"I might not fit that doctor image": Ideal worker norms and women medical students

Risk and protective factors of student burnout among medical students: a multivariate analysis

BACKGROUND

The demanding educational environment requires sustained motivation and resilience, while the intense psychological stress among medical studies increases the risk of depression, anxiety, and burnout. Student burnout is an escalating issue among medical students worldwide, significantly affecting their career success and overall well-being. Understanding these dynamics is crucial for effective burnout prevention strategies. Therefore, this study aims to explore the role of depression, anxiety, academic motivation and resilience in student burnout in a sample of Hungarian medical students.

METHODS

An online survey was conducted among medical students at the University of Szeged, Hungary (N = 214; Mage = 21.82 years; 73.8% female). The survey first collected demographic information, after which participants completed five scales: the Maslach Burnout Inventory Student Survey, the Beck Depression Inventory Short Form, the Spielberger State-Trait Anxiety Inventory, the Academic Motivation Scale, and the Academic Resilience Scale.

RESULTS

Binary logistic regression for emotional exhaustion identified depression (OR = 0.32, p < .001), state anxiety (OR = 0.04, p < .01), and amotivation (OR = 0.19, p < .01) as significant predictors. For cynicism, the final model incorporated state anxiety (OR = 0.05, p < .001), intrinsic motivation through achievement (OR = -0.08, p < .05), external regulation (OR = 0.13 p < .01), and amotivation (OR = 0.41, p < .001). For reduced academic efficacy, depression (OR = 0.15, p < .001), alongside achievement (OR = -0.133, p < .01) and stimulation (OR = -0.10, p < .05) as intrinsic motivations were significant predictors.

CONCLUSIONS

This study reveals a significant prevalence of student burnout among medical students, particularly in clinical years, with emotional exhaustion and cynicism being more prominent. Depression and low motivation were strongly associated with higher student burnout, while intrinsic motivation appeared to protect against reduced academic efficacy. These findings underscore the importance of addressing mental health and fostering resilience to mitigate student burnout during medical training.

Together but separate: a longitudinal study of how spatial context shapes the formation of social ties of women medical students

Developing and maintaining connections with others, or what we refer to as the formation of social ties, may strengthen medical students' sense of belonging in medical school. Social ties play a particularly important role for women medical students as the medical field remains largely dominated by masculine norms. However, forming social ties remains challenging for women in medicine. This study used the COVID-19 pandemic to examine how women medical students navigated the spatial contexts of medical school to form social ties. Using longitudinal qualitative research and narrative inquiry, it describes how 17 women medical students formed social ties during the early stages of COVID-19. Beginning in fall 2020, during the initial two-years of medical school, the participants (1) described how personal ties were deterred from forming in early experiences of medical school; (2) shared experiences that promoted a sense of community bonding during middle and later periods; and (3) expressed limitations of access to the formation of professional ties throughout their initial 2-years. This study has important implications for understanding ways spatial contexts, access to physical connections, and the mental and emotional barriers or pathways play roles in social tie formation for women medical students and how longitudinal qualitative research can narrate these changes through time.

Pushing, standing and bringing to light: How medical trainees conceptualise professional resistance

BACKGROUND

Much of the literature on harm and injustice in medical education focuses on the impact of oppression rather than trainees' efforts to create change. To acknowledge and make visible these efforts, medical education professionals must grasp how trainees perceive resistance and their role in effecting change. Employing functional linguistic and 'everyday' resistance theories, this critical qualitative study aims to understand trainees' conceptions of resistance practices and their representational choices in moments when they talked about and conceptualised resistance.

METHODS

Gathering participants through professional networks and snowball sampling, this study employed in-depth interviews to explore the conceptualisations of resistance among North American medical trainees (9 medical students, 9 residents and fellows). With the use of an applied functional linguistic analysis framework, we analysed the representational metafunction in trainees' conceptualisation of their resistance efforts against social injustice. We began with open coding for 'everyday' acts of resistance and then shifted to focused coding on verbal process types in participants' language to characterise their conceptualisations of resistance.

FINDINGS

Participants conceptualised their resistance practices in three distinct ways: first, an almost physical pushing back, drawing largely on material process types (doing); second, an embodied standing up and being present, based predominantly on material and relational process types (being); and third, an epistemic bringing to light, grounded mostly in mental and verbal process types (thinking). These processes of resistance reflect participants' conceptualisations of their efforts to challenge the status quo around inequity, harm and injustice in medical education.

CONCLUSION

This study builds on resistance literature, offering a potential typology of resistance practices as pushing back, being and bringing to light. Because these are 'everyday' acts of resistance, these are tactics available to everyone, including faculty; we all have the power to resist, whether it is in teaching and learning or interacting with larger structures in medicine.

"I have established this support network": How Chosen Kin Support Women Medical Students During their First Two Years in Medical School

Women medical students experience unique stressors and challenges during medical school related to inherent structural androcentric norms. Through a longitudinal qualitative study of 17 women medical students in their first two years of medical school, we sought to investigate how they navigated their medical school experience. We used a critical lens and narrative inquiry to understand their experiences within the powerful and marginalizing culture of medical school. Our participants identified two essential support groups: those relationships made within, and those sustained outside, medical school. These findings invoked a kinship framework-one where women medical students have a network of chosen kin who provide essential support for them during their first 2 years. The participants' chosen kin within medical school provided support through recognition of one another, belonging by not belonging, being encouraged to reach out, and creating long-term relationships. The chosen kin outside medical school provided support by reminding the student who they are and creating stability. Integrating models of kinship into medical school as practiced by women medical students may have immense value in providing essential supports for medical students, preventing burnout, and changing the culture of care for future physicians that would align recognition and practice of self-care with patient care.

Girls in scrubs: An ethnographic exploration of the clinical learning environment

BACKGROUND

Gender bias is an enduring issue in the medical profession despite women being more represented within medical schools and the health care workforce in numerous countries across the world. There have been frequent calls for further exploration of gender-based discriminations within medical education, owing to its lasting impact on student's professional development and career trajectories. This paper presents an ethnographic exploration of the experiences of female medical students and doctors in the clinical learning environment (CLE), aiming to disrupt the cycle of gender inequity in the clinical workplace.

METHODS

Our research field involved two teaching wards in a Scottish urban hospital, where 120 h of non-participant observations were conducted over 10 months. Combining purposive and convenience sampling, we conducted 36 individual interviews with key informants, which included medical students, foundation doctors, postgraduate trainees, consultant supervisors, and other health care professionals such as nurses and pharmacists. Data was thematically analysed using Bourdieu's theory of social power reproduction. The research team brought diverse professional backgrounds and perspectives to the exploration of data on gendered encounters.

RESULTS

Combining the observational and interview data, five themes were generated, which suggested gender-related differentials in social and cultural capital that the participants acquired in the CLE. Experiences of discriminatory behaviour and stereotypical thought processes impacted the female students' engagement and drive towards learning, implying an adverse influence on habitus. In contrast, the valuable influence of gendered role-models in building confidence and self-efficacy signified a positive transformation of habitus. The research participants displayed considerable internalisation of the gendered processes in the CLE that appeared to be linked to the transient nature of clinical placements.

CONCLUSIONS

This research reveals that despite constituting the majority demographic of medical school, female students struggle to gain social and cultural capital. Gendered hierarchies that structure clinical workplaces disadvantage female students and doctors, and the differential experiences transform their habitus. Based on our theoretically informed investigation, we advocate for role-models given their positive impact on students' and doctors' habitus. Additionally, medical educators may consider extended clinical placements that provide opportunities for female students and early-career doctors to secure social and cultural capital through integrating better in health care teams and building meaningful interprofessional relationships.

Student, Staff and Faculty Experience with a Medical School Racial and Sociopolitical Trauma Protocol: A Mixed Methods Study

Problem: Medical students experience racial and sociopolitical trauma that disrupts their learning and wellbeing. Intervention: University of California, San Francisco (UCSF) School of Medicine students advocated for a systems approach to responding to traumatic events. Students partnered with educators to introduce an innovative protocol that affords short-term flexibility in curricular expectations (e.g., defer attendance, assignments, assessments) to empower students to rest, gather, or pursue community advocacy work. This study explored students' protocol utilization and student, staff, and faculty experience with its implementation. Context: UCSF is a public medical school with a diverse student body. Students raised the need to acknowledge the effects of trauma on their learning and wellbeing. Consequently, students and educators created the UCSF Racial and Sociopolitical Trauma protocol ('protocol') to allow students time-limited flexibility around academic obligations following events anticipated to inflict trauma on a school community level. The protocol affords students space to process events and engage with affected communities while ensuring all students achieve school competencies and graduation requirements. Impact: We conducted a two-phase mixed methods study: (1) retrospective analysis of quantitative data on students' protocol use and (2) focus groups with students, staff, and faculty. We used descriptive statistics to summarize students' protocol use to adjust attendance, assignment submission, and assessments and thematic analysis of focus group data. Across eight protocol activations June 2020 - November 2021, 357 of 664 (54%) students used it for 501 curricular activities: 56% (n = 198) for attendance, 71% (n = 252) for assignments, and 14% (n = 51) for assessments. When deciding to utilize the protocol, student focus group participants considered sources of restoration; impact on their curricular/patient responsibilities; and their identities. The protocol symbolized an institutional value system that made students feel affirmed and staff and faculty proud. Staff and faculty initially faced implementation challenges with questions around how to apply the protocol to curricular components and how it would affect their roles; however, these questions became clearer with each protocol activation. Questions remain regarding how the protocol can be best adapted for the clerkship setting. Lessons Learned: High protocol usage and focus group data confirmed that students found value in the protocol, and staff and faculty felt invested in the protocol mission. This student-initiated intervention supports a cultural shift beyond diversity toward trauma-informed medical education. Partnership among learners and educators can contribute to transforming learning and healthcare environments by enacting systems and structures that enable all learners to thrive.

Past resources, future envisioning, and present positioning: how women who are medical students at one institution draw upon temporal agency for resistance

While women entering medical school are faced with a patriarchal system, they also enter into a community with other women and the potential for resistance. The purpose of this study is to use the theory of temporal agency to explore how first-year medical students who identify as women draw upon past, future, and present agency to resist the patriarchal system of medicine.The data for this study were drawn from the first year (October 2020-April 2021) of a longitudinal project using narrative inquiry to understand the socialization of women students in undergraduate medical education. Fifteen participants performed two interviews and a series of written reflection prompts about their childhood and medical school experiences, each lasting approximately 45 min.Participants' resistance drew on past resources, recognizing themselves as Other, which contributed to categorically locating themselves as part of a broader resisting community, even outside their institution. They also hypothesized future possibilities as part of resistance, either an ideal future where they would exercise power, or an unchanged one and the hypothetical resolutions they would use to manage it. Finally, they contextualized past and future in the present, identifying problems to make strategic decisions and execute actions.Our creative interweaving of the constructs of temporal agency, communal agency, and resistance allows us to paint a nuanced picture of how these women conceive of themselves as part of a larger group of women amidst the hierarchical, patriarchal structures of medical school while, at times, internalizing these hierarchies.

Comparison of medical students' considerations in choosing a specialty: 2020 vs. 2009/10

BACKGROUND

Workforce shortage in healthcare and particularly in physicians poses a threat to healthcare delivery and its quality. In comparison to other OECD countries, Israel currently has a small number of medical graduates relative to its number of physicians, naturally emphasizing the importance of ensuring that this population chooses to remain in medicine. Understanding what is most important to medical students can help improve working conditions in residency. Such information is particularly needed to facilitate policy planning that will encourage the next generation of physicians to specialize in medical fields that are experiencing shortages. We hypothesized that between 2009/2010 and 2020, there were significant changes in medical students' preferences regarding their considerations for choosing a medical specialty.

METHODS

We compared cross-sectional data from questionnaire-based surveys of 5th year medical students performed in 2009-2010 and 2020 at two Israeli universities.

RESULTS

Of the 335 medical students who responded (237 and 98 in 2009/2010 and 2020, respectively) those in 2020 were 2.26 less likely vs. those in 2009/2010, to choose a residency for its high-paying potential (P < 0.05), and had significantly more interest in residencies with greater teaching opportunity (98.8% vs 82.9%, P < 0.05), increased responsibility and chances to make clinical decisions on their own (67.9% vs 51.6%, P < 0.05). Criteria important to both the 2009/2010 and 2020 students were choosing a bedside specialty (70.2%vs 67.9%, NS), and an interesting and challenging specialty (95.2%v s 91.3%, NS).

CONCLUSIONS

These results partially supported our hypothesis that medical students' preferences have changed over the years, though there are fundamental factors that apparently reflect medical students' nature that do not change over time.

Envisioning future roles: How women medical students navigate the figured world of medical school

BACKGROUND

Women medical students experience tensions as they learn to become doctors. These tensions reflect the cultural world of medical school and clinical medicine, spaces that are highly gendered, racist and exclusionary. This study describes how women medical students are envisioning themselves as future doctors during their first 2 years of medical school while experiencing these tensions.

METHODS

Using Figured Worlds theory, this qualitative study focused on four participants from a larger longitudinal study. Each participant was interviewed four times over a 2-year period using narrative methodology and provided multiple written reflections during their first year of medical school. Analysis was performed using deductive methods reflecting Figured Worlds theory.

RESULTS

Participants offered storied experiences about how they understood their place in the figured world, ways they enacted agency and how they responded to contradictions they encountered in medical school as they learned to become doctors. These three findings reflect concepts of Figured Worlds theory: positionality and discourse, power and agency, and improvisation. These findings also illuminate ways women medical students are navigating gendered and hierarchical structures of medical school to reimagine their roles in medicine.

CONCLUSION

Participants' stories illuminate that woman medical students' lived experiences shaped their decision to enter medical school and continue to shape how they navigate their educational experience. These interactions have implications for their future roles as physicians and how medical schools respond to cultures of teaching and learning that may not recognise these students' positionality and potential agency in medical school and clinical medicine.

Redressing injustices: how women students enact agency in undergraduate medical education

This study presents descriptions of epistemic injustice in the experiences of women medical students and provides accounts about how these students worked to redress these injustices. Epistemic injustice is both the immediate discrediting of an individual's knowledge based on their social identity and the act of persistently ignoring possibilities for other ways of knowing. Using critical narrative interviews and personal reflections over an eight-month period, 22 women students during their first year of medical school described instances when their knowledge and experience was discredited and ignored, then the ways they enacted agency to redress these injustices. Participants described three distinct ways they worked to redress injustices: reclaiming why they belong in medicine, speaking up and calling out the curriculum, and uplifting one another. This study has implications for recognizing medical students as whole individuals with lived histories and experiences and advocates for recognizing medical students' perspectives as valuable sources of knowledge.