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Ozone S, Haruta J, Takayashiki A, Maeno T, Maeno T. Three-year evaluation of a program teaching social determinants of health in community-based medical education: a general inductive approach for qualitative data analysis. BMC MEDICAL EDUCATION 2023; 23:332. [PMID: 37173722 PMCID: PMC10176298 DOI: 10.1186/s12909-023-04320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Social determinants of health (SDH) are intricately intertwined with various social and economic factors. Reflection is essential for learning about SDH. However, only a few reports have focused on reflection in SDH programs; most were cross-sectional studies. We aimed to longitudinally evaluate a SDH program in a community-based medical education (CBME) curriculum that we introduced in 2018 based on the level of reflection and content on SDH in students' reports. METHODS Study design: General inductive approach for qualitative data analysis. Education program: A 4-week mandatory clinical clerkship in general medicine and primary care at the University of Tsukuba School of Medicine in Japan was provided to all fifth- and sixth-year medical students. Students underwent a 3-week rotation in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. After a lecture on SDH on the first day, students were instructed to prepare a structural case description based on encounters during the curriculum. On the final day, students shared their experiences in a small group session and submitted a report on SDH. The program was continuously improved and faculty development was provided. STUDY PARTICIPANTS Students who completed the program during October 2018-June 2021. ANALYSIS Levels of reflection were categorized as reflective, analytical, or descriptive. The content was analyzed based on the Solid Facts framework. RESULTS We analyzed 118 reports from 2018-19, 101 reports from 2019-20, and 142 reports from 2020-21. There were 2 (1.7%), 6 (5.9%), and 7 (4.8%) reflective reports; 9 (7.6%), 24 (23.8%), and 52 (35.9%) analytical reports; and 36 (30.5%), 48 (47.5%), and 79 (54.5%) descriptive reports, respectively. The others were not evaluable. The number of Solid Facts framework items in reports were 2.0 ± 1.2, 2.6 ± 1.3, and 3.3 ± 1.4, respectively. CONCLUSIONS Students' understanding of SDH deepened as the SDH program in the CBME curriculum improved. Faculty development might have contributed to the results. Reflective understanding of SDH might require more faculty development and integrated education of social science and medicine.
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Affiliation(s)
- Sachiko Ozone
- Department of Family Medicine, Institute of Medicine, General Practice and Community Health, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Junji Haruta
- Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Ayumi Takayashiki
- Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takami Maeno
- Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Michaeli D, Keough G, Perez-Dominguez F, Polanco-Ilabaca F, Pinto-Toledo F, Michaeli J, Albers S, Achiardi J, Santana V, Urnelli C, Sawaguchi Y, Rodríguez P, Maldonado M, Raffeeq Z, de Araujo Madeiros O, Michaeli T. Medical education and mental health during COVID-19: a survey across 9 countries. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:35-46. [PMID: 35226614 PMCID: PMC9017502 DOI: 10.5116/ijme.6209.10d6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/13/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To investigate students' experience with medical education alongside their mental and physical health since the onset of the COVID-19 pandemic across nine countries. METHODS A cross-sectional online survey was distributed by local collaborators to 2,280 medical students across 148 medical schools in Brazil, Chile, Colombia, Germany, Italy, Japan, Mexico, Spain, and Venezuela using non-probability convenience sampling from June 22 to July 24, 2020. Students answered questions regarding teaching, internet use, COVID-19, physical and mental well-being. A multivariate logistic regression examined factors associated with depressed mood, insomnia, and headache. RESULTS Academic teaching shifted to a virtual (67%, n=1,534) or hybrid environment (23%, n=531), whilst bedside teaching was suspended or cancelled (93%, n=2,120). Across all countries students were equally satisfied with the teaching modality, quantity, quality, and the evaluation system of in-person, hybrid, and online curricula. Negative changes in mental (40% (n=912) insomnia, 57% (n=1,300) emotional irritability, 47% (n=1,072) emotional instability, 41% (n=935) anhedonia, 40% (n=912) depressed mood) and physical (36% (n=821) headache, 57% (n=1,299) ocular tiredness, 49% (n=1,117) backache) health symptoms were frequently observed. Positive associations between the number of daily screen hours and depressed mood (adjusted odds ratio (AOR)=1.09, 95%CI: 1.05-1.12, p<.001), insomnia (AOR=1.08, 95%CI: 1.05-1.11, p<.001), and headache (AOR=1.11, 95%CI: 1.07-1.14, p<.001) were identified. CONCLUSIONS Students' experience with digital and hybrid medical curricula was diverse during the pandemic. Education modality, quantity, and quality were positively evaluated. However, students' mental and physical health worsened. Besides bedside teaching, faculties ought to digitalize and strengthen social communities and extend support services for students.
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Affiliation(s)
- Daniel Michaeli
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Gregory Keough
- Department of Health Policy, London School of Economics and Political Sciences, London, United Kingdom
| | | | | | - Fernanda Pinto-Toledo
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Julia Michaeli
- Department of Obstetrics and Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
| | - Sebastian Albers
- Department of Orthopedic Surgery, ATOS Klinik Fleetinsel Hamburg, Hamburg, Germany
| | - Jadi Achiardi
- Facultad de Medicina y Ciencias de la Salud, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Valeria Santana
- Escuela Luis Razetti, Universidad Central de Venezuela, Caracas, Venezuela
| | - Chiara Urnelli
- Facoltà di Medicina e Chirurgia, Università degli Studi del Piemonte Orientale, Novara, Italy
| | | | - Perla Rodríguez
- Facultad de Medicina, Universidad Panamericana, Ciudad de México, Mexico
| | | | | | | | - Thomas Michaeli
- Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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Differences in Menstruation-Related Symptoms of University Students Depending on Their Living Status in Japan. Healthcare (Basel) 2022; 10:healthcare10010131. [PMID: 35052295 PMCID: PMC8775912 DOI: 10.3390/healthcare10010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
Mothers and family members of young female students play important roles for guiding their self-care strategies for menstruation-related symptoms; which often affect their daily life and academic life. The aim of this study is to clarify the differences in menstruation-related symptoms before and during menstruation in university students living alone and university students living with their family in Japan. We conducted a cross-sectional online survey to assess menstruation-related symptoms before and during menstruation using the menstrual distress questionnaire (MDQ). Among 135 students; the proportion of students living alone was 60.7% and the proportion of students living with their family was 39.3%. Before menstruation; the MDQ total score and the scores for negative affect and behavior change were significantly higher in students living alone than in students living with their family. During menstruation; scores for negative affect and impaired concentration were also significantly higher in students living alone. In addition; before menstruation; scores for an increase in appetite and craving for sweets were significantly higher in students living alone. Thus; living alone affected the psychological aspects of menstruation-related symptoms in young women. The results suggest that university students who live alone should be aware of the importance of talking about their menstruation problems with family members and seeking their advice
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