emotional Intelligence and Resilience Curriculum for Medical Students

Purpose

The purpose of this study was to assess the effectiveness of an educational curriculum focused on Emotional Intelligence (EI) and Resilience among second-year medical students, with emphasis on evaluating the retention of EI skills one year following the curricular intervention.

Methods

Second-year medical students voluntarily participated in an EI-Resilience elective with a curriculum consisting of six sessions aimed at teaching EI and resilience skills. Participants underwent assessment before, immediately after, and one year following the intervention, utilizing the Bar-On Emotional Quotient Inventory 2.0 (EQ-i 2.0). Survey responses were averaged and compared between varying time points.

Results

Thirty students completed the EQ-i 2.0 assessments at three time points: prior to, immediately after, and one-year following the educational intervention. A comparison of mean EI scores pre- and immediate post-intervention showed a significant increase in most components of EI. No significant changes were detected between the immediate post-test and 1-year post-test on any EI components, except for a noteworthy increase in the mean Interpersonal Relationship score. Students demonstrated an average increase in their Interpersonal Relationship skills of 5.7 points (95% CI: 3.0, 8.4, p <0.001) at the one-year post-test compared to the post-test immediately following the intervention. Students reported continued satisfaction and usefulness one-year post-intervention as demonstrated by an internally developed survey. In the one-year post-intervention survey, most students used what they had learned in the elective during their third year (91%, 32/35) and all students found the elective to be applicable during their third year. In free-text responses, students reported improved coping and reflection skills in the third year of medical school following the intervention.

Conclusion

An EI-Resilience curriculum offered as an elective to second-year students continued to be well-received one year following the educational intervention. Data suggests that enhanced EI and resilience skills were sustained over a one-year period following the educational intervention.

Identification of Relationships Among Resilience Factors Using Network Analysis: A Pilot Study

BACKGROUND

Although college life can be fulfilling, it can be stressful, particularly for health professional students. In addition, they may have had Adverse Childhood Experience (ACE) that increases their sensitivity to academic stress. Yet, students need to overcome challenges to become successful professionals. The literature suggests the following factors may be associated with resilience: ACE and academic stress as the antecedents; ego-resilience, emotion regulation, resources, social support, inflammatory markers, and genes as the defining attributes; and mental health and sense of coherence (SOC) as the consequences.

AIMS

The purpose is to identify the relationships among factors associated with resilience using network analysis.

METHODS

A total of 70 college students participated in this cross-sectional pilot study. They completed measures of psychosocial variables and provided saliva samples, which were analyzed for Serotonin Transporter-Linked Promoter Region (5-HTTLPR)/rs25531 and inflammatory markers. Mixed graphical models including all variables were estimated using the R-package mgm.

RESULTS

Network analysis revealed positive associations between (1) mental health and SOC; (2) mental health and resources; (3) mental health and social support; (4) SOC and reappraisal of emotion regulation; (5) resources and reappraisal of emotion regulation; and (6) resources and social support. In addition, SOC and academic stress were negatively associated. Furthermore, the short variant of 5-HTTLPR/rs25531 was associated with stronger suppression of emotion regulation and fewer resources compared with the long variant.

CONCLUSION

Resilience may be influenced by biopsychosocial factors, notably SOC and 5-HTTLPR/rs25531. However, longitudinal research is needed with a larger sample size to better understand how these and other factors may affect resilience.

Multiple recommended health behaviors among medical students in Western Canada: a descriptive study of self-reported knowledge, adherence, barriers, and time use

Background

General medical practitioners are responsible for promoting and prescribing lifestyle modification and serve as role models for healthy behaviors. We aimed to assess self-reported knowledge, adherence, barriers and time spent on all recommended health behaviors among medical students.

Methods

A cross-sectional online survey of eight behavioral domains among undergraduate medical students in The University of British Columbia, Canada, was analysed using descriptive statistics and visual display.

Results

Between March and April 2023, 137 medical students participated in the survey (74% female). Over 80% had knowledge of five health behavior recommendations, but lacked knowledge of specific dietary recommendations in particular. Over 60% reported meeting guideline-recommended levels for tobacco, weekly alcohol, daily alcohol (females only), and physical activity (males only). Large gaps existed between knowledge and adherence for physical activity, sleep, sedentariness, screen time, and dietary recommendations. Sex differences in knowledge and adherence to recommended health behaviors were identified. Time spent on wellness focused on sleep (47-49 h/week), diet (9.6 h/week), exercise (5.8 h/week), and hobbies (6.1 h/week). Forgetting recommendations (69% of females, 71% of males), and lack of time (72% of females, 52% of males) were principal barriers to knowledge and adherence.

Conclusion

Most medical students in Western Canada reported not meeting multiple recommended health behaviors. Time was the largest barrier to adherence and free time was spent on sleep. Medical education may require protected time and dedicated content for health behaviors to ensure future physicians can be role models of health promotion for patients.

An investigative study on the causes of depression and the coping strategies among clinical medical students in private universities in North Central Nigeria

BACKGROUND

Depression is among known mental health conditions and students in schools of medicine are not immune to it. In this investigative study, 211 clinical medical students of two private universities from North-Central Nigeria were examined on depression prevalence, the contributory factors and their coping strategies.

METHODS

The Patient Health Questionnaire 9 (PHQ-9), the Medical Student's Stressor Questionnaire (MSSQ) and identified coping strategies according to Coping Oriented to Problems Experienced Inventory (COPE) were instruments of data collection.

RESULTS

The results were obtained by both descriptive analysis and test of association between some categorical variables. The depression prevalence amongst the participants was 159 (75.4%). Females (124 (78.0%)) were more depressed than males (35 (22.0%)). Factors identified as contributing to depression were the heavy academic workload (124 (78.5%)), insufficient family time (93 (58.1%)) and financial constraints (54 (34.0%)). The most utilized method of coping with their stress was engaging on social media (133 (84.2%)), followed by talking with relatives or friends (99 (62.7%)) and use of recreational drugs (20 (12.8%)). The findings from this study have shown that more than three-quarters of the respondents suffered from varying degrees of depression from mild, 63 (29.9%), moderate, 53 (25.1%) to severe, 43 (20.4%).

CONCLUSIONS

The heavy academic workload was a major source of depression. Colleges of Medicine should take pro-active steps towards their students' mental health and academic workload should be well spaced to reduce the stress imposed by the frequency of examinations.

Not taught in medical school but needed for the clinical job - leadership, communication and career management skills for final year medical students

BACKGROUND

Starting the first job as a young physician is a demanding challenge. Certain skills are important to master this transformation that go beyond the theoretical knowledge and practical skills taught in medical school. Competencies such as communication, leadership and career management skills are important to develop as a young physician but are usually not sufficiently taught in medical school in a structured and comprehensive way.

METHODS

We performed an online survey among final year medical students regarding how they perceive their current competency level in communication, leadership and career management skills. We also assessed how they rate the importance to acquire these competencies and the current emphasis during their medical school education regarding these topics.

RESULTS

Of 450 final year medical students 80 took part in the voluntary survey and 75 complete datasets were returned (16.7%). The majority of respondents rated different communication skills, leadership skills and career management skills as important or very important for their later clinical work. However, most students felt to be poorly or very poorly prepared by the current medical school curriculum, especially for certain leadership and career management skills. Overall, 90.7% of participants expressed interest in an additional educational course that covers subjects of communication, leadership and career management skills during the later stage of medical school, preferably as a hybrid in-person session that also offers synchronous online participation.

CONCLUSIONS

The results of the survey express the need to address communication, leadership and career management skills in the medical curriculum to be better prepare students for the demands of residency and their further course as physicians. An educational format during the final year of medical school may be suitable to address mentioned topics in the framework of clinical practical exposure.

Stress and career aspirations: a longitudinal study with medical students

Background

The psychological well-being of medical students has often been studied in relation to various factors and typically exhibits poorer scores than comparable student groups. This diminished well-being can have far-reaching implications, like impact on career or academic engagement. While there are some studies on specialty choice or academic performance few studies have examined the effects of stress at the beginning of medical school on career ambitions and the associated interest in research. Given the anticipated future shortage of healthcare professionals and the goal of gender equality in higher positions, it is crucial to examine this relationship as early as medical education. The question arises whether medical education and the demands of studying influence the career ambitions of different student groups.

Method

As part of a longitudinal survey, students from a medical cohort are surveyed over three consecutive years. A total of 297 students participated in the surveys, of which 66.4% were women. Stress experiences during medical school and career aspirations are assessed and analyzed using Generalized Estimating Equation (GEE) modeling.

Results

The results indicate that early academic stress is a negative predictor of the career ambitions of medical students (B = 1.637; p = 0.009). Also, female students report lower career goals than male students (B = 1.168; p = 0.018). In addition, gender moderates the impact of stress on career ambitions (p = 0.046). Finally, stress levels are highest when starting the medical program (p = 0.022) and decrease over time.

Discussion

Stress during the initial medical training impedes students to pursue higher career ambitions. Future research as well as medical programs need to elaborate more on and consider structural stress prevention interventions in order to promote well-being and strengthen also scientific career goals at an early stage, specifically for female students.

Enhancing Class Culture: Assessing and Improving the Impact of the "Thriving Together" Workshop for Dalhousie Medical Students

Introduction Collaboration and collegiality in medical school benefit students' experiences and contribute to improved patient care. Learning environments have the potential to foster competition and discourage collaboration. Thriving Together was created to address class dynamics and culture early in medical training. Objective The objective of the study is to thoroughly evaluate the Thriving Together Workshop. Methods The Thriving Together workshop, led by upper-year students, comprises a presentation on class culture, anonymous polling, and small-group case-based exercises. It concludes with a large-group discussion. Pre- and post-workshop survey results were collected via Opinio software. A basic statistical and thematic analysis was conducted to identify response themes.  Results The post-workshop survey response rate was 29 out of 41 attendees (70.7%) in 2022 and 20 out of 55 attendees (36.4%) in 2023. Forty-eight (96.6%) respondents would recommend the workshop to next year's medical cohort, and 44 (89.8%) were interested in a follow-up workshop. Qualitative comments were positive, with feedback focused on attendance, group randomization, and the need for formal resources and post-workshop follow-up. Conclusion The Thriving Together workshop has a positive impact on class culture as evidenced by voluntary attendance and positive survey responses. Strategies to improve attendance will be implemented for upcoming sessions and will focus on refining the workshop to encourage inter-group interactions. In addition, formal resources will be provided to those interested. These adjustments aim to sustain the positive impact of the Thriving Together initiative on medical school culture.

Factors on medical clerkship students' quality of life: A survey study

Introduction

Due to the higher demand for healthcare provision in Indonesia, increasing the number of medical schools in Indonesia was highly encouraged. Meanwhile, medical students were considered a susceptible population to a variety of issues that negatively impact their quality of life (QOL) in comparison to the general community.

Objectives

The study aims to assess the QOL of Indonesian medical students during the clinical clerkship program (years 4-5) of their medical training while also exploring the association between the results and their ongoing rotation.

Methods

The survey was conducted online to 311 students at a private medical school in Jakarta using the Indonesian version of WHOQOL-BREF. Participants' characteristics, sleep duration, physical activity, and smoking history were also assessed to see if there was any association. Results: 82% of 311 registered clerkship students responded to the survey. In terms of overall QOL, being in a major department, 7-9 h of sleep duration, and owning a private vehicle increased the QOL.

Conclusion

This study suggested that medical schools' policies may consider sleep duration, travel time, transportation-related infrastructure, and social-related infrastructure to underpin students' social relationships and, afterward, improve their QOL in intangible ways.

The Effect of Repeated Review of Course Content on Medium- and Long-Term Retention in an Elective Veterinary Cardiology Course

Assessment in veterinary medicine is challenging given the high volume of material and high cognitive load. Differing opinions exist regarding the utility of comprehensive final examinations in veterinary courses. A mixed-methods prospective randomized trial was undertaken with veterinary students (n = 47) in an elective cardiology course. All students received identical content, which was presented through weekly in-class lectures (eight total lessons). They were given access to four different formats of study aids and completed quizzes of content knowledge within 1 week of each lesson. For the cumulative final examination (post-test), students were explicitly instructed to study only for four out of the eight lessons. Students then completed a delayed post-test 3-6 months after completion of the course. Quantitative and qualitative data were collected in the form of in-depth pre- and post-course surveys. Overall, studying a particular lesson for the post-test resulted in higher scores for six out of eight lessons in the post-test (p < .05) but did not result in significantly higher scores for any lesson in the delayed post-test. Time spent studying for individual quizzes, as well as other measures of study habits, decreased significantly throughout the semester. Among study aids, student preference was highest for instructor-provided graphic organizers, and this preference persisted across the semester with a shift away from instructor-provided outlines over time (p = .043). Free-text survey responses showed that students had realistic expectations for the impact of studying for the post-test and appreciated exposure to a variety of study aid formats. In an elective veterinary cardiology course, review of material prior to a cumulative final examination led to improved short-term performance but no difference in retention 3-6 months later.

Mobile Phone Addiction and Psychological Capital Mediates the Relationship Between Life Satisfaction and Learning Burnout in Chinese Medical Postgraduate Students: A Structural Equation Model Analysis

Purpose

To analyze the relationship between life satisfaction and learning burnout, and explore the mediating effect of mobile phone addiction and psychological capital, and to provide a theoretical basis for the study of measures for medical postgraduate students to maintain a positive psychological state and keep interest and enthusiasm in academic life.

Methods

Convenience cluster sampling was used to recruit 628 medical postgraduate students in Chongqing, China. The Learning Burnout Questionnaire (LBQ), life satisfaction self-rated item, Mobile Phone Addiction Tendency Scale (MPATS), and the Psychological Capital Questionnaire (PCQ) were used to examine participants. Hierarchical regression was used to analyze the effect of life satisfaction, mobile phone addiction, and psychological capital on learning burnout. A structural equation model (SEM) with maximum likelihood was used to evaluate the mediating effect of mobile phone addiction and psychological capital on the relationship between life satisfaction and learning burnout. The bootstrap method was used to confirm the significance of the mediating effect.

Results

The average learning burnout score was (55.81±10.55). Results of hierarchical regression revealed that life satisfaction and psychological capital had a significant negative predictive effect on learning burnout, and mobile phone addiction had a positive predictive effect on learning burnout (p<0.05). The SEM revealed that the total and direct effects of life satisfaction on learning burnout were significant, and the mediating effects of mobile phone addiction and psychological capital between life satisfaction and learning burnout were significant (p<0.05).

Conclusion

Life satisfaction is a direct predictor of learning burnout among Chinese medical postgraduate students, and this relationship is mediated by mobile phone addiction and psychological capital.

Community and family relationships across the transition to medical school: links to student adjustment

Introduction

Supporting students during the transition to medical school is crucial for their academic adjustment. However, there has been limited research on the protective role of community and family support during this transition, despite evidence of the benefits of supportive relationships in higher education. Guided by self-determination theory, the current cross-sectional study explored how changes in family and community relationships impact Cuban medical students' sense of belonging in their field and their grade expectations.

Methods

A total of 881 medical students (M Age = 21.51, SD= 2.23, range = 18-33; 54% female; 72.2% Cuban) participated in this study. Participants included students across 6 years of medical school (1st year = 14.8%, 2nd year = 10%, 3rd year = 24.1%, 4th year = 19.3%, 5th year = 11.8%, 6th year = 20%).

Results

Controlling for key demographics (e.g., student aid experience, family legacy, nationality, year in medical school, prior academic performance, gender, and offspring), our findings revealed that improvements in community relationships-rather than family relationships-were associated with higher levels of field belonging. Additionally, more extensive experience as a student aid and a greater number of family members with a medical background were linked to higher levels of field belonging and higher grade expectations. Notably, higher prior academic performance was associated with increased field belonging but did not affect grade expectations. Conversely, identifying as female was related to both higher field belonging and higher grade expectations.

Discussion

Our study highlights the importance of supportive community relationships for medical students' academic adjustment. We discuss the potential benefits of enhancing community relationships within medical school training programs.

Use of service and treatment adequacy in medical students and residents suffering from depression in France: A nationwide study

Depression was already a public health issue before the Covid-19 pandemic. Use of service and treatment adequacy in medical students was poorly known. A 2021 French national study found the prevalence of 12-month major depressive disorder (MDD) was 25 % in medical school students and residents (MSSR). The main objective of our study was to measure the prevalence of service use and adequate treatment (therapy and/or recommended pharmacotherapy) and their associated factors. A national online survey was conducted in 2021. The Composite International Diagnostic Interview Short-Form questionnaire was used to assess MDD; 12-months service use and pharmacotherapy were assessed. Univariate and multivariate logistic regressions were performed between students' demographic characteristics, use of services, and treatment adequacy. Among included MSSR who experienced MDD in the last 12 months, only 32 % received adequate treatment, including 20 % with recommended pharmacotherapy. Being more advanced in medical studies and being treated both by a general practitioner and a psychiatrist were associated with receiving recommended pharmacotherapy. To our knowledge, our study is the largest to assess use of service and treatment adequacy in MSSR. Given the low percentage of depressed students receiving recommended treatment, it seems important to develop new interventions to better detect and treat MDD in MSSR.

Signs, Sources, Coping Strategies, and Suggested Interventions for Burnout Among Preclerkship Students at a U.S. Medical School: A Qualitative Focus Group Study

PURPOSE

Research suggests that burnout can begin early in medical school, yet burnout among preclerkship students remains underexplored. This study aimed to characterize burnout signs, sources, coping strategies, and potential interventions among preclerkship students at one U.S. medical school.

METHOD

The authors conducted a qualitative study of preclerkship students at Mayo Clinic Alix School of Medicine (MCASOM) in June 2019. Participants completed 2 Maslach Burnout Inventory (MBI) items (measuring frequency of emotional exhaustion and depersonalization) and 2 free-text questions on burnout before participating in 1 of 3 semistructured focus groups. Focus group questions were derived from a literature review on medical student burnout with input from the MCASOM Student Life and Wellness Committee. Group discussions were recorded, transcribed, coded inductively, and analyzed iteratively (along with free-text comments) using a general inductive approach from a constructivist perspective.

RESULTS

Eighteen of 111 eligible students (16%) participated, with 5/18 (28%) reporting weekly emotional exhaustion and/or depersonalization on MBI items. Analysis of focus group transcripts showed that most students had experienced burnout symptoms during their first or second year, corresponding with school-related stressors and manifesting in cognitive-emotional, physical, and verbal-behavioral ways. Students identified systemic, institutional, and individual burnout drivers and discussed how these drivers interacted (e.g., high standards of excellence at the system level interacted with anxiety and maladaptive thinking at the individual level, creating pressure to always do more). Students used various coping strategies (e.g., self-care, peer support, reframing, and compartmentalization) but emphasized limitations of these strategies and recommended interventions directed toward systemic and institutional burnout drivers.

CONCLUSIONS

This study offers insights into burnout signs and sources among preclerkship medical students that can inform future large-scale studies. Results suggest that burnout emerges from dynamic interactions among systemic, institutional, and individual factors and may benefit from multipronged interventions.

Predictive factors of stress response of nursing student repeaters under the background of abolishing the final supplementary examination in China

BACKGROUND

Academic pressure and frustration stimulation are significant stressors in college students, and response to the prolonged stimuli would cause adverse mental and physical outcomes. However, more is needed to know about the stress response and its predictors among undergraduate nursing students retaking failed course under the background of the abolition of the Final Supplementary Examination in China. This study aimed to investigate the stress response and its predictive factors of nursing student repeaters who are retaking at least one failed course.

METHODS

A cross-sectional study was conducted, utilizing convenience sampling to recruit 120 nursing student repeaters from four 4-year undergraduate medical universities in China between September 2020 and May 2021. Data collection instruments included a general information questionnaire, a stress response questionnaire, the Connor-Davidson resilience scale, a self-control scale, and a academic self-efficacy questionnaire. The data were analyzed using descriptive statistics, Pearson correlation coefficients, t-tests, analysis of variance (ANOVA), and multiple linear regression.

RESULTS

The average scores of the total stress response, emotional response, physical response, and behavioral response were 58.07 ± 26.72, 86.97 ± 17.12, 57.69 ± 9.75, 67.16 ± 9.22, respectively. Stress response was predicted by psychological resilience, self-control ability, academic self-efficacy and the number of retaking courses.

CONCLUSIONS

The stress response among nursing student repeaters is relatively active. Higher psychological resilience, self-control ability, and academic self-efficacy predict lower levels of stress response. In order to help nursing students with failing and repeating course release their psychological stress and maintain well-being, nursing educators could adopt self-control promotion strategies and emphasize the cultivation of psychological resilience and academic self-efficacy as parts of health promotion programs for this particular student group.

Assessing mental resilience with individual and lifestyle determinants among nursing students: An observational study from Greece

The educational environment is important for the development of life skills of nursing students in late- and post-adolescence. Strengthening their mental resilience, enhancing their individual confidence, and controlling stress are necessary conditions in this direction, which will help them cope with the future challenges of their chosen profession. We aimed to study the resilience profiles of nursing students by investigating their mental resilience and its association with their individual characteristics and lifestyle factors. The Connor-Davidson Resilience Scale (CD-RISC-25) scale for resilience, the Perceived Stress Scale (PSS-14) scale for perceived stress, and the Personal Trust and Connection (PerTC) scale for trust and connections were used. The lifestyle determinants were also assessed. An e-survey that targeted 250 nursing students was conducted from November 22 to April 23. Descriptive and advanced statistical analyses were performed. 146 students participated in the study via an on-line questionnaire; the students were predominantly female (82.2%) with mean age of 22 years (SD = 6.8). Two out of ten students smoked (20.5%), 66.4% consumed at least one drink during a usual week, and 48.0% participated in sports during the last year. The mean hours spent on the Internet daily was 4.2 (SD = 1.8) and on social media was 2.7 (SD = 1.6) hours/day. The students scored highly on the 1-to-10 life-satisfaction item (Mean = 6.3, SD = 1.9), where the perceived stress was assessed as moderate/high with a mean of 33 (SD = 4.4) and trust and connections had a mean of 6.2 (SD = 1.1). In the multivariate analysis, the factors found to significantly associate with resilience (CD-RISC-25; Mean = 64.2, SD = 11.8) were age (β = 0.4; 95% CI: 0.1, 0.7), sports participation (β = 5.7; 95% CI: 2.3, 9.1), hours per day spent on social media (β = -1.3; 95% CI: -2.3, -0.3), and the number of friends (β = 0.3; 95% CI: 0.05, 0.5). Finally, resilience was positively associated with life satisfaction and the trust and connections scale (β = 1.8; 95% CI: 0.9, 2.7 and β = 1.8; 95% CI: 0.2, 3.4, respectively).

On-site peer mentorship's effect on personal and professional development, stress reduction, and ease of transition into the medical education system

CONTEXT

Mentorship aids in the transition into the medical education system, which is a demanding and stressful time for learners. The development of new medical schools to offset the physician shortage has posed a challenge in that the inaugural class of students lacks an upperclassman cohort as a resource for advice and mentorship. Mentorship has proven to have positive impacts on three domains: personal and professional development (PPD), stress reduction (SR), and ease of transition (ET) into medical school.

OBJECTIVES

The purpose of this study was to identify sources of mentorship within the medical education system and compare the subjective growth of the inaugural and second classes of a newly established medical school in the three domains.

METHODS

The inaugural and second classes at a newly established medical school completed an Institutional Review Board (IRB)-approved anonymous survey with questions pertaining to unidentifiable demographics, sources of mentorship, and a five-point Likert scale assessing characteristics related to the three domains.

RESULTS

Twenty-three students responded to the survey. The second class (n=9) rated their growth higher in all three domains compared to the inaugural class (n=14). The inaugural class utilized the faculty mentor the most (11/14, 78.6 %). The second class utilized the on-site peer mentor the most (9/9, 100 %). Qualitative data analysis led to the emergence of three themes: (1) students utilizing their faculty mentor had the greatest growth in PPD and ET; (2) students utilizing on-site peer mentorship reporting the greatest growth in SR; and (3) informal peer mentorship utilization correlating with less growth in the three domains.

CONCLUSIONS

Our study demonstrates the profound impact that mentorship has on growth in the three domains regardless of the type of mentorship utilized. The benefits, specifically with regard to SR, of an on-site peer mentorship program may not have been satisfied by other sources of mentorship.

Cognitive empathy variations during internship: a study from Iran

OBJECTIVE

Despite the critical role of empathy in medical students, various studies have provided conflicting evidence regarding changes in empathy during medical study. The present study was designed to investigate changes in cognitive empathy during the internship.

METHOD

A study was conducted at the Afzalipour School of Medicine, Kerman University of Medical Sciences. All medical students at the beginning of their internship were entered the study as a cohort and asked to complete a two-part questionnaire including demographic characteristics and the Persian version of the Jefferson Scale of Empathy-Student Version (JSE-S). The questionnaire was completed again at the end of the internship. Data were analyzed using SPSS software using paired t- test and one-way repeated measures.

RESULTS

A total of 108 interns participated with a mean age of 23.85 ± 1.47 years, and a female majority (61.1%). The mean score of standing in the patient's shoe increased significantly (P < 0.001) during the internship, whereas the mean score of compassionate care decreased (P < 0.001). The overall score of empathy decreased during the internship, but the difference was not statistically significant. (P = 0.105). No statistically significant difference was found in the mean score of empathy and its subscales based on demographic characteristics in the two phases of the study.

CONCLUSION

our results revealed that the level of cognitive empathy in the current study was higher than that in previous studies. The changes were consistent with some studies and contradictory to others. Considering that similar changes were observed in the subgroup analysis, it is necessary to focus more on the factors that cause this feeling to fade during the internship through appropriate assessment and timely intervention.

Diet quality in medical trainees: a cross-sectional assessment comparing medical students and primary care residents using the Rapid Eating Assessment for Participants-shortened version

BACKGROUND

The diet quality of the US population is significantly unhealthy, with critical long-term implications for the nation's health. A few studies have explored diet quality in the future primary care workforce. This cross-sectional study quantifies the diet quality of medical students and primary care residents at a Midwestern college of medicine in the United States.

METHODS

250 medical students and 148 primary care residents were surveyed electronically utilizing the Rapid Eating Assessment for Participants-Shortened Version (REAP-S). The survey consists of 13 questions that can be scored on a scale from 1 to 3, along with 3 questions that are not scored. The average REAP-S score for a US omnivorous diet is 32 (range 13 to 39) with higher scores indicating a higher quality diet. We obtained average REAP-S scores for all respondents and descriptive summary statistics for individual REAP-S items. Students' REAP-S total scores were compared to those of residents and the interaction between student/resident status and BMI category on REAP-S total scores were analyzed using analyses of variance. Differences between students and residents on BMI categories and other outcomes (individual REAP-S items, pandemic dietary and weight changes) were analyzed using Chi-Square Tests of Independence or Fisher's Exact Tests.

RESULTS

Medical students (n = 99; 39.6% response rate) had a significantly higher mean REAP-S score (30.5, SD = 3.9) than primary care residents (n = 72; 49% response rate) (mean = 28.6, SD = 3.9; p = 0.006). Total mean REAP-S scores were significantly higher for those with BMI < 25 (mean = 30.8, SD = 3.7) than for those with BMI > = 25 (mean = 28.3, SD = 4.0; p < 0.001). There was not a statistically significant interaction between role (student vs. resident) and BMI category on total REAP-S scores (p = 0.39). Most respondents (89.3%) indicated that they were willing to improve their diet.

CONCLUSION

Our data suggest that the diet quality of surveyed medical students and primary care residents, as quantified by the REAP-S, is suboptimal. Early detection and improvement of diet quality may be necessary for our medical profession trainees to avert potential long-term adverse cardiometabolic health outcomes, and to optimize the health of our future primary care workforce.

Understanding learners' experiences across three major transitions in undergraduate medical education

BACKGROUND

Medical students in the United States undergo three significant transitions as they progress from pre-clinical to clinical rotations, to acting interns, and ultimately to first-year resident. However, there is limited understanding of whether the factors and strategies that impact these transitions remain consistent or are unique to each individual transition.

METHODS

Qualitative data was collected from three Nominal Group Technique (NGT) sessions held separately for third-year students (M3), fourth-year students (M4), and first-year residents (PGY-1). The participants were asked to share their perceptions on their most recent medical school transition. These responses were independently coded into thematic categories.

RESULTS

The NGT session with M3 students (n = 9) identified 67 transition factors and 64 coping strategies. The M4 (n = 8) session identified 33 transition factors and 72 strategies to manage their transition. The PGY-1 (n = 5) session identified 28 factors and 25 strategies. The coping strategies for each session were categorized into seven themes and the transition factors were assigned to ten thematic categories.

CONCLUSION

Just as each transition is unique, so too are the number and variety of factors and strategies to manage each transition. Despite these differences, the themes of "Professional socialization" and "Prioritization, efficiency, and delegation" emerged as impactful in all three transitions.