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Roze des Ordons AL, Ellaway RH. Storylines of Trauma in Health Professions Education: A Critical Metanarrative Review. TEACHING AND LEARNING IN MEDICINE 2024:1-13. [PMID: 38635478 DOI: 10.1080/10401334.2024.2342443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/29/2024] [Indexed: 04/20/2024]
Abstract
PHENOMENON Learners in medical education are often exposed to content and situations that might be experienced as traumatic, which in turn has both professional and personal implications. The purpose of this study was to synthesize the literature on how trauma has been conceptualized and approached within medical education, and the implications thereof. APPROACH A metanarrative approach was adopted following the RAMESES guidelines. Searches of 7 databases conducted in January 2022 with no date limitations yielded 7,280 articles, of which 50 were identified for inclusion through purposive and theoretical sampling. An additional 5 articles were added from manual searches of reference lists. Iterative readings, interpretive and reflexive analysis, and research team discussions were performed to identify and refine metanarratives. FINDINGS Five metanarratives were identified, including the concept of trauma, the trauma event, the person with trauma, the impact of trauma, and addressing trauma, with each metanarrative encompassing multiple dimensions. A biomedical concept of trauma predominated, with lack of conceptual clarity. Theory was not integrated or developed in the majority of articles reviewed, and context was often ambiguous. Trauma was described in myriad ways among studies. Why certain events were experienced as trauma and the context in which they took place were not well characterized. The impact of trauma was largely concentrated on harmful effects, and manifestations beyond symptoms of post-traumatic stress were often not considered. Furthermore, the dominant focus was on the individual, yet often in a circumscribed way that did not seek to understand the individual experience. In addressing trauma, recommendations were often generic, and earlier research emphasized individually-focused interventions while more recent studies have considered systemic issues. INSIGHTS Multiple dimensions of trauma have been discussed in the medical education literature and from many conceptual standpoints, with biomedical, epidemiologic, and individualized perspectives predominating. Greater precision and clarity in defining and understanding trauma is needed to advance research and theory around trauma in medical education and the associated implications for practice. Exploring trauma from intersectional and collective experiences and impacts of trauma and adapting responses to individual needs offers ways to deepen our understanding of how to better support learners impacted by trauma.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine, Division of Palliative Medicine, Department of Oncology, Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mira JJ, Matarredona V, Tella S, Sousa P, Ribeiro Neves V, Strametz R, López-Pineda A. Unveiling the hidden struggle of healthcare students as second victims through a systematic review. BMC MEDICAL EDUCATION 2024; 24:378. [PMID: 38589877 PMCID: PMC11000311 DOI: 10.1186/s12909-024-05336-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND When healthcare students witness, engage in, or are involved in an adverse event, it often leads to a second victim experience, impacting their mental well-being and influencing their future professional practice. This study aimed to describe the efforts, methods, and outcomes of interventions to help students in healthcare disciplines cope with the emotional experience of being involved in or witnessing a mistake causing harm to a patient during their clerkships or training. METHODS This systematic review followed the PRISMA guidelines and includes the synthesis of eighteen studies, published in diverse languages from 2011 to 2023, identified from the databases MEDLINE, EMBASE, SCOPUS and APS PsycInfo. PICO method was used for constructing a research question and formulating eligibility criteria. The selection process was conducted through Rayyan. Titles and abstracts of were independently screened by two authors. The critical appraisal tools of the Joanna Briggs Institute was used to assess the risk of bias of the included studies. RESULTS A total of 1354 studies were retrieved, 18 met the eligibility criteria. Most studies were conducted in the USA. Various educational interventions along with learning how to prevent mistakes, and resilience training were described. In some cases, this experience contributed to the student personal growth. Psychological support in the aftermath of adverse events was scattered. CONCLUSION Ensuring healthcare students' resilience should be a fundamental part of their training. Interventions to train them to address the second victim phenomenon during their clerkships are scarce, scattered, and do not yield conclusive results on identifying what is most effective and what is not.
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Affiliation(s)
- José Joaquín Mira
- Atenea Research. FISABIO, Alicante, Spain.
- Universidad Miguel Hernández, Elche, Spain.
| | | | - Susanna Tella
- Faculty of Health and Social Care, LAB University of Applied Sciences, Lappeenranta, Finland
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | | | - Reinhard Strametz
- Wiesbaden Institute for Healthcare Economics and Patient Safety (WiHelP), RheinMain UAS, Wiesbaden, Germany
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Cao F, Li J, Xin W, Cai N. Impact of social support on the resilience of youth: mediating effects of coping styles. Front Public Health 2024; 12:1331813. [PMID: 38572006 PMCID: PMC10987842 DOI: 10.3389/fpubh.2024.1331813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
Background Chinese youth are at high risk for depression with a significantly higher detection rate of depression risk than other age groups, which brings about a huge challenge to the mental health work of universities. Developing supportive resources that promote resilience against adverse environmental influences in high-risk groups is quite more urgent than medical treatment for firm diagnoses of mental issues that have developed into depression in the current background. Methods A total of 665 university students in China completed self-reported questionnaires measuring psychological resilience, social support, and coping styles. The structural equation model testing on the goodness of fit of the theoretical framework was first performed. Descriptive statistics and Pearson's correlation analysis among social support, resilience, and coping styles were then conducted. At last, we tested the mediating role of coping styles. Results Social support has a significant positive effect on the psychological resilience of the youth. Mixed coping and immature coping styles have significant negative impacts on both social support and resilience, while mature coping styles have a significant positive effect on social support and resilience. Mature and immature coping styles mediate the association between social support and resilience in youth. Conclusion Based on stress theory, this study explores mechanisms that facilitate the development of resilience in young people with regard to social support and coping styles. The current research depicts an interventional perspective of building a social support network that guides the youth to adopt mature coping styles to enhance their resilience and facilitate their mental health.
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Affiliation(s)
- Fei Cao
- Department of Sociology, School of Law, Jiangnan University, Wuxi, China
| | - Juan Li
- Department of Sociology, School of Law, Jiangnan University, Wuxi, China
| | - Wei Xin
- Department of Medical Psychology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Nan Cai
- Student Mental Health Education and Counseling Center, Xi'an International Studies University, Xi'an, China
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Li H, Upreti T, Do V, Dance E, Lewis M, Jacobson R, Goldberg A. Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. MEDICAL TEACHER 2024; 46:82-101. [PMID: 37405740 DOI: 10.1080/0142159x.2023.2231625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary. METHODS Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed. RESULTS 221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once. CONCLUSIONS Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.
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Affiliation(s)
- Henry Li
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tushar Upreti
- Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
| | - Victor Do
- Department of Pediatrics, Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Erica Dance
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Lewis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ryan Jacobson
- Office of Advocacy and Wellbeing, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
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Krogh TB, Mielke-Christensen A, Madsen MD, Østergaard D, Dieckmann P. Medical students' experiences, perceptions, and management of second victim: an interview study. BMC MEDICAL EDUCATION 2023; 23:786. [PMID: 37875909 PMCID: PMC10598910 DOI: 10.1186/s12909-023-04763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The term second victim describes a healthcare professional who has been involved in an adverse event and feels wounded by the event. The effects of this experience differ. It can present as second victim syndrome, describing a wide range and degree of emotional and behavioural responses. Studies show that medical students can also experience second victim. The aim of this study was to elucidate medical students' experiences, perceptions, and management of second victim and second victim syndrome and to describe possible learning needs around these issues. METHODS Thirteen medical students and two recent medical graduates participated in semi-structured focus group interviews. The interviews lasted 1.5-2 h and were audiotaped, transcribed, and analysed using Braun and Clarke's six-step approach for thematic analysis. RESULTS Four main themes were identified: contributing factors; current coping strategies; perception of own requirements and learning needs; wishes for the future healthcare system. Students' behavioural and emotional response to dilemmas were affected by stakeholders and practices embedded in the healthcare system. Students described patient-injury and unexpected events as triggers for second victim, but also harmful interactions with individuals and feelings of self-blame. Students' coping centred around their network, formal offers, and separation of personal- and work-life. Students sought a clear definition of second victim and a desire for role-models. Students' wished to learn how to handle feeling like a burden to others, managing waiting time after patient complaints, and learning how to help second victims recover. Students emphasized the importance of the healthcare organisation understanding students' needs and providing them relevant support. CONCLUSION Students experience second victim as described in the literature. Students' emotional responses were caused by classical second victim triggers, but also other triggers in the educational environment: harmful interactions and self-blame. Although some triggers differ from the second victim definition, these different triggers should be considered equally serious and acknowledged. We must aim to prepare students for future adverse events and emotional responses. The health organisation and healthcare professionals must support students' mental well-being and contribute to ideal conditions for students' professional development and management of second victim as future physicians.
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Affiliation(s)
- Tobias Browall Krogh
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark.
| | - Anne Mielke-Christensen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
| | - Marlene Dyrløv Madsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
- Department of Quality and Health Technology, University Stavanger, Stavanger, Norway
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
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Newman K, Larson S, Ruble MJ, Thomason Watts M. A Call to Action to Address Well-Being Within Experiential Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100078. [PMID: 37714656 DOI: 10.1016/j.ajpe.2023.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/24/2023] [Accepted: 02/18/2023] [Indexed: 09/17/2023]
Abstract
There is a significant lack of literature exploring or describing pharmacy student well-being during experiential learning even though students spend 30% of their doctor of pharmacy curricula in this environment. Drawing on inspiration from literature describing well-being challenges and solutions for pharmacy residents and other health disciplines, this commentary explores the unique challenges of supporting pharmacy student well-being during experiential education. Approaches for interventions are described along with a call to action for the academy.
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Affiliation(s)
- Kate Newman
- Southern Illinois University Edwardsville, Edwardsville, IL, USA.
| | | | - Melissa J Ruble
- University of South Florida Health, Taneja College of Pharmacy, Tampa, FL, USA
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Kopstick AJ, Sanders BW, Yarris LM, Kelly SP. Preparing for the PICU: A Qualitative Study of Residents as They Prepare for Their First Pediatric Critical Care Rotation. J Pediatr Intensive Care 2023; 12:210-218. [PMID: 37565012 PMCID: PMC10411277 DOI: 10.1055/s-0041-1731431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022] Open
Abstract
Learning critical care medicine in the pediatric intensive care unit (PICU) can be stressful. Through semistructured interviews ( n = 16), this study explored the emotions, perceptions, and motivations of pediatric medicine (PM) and emergency medicine (EM) residents, as they prepared for their first PICU rotation. Qualitative data were collected and analyzed using the grounded theory method. Three resultant themes emerged: (1) residents entered the PICU with a range of intense emotions and heightened expectations; (2) they experienced prior history of psychologically traumatic learning events (adverse learning experiences or ALEs); and (3) informed by ALEs, residents prepared for their rotation by focusing heavily on their most basic level of physiological needs and adopting a survival mindset prior to the start of the rotation. These three themes led to a substantive, or working, theory that ALE-associated events may affect how residents approach upcoming learning opportunities. Consequently, adapting a trauma-informed approach as a component of medical education may improve resident learning experiences in the PICU and beyond.
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Affiliation(s)
- Avi J Kopstick
- Division of Pediatric Critical Care Medicine, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, United States
| | - Benjamin Wilson Sanders
- Division of General Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science Universality, Portland, Oregon, United States
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Lalena M Yarris
- Department of Emergency Medicine, Faculty Development, Oregon Health and Science University, Portland, Oregon, United States
| | - Serena P Kelly
- Division of Pediatric Critical Care Medicine, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, United States
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Soh M, Bunin J, Uijtdehaage S, Artino AR, Barry ES, Durning SJ, Grunberg NE, Landoll RR, Maranich A, Moores LK, Servey J, Torre D, Williams PM, Dong T. Well-being at a Military Medical School and Implications for Military Retention. Mil Med 2023; 188:19-25. [PMID: 37201488 DOI: 10.1093/milmed/usac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student's quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student's likelihood to continue serving in the military and practicing medicine. METHODS In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections-the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions. RESULTS Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to "reconsider" their medical career choice compared to their pre-clerkship student counterparts. "Medicine-oriented" likelihood questions were associated with four unique MSWBI items, whereas "military-oriented" likelihood questions were associated with one unique MSWBI item. CONCLUSION The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine.
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Affiliation(s)
- Michael Soh
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jessica Bunin
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Sebastian Uijtdehaage
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Anthony R Artino
- Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA
| | - Erin S Barry
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Steven J Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Neil E Grunberg
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ryan R Landoll
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ashley Maranich
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Lisa K Moores
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jessica Servey
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Dario Torre
- Department of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Pamela M Williams
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ting Dong
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Stanislawski ER, Saali A, Magill EB, Deshpande R, Kumar V, Chan C, Hurtado A, Charney DS, Ripp J, Katz CL. Longitudinal Mental Health Outcomes of Third-year Medical Students Rotating Through the Wards During COVID-19. Psychiatry Res 2023; 320:115030. [PMID: 36623426 PMCID: PMC9791716 DOI: 10.1016/j.psychres.2022.115030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022]
Abstract
This study investigated third year medical students' psychological well-being during clinical rotations at Mount Sinai hospitals in New York City during the COVID-19 pandemic. All students (n = 147) starting rotations (psychiatry, surgery, obstetrics-gynecology, neurology, pediatrics, and medicine) could participate in quarterly, online, anonymous surveys comprised of validated screeners for: psychological symptoms, risk, coping, and protective factors, demographics, COVID-19 worries, and stressful clerkship-related events. Associations between variables were examined with Chi-squared, Fisher's exact, t-, Wilcoxon Rank Sum, one-way ANOVA, and McNemar tests. Significant univariate predictors of psychological distress were included in stepwise multivariable linear regression models. The baseline survey was completed by 110 (74.8%) students; ninety-two (62.6%) completed at least one other survey. During the year, 68 (73.9%) students screened positive for depression, anxiety, or PTSD. The prevalence of psychiatric symptoms peaked in June 2020 without significant changes in average scores over time. COVID-19 worries decreased over time but did not influence psychological symptoms at year-end. Eighty-three students (90.2%) experienced stressful clerkship-related events, which were traumatic and/or COVID-19-related for 26 (28.3%) and 22 students (24.0%), respectively. Baseline psychological distress, childhood emotional abuse, and resilience predicted depression, anxiety, and/or PTSD by year-end. This study highlights the importance of recognizing psychological distress and implementing interventions to support students' well-being.
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Affiliation(s)
- Emma R. Stanislawski
- Department of Psychiatry, 22 Bramhall Street, Maine Medical Center, Portland, ME, United States of America,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America,Correspondence author
| | - Alexandra Saali
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Elizabeth B. Magill
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Richa Deshpande
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Vedika Kumar
- Department of Psychiatry, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, New York, United States of America
| | - Chi Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America,Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY, United States of America
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Dennis S. Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Jonathan Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Craig L. Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
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Ryan A, Hickey A, Harkin D, Boland F, Collins ME, Doyle F. Professional Identity Formation, Professionalism, Leadership and Resilience (PILLAR) in Medical Students: Methodology and Early Results. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231198921. [PMID: 37692556 PMCID: PMC10483968 DOI: 10.1177/23821205231198921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/13/2023] [Indexed: 09/12/2023]
Abstract
Objectives The fundamental role of medical education is the transformation of students to doctors, through a process of education and professional identity formation (PIF), which can be informed by several educational, behavioural and emotional factors. PIF has been deemed to be of equal importance to the acquisition of clinical knowledge and skills and includes constructs such as professionalism, leadership and resilience. We aimed to assess professional identity formation, professionalism, leadership and resilience (PILLAR) in the junior years of medical school in the 2020/2021 academic year and illustrate the potential role of quantitative assessment to demonstrate progression in these areas. In this research, we provide the methods and baseline results for the PILLAR study. Methods We implemented a compulsory assessment in pre-clinical years of graduate entry and direct entry medicine at the Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland. Validated scales were used to assess students' PILLAR. Descriptive and univariable statistical techniques were used to compare student scores between respective years. Results A total of 1311 students (92% response rate) provided their consent for research. For the psychometric scales, there were no evident trends among the years on these assessment measures. Results indicated significant differences in all measures, however, these did not correspond to ascending years of seniority. Conclusion The PILLAR methodology provides important information on the challenges of quantitatively assessing medical students in the four key areas of PIF, professionalism, leadership, and resilience. Our cross-sectional results point to cohort effects, without the expected progression per year in the cross-sectional data, or suggest that the chosen quantitative measures may be problematic for these constructs in pre-clinical students. Therefore, while we believe that PILLAR has potential as a progress test for these constructs, this will only truly be elucidated by repeated measures of each cohort over time.
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Affiliation(s)
- Aine Ryan
- Centre for Professionalism in Medicine and Health Sciences, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis Harkin
- Centre for Professionalism in Medicine and Health Sciences, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mary E. Collins
- Royal College of Surgeons in Ireland Graduate School of Healthcare Management, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
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Tsang R. Practical Applications of ChatGPT in Undergraduate Medical Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231178449. [PMID: 37255525 PMCID: PMC10226299 DOI: 10.1177/23821205231178449] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
ChatGPT is a chatbot developed by OpenAI that has garnered significant attention for achieving at or near a passing standard on the United States Medical Licensing Exam (USMLE). Currently, researchers and users are exploring ChatGPT's broad range of potential applications in academia, business, programming, and beyond. We attempt outline how ChatGPT may be applied to support undergraduate medical education during the preclinical and clinical years, and highlight possible concerns regarding its use which necessitates the creation of formal policies and training by medical schools.
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Affiliation(s)
- Ricky Tsang
- Department of Medicine, Faculty of Medicine, University of British
Columbia, Vancouver, BC, Canada
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Willms J, McCauley B, Kerr L, Presto P, Arun A, Shah N, Irby K, Strawn M, Kopel J. Case report: Medical student types journals during ketamine infusions for suicidal ideation, treatment-resistant depression, post-traumatic stress disorder, and generalized anxiety disorder. Front Psychiatry 2022; 13:1020214. [PMID: 36620675 PMCID: PMC9811588 DOI: 10.3389/fpsyt.2022.1020214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
Suicide is the most common cause of death in male resident physicians and the second most common cause of death in resident physicians overall. Physicians also experience high rates of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and burnout. These conditions frequently develop during medical school, and threaten not only physicians but the patients they care for. A 30-year-old medical student presented to our clinic with a history of treatment-resistant depression (TRD), generalized anxiety disorder (GAD), PTSD, and 5 years of daily suicidal ideation. Previous treatments included therapy, lifestyle modifications, and various combinations of six antidepressants. These interventions had little effect on the patient's mental health. The patient was treated at our clinic with an 8-month regimen of IV ketamine infusions and ketamine-assisted psychotherapy (KAP). The patient achieved remission from suicidality and PTSD within 1 month; and TRD and GAD within 7 months. The patient's Patient Health Questionnaire (PHQ-9) score decreased from 25 (severe depression) to 1 (not depressed). These findings suggest that ketamine and KAP may represent effective interventions for mental health applications in healthcare professionals. The patient made the unique decision to attempt to type narrative journals during four of his ketamine infusions (doses ranged from 1.8 to 2.1 mg/kg/h IV). The patient successfully typed detailed journals throughout each 1-h ketamine infusion. To our knowledge, these journals represent the first independently typed, first-person, real-time narratives of ketamine-induced non ordinary states of consciousness. The transcripts of these journals may provide useful insights for clinicians, particularly in the context of KAP.
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Affiliation(s)
- Joshua Willms
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Denovo Therapy, Lubbock, TX, United States
- Researchers for Change, Lubbock, TX, United States
| | | | | | - Peyton Presto
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Ankith Arun
- Researchers for Change, Lubbock, TX, United States
| | - Nazeen Shah
- Researchers for Change, Lubbock, TX, United States
| | - Kierra Irby
- Researchers for Change, Lubbock, TX, United States
| | - Megan Strawn
- Researchers for Change, Lubbock, TX, United States
| | - Jonathan Kopel
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX, United States
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13
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Mann A, Fainstad T, Shah P, Dieujuste N, Thurmon K, Dunbar K, Jones C. "We're all going through it": impact of an online group coaching program for medical trainees: a qualitative analysis. BMC MEDICAL EDUCATION 2022; 22:675. [PMID: 36100880 PMCID: PMC9468533 DOI: 10.1186/s12909-022-03729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Trainees in graduate medical education are affected by burnout at disproportionate rates. Trainees experience tremendous growth in clinical skills and reasoning, however little time is dedicated to metacognition to process their experiences or deliberate identity formation to create individualized definitions of success and wellbeing. The purpose of this study was to understand the perspectives and experiences of trainees who participated in a 6-month, web-based, group coaching program for women residents in training. METHODS Better Together Physician Coaching is a six-month, self-paced, online, asynchronous, coaching program with multiple components including live coaching calls, unlimited written coaching, and self-study modules. Semi-structured interviews of seventeen participants of Better Together from twelve GME programs within a single institution in Colorado were conducted from May to June of 2021. All identified as women and had participated in a 6-month coaching program. Both inductive and deductive methods were used in collecting and analyzing the data with an aim to understand learners' perceptions of the coaching program, including "how and why" the coaching program affected training experiences and wellbeing. RESULTS Three main themes emerged as benefits to the coaching program from the data: 1) practicing metacognition as a tool for healthy coping 2) building a sense of community, and 3) the value of a customizable experience. CONCLUSIONS Female trainees who participated in a group coaching program expressed that they found value in learning how to cope with stressors through metacognition-focused coaching. They also described that building a community and being able to customize the experience were positive aspects of the program. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05280964 . Date of registration: March 15th 2022. Retrospectively registered. URL of trial registry record.
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Affiliation(s)
- Adrienne Mann
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Veterans Health Administration, Aurora, CO, USA.
- Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St., Aurora, CO, 80045, USA.
| | - Tyra Fainstad
- Department of Medicine, Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Lowry Internal Medicine, 8101 E Lowry Blvd Ste 120, Denver, CO, 80230, USA.
| | - Pari Shah
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Nathalie Dieujuste
- Adult & Child Consortium for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado, School of Medicine, Aurora, CO, USA
| | - Kerri Thurmon
- Department of Surgery, Division of Urology, Denver Health, Denver, USA
| | - Kimiko Dunbar
- Department of Pediatrics, Division of Hospital Medicine, Children's Hospital, Aurora, USA
| | - Christine Jones
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Veterans Health Administration, Aurora, CO, USA
- Veterans Health Administration, Eastern CO Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA
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14
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Saali A, Stanislawski ER, Kumar V, Chan C, Hurtado A, Pietrzak RH, Charney DS, Ripp J, Katz CL. The Psychiatric Burden on Medical Students in New York City Entering Clinical Clerkships During the COVID-19 Pandemic. Psychiatr Q 2022; 93:419-434. [PMID: 34618278 PMCID: PMC8495188 DOI: 10.1007/s11126-021-09955-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 01/20/2023]
Abstract
For medical students first entering the clinical space in July 2020, the unique challenges related to the coronavirus pandemic threatened to amplify the psychological distress associated with clerkship rotations. This study aimed to characterize the mental health of third-year medical students starting clinical clerkships in the midst of a pandemic by assessing symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) as well as risk, coping, and protective factors associated with psychological outcomes. Of 147 third-year medical students at the Icahn School of Medicine at Mount Sinai in New York City, 110 (75%) participated in this prospective survey-based study with 108 included in the final analysis. 43 (39.8%) respondents screened positive for symptoms of either MDD, GAD, or PTSD. Multiple regression analyses revealed that greater overall symptom severity was associated with more avoidant coping, more traumatic events witnessed, poorer student and leisure functioning, lower trait emotional stability, and lower social support. Worries related to COVID-19 did not significantly influence outcome variables. To better understand the role of the pandemic on psychological outcomes in third-year medical students, additional research should focus on the trajectory of these outcomes over the year during the coronavirus pandemic.
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Affiliation(s)
- Alexandra Saali
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma R Stanislawski
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Psychiatry, Maine Medical Center, Portland, ME, USA.
| | - Vedika Kumar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital, New York, NY, USA
| | - Chi Chan
- Mental Illness Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Ripp
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Craig L Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Risk factors associated with student distress in medical school: Associations with faculty support and availability of wellbeing resources. PLoS One 2022; 17:e0265869. [PMID: 35395007 PMCID: PMC8992977 DOI: 10.1371/journal.pone.0265869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background
It is estimated that over half of medical students experience severe distress, a condition that correlates with low mental quality-of-life, suicidal ideation and serious thoughts of dropping out. While several risk factors for the development of severe distress have been identified, most focus on individual student characteristics. Currently, little is known about the impact medical schools have on student wellbeing.
Methods
Prospective, observational survey study from 2019–2020 from a national cohort of US medical students. Student wellbeing, school characteristics, and wellbeing resource availability was measured with a 30-question electronic survey. Medical student distress was defined as a Medical Student Wellbeing Index (MS-WBI) of ≥4. Risk factors for the development of severe distress were evaluated in a multivariate logistic regression model. The impact of the number of wellbeing resources available on student wellbeing was measured along multiple wellbeing domains. Independent reviewers categorized free text analysis of survey responses about desired wellbeing resources into themes.
Results
A total of 2,984 responses were included in the study, representing 45 unique medical schools. Medical school characteristics independently associated with severe distress included low faculty support (OR 4.24); the absence of mentorship resources (OR 1.63) and the absence of community building programs (OR 1.45) in a multivariate model. Increased availability of wellbeing resources was associated with lower average MS-WBI (4.58 vs. 3.19, p<0;05) and a smaller percentage of students who had taken or considered taking a leave of absence (40% vs. 16%, p<0.05). The resources most desired by students were mental health services and scheduling adjustments.
Conclusions
The majority of medical school characteristic that contribute to student distress are modifiable. Improving faculty support and offering more and varied wellbeing resources may help to mitigate medical student distress. Student feedback is insightful and should be routinely incorporated by schools to guide wellbeing strategies.
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16
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Yin W, Pan Y, Zhou L, Wei Q, Zhang S, Hu H, Lin Q, Pan S, Dai C, Wu J. The relationship between childhood trauma and depressive symptom among Zhuang adolescents: Mediating and moderating effects of cognitive emotion regulation strategies. Front Psychiatry 2022; 13:994065. [PMID: 36147972 PMCID: PMC9485581 DOI: 10.3389/fpsyt.2022.994065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Not all adolescents who have endured childhood trauma will develop depressive symptom, nor will they all experience the same level of depressive symptom. According to previous research, cognitive emotion regulation strategies may explain a portion of the variance. Observe the connection between childhood trauma and depressive symptom and investigate whether cognitive emotion regulation strategies mediate or moderate this association. METHODS In October 2019, a cross-sectional study measuring childhood trauma, cognitive emotion regulation strategies, and depressive symptom among Zhuang adolescents was done in one senior high school and two junior highs in Chongzuo, Guangxi, China, using a self-report questionnaire. To examine the hypothesis of mediating and moderating effects, SPSS PROCESS was utilized. RESULTS In this study, there was a positive relationship between childhood trauma and depressive symptom, whereas there were positive correlations between expressive suppression and childhood trauma and depressive symptom (r = 0.380, 0.246, and 0.089, respectively, p < 0.01). The 5,000-sample bootstrap procedure revealed that the indirect relationship between the independent variable (childhood trauma or emotional abuse) and the dependent variable (depressive symptom) was statistically significant (β = 0.0154 95% CI: 0.0019, 0.0165, β = 0.0442 95% CI: 0.0008, 0.0117). The statistical significance of the interaction effect enhanced the R-square value of the moderating effect when the independent variable was the total childhood trauma score (ΔR2 = 0.0044, 0.0089). CONCLUSIONS Our findings corroborated the conclusion of prior research that cognitive emotion regulation strategies mediate and moderate the development of depressive symptom. Although we demonstrate that cognitive emotion regulation strategies play a mediating and moderating role in the relationships between childhood trauma and depressive symptom, the mediating effects on the relationships between the other types of childhood traumas, including physical abuse and neglect, sexual abuse, emotional neglect, and depressive symptom, did not emerge.
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Affiliation(s)
- Wenwen Yin
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning, China
| | - Yuli Pan
- Department of Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Linhua Zhou
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning, China
| | - Qiaoyue Wei
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning, China
| | - Shengjie Zhang
- Department of Graduate Management, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Hong Hu
- Department of Medical Institution, Guangxi Nanning Fifth People's Hospital, Nanning, China
| | - Qinghong Lin
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning, China
| | - Shuibo Pan
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning, China
| | - Chenyangzi Dai
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning, China
| | - Junduan Wu
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning, China.,Department of School of Public Health, Guangxi Medical College, Nanning, China
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17
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Alexander NL, Sheu JC, Villagran AM, Guerrini CJ, Storch EA. Impact of the Texas-Wide Premedical Mentoring Program during the COVID-19 pandemic. Proc AMIA Symp 2022; 35:35-42. [PMID: 34970029 DOI: 10.1080/08998280.2021.1980357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The COVID-19 pandemic disrupted the usual processes and support systems related to applying to medical school in the United States. The Texas-Wide Premedical Mentoring Program (TPMP) was established to pair medical student mentors in Texas with medical school applicants attending Texas colleges and universities. Our objective was to demonstrate the effect of the TPMP on application preparedness and self-reported mental health outcomes of program participants. A survey was developed to understand the program's impact on both mentees and mentors. Participants were sent a survey link 3 months after the TPMP launch. In total, 313 participants, comprising 62% premedical student mentees and 38% medical student mentors, completed the survey. Mentees reported a significantly positive effect of the program on anxiety, uncertainty of acceptance, connection to medicine, and making the road to medical school seem less impossible. After participation, mentees felt less alone and reported a positive impact on their perception of the application process. The TPMP positively impacted the mental wellness of both mentees and mentors, and about 80% of mentors felt more fulfilled despite not participating in clinical duties in light of suspensions. In conclusion, program participation was associated with decreasing application knowledge gaps, easing anxiety, and providing alliance for mentees. The TPMP had a similarly positive influence on the mental wellness of mentees and mentors as well as contributed to medical student mentors' sense of fulfillment.
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Affiliation(s)
| | | | | | - Christi J Guerrini
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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18
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Kiesewetter J, Huber J. A primer of an in-depth resilience status for German medical graduates: results of a cross-sectional survey on the status quo of resilience among graduates of human medicine in Bavaria, Germany - a necessary step in building an emotionally equipped healthcare work-force. BMC MEDICAL EDUCATION 2021; 21:573. [PMID: 34772423 PMCID: PMC8588593 DOI: 10.1186/s12909-021-02933-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Resilience is a widely-used catchword in the last couple of years to describe the resistance to psychological strains of life, especially for the healthcare work-force. The promises of resilience to burnout sound great and what we all would want: less health impairment despite stress, higher work satisfaction and last but not least higher work performance. There is research that shows that students and physicians have high emotional distress and low resilience, yet comparably little is known which aspects of resilience are exactly impaired in the upcoming work-force. With our study we investigated the in-depth resilience status of medical graduates from five medical schools within their first year after graduation. In this, additionally to assessing the resilience status as a whole we investigate the answers on the singular items and the relationship of the resilience status with neighboring constructs. METHODS In 2018, 1610 human medical graduates from five Bavarian medical schools were asked to take part at cross-sectional Bavarian graduate survey (Bayerische Absolventenstudie Medizin, MediBAS). The response rate was 38,07, 60% of the participants were female. For the identification of the in-depth resilience status we included the 5-point Likert 10-Item Connor-Davidson Resilience Scale, German Version in a graduate survey posted to 5 medical schools and over 1610 eligible participants of whom 610 (60% female) filled out at least parts of the survey. To identify relationships to other aspects we posed further questionnaires. RESULTS The resilience status showed a mean resilience score of M = 37.1 (SD = 6.30). The score ranges from 3.22 (I am not easily discouraged by failure) to 4.26 (I am able to adapt to change). One third of the participants chose not to answer the item "I am able to handle unpleasant feeling". Relationships to job satisfaction, scientific competence and stress are presented in the article. CONCLUSIONS The study shows that the overall resilience status of medical graduates one year after their graduation is rather high, but subjectively they do not feel equivalently resilient for the different aspects they face in their job. Especially, how to handle their emotions seems to be challenging for some of the young physicians. In the article we sketch ideas how to handle the specific training needs the study has identified.
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Affiliation(s)
- J Kiesewetter
- Institut für Didaktik und Ausbildungsforschung in der Medizin am Klinikum der LMU München, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, Munich, Germany.
| | - J Huber
- Institut für Didaktik und Ausbildungsforschung in der Medizin am Klinikum der LMU München, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, Munich, Germany
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19
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Nolan HA, Roberts L. Medical educators' views and experiences of trigger warnings in teaching sensitive content. MEDICAL EDUCATION 2021; 55:1273-1283. [PMID: 34060096 DOI: 10.1111/medu.14576] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Trigger warnings-prior notification of topics so recipients may prepare for ensuing distress-are encountered widely in contemporary culture. Students at some universities have expressed expectations for trigger warnings. Medical education routinely exposes students to numerous potentially distressing topics. However, this topic remains understudied in medical education. Little is understood about educators' views or practice relating to warnings in the context of medical education. METHODS Twenty medical educators from a medical degree programme in the UK participated in a semi-structured qualitative interview study, exploring medical educators' views and experiences of managing distressing situations and, specifically, their use of warnings. We analysed interview transcripts by thematic coding and identified themes. RESULTS Analysis identified themes relating to educators' conceptualisation of trigger warnings and rationale for use, concerns about the use of warnings and the critical purpose of medical school in ensuring preparedness for clinical practice. Participants shared that warnings were given to empower students in approaching distressing topics and to enable engagement with learning. Warnings acknowledged that some experiences would be distressing and normalised and signalled acceptability of emotional responses. Decisions to use warnings were influenced by the nature of content and, reactively, in response to experiences of student distress. Terminology regarding trigger warnings was interpreted varyingly by participants. A broad variety of topics were identified as potentially sensitive. A number of concerns were noted regarding the use of warnings. DISCUSSION Warnings alone did not fulfil educators' responsibility in supporting students' professional development, but may be a useful adjunct, signalling that self-care is valued and should be prioritised. Despite frequent use of warnings, individual educator practice was shaped by varying rationale. A framework that addresses competing tensions of preventing distress and supporting professional development is needed as part of a trauma-informed approach to medical education.
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Affiliation(s)
| | - Lesley Roberts
- Warwick Medical School, University of Warwick, Coventry, UK
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20
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Gidi NW, Horesa A, Jarso H, Tesfaye W, Tucho GT, Abera M, Abafita J. Prevalence of Low Self-esteem and Mental Distress among Undergraduate Medical Students in Jimma University: A Cross-Sectional Study. Ethiop J Health Sci 2021; 31:573-580. [PMID: 34483614 PMCID: PMC8365492 DOI: 10.4314/ejhs.v31i3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background Medical students often experience chronic stress. Self-esteem is one of the most important factors in the process of psychosocial growth and has remarkable effect on thoughts, feelings, values, and goals. The aim of this study was to assess the prevalence and associated factors of low self-esteem (LSE) and mental distress among Medical Students of Jimma University. Method This cross-sectional study was conducted in Jimma University from June to July, 2018. Self-esteem was measured with Rosenberg self-esteem scale. Self-administered Short form with General Health Questionnaire was used to assess presence of mental distress. Result Out of 422 students enrolled to the study, 279 (66.1%) were male, and 413 (97.9 %) were 18 to 25 years of age. The prevalence of LSE and mental distress were 19.0%, and 19.7 %, respectively. Students who had LSE had 5 times higher risk of having mental distress, AOR= 5.1 (95% CI, 2.9-8.9). Moreover, female students had higher risk of developing mental distress (AOR=1.9, 95% CI, 1.1-3.3). Students who had poor social support were 4.3 times at higher risk of developing LSE, AOR=4.3 (95% CI, 1.9-9.8). Those who reported to have poor academic performance were also more likely to have LSE AOR= 3.7 (95% CI, 1.3-10.0). Conclusion One in five medical students had LSE and it is strongly associated with metal distress. Female students were at higher risk of mental distress. Preventive, curative and rehabilitative mental health services should be available for medical students with particular attention to those with poor social support.
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Affiliation(s)
| | - Ararsa Horesa
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Habtemu Jarso
- Department of Epidemiology, Jimma University, Jimma, Ethiopia
| | - Workineh Tesfaye
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Gudina Terefe Tucho
- Department of Environmental health sciences and technology, Jimma University, Jimma, Ethiopia
| | - Mubarek Abera
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Jemal Abafita
- Department of Economics, Jimma University, Jimma, Ethiopia
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Henning MA, Stonyer J, Chen Y, Hove BAT, Moir F, Webster CS. Medical Students' Experience of Harassment and Its Impact on Quality of Life: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2021; 31:1487-1499. [PMID: 34457988 PMCID: PMC8368306 DOI: 10.1007/s40670-021-01301-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Medical students' experiences of harassment and its influence on quality of life were examined. DESIGN A set of databases were employed in this review, and using ATLAS.ti, a set of emergent themes were identified. RESULTS The initial search identified 4580 potential articles for review. The inclusion and exclusion criteria reduced the list to 48 articles. Two predominant emergent themes were categorised as 'Antecedents' of 'harassment' and 'Consequences' on quality of life. CONCLUSIONS Harassment likely has an adverse impact on quality of life, although more empirical research is required to establish more definitive links between the two variables.
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Affiliation(s)
- Marcus A. Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Building 507, Grafton, Auckland, 1023 New Zealand
| | - Josephine Stonyer
- School of Medicine, University of Auckland, Grafton, Auckland, 1023 New Zealand
| | - Yan Chen
- Centre for Medical and Health Sciences Education, University of Auckland, Building 507, Grafton, Auckland, 1023 New Zealand
| | | | - Fiona Moir
- Department of General Practice and Primary Healthcare, Population Health, University of Auckland, Grafton, Auckland, 1023 New Zealand
| | - Craig S. Webster
- Centre for Medical and Health Sciences Education, University of Auckland, Building 507, Grafton, Auckland, 1023 New Zealand
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22
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Dyrbye LN, West CP, Herrin J, Dovidio J, Cunningham B, Yeazel M, Lam V, Onyeador IN, Wittlin NM, Burke SE, Hayes SN, Phelan SM, van Ryn M. A Longitudinal Study Exploring Learning Environment Culture and Subsequent Risk of Burnout Among Resident Physicians Overall and by Gender. Mayo Clin Proc 2021; 96:2168-2183. [PMID: 34218879 DOI: 10.1016/j.mayocp.2020.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore the relationship between learning environment culture and the subsequent risk of developing burnout in a national sample of residents overall and by gender. METHODS From April 7 to August 2, 2016, and May 26 to August 5, 2017, we surveyed residents in their second (R2) and third (R3) postgraduate year. The survey included a negative interpersonal experiences scale (score range 1 to 7 points, higher being worse) assessing psychological safety and bias, inclusion, respect, and justice; an unfair treatment scale (score range 1 to 5 points, higher being worse), and two items from the Maslach Burnout Inventory. Individual responses to the R2 and R3 surveys were linked. RESULTS The R2 survey was completed by 3588 of 4696 (76.4%) residents; 3058 of 3726 (82.1%) residents completed the R3 survey; and 2888 residents completed both surveys. Women reported more negative interpersonal experiences (mean [SD], 3.00 [0.83] vs 2.90 [0.85], P<.001) and unfair treatment (66.5% vs. 58.7%, P<.001) than men at R2. On multivariable analysis, women at R3 were more likely than their male counterparts to have burnout (odds ratio, 1.23; 95% CI, 1.02 to 1.48; P=.03). Both men and women who reported more negative interpersonal experiences at R2 were more likely to have burnout at R3 (odds ratio, 1.32; 95% CI, 1.14 to 1.52; P<.001). The factors contributing to burnout did not vary in effect magnitude by gender. CONCLUSION These findings indicate women residents are more likely to have burnout relative to men in the third year of residency. Negative culture predicted subsequent burnout 1 year later among both men and women. Differences in burnout were at least partly due to differing levels of exposure to negative interactions for men versus women rather than a negative interaction having a differential impact on the well-being of men versus women.
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Affiliation(s)
- Liselotte N Dyrbye
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Colin P West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jeph Herrin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | | | - Brooke Cunningham
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Mark Yeazel
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Ivuoma N Onyeador
- Department of Management and Organizations, Kellogg School of Management, Northwestern University, Kirkland, WA
| | | | - Sara E Burke
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sean M Phelan
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, Portland, OR
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Nikolis L, Wakim A, Adams W, DO PB. Medical student wellness in the United States during the COVID-19 pandemic: a nationwide survey. BMC MEDICAL EDUCATION 2021; 21:401. [PMID: 34311722 PMCID: PMC8312706 DOI: 10.1186/s12909-021-02837-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/15/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND As United States (US) medical students suffer higher rates of depression and anxiety than the general population, the wellness of medical students is particularly salient. One definition describes wellness as having eight dimensions: Intellectual, emotional, physical, social, occupational, financial, environmental, and spiritual. As the coronavirus (COVID-19) pandemic poses unique challenges for medical students, we aimed to compare medical student wellness before and during the COVID-19 pandemic. METHODS An informal survey was created to assess eight wellness dimensions and was distributed via Survey Monkey to US allopathic and osteopathic medical students via email and social media. The survey was administered from March 29, 2020 to June 23, 2020. Univariable and multivariable linear mixed-effects models were used to estimate the change in students' overall wellness using an 11-point scale ranging from 0 (least well) to 10 (most well). Generalized estimating equations were used to estimate the change in students' responses to the eight dimensions before and during the COVID-19 pandemic. RESULTS On multivariable analysis, students reported a decline in their overall wellness during COVID-19 (Mdiff = -1.08; p < .001). Asian respondents reported little change in overall wellness (M = -0.65) when compared to White respondents (M = -1.16) and Black respondents (M = -1.57). Students felt less supported and comfortable with their social (OR = 0.47) and daily (OR = 0.45) environments and expressed decreased satisfaction with their exercise (OR = 0.85), sense of purpose (OR = 0.33), and financial status (OR = 0.75). Students also expressed lower confidence (OR = 0.15) and satisfaction (OR = 0.11) with their medical education and increased anxiety (OR = 3.37) and depression (OR = 2.05). CONCLUSIONS Medical students reported declines in overall wellness and individual wellness dimensions. These findings can be used to implement changes to improve medical student wellness.
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Affiliation(s)
- Louis Nikolis
- Loyola University Chicago Stritch School of Medicine, 2160 South First Avenue, 60153, Maywood, Illinois, USA
| | - Andrea Wakim
- Loyola University Chicago Stritch School of Medicine, 2160 South First Avenue, 60153, Maywood, Illinois, USA
| | - William Adams
- Departments of Medical Education and Public Health Sciences, Chicago Health Sciences Division, Loyola University, 2160 South First Avenue, 60153, Maywood, Illinois, USA
| | - Prempreet Bajaj DO
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, 60153, Maywood, Illinois, USA.
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Yau BN, Chen AS, Montgomery KB, Dubuque N, McDowelle DM. An Internal Perspective: the Psychological Impact of Mistreatment. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:308-314. [PMID: 33709287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Student mistreatment remains a prominent issue in medical education. Mistreatment has been linked to negative mental health outcomes, including depression, anxiety, and burnout. Continued challenges in this arena include difficulties in identifying mistreatment and underreporting. The objective of this study was to better understand the nuances of individual students' reactions to mistreatment. METHODS Medical students, who had experienced mistreatment, were invited to participate in this study. Individual, semi-structured, peer-to-peer interviews were conducted with 21 students. Interview transcriptions were coded using grounded theory and inductive analysis, and themes were extracted. RESULTS The interviews generated 34 unique mistreatment incidents. Four major themes arose in students' reactions to mistreatment. (1) Descriptions-the student described the incident as inappropriate, unusual, or unnecessary. (2) Recognition-most students did not immediately recognize the incident as mistreatment. (3) Emotions-the student described negative emotions (negative self-views, anger, powerlessness, shock, discomfort) associated with the mistreatment incident. (4) Coping mechanisms-the student utilized avoidance and rationalization to process their mistreatment. CONCLUSIONS Mistreatment generates complex emotions and coping mechanisms that impair the learning process. These complex emotions and coping mechanisms also make it difficult for trainees to identify mistreatment and to feel safe to report. Increasing understanding of the psychological impact of mistreatment can help peers and educators better screen for mistreatment in trainees and guide them in reporting decisions.
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Affiliation(s)
- Bernice N Yau
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Effects of polygenic risk score, childhood trauma and resilience on depressive symptoms in Chinese adolescents in a three-year cohort study. J Affect Disord 2021; 282:627-636. [PMID: 33445085 DOI: 10.1016/j.jad.2020.12.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/27/2020] [Accepted: 12/24/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Polygenic risk score (PRS) is a method of revealing multiple genes effect. The study of PRS and childhood trauma (CT) and resilience on adolescent depressive symptoms are fewer reported, especially the functional mechanism of resilience among them. METHODS 718 Chinese adolescents aged 10-14 years were surveyed including CT, resilience, depressive symptoms, and phenotype data in three years of the cohort study. PRS was calculated by the weighted accumulation effects of alleles on depressive symptoms. Their relationships were analyzed by the mediation and moderation models. RESULTS PRS and CT were risk factors for depressive symptoms. Interaction (PRS × CT) on depressive symptoms had no statistical significance. Resilience acted as the protective mediator from CT (emotional abuse, emotional neglect, physical neglect) to depressive symptoms and moderator from CT (emotional abuse) to depressive symptoms. LIMITATIONS The sample size was a little small so that the inference were drawn prudently. Except gene data, other were collected by self-reported questionnaire instruments which inevitably brought recall bias. CONCLUSIONS PRS and CT could have adverse impact on depressive symptoms, resilience could alleviate these risk effects as a moderator and a mediator. The findings have important implications for prevention and intervention in adolescent depressive symptoms.
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Cheung EO, Kwok I, Ludwig AB, Burton W, Wang X, Basti N, Addington EL, Maletich C, Moskowitz JT. Development of a Positive Psychology Program (LAVENDER) for Preserving Medical Student Well-being: A Single-Arm Pilot Study. Glob Adv Health Med 2021; 10:2164956120988481. [PMID: 33614252 PMCID: PMC7868853 DOI: 10.1177/2164956120988481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/15/2020] [Accepted: 12/23/2020] [Indexed: 12/30/2022] Open
Abstract
Background Mental health tends to worsen over the course of medical school, with steep declines in well-being in students' clerkship year (M3). Positive emotion promotes adaptive coping to stress and may help preserve medical student well-being. Objective This study describes the development of LAVENDER (Leveraging Affect and Valuing Empathy for Nurturing Doctors' Emotional Resilience), a program aimed at increasing positive emotion to preserve well-being in medical students. Methods We conducted a single-arm pilot of LAVENDER, a positive psychology intervention developed for medical students delivered in an interactive classroom format to a cohort of 157 third-year medical students at the Albert Einstein College of Medicine. Our primary outcome was the acceptability of LAVENDER. We also examined preliminary efficacy using measures of emotion, stress and burnout collected at each intervention session. Results LAVENDER showed good acceptability: 76% of participants agreed that the LAVENDER skills were useful and 72% agreed that they would recommend the LAVENDER program to others. Qualitative feedback suggested that medical students enjoyed the program and found the skills to be useful for coping with stress, but also reported the following barriers to engagement: lack of time to practice the skills, resistance to the mandatory nature of the wellness sessions, and difficulty integrating the skills in daily life. We did not find support for the preliminary efficacy of LAVENDER for improving medical student well-being in students' clerkship year. Participants showed decreases in positive emotion and increases in symptoms of burnout over the intervention period (ps < .01). Conclusion The current paper describes the development and a single-arm pilot test of LAVENDER, a positive psychology program tailored for medical students. Although we found preliminary evidence for the acceptability of LAVENDER, we did not find support for the preliminary efficacy. Lessons learned and next steps for the program are discussed.
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Affiliation(s)
- Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Osher Center for Integrative Medicine, Northwestern Medicine, Chicago, Illinois
| | - Ian Kwok
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Allison B Ludwig
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York City, New York
| | - William Burton
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York City, New York
| | - Xinzi Wang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Neha Basti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Osher Center for Integrative Medicine, Northwestern Medicine, Chicago, Illinois
| | - Carly Maletich
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Osher Center for Integrative Medicine, Northwestern Medicine, Chicago, Illinois
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Ueno T, Ito K, Murai T, Fujiwara H. Mental Health Problems and Their Association With Internet Use in Medical Residents. Front Public Health 2020; 8:587390. [PMID: 33194994 PMCID: PMC7641600 DOI: 10.3389/fpubh.2020.587390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/16/2020] [Indexed: 12/22/2022] Open
Abstract
Objectives: Mental health problems (MHP) among medical residents are often found in clinical settings and sometimes lead to professional lapses. Evidence suggests that excessive Internet use is associated with MHP. We investigated the MHP of residents (depression, anxiety, and self-esteem) and their association with Internet use using a longitudinal design. Methods: Participants were 208 residents. The General Health Questionnaire (GHQ), Patient Health Questionnaire (PHQ), and the Rosenberg Self-Esteem Scale (RSES) were used to assess anxiety, depression, and self-esteem. The Generalized Problematic Internet Use Scale 2 (GPIUS2) was used to measure Internet use. Data were obtained twice, at baseline and 3 months later when the risk of MHP in residency is highest. Results: Residents with MHP (N = 36) had higher GHQ scores than those without MHP (N = 172) at follow-up. Residents with MHP had more depression and less self-esteem than those without MHP at baseline and follow-up. GPIUS2 total scores, and scores on the subscale preference for online social communication, were higher in residents with MHP. Preference for online social communication at follow-up was positively correlated with depression at baseline and follow-up, and negatively correlated with self-esteem at follow-up. Conclusions: Depression and self-esteem may predict Internet use when the risk of MHP is greatest for residents, indicating potential risks of excessive Internet use or Internet use as a compensatory coping behavior. Together with depression and self-esteem assessment, Internet use may be a useful index of resident mental health.
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Affiliation(s)
- Tsukasa Ueno
- Integrated Clinical Education Center, Kyoto University Hospital, Kyoto, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazushi Ito
- Integrated Clinical Education Center, Kyoto University Hospital, Kyoto, Japan
| | - Toshiya Murai
- Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironobu Fujiwara
- Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Artificial Intelligence Ethics and Society Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
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Margolius SW, Papp KK, Altose MD, Wilson-Delfosse AL. Students perceive skills learned in pre-clerkship PBL valuable in core clinical rotations. MEDICAL TEACHER 2020; 42:902-908. [PMID: 32799598 DOI: 10.1080/0142159x.2020.1762031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose: Problem-based learning (PBL) is an instructional method widely used by medical educators that promotes an environment in which students effectively learn the foundational knowledge and skills that are prerequisites for graduation. This study evaluated medical students' perceptions of the helpfulness of skills acquired in PBL to core clerkship rotations.Methods: A 25-item survey was designed to assess students' perceptions of skills learned in PBL that were helpful on core clerkships and transferable to the clinical setting. A random sample of students with at least 8 months of clerkship experience were invited to complete the survey.Results: Of 68 students, 35 (52%) returned questionnaires. Results suggest a clustering of themes based on their perceived value. Skills learned in PBL that students rated most highly as helpful or very helpful during core clinical rotations include: comfort discussing concepts, identifying key information, presentation skills, interpersonal skills, diagnostic thinking, finding information, self-awareness, and organizing information. Other items rated highly included: forming questions, time management, primary literature (engaging with published original research articles), and leadership. The skills acquired in PBL were associated with multiple competency domains.Conclusions: Although conditions of the pre-clerkship curriculum are substantially different from the learning environment of clerkship rotations, skills learned in PBL are perceived as applicable to authentic clinical training.
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Affiliation(s)
- S W Margolius
- Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - K K Papp
- Department of General Medical Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - M D Altose
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA Ohio
| | - A L Wilson-Delfosse
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Lee SJ, Park CS, Kim BJ, Lee CS, Cha B, Lee YJ, Kim SJ, Hahm JR, Seo JH, Lee D, Seo J, Choi JW. Psychological Development during Medical School Clerkship: Relationship to Resilience. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:418-422. [PMID: 32048174 DOI: 10.1007/s40596-020-01191-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The authors investigated changes in medical students' defenses during clerkship and examined the effects of these changes on students' resilience. METHODS Between 2012 and 2014, all year-2 preclinical students (N = 249) at Gyeongsang National University Medical School were asked to participate. Those who agreed to participate (N = 237) completed the Korean version of the Defense Style Questionnaire (K-DSQ) and the Connor-Davidson resilience scale-10 (CD-RISC-10). After clerkship, students who proceeded to year 4 in 2 years (n = 187 (93 females), aged 24-38 years (mean, 28.9 ± 2.8 years)) completed the K-DSQ, CD-RISC-10, and the Korean version of the Hospital Anxiety and Depression Scale (K-HADS) in September 2014, 2015, and 2016. RESULTS The use of adaptive (W = 11,603.5, p < 0.001, r = 0.39) and self-inhibiting (W = 10,901.5, p < 0.001, r = 0.32) styles increased significantly after clerkship. A multiple linear regression analysis showed that changes in adaptive defense styles (B = 1.336, SE = 0.386, β = 0.218, p = 0.001) during clerkship were significantly related to resilience after adjusting for age, sex, depression, and anxiety. CONCLUSIONS Both positive personality development and maladaptive changes in defenses were evident. An increase in the adaptive defense style score was related to resilience.
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Affiliation(s)
- So-Jin Lee
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Chul-Soo Park
- Gyeongsang National University Hospital, Jinju, Republic of Korea.
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
| | - Bong-Jo Kim
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Cheol-Soon Lee
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Boseok Cha
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Yu-Jin Lee
- Seoul National University Hospital, Seoul, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seog-Ju Kim
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Ryeal Hahm
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ji-Hyun Seo
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Dongyun Lee
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jiyeong Seo
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae-Won Choi
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Lander L, Baxter SL, Cochran GL, Gali HE, Cook K, Hatch T, Taylor R, Awdishu L. Self-Perceptions of Readiness to Use Electronic Health Records Among Medical Students: Survey Study. JMIR MEDICAL EDUCATION 2020; 6:e17585. [PMID: 32442135 PMCID: PMC7320310 DOI: 10.2196/17585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although several national organizations have declared the ability to work with electronic health records (EHRs) as a core competency of medical education, EHR education and use among medical students vary widely. Previous studies have reported EHR tasks performed by medical students, but students' self-perceived readiness and comfort with EHRs are relatively unknown. OBJECTIVE This study aimed to better understand medical students' self-perceived readiness to use EHRs to identify potential curricular gaps and inform future training efforts based on students' perspectives. METHODS The authors deployed a survey investigating self-perceived comfort with EHRs at 2 institutions in the United States in May 2019. Descriptive statistics were generated regarding demographics, comfort level with various EHR-related tasks, and cross-institutional comparisons. We also assessed the impact of extracurricular EHR experience on comfort level. RESULTS In total, 147 medical students responded, of which 80 (54.4%) were female, with equal distribution across all 4 years of training. Overall confidence was generally higher for students with longer extracurricular EHR experience, even when adjusted for age, gender, year of training, and institution. Students were most comfortable with tasks related to looking up information in the EHR and felt less comfortable with tasks related to entering new information and managing medications. Fourth-year students at both schools reported similar levels of comfort with EHR use, despite differences in preclinical EHR training. Open-ended comments emphasized the value of experiential training over didactic formats. CONCLUSIONS Information entry and medication management in the EHR represent areas for future curricular development. Experiential training via extracurricular activities and early clinical exposure may be high-yield approaches to help medical students achieve critical EHR competencies.
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Affiliation(s)
- Lina Lander
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Sally L Baxter
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla, CA, United States
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States
| | - Gary L Cochran
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Helena E Gali
- School of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Kristen Cook
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Thomas Hatch
- Information Services Department, University of California San Diego Health, La Jolla, CA, United States
| | - Regan Taylor
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Linda Awdishu
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, United States
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Castillo-Angeles M, Calvillo-Ortiz R, Barrows C, Chaikof EL, Kent TS. The Learning Environment in Surgery Clerkship: What are Faculty Perceptions? JOURNAL OF SURGICAL EDUCATION 2020; 77:61-68. [PMID: 31375466 DOI: 10.1016/j.jsurg.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/24/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Multiple efforts have sought to improve teaching effectiveness and the learning environment (LE), but prior research has not focused on attending physicians' perceptions of mistreatment or contribution to the LE. The purpose of this study was to assess the perception and role of surgical faculty in the medical student LE. DESIGN A semistructured interview guide was developed using a comprehensive approach including extensive literature search and focus groups. Data were audio-recorded and transcribed verbatim. Content analysis was used to identify emergent themes. SETTING Beth Israel Deaconess Medical Center, an academic tertiary care facility located in Boston, Massachusetts. PARTICIPANTS Fifteen faculty in the Department of Surgery underwent detailed interviews. Participants were selected using purposive-stratified criterion-based sampling. RESULTS Multiple themes emerged: (1) The competing demands on medical student's time are a negative factor in the LE; (2) Faculty expectations conflict with the existing curriculum; (3) Faculty are concerned with the possibility of being reported for providing negative feedback; (4) Faculty remain unfamiliar with policies regarding the LE/mistreatment; (5) A motivated medical student makes the educational interaction more productive independent of specialty of choice. CONCLUSIONS Faculty identified that the most important factors contributing to a negative LE were a mismatch between expectations of medical students and faculty, and the conflict between the current curriculum and the faculty member's perceived ideal educational framework. Importantly, faculties were largely unfamiliar with LE/mistreatment policies and standards. These findings suggest a need for targeted curricula for faculty to raise awareness of components of a positive LE and tools to teach effectively within the contemporary medical school curriculum.
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Affiliation(s)
| | | | - Courtney Barrows
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elliot L Chaikof
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Lin YK, Lin CD, Lin BYJ, Chen DY. Medical students' resilience: a protective role on stress and quality of life in clerkship. BMC MEDICAL EDUCATION 2019; 19:473. [PMID: 31881997 PMCID: PMC6935077 DOI: 10.1186/s12909-019-1912-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/19/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Resilience refers to the ability to be flexible and adaptive in response to challenges. Medical students in clerkship who are transitioning from medical studies to clinical practice face a variety of workplace demands that can lead to negative learning experiences and poor quality of life. This study explored whether medical students' resilience plays a protective role against the stresses incurred during workplace training and on their professional quality of life during clerkships. METHODS This was a 1-year prospective web-based questionnaire study comprising one cohort of medical students in their fifth year who were working as clerks as part of their 6-year medical education programme at one medical school in Taiwan between September 2017 and July 2018. Web-based, validated, structured, self-administered questionnaires were used to measure the students' resilience at the beginning of the clerkship and their perceived training stress (i.e. physical and psychological demands) and professional quality of life (i.e. burnout and compassion satisfaction) at each specialty rotation. Ninety-three medical students who responded to our specialty rotation surveys at least three times in the clerkship were included and hierarchical regressions were performed. RESULTS This study verified the negative effects of medical students' perceived training stress on burnout and compassion satisfaction. However, although the buffering (protective) effects of resilience were observed for physical demands (one key risk factor related to medical students' professional quality of life), this was not the case for psychological demands (another key risk factor). In addition, through the changes in R square (∆R2) values of the hierarchical regression building, our study found that medical students' perceived training stresses played a critical role on explaining their burnout but their resilience on their compassion satisfaction. CONCLUSIONS Medical students' resilience demonstrated a buffering effect on the negative relationship between physical demands and professional quality of life during clerkships. Moreover, different mechanisms (predictive paths) leading to medical students' professional quality of life such as burnout and compassion satisfaction warrant additional studies.
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Affiliation(s)
- Yung Kai Lin
- Surgery Department, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan, Republic of China
- Division of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Der Lin
- School of Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Department of Otolaryngology-Head & Neck Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Blossom Yen-Ju Lin
- Department of Medical Humanities and Social Sciences, School of Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan City, 33302 Taiwan, Republic of China
| | - Der-Yuan Chen
- Center of Rheumatology and Immunology, China Medical University Hospital, Taichung, Taiwan, Republic of China
- College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
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Pradhan A, Buery-Joyner SD, Page-Ramsey S, Bliss S, Craig LB, Everett E, Forstein DA, Graziano S, Hopkins L, McKenzie M, Morgan H, Hampton BS. To the point: undergraduate medical education learner mistreatment issues on the learning environment in the United States. Am J Obstet Gynecol 2019; 221:377-382. [PMID: 31029660 DOI: 10.1016/j.ajog.2019.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/08/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
Abstract
This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is an overview of issues to consider regarding learner mistreatment and its effects on the undergraduate medical education learning environment in the United States. National data from the American Association of Medical Colleges Graduate Questionnaire and local data regarding learner mistreatment provide evidence that the learning environment at most medical schools needs to be improved. The American Association of Medical Colleges' definition of learner mistreatment focuses on active mistreatment, but data on passive mistreatment also contribute to a negative learning environment. The lack of tolerance for active mistreatment issues such as public humiliation and sexual and racial harassment need to be made transparent through institutional and departmental policies. Additionally, reporting mechanisms at both levels need to be created and acted upon. Passive mistreatment issues such as unclear expectations and neglect can also be addressed at institutional and departmental levels through training modules and appropriate communication loops to address these concerns. To fully confront and solve this challenging issue regarding learner mistreatment at the undergraduate medical education level, solutions to need to be implemented for faculty, residents, and students in the institutional, departmental, and clerkship settings.
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Zhu G, Tan TK. Medical student mistreatment by patients in the clinical environment: prevalence and management. Singapore Med J 2019; 60:353-358. [PMID: 31378822 DOI: 10.11622/smedj.2019075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Medical students rely on patients and their families as teachers during the learning journey. However, ill patients and their families may not welcome having students participating in their care, and anecdotal instances of abuse against clinical medical students are not uncommon. We aimed to determine the prevalence of medical student mistreatment by patients and their families and describe students' self-reported responses to such incidents. METHODS An email link to an anonymised electronic survey form was sent to all clinical students (n = 184) at a Singapore medical school. The first part of the survey sought information on whether the student had previous experiences of mistreatment by patients and their families. If so, the frequency of mistreatment, circumstances when mistreatment happened and students' reactions were collected. In the second part, the students were asked if they knew how to handle such mistreatment incidents. RESULTS There were a total of 91 respondents, 14.3% of whom had experienced mistreatment by patients and their families in our institution. One-third of the affected students felt fearful or humiliated. However, the majority chose to be passive by saying nothing or moving away. Less than half of the students knew how to handle such incidents or where to seek help. CONCLUSION Incidents of mistreatment in our school are not uncommon. Our study revealed a need for more clarity and guidance about how students can manage such situations. This is an important topic because such mistreatment is known to inflict emotional disturbance in students. We proposed a workflow to help students deal with mistreatment.
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Affiliation(s)
- Guili Zhu
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Tong Khee Tan
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Gold JA, Hu X, Huang G, Li WZ, Wu YF, Gao S, Liu ZN, Trockel M, Li WZ, Wu YF, Gao S, Liu ZN, Rohrbaugh RM, Wilkins KM. Medical student depression and its correlates across three international medical schools. World J Psychiatry 2019; 9:65-77. [PMID: 31799151 PMCID: PMC6885454 DOI: 10.5498/wjp.v9.i4.65] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/26/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Medical students have high rates of depression, anxiety, and burnout that have been found to affect their empathy, professional behaviors, and performance as a physician. While studies have examined predictors for burnout and depression in the United States (US), no study, to our knowledge, has compared depression in medical students cross-culturally, or has attempted to examine the effect of factors influencing rates including burnout, exercise, stress, unmet mental health needs, and region.
AIM To examine rates of depression in three international cohorts of medical students, and determine variables that may explain these differences.
METHODS Convenience samples of medical students from three countries (US, China, and a Middle Eastern country whose name remains anonymous per request from the school) were surveyed in this observational study. Using the Patient Health Questionnaire-2 (PHQ-2) and a modified Maslach Burnout Inventory, depression and burnout were examined among medical students from the three cohorts (n = 473). Chi-square test and analysis of variance were used to examine differences in demographics, behavioral, and psychological variables across these three schools to identify potentially confounding descriptive characteristics. Analysis of covariance compared depression and the emotional exhaustion component of burnout identified through Principal Component Analysis across countries. Multiple linear regression was used to analyze the impact of demographic, behavioral, and psychological variables on screening positive for depression.
RESULTS Medical students from the Middle Eastern country had the highest rates of positive depression screens (41.1%), defined as a PHQ-2 score of ≥ 3, followed by China (14.1 %), and then the US (3.8%). More students in the Middle Eastern school had unmet mental health needs (50.8%) than at the medical school in China (34.8%) or the school in the US (32.8%) (Pearson chi-square significance < 0.05). Thus, PHQ-2 scores were adjusted for unmet mental health needs; however, the Middle Eastern country continued to have the highest depression. Adjusting for PHQ-2 score, medical students from the US scored the highest on emotional exhaustion (a measure of burnout). Demographic variables did not significantly predict medical student depression; however, lack of exercise, unmet mental health needs, stress, and emotional exhaustion predicted nearly half of depression in these cohorts. In comparison to the US, coming from the Middle Eastern country and China predicted higher levels of depression.
CONCLUSION Depression rates differ in three international cohorts of medical students. Measured factors contributed to some observed differences. Identifying site-specific prevention and intervention strategies in medical student mental health is warranted.
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Affiliation(s)
- Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO 63110, United States
| | - Xinran Hu
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
| | - Gan Huang
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Wan-Zhen Li
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Yi-Fan Wu
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Shan Gao
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Zhe-Ning Liu
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Mickey Trockel
- Department of Psychiatry, Stanford University, Stanford, CA 94305, United States
| | | | | | | | | | - Robert M Rohrbaugh
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
| | - Kirsten M Wilkins
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
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Isaac V, McLachlan CS, Walters L, Greenhill J. Screening for burn-out in Australian medical students undertaking a rural clinical placement. BMJ Open 2019; 9:e029029. [PMID: 31289089 PMCID: PMC6615879 DOI: 10.1136/bmjopen-2019-029029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate Australian medical student burn-out during rural clinical placement. Second, to examine the association between perceived burn-out and rural career intent at the time of finishing their rural placement. DESIGN, SETTINGS AND PARTICIPANTS The 2016 Federation of Rural Australian Medical Educators evaluation survey is a cross-sectional study of medical students from 17 Australian universities. Specifically, those medical students who completed a full academic year or more at a Rural Clinical School (RCS). Responses from 638 medical students from regional Australia were analysed in the study of all eligible 756 medical students (response rate 84.3%). PRIMARY AND SECONDARY OUTCOME MEASURES The primary objective was to determine self-reported burn-out (emotional exhaustion) in rural placements for medical students. Secondary outcome measures were designed to explore interactions with rural practice self-efficacy and rural intentions. Logistic regression models explored factors associated with burn-out. RESULTS 26.5% of students reported experiencing burn-out during a rural placement. Factors associated with burn-out were female gender, rural origin, low preference for RCS, stress in the year prior to a rural clinical placement, perceived social isolation during rural placement and lower rural practice self-efficacy. Burn-out was not associated with rural career intentions. Social isolation and low rural self-efficacy were independently associated with burn-out during rural placement and together explained 10% of variance in burn-out (Model Nagelkerke R2=0.23). CONCLUSION Burn-out during rural placement may be a consequence of stress prior to a medical school placement. Social isolation and rural self-efficacy are amendable factors to mitigate medical student burn-out during rural placements.
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Affiliation(s)
- Vivian Isaac
- Flinders Rural Health South Australia, College of Medicine and Public Health, Flinders University, Renmark, South Australia, Australia
| | - Craig S McLachlan
- School of Health, Torrens University Australia, Sydney, New South Wales, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jennene Greenhill
- Flinders Rural Health South Australia, College of Medicine and Public Health, Flinders University, Renmark, South Australia, Australia
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Dyrbye LN, Sciolla AF, Dekhtyar M, Rajasekaran S, Allgood JA, Rea M, Knight AP, Haywood A, Smith S, Stephens MB. Medical School Strategies to Address Student Well-Being: A National Survey. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:861-868. [PMID: 30681453 DOI: 10.1097/acm.0000000000002611] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE To describe the breadth of strategies U.S. medical schools use to promote medical student well-being. METHOD In October 2016, 32 U.S. medical schools were surveyed about their student well-being initiatives, resources, and infrastructure; grading in preclinical courses; and learning communities. RESULTS Twenty-seven schools (84%) responded. Sixteen (59%) had a student well-being curriculum, with content scheduled during regular curricular hours at most (13/16; 81%). These sessions were held at least monthly (12/16; 75%), and there was a combination of optional and mandatory attendance (9/16; 56%). Most responding schools offered a variety of emotional/spiritual, physical, financial, and social well-being activities. Nearly one-quarter had a specific well-being competency (6/27; 22%). Most schools relied on participation rates (26/27; 96%) and student satisfaction (22/27; 81%) to evaluate effectiveness. Sixteen (59%) assessed student well-being from survey data, and 7 (26%) offered students access to self-assessment tools. Other common elements included an individual dedicated to overseeing student well-being (22/27; 82%), a student well-being committee (22/27; 82%), pass/fail grading in preclinical courses (20/27; 74%), and the presence of learning communities (22/27; 81%). CONCLUSIONS Schools have implemented a broad range of well-being curricula and activities intended to promote self-care, reduce stress, and build social support for medical students, with variable resources, infrastructure, and evaluation. Implementing dedicated well-being competencies and rigorously evaluating their impact would help ensure appropriate allocation of time and resources and determine if well-being strategies are making a difference. Strengthening evaluation is an important next step in alleviating learner distress and ultimately improving student well-being.
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Affiliation(s)
- Liselotte N Dyrbye
- L.N. Dyrbye is professor of medicine and medical education, Program on Physician Well-Being, Department of Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota. A.F. Sciolla is associate professor, University of California, Davis, School of Medicine, Sacramento, California. M. Dekhtyar is research associate, Medical Education Outcomes, American Medical Association, Chicago, Illinois. S. Rajasekaran is professor of pharmacology, Department of Physiological Sciences, and associate dean of academic affairs, Eastern Virginia Medical School, Norfolk, Virginia. J.A. Allgood is associate professor, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona. M. Rea is director of student wellness, University of California, Davis, School of Medicine, Sacramento, California. A.P. Knight is associate dean for student affairs and assistant professor of psychiatry and behavioral sciences, Eastern Virginia Medical School, Norfolk, Virginia. A. Haywood is assistant dean for student affairs, Indiana University School of Medicine, Indianapolis, Indiana. S. Smith is associate dean for student affairs, Dell Medical School, University of Texas at Austin, Austin, Texas. M.B. Stephens is professor of family and community medicine, Penn State College of Medicine, Hershey, Pennsylvania
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Logan AA, DeLisser HM. "Rebuilding what has eroded": a descriptive, survey-based study of near-peer instructors' experiences in a critical pedagogy-based sociomedical course. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:253-262. [PMID: 31118863 PMCID: PMC6504679 DOI: 10.2147/amep.s195864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
Purpose: Near-peer assisted learning has been deployed in numerous settings within medical education with promising results. However, there is very little experience utilizing near-peers in sociomedical or cultural competency training. We recently described a novel model for sociomedical learning based on Introduction to Medicine and Society (IMS), a critical pedagogy-based course at the Perelman School of Medicine at the University of Pennsylvania (PSOM). Near-peer facilitation, by senior medical students, is central to this model. The aim of this descriptive study is to examine how facilitating within this curriculum impacts senior medical students' self-reported attitudes toward course content, medical education, as well as self-care and medical practice. Methods: At the conclusion of the course, near-peer facilitator attitudes were assessed in three key domains through an anonymous survey. Attitudes were rated according to a 5-point Likert scale. Data from subgroups were analyzed using standard two-tailed t-tests. Optional narrative data were also collected. Results: Twenty six of 34 (76%) eligible facilitators completed the survey. Strong majorities of facilitators felt that their experience facilitating IMS had a favorable effect on attitudes related to course content (sociomedical issues and communication skills). A majority also endorsed favorable changes in their attitudes toward teaching and medical education. Large proportions of facilitators endorsed positive changes in a number of domains linked to trainee resilience. Conclusions: Our descriptive data suggest that acting as a near-peer facilitator as a senior medical student within a critical pedagogy-based course could help to fill multiple important curricular gaps at the transition from medical school to residency. Moreover, we find that a sociomedical facilitation experience during this important transition may increase enthusiasm for careers in medical education and undo some of the negative impacts of clinical training during medical school.
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Affiliation(s)
| | - Horace M DeLisser
- Academic Programs Office, Perelman School of School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Castillo-Angeles M, Calvillo-Ortiz R, Acosta D, Watkins AA, Evenson A, Atkins KM, Kent TS. Mistreatment and the Learning Environment: A Mixed Methods Approach to Assess Knowledge and Raise Awareness Amongst Residents. JOURNAL OF SURGICAL EDUCATION 2019; 76:305-314. [PMID: 30318301 DOI: 10.1016/j.jsurg.2018.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/07/2018] [Accepted: 07/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Trainee mistreatment, either intentional or unintentional, negatively affects the learning environment. This study was undertaken to evaluate the impact of an educational intervention about mistreatment and the learning environment on general surgery residents. DESIGN Video-based modules were developed and added to the residency curriculum. Modules provided definitions and examples of active and passive mistreatment and components of positive and negative learning environments. A mixed-methods approach was used to assess the impact of this intervention. Residents completed a previously validated pre and post-test of related knowledge and attitudes (Abuse Sensitivity Questionnaire). Wilcoxon Signed Rank test was used to compare test results. During video-review sessions, discussion was prompted amongst residents using a semistructured interview guide. Immersion crystallization method was used to identify dominant themes. SETTING Beth Israel Deaconess Medical Center, an academic tertiary care facility located in Boston, Massachusetts. PARTICIPANTS All general surgery residents in our institution (n = 58) were invited to complete a survey at 3 time points. RESULTS Fifty-eight residents (55% male) responded to the survey (100% response rate). Mean age was 30.2 year (SD 3.9). Perception of nicknames related to personal identifiers (p = 0.0065) and name-calling (p = 0.02) changed significantly postintervention (Table 1). Regarding standards of behavior, 42 (72.4%) residents considered yelling not to be abusive unless it occurred frequently or constantly; 15 (25.8%) residents considered swearing (not directed at a person) as "not abuse"; 6 (10.3%) considered constructive criticism to be abusive if it was frequent or constant; and 24 (41%) residents feel powerless to intervene in these scenarios. Multiple themes emerged regarding resident-student interactions: (1) resident perception that description of behavior as mistreatment depends on medical student sensitivity; (2) neglect of medical students avoids trouble (e.g., being labeled as active mistreatment); (3) failure to integrate students into the surgical team may occur due to perceived lack of student interest; and (4) communication with the medical student is key. Residents reported that discussion along with video review was more effective than video review alone. CONCLUSIONS The video-based curriculum on mistreatment and the learning environment created awareness amongst residents about this important topic. Knowledge and attitudes about mistreatment changed in some areas postintervention. These findings suggest a need for development of complementary curricula to improve resident awareness and understanding of components of a positive learning environment and definition/examples of mistreatment.
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Affiliation(s)
| | | | - Danilo Acosta
- Department of Obstetrics & Gynecology, Maimonides Medical Center, Brooklyn, New York.
| | - Ammara A Watkins
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Amy Evenson
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Katharyn M Atkins
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Romo-Nava F, Bobadilla-Espinosa RI, Tafoya SA, Guízar-Sánchez DP, Gutiérrez JR, Carriedo P, Heinze G. Major depressive disorder in Mexican medical students and associated factors: A focus on current and past abuse experiences. J Affect Disord 2019; 245:834-840. [PMID: 30699867 DOI: 10.1016/j.jad.2018.11.083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/18/2018] [Accepted: 11/11/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent among medical students (MS). Abuse experiences, as well as stress, are among the factors associated with MDD. However, their association with MDD in MS has been scarcely addressed. METHODS A cross-sectional study design was used to evaluate the association between MDD and possible risk factors, focusing on current and past abuse experiences inside and outside the academic setting in a large representative MS sample (n = 1,068) using self-report instruments to assess MDD (PHQ-9) and perceived academic stress levels during exam season. RESULTS Depressive symptom severity directly correlates with levels of perceived academic stress. The prevalence of MDD was 16.2%. A history of emotional abuse during childhood or adolescence, as well as most types of current abuse were associated with MDD. Multiple logistic regression analysis showed that current emotional abuse outside school had the strongest association with MDD in MS, followed by a personal history of depression and suicide attempt, a family history of depression, and perceived academic stress levels. LIMITATIONS Cross-sectional design, participants represent a specific population, and other variables that could be associated with MDD: comorbid psychiatric disorders, current antidepressant treatment and protective factors (resilience and health-promoting coping strategies) were not evaluated. CONCLUSIONS MDD is strongly associated with several risk factors that include most types of current and past abuse experiences. Timely identification of individuals at-risk will be critical to establish preventive strategies to limit the impact of MDD in MS and offer prompt therapeutic alternatives when needed.
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Affiliation(s)
- Francisco Romo-Nava
- Lindner Center of HOPE Research Institute, Mason, OH, USA; Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Rosa I Bobadilla-Espinosa
- Departamento de Salud Pública de la Universidad Nacional Autónoma de México (UNAM), Unidad de Medicina Familiar No. 1, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Silvia A Tafoya
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Diana P Guízar-Sánchez
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Joaquín R Gutiérrez
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Pilar Carriedo
- Servicios Clínicos, Instituto Nacional de Psiquiatría ``Ramón de la Fuente Muñiz", Ciudad de México, México
| | - Gerhard Heinze
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México; Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México.
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Dyrbye LN, Wittlin NM, Hardeman RR, Yeazel M, Herrin J, Dovidio JF, Burke SE, Cunningham B, Phelan SM, Shanafelt TD, van Ryn M. A Prognostic Index to Identify the Risk of Developing Depression Symptoms Among U.S. Medical Students Derived From a National, Four-Year Longitudinal Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:217-226. [PMID: 30188367 DOI: 10.1097/acm.0000000000002437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To determine baseline individual and school-related factors associated with increased risk of developing depression symptoms by year four (Y4) of medical school, and to develop a prognostic index that stratifies risk of developing depression symptoms (Depression-PI) among medical students. METHOD The authors analyzed data from 3,743 students (79% of 4,732) attending 49 U.S. medical schools who completed baseline (2010) and Y4 (2014) surveys. Surveys included validated scales measuring depression, stress, coping, and social support. The authors collected demographics and school characteristics and conducted multivariate analysis to identify baseline factors independently associated with Y4 depression symptoms. They used these factors to create a prognostic index for developing depression. They randomly divided the data into discovery (n = 2,455) and replication (n = 1,288) datasets and calculated c statistics (c). RESULTS The authors identified eight independent prognostic factors for experiencing depression symptoms during training within the discovery dataset: age; race; ethnicity; tuition; and baseline depression symptoms, stress, coping behaviors, and social support. The Depression-PI stratified four risk groups. Compared with the low risk group, those in the intermediate, high, and very high risk groups had an odds ratio of developing depression of, respectively, 1.75, 3.98, and 9.19 (c = 0.71). The replication dataset confirmed the risk groups. CONCLUSIONS Demographics; tuition; and baseline depression symptoms, stress, coping behaviors, and social support are independently associated with risk of developing depression during training among U.S. medical students. By stratifying students into four risk groups, the Depression-PI may allow for a tiered primary prevention approach.
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Affiliation(s)
- Liselotte N Dyrbye
- L.N. Dyrbye is professor of medicine and medical education, Program on Physician Well-Being, Department of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7820-704X. N.M. Wittlin is PhD student, Department of Psychology, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-0858-3576. R.R. Hardeman is assistant professor, Division of Health Policy and Management, University of Minnesota, School of Public Health, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0003-3913-5933. M. Yeazel is associate professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota. J. Herrin is assistant professor of medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-3671-3622. J.F. Dovidio is Carl Iver Hovland Professor of Psychology and professor of public health, Department of Psychology, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-6110-8344. S.E. Burke is assistant professor, Department of Psychology, Syracuse University, Syracuse, New York; ORCID: https://orcid.org/0000-0002-6952-924X. B. Cunningham is assistant professor of health disparities, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-3205-5538. S.M. Phelan is associate professor of health services research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2091-6297. T.D. Shanafelt is Jeanie and Stewart Ritchie Professor of Medicine and associate dean, Stanford School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-7106-5202. M. van Ryn is Grace Phelps Distinguished Professor, Oregon Health & Science University School of Nursing, Portland, Oregon; ORCID: https://orcid.org/0000-0002-4258-7319
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Hatem DS, Halpin T. Becoming Doctors: Examining Student Narratives to Understand the Process of Professional Identity Formation Within a Learning Community. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519834546. [PMID: 30937388 PMCID: PMC6435868 DOI: 10.1177/2382120519834546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Professional identity formation is a key aim of medical education, yet empiric data on how this forms are limited. METHODS Our study is a qualitative analysis of student reflections written during the final session of our Becoming a Physician curriculum. After reading their medical school admission essay and their class oath, students wrote about a "time, or times during your third year when you felt like a doctor." The reflections were qualitatively analyzed by the evaluation team, looking for themes found in the reflections. RESULTS Narrative themes separated into 4 distinct categories, specifically that performing physician tasks can make one feel like a doctor, demonstrating caring is a fundamental task of doctors, integrating personal ideals with professional values promotes professional identity formation, and the theme of never feeling like a doctor. Subsets of these broad categories provide further insight into individual and integrative tasks. Patients, patient families, and students through their own reflection prompted learners to feel like doctors in 74% of narratives, whereas physicians or the care team did so in 26% of our narratives. CONCLUSION Students are able to reflect on times during their principal clinical year where they feel like doctors, taking a step toward forming a professional identity. Having faculty prompt and support such reflection can help faculty understand the student experience of their principal clinical year and promote professional identity formation.
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Affiliation(s)
- David S Hatem
- Division of General Medicine and Primary Care, University of Massachusetts Medical School, Worcester, MA, USA
| | - Thomas Halpin
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
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Chung MP, Thang CK, Vermillion M, Fried JM, Uijtdehaage S. Exploring medical students' barriers to reporting mistreatment during clerkships: a qualitative study. MEDICAL EDUCATION ONLINE 2018; 23:1478170. [PMID: 29848223 PMCID: PMC5990956 DOI: 10.1080/10872981.2018.1478170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Despite widespread implementation of policies to address mistreatment, the proportion of medical students who experience mistreatment during clinical training is significantly higher than the proportion of students who report mistreatment. Understanding barriers to reporting mistreatment from students' perspectives is needed before effective interventions can be implemented to improve the clinical learning environment. OBJECTIVE We explored medical students' reasons for not reporting perceived mistreatment or abuse experienced during clinical clerkships at the David Geffen School of Medicine at UCLA (DGSOM). DESIGN This was a sequential two-phase qualitative study. In the first phase, we analyzed institutional survey responses to an open-ended questionnaire administered to the DGSOM graduating classes of 2013-2015 asking why students who experienced mistreatment did not seek help or report incidents. In the second phase, we conducted focus group interviews with third- and fourth-year medical students to explore their reasons for not reporting mistreatment. In total, 30 of 362 eligible students participated in five focus groups. On the whole, 63% of focus group participants felt they had experienced mistreatment, of which over half chose not to report to any member of the medical school administration. Transcripts were analyzed via inductive thematic analysis. RESULTS The following major themes emerged: fear of reprisal even in the setting of anonymity; perception that medical culture includes mistreatment; difficulty reporting more subtle forms of mistreatment; incident is not important enough to report; reporting process damages the student-teacher relationship; reporting process is too troublesome; and empathy with the source of mistreatment. Differing perceptions arose as students debated whether or not reporting was beneficial to the clinical learning environment. CONCLUSIONS Multiple complex factors deeply rooted in the culture of medicine, along with negative connotations associated with reporting, prevent students from reporting incidents of mistreatment. Further research is needed to establish interventions that will help identify mistreatment and change the underlying culture.
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Affiliation(s)
- Melody P. Chung
- Deans Office, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christine K. Thang
- Deans Office, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Michelle Vermillion
- Deans Office, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joyce M. Fried
- Deans Office, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- CONTACT Joyce M. Fried
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Peng J, Clarkin C, Doja A. Uncovering cynicism in medical training: a qualitative analysis of medical online discussion forums. BMJ Open 2018; 8:e022883. [PMID: 30341130 PMCID: PMC6196850 DOI: 10.1136/bmjopen-2018-022883] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The development of cynicism in medicine, defined as a decline in empathy and emotional neutralisation during medical training, is a significant concern for medical educators. We sought to use online medical student discussion groups to provide insight into how cynicism in medicine is perceived, the consequences of cynicism on medical trainee development and potential links between the hidden curriculum and cynicism. SETTING Online analysis of discussion topics in Premed101 (Canadian) and Student Doctor Network (American) forums. PARTICIPANTS 511 posts from seven discussion topics were analysed using NVivo 11. Participants in the forums included medical students, residents and practising physicians. METHODS Inductive content analysis was used to develop a data-driven coding scheme that evolved throughout the analysis. Measures were taken to ensure the trustworthiness of findings, including duplicate independent coding of a sub-sample of posts and the maintenance of an audit trail. RESULTS Medical students, residents and practising physicians participating in the discussion forums engaged in discourse about cynicism and highlighted themes of the hidden curriculum resulting in cynicism. These included the progression of cynicism over the course of medical training as a coping mechanism; the development of challenging work environments due to factors such as limited support, hierarchical demands and long work hours; and the challenge of initiating change due to the tolerance of unprofessionalism and the highly stressful nature of medicine. CONCLUSION Our unique study of North American medical discussion posts demonstrates that cynicism develops progressively and is compounded by conflicts between the hidden and formal curriculum. Online discussion groups are a novel resource to provide insight into the culture of medical training.
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Affiliation(s)
- Jenny Peng
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Chantalle Clarkin
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Asif Doja
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Jenkins TM, Kim J, Hu C, Hickernell JC, Watanaskul S, Yoon JD. Stressing the journey: using life stories to study medical student wellbeing. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:767-782. [PMID: 29730708 DOI: 10.1007/s10459-018-9827-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/01/2018] [Indexed: 05/27/2023]
Abstract
While previous studies have considered medical student burnout and resilience at discrete points in students' training, few studies examine how stressors and resilience-building factors can emerge before, and during, medical school. Our study focuses on students' life stories to comprehensively identify factors contributing to student wellbeing. We performed a secondary analysis of life-story interviews with graduating fourth year medical students. These interviews were originally conducted in 2012 as part of the Project on the Good Physician, and then re-analyzed, focusing on student wellbeing. Respondents were encouraged to identify turning points in their life stories. De-identified transcripts were then coded using a consensus-based iterative process. 17 of 21 respondents reported feeling burned out at least once during medical school. Students identified three major stressors: negative role models, difficult rotations, and the United States Medical Licensing Examination Step 1. Two "motivational stressors"-financial concerns and personal life events-emerged as sources of stress that also motivated students to persevere. Finally, students identified four factors-positive role models, support networks, faith and spirituality, and passion-that helped them reframe stressors, making the struggle seem more worthwhile. These findings suggest that a life-story approach can add granularity to current understandings of medical student wellbeing. Initiatives to reduce stress and burnout should extend beyond the immediate medical school context and consider how past challenges might become future sources of resilience. This study also provides an example of secondary analysis of qualitative data, an approach which could be useful to future research in medical education.
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Affiliation(s)
- Tania M Jenkins
- Department of Sociology, Temple University, Room 713 Gladfelter Hall, 1115 Polett Walk, Philadelphia, PA, 19122, USA.
| | - Jenny Kim
- Department of Biological Sciences, University of Chicago, Chicago, IL, USA
| | - Chelsea Hu
- Department of Economics, University of Chicago, Chicago, IL, USA
- Department of Political Science, University of Chicago, Chicago, IL, USA
| | | | - Sarah Watanaskul
- The MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
| | - John D Yoon
- Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
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Johnson L, Malik N, Gafson I, Gostelow N, Kavanagh J, Griffin A, Gishen F. Improving patient safety by enhancing raising concerns at medical school. BMC MEDICAL EDUCATION 2018; 18:171. [PMID: 30055604 PMCID: PMC6064143 DOI: 10.1186/s12909-018-1281-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Doctors and medical students have a professional responsibility to raise concerns. Failure to raise concerns may compromise patient safety. It is widely known that medical students frequently encounter unprofessional behaviours in the workplace, but little is known about the barriers to raising concerns amongst medical students. This paper explores these issues and discusses some innovations in the medical undergraduate curriculum, offering a good practice model for other medical and healthcare curricula. We set out to ascertain the attitudes and experiences of medical students in relation to raising concerns. This data was then used to innovate the raising concerns curriculum, and access to the raising concerns system, in order to fundamentally improve patient safety and experience, as well as the student experience. METHODS The authors conducted a mixed methods quantitative and qualitative research study. Research was based at a UK medical school and involved data collection using an anonymous, voluntary survey emailed to all medical students (n = 363) as well as voluntary attendance focus groups (n = 24) recruited by email. Both tools investigated student attitudes towards raising concerns and explored student ideas for solutions to improving the process. The focus group data was thematically analysed by three researchers. RESULTS The authors identified five key themes which described medical student attitudes towards raising concerns. This article discusses these themes and the resulting work to enhance medical education within the medical school curriculum. CONCLUSIONS More research is needed to further address the barriers that medical students find in raising concerns. However, despite being a single study in one UK medical school, the authors propose some changes which they hope may inspire other educators to build upon their raising concerns curricula to foster more transparent undergraduate cultures and ultimately improve patient experience and safety.
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Affiliation(s)
- Luke Johnson
- University College London Medical School, London, England
| | - Natasha Malik
- University College London Medical School, London, England
| | - Irene Gafson
- University College London Medical School, London, England
| | - Naomi Gostelow
- University College London Medical School, London, England
| | - Jayne Kavanagh
- University College London Medical School, London, England
| | - Ann Griffin
- University College London Medical School, London, England
| | - Faye Gishen
- University College London Medical School, London, England
- Royal Free London NHS Foundation Trust, London, UK
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Candido FJ, Souza R, Stumpf MA, Fernandes LG, Veiga R, Santin M, Kluthcovsky A. The use of drugs and medical students: a literature review. Rev Assoc Med Bras (1992) 2018; 64:462-468. [DOI: 10.1590/1806-9282.64.05.462] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/06/2017] [Indexed: 11/21/2022] Open
Abstract
SUMMARY INTRODUCTION The consumption and abuse of alcohol and other drugs are increasingly present in the lives of university students and may already be considered a public health problem because of the direct impacts on the physical and mental health of these individuals. The requirements of the medical program play a vital role in the increasing rate of drug users. OBJECTIVES To carry out a systematic review of the literature on the use of drugs, licit or not, in Brazilian medical students. METHODS A descriptive-exploratory study, in which the SciELO and MEDLINE databases were used. A total of 99 articles were found, of which 16 were selected for this review. RESULTS Alcohol and tobacco were the most frequently used licit drugs among medical students. The most consumed illicit drugs were marijuana, solvents, “lança-perfume” (ether spray), and anxiolytics. The male genre presented a tendency of consuming more significant amounts of all kinds of drugs, with the exception of tranquilizers. It was found an increasing prevalence of drug consumption in medical students, as the program progressed, which may result from the intrinsic stress from medical school activities. Students who do not use psychoactive drugs are more likely to live with their parents, to disapprove drugs consumption, to practice religious beliefs and to be employed. Conclusion The prevalence of licit and illicit drug use among medical students is high, even though they understand the injuries it may cause.
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Stoffel JM, Cain J. Review of Grit and Resilience Literature within Health Professions Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6150. [PMID: 29606705 PMCID: PMC5869747 DOI: 10.5688/ajpe6150] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/01/2017] [Indexed: 05/11/2023]
Abstract
Objective. To review literature pertaining to grit and resilience in health professions education. Findings. There is significant interest in grit and resilience throughout the health professions, but little has been published with regard to pharmacy. Although there are methodological issues with defining and measuring grit and resilience, several studies have shown relationships between the constructs and personal and academic well-being. Educational interventions aimed at increasing grit and resilience have produced mixed results. Developing protective factors appears to be the most common approach in helping students become more resilient. Summary. Literature pertaining to grit and resilience reveals that the terms are nuanced, complex, and difficult to measure and understand. Regardless, the general characteristics associated with grit and resilience are of interest to educators and warrant further study.
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Affiliation(s)
- Jaclyn M. Stoffel
- Methodist University Hospital – Methodist Le Bonheur Healthcare, Memphis, Tennessee
| | - Jeff Cain
- University of Kentucky College of Pharmacy, Lexington, Kentucky
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Farquhar J, Lie D, Chan A, Ow M, Vidyarthi A. Understanding Medical Students' Experience with Stress and Its Related Constructs: A Focus Group Study from Singapore. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:48-57. [PMID: 28421479 DOI: 10.1007/s40596-017-0703-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE In order to protect medical students from burnout and its untoward psychiatric effects, it is imperative to understand their stress, burnout, coping, and resilience experiences. This study aimed to derive collective definitions from the medical student perspective, to identify common themes of students' experiences, and to distinguish pre-clinical and clinical year students' experiences relating to these four constructs. METHODS The authors conducted focus groups of medical students in Singapore across 4 years using a semi-structured question guide. Participants shared their understanding, experiences, and the relationships between stress, burnout, coping, and resilience. Coders independently evaluated construct definitions and derived common themes through an iterative process, and compared transcripts of pre-clinical and clinical year students to determine differences in experience over time. RESULTS Nine focus groups (54 students, 28 females, mean age 24.3) were conducted. Students identified common definitions for each construct. Nine themes emerged within three domains: (1) relating constructs to personal experience, (2) interrelating stress, burnout, coping, and resilience, and (3) understanding the necessity of stress. Compared to clinical students, pre-clinical students reported theory-based rather than reality-based experiences and exam-induced stress, defined constructs using present rather than future situations, and described constructs as independent rather than interrelated. CONCLUSIONS This sample of medical students in Singapore shares a common understanding of stress, burnout, coping, and resilience, but experiences these uniquely. They perceive a positive role for stress. These findings build upon prior literature, suggesting an interrelationship between stress and its related constructs and adding the novel perspective of students from an Asian country.
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Affiliation(s)
| | - Desiree Lie
- Duke-NUS Medical School, Singapore City, Singapore
| | | | - Mandy Ow
- Duke-NUS Medical School, Singapore City, Singapore
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Farquhar J, Kamei R, Vidyarthi A. Strategies for enhancing medical student resilience: student and faculty member perspectives. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:1-6. [PMID: 29334480 PMCID: PMC5834818 DOI: 10.5116/ijme.5a46.1ccc] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 12/29/2017] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To improve programs aimed to enhance medical student resiliency, we examined both medical student and faculty advisor perspectives on resiliency-building in an Asian medical school. METHODS In two separate focus groups, a convenience sample of 8 MD-PhD students and 8 faculty advisors were asked to identify strategies for enhancing resilience. Using thematic analysis, two researchers independently examined discussion transcripts and field notes and determined themes through a consensus process. They then compared the themes to discern similarities and differences between these groups. RESULTS Themes from the student suggestions for increasing resilience included "Perspective changes with time and experience", "Defining effective advisors," and "Individual paths to resiliency". Faculty-identified themes were "Structured activities to change student perspectives," "Structured teaching of coping strategies", and "Institution-wide social support". Students described themselves as individuals building their own resilience path and preferred advisors who were not also evaluators. Faculty, however, suggested systematic, structural ways to increase resilience. CONCLUSIONS Students and advisors identified some common, and many distinct strategies for enhancing medical student resilience. Student/advisor discrepancies may exemplify a cultural shift in Singapore's medical education climate, where students value increased individualism and autonomy in their education. As medical schools create interventions to enhance resilience and combat potential student burnout, they should consider individually-tailored as well as system-wide programs to best meet the needs of their students and faculty.
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MESH Headings
- Adaptation, Psychological
- Burnout, Professional/epidemiology
- Burnout, Professional/prevention & control
- Burnout, Professional/psychology
- Education, Medical/methods
- Education, Medical/organization & administration
- Education, Medical/statistics & numerical data
- Faculty, Medical/organization & administration
- Faculty, Medical/psychology
- Faculty, Medical/statistics & numerical data
- Humans
- Mentors/psychology
- Mentors/statistics & numerical data
- Perception
- Resilience, Psychological
- Singapore/epidemiology
- Students, Medical/psychology
- Students, Medical/statistics & numerical data
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